A joint behavioral and emotive analysis of synchrony in music therapy of children with autism spectrum disorders
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Observation, Diagnosis and Education Laboratory, Psychology and Cognitive Sciences Department, University of Trento, Italy
IRCCS Stella Maris Foundation, Pisa, Italy
University of Pisa, Italy
Submission date: 2016-07-27
Final revision date: 2016-11-03
Acceptance date: 2016-11-10
Online publication date: 2016-12-13
Publication date: 2016-12-14
Health Psychology Report 2017;5(2):162–172
Synchrony is an essential component of interactive exchanges. In mother-infant interaction, synchrony underlies reciprocity and emotive regulation. A severe lack of synchrony is indeed a core issue within the communication and interaction deficit that characterizes autism spectrum disorders (ASD) in accordance with the DSM-5 classification. Based on emerging evidence that music therapy can improve the communication and regulation ability in children with ASD, we aim to verify quantitatively whether: 1) children with ASD improve synchrony with their therapist during music therapy sessions, and 2) this ability persists in different structured contexts.

Participants and procedure
Twenty-five children, aged from 4 to 6 years (M = 57.80, SD = 16.70), with an autistic disorder diagnosis based on DSM IV-TR and the Autism Diagnostic Observation Schedule (ADOS), participated in the study. An observational tool for coding behaviors and emotive states of synchrony (Child Behavioral and Emotional status Code [CBEC] and Adult Behavioral and Emotional status Code [ABEC]) was applied in video recorded sessions of improvisational music therapy (IMT) for the subject-therapist pair. For each subject, we considered the 20 central minutes of the first, tenth and twentieth session of IMT. To verify the persistence of effect in a different context with a different adult, we administered and coded the interactive ADOS section (anticipation of a routine with objects) applied after session 20 of therapy.

During the IMT cycle, the amount of synchronic activity increases, with a significant difference from Session 1 to Session 20 in behavioral synchrony and emotional attunement. Also, the increase of synchrony is confirmed at the end of the therapy cycle as measured by an interactive ADOS section.

Synchrony is an effective indicator of efficacy for music therapy in children with ASD, in particular to evaluate the expansion of positive emotive exchanges.
American Psychiatric Association (APA). (2000). Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). Washington, D.C.: APA.
Ainsworth, M. D. S., Bell, S. M., & Stayton, D. J. (1974). Infant-mother attachment and social development: “Socialisation” as a product of reciprocal responsiveness to signals. In M. P. M. Richards (ed.), The integration of a child into a social world (pp. 99–135). New York: Cambridge University Press.
Alvin, J. (1978). Music therapy for the autistic child. London, UK: Oxford University Press.
Baker, J. K., Messinger, D. S., Lyons, K. K., & Grantz, C. J. (2010). A pilot study of maternal sensitivity in the context of emergent autism. Journal of Autism and Developmental Disorders, 40, 988–999.
Baker, J. K., Fenning, R. M., Howland, M. A., Baucom, B. R., Moffitt, J., & Erath, S. A. (2015). Brief Report: A Pilot Study of Parent–Child Biobehavioral Synchrony in Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 45, 4140–4146.
Beadle-Brown, J. (2004). Elicited imitation in children and adults with Autism: the effect of different type of actions. Journal of Applied Research in Intellectual Disabilities, 17, 38–48.
Belsky, J., Rovine, M., & Taylor, D. G. (1984). The Pennsylvania Infant and Family Development Project: III. The origins of individual differences in infant-mother attachment: Maternal and infant contributions. Child Development, 55, 718–728.
Black, B., & Logan, A. (1995). Links between communication patterns in mother-child, father-child, and child-peer interactions and children’s social status. Child Development, 66, 255–271.
Bornstein, M. H., & Lamb, M. E. (2015). Developmental science: An advanced textbook (7th ed.). New York, NY: Psychology Press.
Bunt, L. (1994). Music therapy, an art beyond words. London: Routledge.
Burack J. A., & Volkmar F. R. (1992) Development of low and high functioning in autistic children. Journal of Child Psychology and Psychiatry, 33, 607–616.
Caria, A., Venuti, P., & de Falco, S. (2011). Functional and dysfunctional brain circuits underlying emotional processing of music in autism spectrum disorders. Cerebral Cortex, 21, 2838–2849.
Cole, P. M., Hall, S. E., & Radzich, A. M. (2009). Emotional dysregulation and the development of serious misconduct. In S. L. Olson & A. J. Sameroff (eds.). Biopsychosocial regulatory processes in the development of childhood behavioral problems (pp. 186–211). New York, NY, US: Cambridge University Press.
Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20, 775–803.
De Falco, S., & Venuti, P. (2006). “E’ possibile aumentare l’attenzione condivisa in soggetti con disturbo dello spettro autistico?” [Is it possible to improve the joint attention in individuals with autism spectrum disorder?]. Giornale Italiano delle Disabilitŕ, 6, 14–27.
Dumas, G., Nadel, J., Soussignan, R., Martinerie, J., & Garnero, L. (2010). Inter-brain synchronization during social interaction. PLoS One, 5, e12166–e12166.
Edgerton, C. L. (1994). The effect of improvisational music therapy on the communication behaviors of autistic children. Journal of Music Therapy, 31, 31–61.
Escalona, A., Field, T., Nadel, J., & Lundy, B. (2002). Brief report: Imitation effects on children with autism. Journal of Autism and Developmental Disorders, 32, 141–144.
Feldman, R. (2012). Parent–Infant Synchrony: a biobehavioral model of mutual influences in the formation of affiliative bonds. Monographs of the Society for Research in Child Development, 77, 42–51.
Fox, J., & Weisberg, S. (2011). An R Companion to Applied Regression (2nd ed.). Thousand Oaks CA: Sage. URL: http://socserv.socsci.mcmaster....
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, 258–281. doi: 10.1093/jmt/thv005.
Geretsegger, M., Elefant, C., Mössler, K. A., & Gold, C. (2014). Music therapy for people with autism spectrum disorder. Cochrane Database of Systematic Reviews, 17, CD004381.
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), 2.
Gerlanc, D., & Kirby, K. (2015). bootES: Bootstrap Effect Sizes. R package version 1.2. https://CRAN.R-project.org/pac....
Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autistic spectrum disorder (Cochrane Review). The Cochrane Library, 2.
Greenspan, S. I., & Wieder, S. (1999). A functional developmental approach to autism spectrum disorders. Research and Practice for Persons with Severe Disabilities, 24, 147–161.
Griffiths, R. (1996). Griffiths Mental Development Scales. Firenze: Organizzazioni Speciali.
Harrist, A. W., & Waugh, R. M. (2002). Dyadic synchrony: Its structure and function in children’s development. Department of Human Development and Family Science, 22, 555–592.
Hughes, M. H. (1995). A comparison of mother–infant interactions and the client–therapist relationship in music therapy sessions. In T. Wigram, B. Saperston, & R. West (eds.), The art & science of music therapy: A handbook (pp. 296–308). The Netherlands: Harwood Academic Publishers.
Hobson, R. P., & Hobson, J. A. (2008). Dissociable aspects of imitation: A study in autism. Journal of Experimental Child Psychology, 101, 170–185.
Holck, U. (2002). Music therapy for children with communication disorders. In T. Wigram, I. N. Pedersen, & L. Bonde (eds.), A comprehensive guide to music therapy (pp. 183–187). London: Jessica Kingsley Publishers.
Holck, U. (2004a). Interaction themes in music therapy-definition and delimitation. Nordic Journal of Music Therapy, 13, 3–9.
Holck, U. (2004b). Turn-taking in music therapy with children with communication disorders. British Journal of Music Therapy, 18, 45–54.
Johnson, M. H., Jones, E. J. H., & Gliga, T. (2015). Brain adaptation and alternative developmental trajectories. Development and Psychopathology, 27, 425–442.
Kasari, C., Gulsrud, A. C., Wong, C., Kwon. S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40, 1045–1056.
Kim, J. (2006). The effects of improvisational music therapy on joint attention behaviors in children with autistic spectrum disorder. Unpublished Ph.D thesis. Denmark: Aalborg University.
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 and Developmental Disorders, 38, 1758–1766.
Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13, 389–409.
Landa, R. (2007). Early communication development and intervention for children with autism. Mental Retardation and Developmental Disabilities Research Reviews, 13, 16–25.
Landa, R. J., Holman, K. C., & Garrett-Mayer, E. (2007). Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders. Archives of General Psychiatry, 64, 853–864.
Leclère, C., Viaux, S., Avril, M., Achard, C., Chetouani, M., Missonnier, S., & Cohen, D. (2014). Why synchrony matters during mother-child interactions: a systematic review. PLoS One, 9, 1–34.
Lewy, A. L., & Dawson, G. (1992). Social stimulation and joint attention in young autistic children. Journal of Abnormal Child Psychology, 20, 555–566.
Lord, C., Rutter, M., DiLavore, P.C., & Risi, S. (2002). Autism Diagnostic Observation Schedule. Los Angeles: Western Psychological Services.
Maccoby, E. E., & Martin, J. A. (1983). Socialization in the context of the family: Parent-child interaction. In E. M. Hetherington & P. H. Mussen (eds.), Handbook of child psychology: Vol. 4. Socialization, personality, and social development (pp. 1–87). New York: Wiley.
Mastrogiuseppe, M., Capirci, O., Cuva, S., & Venuti, P. (2015). Gestural communication in children with autism spectrum disorders during mother-child interaction. Autism, 19, 469–481.
Nordoff, P., & Robbins, C. (1977). Creative music therapy. New York: John Day Company.
Pavlicevic, M. (1997). Music therapy in context; music, meaning and relationship. London: Jessica Kingsley Publishers.
Plahl, C. (2000). Entwicklung Fo¨rdern durch Musik. Evaluation Musiktherapeutischer Behandlung [Development through music. Assessment of music therapy treatment]. Unpublished Ph.D thesis, 1999. Münster: Waxman.
Quintin, E. M., Bhatara, A., Poissant, H., Fombonne, E., & Levitin, D. J. (2011). Emotion perception in music in high-functioning adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 41, 1240–1255.
R Core Team. (2016). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.
Robarts, J. Z. (1996). Music therapy for autistic children. In C. Trevarthen, K. Aitken, D. Papoudi, & J. Robarts (eds.), Children with Autism: Diagnosis and interventions to meet their needs (pp. 132–160). London: Jessica Kingsley Publishers.
Siller, M., & Sigman, M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders, 32, 77–89.
Siller, M., & Sigman, M. (2008). Modeling longitudinal change in the language abilities of children with autism: parent behaviors and child characteristics as predictors of change. Developmental Psychology, 44, 1691–1704.
Simpson, K., & Keen, D. (2011). music interventions for children with autism: narrative review of the literature. Journal of Autism and Developmental Disorders, 41, 1507–1514.
Saperston, B. (1973). The use of music in establishing communication with an autistic mentally retarded child. Journal of Music Therapy, 10, 184–188.
Stern, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic Books.
Trolldalen, G. (2005). Sharing through affects: The role of ‘affect attunement’ in musical improvisation. Unpublished paper presented at the 11th World Congress of Music Therapy, Brisbane, Australia.
Tronick, E. Z., Als, H., & Brazelton, T. B. (1977). Mutuality in mother-infant interaction. Journal of Communication, 27, 74–79.
Tronick, E. Z., Als, H., & Brazelton, T. B. (1980). Monadic Phases: a structural descriptive analysis of infant-mother face to face interaction. Merrill Palmer Quarterly of Behavior and Development, 26, 3–24.
Venuti, P., & Bentenuto, A. (2013). Manual of Code for behavioral and emotional state during adult infant interaction. Unpublished Manuscript.
Venuti, P., & Bentenuto, A. (2015), Intervento precoce ed intensivo con i bambini con ASD: come cambia il profilo di sviluppo? Oral presentation to the Conference: “Autismo: trasformazioni possibili in rapporto all’etŕ e ai sottotipi clinici” [Early and intensive intervention for children with ASD: How to change the developmental profile]. Rome, October 2015.
Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 237–257.
Watson, L. R. (1998). Following the child’s lead: Mothers’ interaction with children with autism. Journal of Autism and Developmental Disorders, 28, 51–59.
Wetherby, A. M., Woods, J., Allen, L., Cleary, J., Dickinson, H., & Lord, C. (2004). Early indicators of autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 34, 473–493.
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, 535–542.
Wigram, T., & Elefant, C. (2008). Therapeutic dialogues in music: Nurturing musicality of communication in children with autistic spectrum disorder and Rett syndrome. In C. Trevarthen & S. Malloch (eds.), Communicative Musicality (pp. 423–446). Oxford: Oxford University Press.
Zuur, A. F., Ieno E. N., & Elphick, C. S. (2010). A protocol for data exploration to avoid common statistical problems. Methods in Ecology and Evolution, 1, 3–14.