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NDIS Joint Standing Committee
Australian Music Therapy Association
Supplementary Submission – 22 November 2019
The Australian Music Therapy Association (AMTA) would again like to thank members of the NDIS Joint Standing Committee for the opportunity to present evidence at its recent Public Hearing on 7 November 2019 in Melbourne.
In addition to AMTA’s submission forwarded to the NDIS Joint Standing Committee, AMTA would like to provide additional information regarding a response to Senator Hughes’ comments about the evidence base for music therapy with autism, “I know personally, being an ABA mum, that I could take in folders of data of every single program we had done and the development, and I never got those sorts of data feedback from my OT or from my speechie. I must say we did not do music therapy. It is not quite up there for autism in that evidence based area, so that was not for us.”
AMTA believes that Senator Hughes’ comments infer that music therapy is not evidenced based (with regard to autism) which AMTA argues is incorrect and perpetuates the challenges AMTA reports around NDIS planners’ dissemination of misleading information about music therapy. AMTA is concerned that Senator Hughes’ comments may be informed by an NDIA commissioned report intended to assist NDIS planners with making decisions about service delivery to pre school children with autism, and their families and carers (Autism spectrum disorder: Evidence based/evidence-informed good practice for supports provided to preschool children, their families and carers. A report prepared by Jacqueline M. A. Roberts Griffith University and Katrina Williams, University of Melbourne).
This report lists music therapy as an “emerging intervention” (Wong, et al. 2014, p66) and is often referred to by NDIA when making decisions about funded support for music therapy. Wong, et al.’s (2014) systematic review makes this conclusion after consideration of only three articles published at least 12 years ago, all from the same author, with only one research group - Kern & Aldridge (2006); Kern, Wakeford, & Aldridge (2007); Kern, Wolery, & Aldridge (2007). The NDIA’s reliance on this report when determining whether or not to fund music therapy in participants’ plans, results in the exclusion of a much wider body of music therapy research and leads to a very narrow perspective on the effectiveness of music therapy for children with autism. Unfortunately, this NDIA commissioned report does not, in any way, come close to summarising music therapy’s effectiveness for people with autism in its very narrow exploration of the available peer reviewed literature and evidence.
AMTA is also concerned that NDIS planners are generalising the report’s findings to other NDIS participants, regardless of whether they are preschool children with autism. Given the extensive research findings supporting music therapy in disability, this is obviously inappropriate and contributing to the invalid refusal of music therapy from participants’ plans.
In the NDIA’s commissioned report, it is unclear whether authors, Wong et al. (2014) are comparing music therapy to other entire allied health disciplines, or looking at it alongside single interventions therefore reducing music therapy to one intervention only. Music therapy is a discipline along with other allied health professions. Disciplines in themselves are not typically
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described as evidence- based. Rather, interventions or methods used within allied health disciplines (including music therapy) can be described as evidence-based. The NDIA continues NOT to reference the researched evidence supporting music therapy interventions or methods, and instead references music therapy as though it were a single method. This in incorrect and creates confusion among participants and their carers and families.
The NDIA commissioned report is now several years old and does not take into account current research. An extensive list of references of research on music therapy and autism spectrum disorder is included at the end of this document. It is anticipated that review of these references will broaden NDIA’s awareness of the evidence-base for methods that Registered Music Therapist’s use. Along with other information and published research previously forwarded to NDIA, these references will also confirm music therapy as an ‘effective and beneficial’ allied health support for not only preschool children with autism, but other NDIS participants seeking the inclusion of music therapy in their plans.
Particularly noteworthy is the 2016 Cochrane Review, Music Therapy for people with Autism Spectrum Disorder (Geretsegger, M. et.al). This systematic review of Randomised Control Trials compared music therapy or music therapy added to standard care to ‘placebo’ therapy, no treatment, or standard care for individuals with Autism Spectrum Disorder. The following quote outlines the findings: “The findings of this updated review provide evidence that music therapy may help children with ASD to improve their skills in primary outcome areas that constitute the core of the condition including social interaction, verbal communication, initiating behaviour, and social emotional reciprocity. Music therapy may also help to enhance non-verbal communication skills within the therapy context. Furthermore, in secondary outcome areas, music therapy may contribute to increasing social adaptation skills in children with ASD and to promoting the quality of parent-child relationships. In contrast to the studies included in an earlier version of this review published in 2006, the new studies included in this update enhanced the applicability of findings to clinical practice. …… When applying the results of this review to practice, it is important to note that the application of music therapy requires specialised academic and clinical training” (Geretsegger, et al., 2016, p2).
With regard to music therapy, the above NDIA commissioned report is an unreliable source for NDIS planners to refer to when making decisions about the inclusion of music therapy in participants’ plans. The music therapy research referenced is limited, outdated and methodologically flawed. We recommend that NDIA urgently update the internal policies used to assist planners in their decision making with current music therapy research. This may be successfully achieved by using information previously provided by the AMTA and to start to work transparently and collaboratively with the AMTA to ensure information is current and relevant. Such information will support planners in making informed and appropriate decisions for NDIS participants.
Finally, the report that NDIA commissioned includes a list of other evidence- based methods and states that these can be used by professionals, parents/carers and siblings/peers. These methods (including, but not lmimted to, imitation, cognitive behavioural intervention, PECS, social skills training etc) are currently accepted by the NDIA, as well as other international funding schemes in countries including the USA. Consistant with Kern et al’s (2013) research findings, Registered Music Therapists also incorporate these methods into sessions.
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Association In conclusion and in response to Sentaor Hughes’ comments, Registered Music Therapists use evidence-based methods. They use these methods to deliver successful outcomes for NDIS participants, including, but not limited to many of the recommended evidence- based methods listed in the report commissioned by the NDIA for pre-school children with autism.
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Association Literature Review: Music Therapy and Autism (please note that this list is a guide only and does not cite all available literature in the field of music therapy and autism spectrum disorder).
Allen, R., Davis, R., & Hill, E. (2013). The effects of autism and alexithymia on physiological and verbal responsiveness to music. Journal of Autism & Developmental Disorders, 43(2), 432-444.
Bergmann, T., Sappok, T., Diefenbacher, A., Dames, S., Heinrich, M., Ziegler, M., & Dziobek, I. (2015). Music-based autism diagnostics (MUSAD) – A newly developed diagnostic measure for adults with intellectual developmental disabilities suspected of autism. Research in Developmental Disabilities, 43–44, 123-135.
Bergmann, T., Sappok, T., Diefenbacher, A., & Dziobek, I. (2015). Music in diagnostics: Using musical interactional settings for diagnosing autism in adults with intellectual developmental disabilities. Nordic Journal of Music Therapy, Advance online publication.
Carpente, J.A., & LaGasse, A.B. (2015). Music Therapy for Children with Autism Spectrum Disorder. In B. L. Wheeler (Ed.), Music Therapy Handbook (pp. 290- 301). London; New York: Guilford Press.
Chiengchana, N., & Somchai, T. (2014). The effect of Kodály-based music experiences on joint attention in children with Autism Spectrum Disorders. Asian Biomedicine, 8(4), 547-555.
De Bruyn, L., Moelants, D., & Leman, M. (2012). An embodied approach to testing musical empathy in participants with an Autism Spectrum Disorder. Music and Medicine, 4(1), 28-36.
De Vries, D., Beck, T., Stacey, B., Winslow, K., & Meines, K. (2015). Music as a therapeutic intervention with autism: A systematic review of the literature. Therapeutic Recreation Journal, 49(3), 220.
Dezfoolian, L., Zarei, M., Ashayeri, H., & Looyeh, M.Y. (2013). A pilot study on the effects of Orff based therapeutic music in children with Autism Spectrum Disorder. Music and Medicine, 5(3), 162-168.
Dimitriadis, T., & Smeijsters, H. (2011). Autistic Spectrum Disorder and music therapy: Theory underpinning practice. Nordic Journal of Music Therapy, 20(2), 108-122.
Gadberry, A.L. (2011). A survey of the use of aided augmentative and alternative communication during music therapy sessions with persons with Autism Spectrum Disorders. Journal of Music Therapy, 48(1), 74-89.
Gadberry, A.L., & Harrison, A. (2016). Music therapy promotes self- determination in young
people with Autism Spectrum Disorder. International Journal of School & Educational Psychology,
4(2), 1-4.
Gattino, G., Riesgo, R., Longo, D., Leite, J., & Faccini, L. (2011). Effects of relational music therapy on communication of children with autism: A randomized controlled study. Nordic Journal of Music Therapy, 20(2), 142-154.
Gebauer, L., Skewes, J., Westphael, G., Heaton, P.F., & Vuust, P. (2014). Intact brain processing of musical emotions in Autism Spectrum Disorder, but more cognitive load and arousal in happy vs. sad music. Frontiers in Neuroscience, 8(192).
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Association Geretsegger, M., Elefant, C., Mössler, K.A., & Gold, C. (2014). Music therapy for people with Autism Spectrum Disorder. Cochrane Database of Systematic Reviews, 6.
Geretsegger, M., Holck, U., Bieleninik, Ł., & Gold, C. (2016). Feasibility of a trial on improvisational music therapy for children with Autism Spectrum Disorder. Journal of Music Therapy, 53(2), 93 120.
Geretsegger, M., Holck, U., Carpente, J.A., Elefant, C., Kim, J., & Gold, C. (2015). Common characteristics of improvisational approaches in music therapy for children with Autism Spectrum Disorder: Developing treatment guidelines. Journal of Music Therapy, 52(2), 258-281.
Geretsegger, M., Holck, U., & Gold, C. (2012). Randomised controlled trial of improvisational music therapy’s effectiveness for children with autism spectrum disorders (TIME-A): Study protocol. BMC Pediatrics, 12(1).
Ghasemtabar, S.N., Hosseini, M., Fayyaz, I., Arab, S., Naghashian, H., & Poudineh, Z. (2015). Music therapy: An effective approach in improving social skills of children with autism. Advanced Biomedical Research, 4(157).
Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for Autistic Spectrum Disorder. Cochrane Database of Systematic Reviews, 2006(2). Holck, U. (2004). Turn-taking in music therapy with children with communication disorders. British Journal of Music Therapy, 18(2), 45-54.
Kern, P., Rivera, N., Chandler, A., Humpal, H., (2013) Music therapy services for individuals with autism spectrum disorder: A survey of clinical practices and training needs, Journal of Music Therapy, 50, 4, p 274– 303, https://doi.org/10.1093/jmt/50.4.274
Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: A randomized controlled study. Journal of Autism & Developmental Disorders, 38(9), 1758-1766.
LaGasse, A.B. (2014). Effects of a music therapy group intervention on enhancing social skills in children with autism. Journal of Music Therapy, 51(3), 250-275.
LaGasse, A. B. (2017). Social outcomes in children with autism spectrum disorder: a review of music therapy outcomes. Patient Relat. Outcome Meas. 8, 23 –32. Lai, G., Pantazatos, S.P., Schneider, H., & Hirsch, J. (2012). Neural systems for speech and song in autism. Brain, 135(3), 961-975.
Lim, H.A. (2011). Developmental Speech-Language Training through Music for Children with Autism Spectrum Disorders: Theory and Clinical Application. London: Jessica Kingsley.
Markworth, L. (2014). Without words: Music as communication for children with autism. Qualitative Inquiries In Music Therapy, 9, 1-42.
Ockelford, A. (2012). Songs Without Words: Exploring How Music Can Serve as a Proxy Language
in Social Interaction with Autistic Children. In R. MacDonald, G. Kreutz & L. Mitchell (Eds.), Music, Health, and Wellbeing (pp. 289-323). Oxford: Oxford University Press.
Paul, A., Sharda, M., Menon, S., Arora, I., Kansal, N., Arora, K., & Singh, N.C. (2015). The effect of sung speech on socio-communicative responsiveness in children with Autism Spectrum Disorders. Frontiers in Human Neuroscience, 9(555), 1-9.
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Association Preis, J., Amon, R., R.D., Silbert, & Rozegar, A. (2016). Does music matter? The effects of background music on verbal expression and engagement in children with Autism Spectrum Disorders. Music Therapy Perspectives, 34(1), 106-115.
Sandiford, G., Mainess, K., & Daher, N. (2013). A pilot study on the efficacy of melodic based communication therapy for eliciting speech in nonverbal children with autism. Journal of Autism & Developmental Disorders, 43(6), 1298-1307.
Schwartzberg, E.T., & Silverman, M.J. (2013). Effects of music-based social stories on comprehension and generalization of social skills in children with autism spectrum disorders: A randomized effectiveness study. The Arts in Psychotherapy, 40(3), 331-337.
Sharda, M., Midha, R., Malik, S., Mukerji, S. & Singh, N. C. (2015). Fronto-temporal connectivity is preserved during sung but not spoken word listening, across the autism spectrum. Autism Res. 8, 174–186.
Sharda, M., et.al (2018). Music improves social communication and auditory– motor connectivity in children with autism. Translational Psychiatry, 8(231).
Silverman, S. (2008). Nonverbal communication, music therapy, and autism: A review of literature and case example. Journal of Creativity in Mental Health, 3(1), 3-19.
Thompson, G., & McFerran, K.S. (2015). “We’ve got a special connection”: Qualitative analysis of descriptions of change in the parent–child relationship by mothers of young children with Autism Spectrum Disorder. Nordic Journal of Music Therapy, 24(1), 3-26.
Thompson, G.A., McFerran, K.S., & Gold, C. (2014). Family-centred music therapy to promote social engagement in young children with severe autism spectrum disorder: A randomized controlled study. Child: Care, Health and Development, 40(6), 840-852.
Wigram, T., & Gold, C. (2006). Music therapy in the assessment and treatment of Autistic Spectrum Disorder: Clinical application and research evidence. Child: Care, Health and Development, 32(5), 535-542.