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Original Investigation
August 8, 2017

Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial

Author Affiliations
  • 1GAMUT—The Grieg Academy Music Therapy Research Centre, Uni Research Health, Uni Research, Bergen, Norway
  • 2Melbourne Conservatorium of Music, University of Melbourne, Melbourne, Australia
  • 3Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
  • 4Postgraduate Program in Child and Adolescent Health, Faculty of Medicine, Rio Grande do Sul Federal University, Porto Alegre, Brazil
  • 5School for Creative Arts Therapies, University of Haifa, Haifa, Israel
  • 6Music Therapy Program, David-Yelin College, Jerusalem, Israel
  • 7IRCCS Stella Maris Foundation, Pisa, Italy
  • 8Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
  • 9Jeonju University, Jeonju, South Korea
  • 10Centre for Psychiatry, Imperial College London, London, United Kingdom
  • 11Anglia Ruskin University, Cambridge, United Kingdom
  • 12Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
  • 13Rebecca Center for Music Therapy at Molloy College, Rockville Centre, New York
  • 14Personal Social Services Research Unit, LSE Health and Social Care, The London School of Economics and Political Science, London, United Kingdom
  • 15Villa Santa Maria Institute, Tavernerio, Italy
JAMA. 2017;318(6):525-535. doi:10.1001/jama.2017.9478
Key Points

Question  Does improvisational music therapy improve symptom severity of children with autism spectrum disorder?

Findings  In a randomized clinical trial of 364 children in 9 countries, mean autism severity, as measured on the Autism Diagnostic Observation Schedule, social affect domain, over 5 months, was reduced from 14.08 to 13.23 in the improvisational music therapy group and from 13.49 to 12.58 in the enhanced standard care group, which included parent counseling and other available interventions, a nonsignificant mean difference of 0.06.

Meaning  In children with autism spectrum disorder, music therapy did not result in significant improvements in mean symptom scores compared with enhanced standard care.


Importance  Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication.

Objective  To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD.

Design, Setting, and Participants  Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016.

Interventions  Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child’s focus of attention, to help children develop affect sharing and joint attention.

Main Outcomes and Measures  The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months.

Results  Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 [95% CI, −0.70 to 0.81]; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference.

Conclusions and Relevance  Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder.

Trial Registration  isrctn.org Identifier: ISRCTN78923965