Music Therapy for Autism: What Does the Research Support?

What can music therapy offer autistic children, and what does research support? What happens in sessions, the limits of the evidence and connecting at home.

A child who finds eye contact difficult and does not turn when their name is called may come running and start rocking in front of the screen the moment their favourite advert jingle begins. Many parents notice that their autistic child has a special relationship with music and wonder whether this relationship could become a bridge. Music therapy for autism is an area researched precisely as a result of this curiosity. In this article we try to set out honestly what music therapy for autism is, what happens in sessions, what research supports today and what it cannot yet say. Our aim is not to raise hopes but to offer a realistic, information-based framework.

What Is Music Therapy for Autism?

Music therapy is an approach in which a trained practitioner interacts with a participant through music within a therapeutic framework. Two points in this definition matter: a therapeutic framework and mutual musical interaction. In other words, simply playing music to a child, however enjoyable that may be, is not music therapy in this sense.

In work with children on the autism spectrum, music is often used as a shared language where verbal communication is difficult. The practitioner responds with music to the sounds, rhythms and movements the child makes; in this way they try to create a space for interaction in which what the child does is "heard" and answered.

If you are curious about the general framework of music therapy, you can find detailed information in our article on music therapy. Here we look at the subject specifically from the point of view of children on the autism spectrum and their families.

A brief reminder about autism

Autism spectrum disorder is a neurodevelopmental condition characterised by differences in social communication and interaction, together with repetitive behaviours and restricted interests. Every autistic child is different; some children speak fluently while others may not speak at all, and some are very sensitive to sounds while others respond less. For this reason it is not possible to speak of a single method that is "good for autism". If you are curious about the early signs of autism, take a look at our article on signs of autism.

What Happens in a Music Therapy Session for Autism?

Sessions are shaped around the child's age, interests, level of communication and sensory sensitivities. Even so, some familiar elements can be described:

• Improvisation: the practitioner and the child make sounds together on easy-to-play instruments such as drums, cymbals, xylophones and the piano. The practitioner follows the child's rhythm, tempo or volume and responds to it.
• Turn-taking games: simple musical games such as "First I play, then you" can be used to experience the basic building blocks of mutual interaction.
• Songs and routines: fixed "hello" and "goodbye" songs sung at the beginning and end of the session provide predictability. This can be reassuring for children who are sensitive to change.
• Music with movement: movements such as rocking, jumping and clapping can be brought into the music.
• Parental involvement: in some approaches, a parent also joins the session and learns musical games they can use at home.

Imagine a four-year-old boy who, in the first minutes of the session, plays a cymbal over and over in a corner of the room and does not look at the practitioner. The practitioner begins following his cymbal rhythm on a drum. A few weeks later, the boy shows that while playing the cymbal he now pauses now and then and waits for the drum to answer; in one session he looks at the practitioner and smiles for the first time. This small moment does not change everything; but it can be a meaningful sign that the child is beginning to share something with the person in front of him. This fictional example does not mean the same thing will happen with every child.

In music therapy the aim is not to "fix" the child, but to open a door into their world through music.

What Does Research Support About Music Therapy for Autism?

The most reliable answer to this question comes from the current Cochrane review, published in 2022. Cochrane reviews are comprehensive studies that systematically bring together the research done on a topic and assess the quality of the evidence.

The findings of this review can be summarised briefly as follows:

• Global symptoms: music therapy probably brings about an improvement in the global symptoms of autism at the end of treatment. The certainty of this finding is moderate.
• Social interaction and communication: the effect of music therapy on social interaction and communication is uncertain. In other words, the current evidence is not sufficient to draw a clear conclusion in these areas.
• Side effects: music therapy probably has no side effects.
• The long term: it is not known whether the effects last in the long term.

How should these findings be read? First of all, the picture is promising: music therapy appears to be a safe and, in some respects, supportive approach for autistic children. However, in the areas parents most want to know about, namely the child's communication and social interaction, the evidence is not yet clear. For this reason it is realistic to think of music therapy not as a replacement for other autism support but as an approach that can accompany it.

Expressions such as "probable improvement" and "uncertain effect" may sound cold and technical at first. Yet they are a way of being honest with families. When you come across promotional material claiming that a method "definitely works", it is always appropriate to ask which research that sentence is based on. Questions that research cannot yet answer do not mean a method is worthless; they simply remind us that expectations need to be set carefully. Noting the changes you observe in your child, whether positive or challenging, and sharing them with the team that follows your child also helps the process run well.

Common limitations of the research

The general limitations of research in music therapy apply to autism studies too:

• Participant numbers are mostly small.
• Blinding is impossible, because families and children know what they are taking part in.
• Some of the measurements rely on reports from parents or practitioners.
• Follow-up periods are short.
• "Music therapy" and general "music activities" are sometimes mixed up in studies.

The place of music therapy in Turkey

In Turkey, music therapy is one of the methods defined in the Regulation on Traditional and Complementary Medicine Practices, which came into force in 2014; in the academic field, Anadolu University runs a master's programme in music therapy. We have looked separately at what the regulation does and does not say in our article on GETAT music therapy. A practice being included in legislation does not mean it is suitable or effective for every child; it is important to assess, together with the specialist team following your child, which forms of support should take priority for them.

Common Misconceptions About Music Therapy for Autism

Many claims about autism and music circulate online and on social media. Some of them call for caution.

• "Music that cures autism": autism is a neurodevelopmental condition, and no music makes it go away. Commercial claims such as "Play music at this frequency and your child will talk" are not scientifically supported.
• "Maqam music is good for autism": it is known that Ottoman-era treatises paired maqams (the modal systems of Turkish classical music) with illnesses; but these pairings have never been scientifically tested and cannot be used as a treatment recommendation today.
• "Playing classical music boosts intelligence": this claim, known as the Mozart effect, is not supported by evidence that it permanently increases intelligence.
• "The more music, the better": some autistic children are very sensitive to sound. Music constantly playing in the background can increase restlessness in some children.

In moments of desperation, these claims can be tempting for families. However, when time and effort are devoted to evidence-based support, they can contribute more to the child's development.

Suggestions for Connecting Through Music at Home

The suggestions below are not therapy; they are simple ideas you can try for sharing enjoyable and safe moments with your autistic child through music. Because every child is different, it is important to adapt them by watching your child's reactions.

• Follow your child's rhythm: if your child is tapping on the table, join in with their rhythm. First copy them, then add a small change and watch their response.
• Use routine songs: singing the same short song every time at daily transitions such as brushing teeth, mealtimes and bedtime can provide predictability.
• Leave a gap in the song: when singing a song your child loves, stop before the last word and wait. Give them the chance to complete it with a sound, a movement or a look.
• Watch the volume: if your child covers their ears, becomes restless or runs away, turn the sound down or switch the music off. Sensitivity to sound is common in autism.
• Get some simple instruments: a tambourine, a shaker or a xylophone are inexpensive tools that give the child room to explore.
• Do not put pressure on yourself: your singing ability does not matter. The most familiar voice for your child is yours.

These moments do not have to become an educational goal. A few minutes in which you laugh together with your child and sway in the same rhythm are valuable in themselves.

Siblings and the wider family

An autistic child's siblings and grandparents can also take part in musical games. During bayram (religious holiday) visits or crowded family gatherings, loud noise and crowds can be tiring for an autistic child; in such situations a quiet room and a familiar song can help the child calm down. Explaining the child's sensitivity to sound to older family members beforehand can reduce possible tension. Showing siblings how they can join in the play also helps them feel part of the process rather than left out.

For Parents: Keeping Expectations Realistic and Looking After Yourself

The family of a child who has received an autism diagnosis is often faced with a great deal of information, advice and decisions in a short time. "Have you tried this?" questions from relatives, neighbours and social media, however well-meant, can be exhausting. Amid this intensity, clinging hopefully to every new method and then feeling disappointed is a very understandable cycle.

When starting music therapy or any other support, the following questions can help keep expectations realistic:

• What do I expect from this work for my child, and how consistent is that expectation with the research?
• Is my child enjoying this work, or struggling with it?
• How will this support fit alongside my child's other educational and therapeutic processes?
• Are our family's time, budget and energy enough to sustain this process?

There is one more thing not to forget: the parent's own wellbeing also matters for the child's development. It is hard for a parent who is constantly rushing about, sleep-deprived and anxious to share enjoyable moments with their child. Giving yourself breaks, sharing the care load with your partner or relatives, connecting with families going through similar experiences and getting support for yourself when needed are not selfish; they are part of care that can be sustained.

When Should You Seek Professional Support?

An autism diagnosis is made after a comprehensive assessment by child psychiatry and other relevant specialists. If you notice the following signs in your child, it is important to consult a specialist:

• A marked delay in the language and communication skills expected for their age
• Not responding to their name, marked difficulty making eye contact
• Repetitive movements, insistence on particular routines and intense reactions to change
• Loss of skills they had previously gained

As the family of a child diagnosed with autism, getting support is important too. Parents can become worn out by the heavy care load, uncertainty, social prejudice and worries about the future. Within child and play therapy, the child's emotional needs and relationships within the family can be addressed, and parents can be supported with ways of communicating with their child. Special education and other autism-specific interventions are planned by the relevant specialist teams; music-based work can accompany these processes but does not take their place.

Frequently Asked Questions

Will music therapy for autism help my child to talk?

Current research shows that the effect of music therapy on communication is uncertain. In some children, musical interaction may open a door to communication, but it is not possible to say this will happen with every child.

Is music therapy harmful for autistic children?

According to the Cochrane review, music therapy probably has no side effects. Even so, with children who are sensitive to sound, it is important to pay attention to the volume and to the child's reactions.

Can playing music at home replace music therapy?

No. Music therapy is a mutual interaction carried out with a trained practitioner within a therapeutic framework. Listening to music or singing together at home is an enjoyable and valuable family activity, but it is not the same as therapy.

At what age can music therapy start?

Research has been carried out with children in different age groups. At what age and with what support to start should be assessed according to the child's needs, together with the specialist team following the child.

• #autism
• #music therapy
• #parent guide
• #communication

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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