Neurobehavioural Outcomes of a Music Intervention for Autism - a Randomized Controlled Trial

Background: Music is an intrinsically rewarding stimulus that can enhance social-communication and sensorimotor abilities by engaging multiple brain networks. Previous studies of music-based interventions for children with autism spectrum disorder (ASD) have suggested positive outcomes (Geretsegger et al, 2015). Preliminary neuroimaging findings have shown that children with ASD have preserved functional connectivity during song-listening (Sharda et al, 2015). However, neurobiological mechanisms underlying specific benefits of music-based therapies for ASD remain unknown. Here, we evaluate the neurobehavioural effects of a music-based intervention compared to a non-music behavioural intervention for school-age children with ASD, using a randomized control trial (RCT).

Objectives: Our specific goal was to evaluate resting-state functional connectivity (RSFC) in children with ASD before and after 12 weeks of a music or non-music intervention, particularly in fronto-temporal and salience brain networks implicated in social-communication and shown to be altered in ASD.

Methods: Fifty-one children with ASD (43 boys), 6-12 years old, participated in a single-blind, parallel-arm RCT of music therapy (ISRCTN26821793). Participants were randomly assigned to 12 weekly sessions of individual music (MT, n=26) or non-music (NM, n=25) therapy. Sessions in MT involved use of songs and rhythmic cues to improve turn-taking and reciprocal social interactions and communication skills. The NM sessions targeted similar skills but without the use of music. Groups did not differ on age, sex, IQ and socioeconomic status at baseline. Both behavioural (Children’s Communication Checklist-2 composite score; CCC-2) and neuroimaging measures (T1; resting-state functional MRI) were obtained pre- and post-intervention. Here, we report preliminary neuroimaging results of 45 (MT=24, NM=21) participants with usable data. Seed-based RSFC maps with 4 apriori seeds were generated using an FSL-based pipeline for each participant. Seeds were anchored in language (left IFG) and salience (right fronto-insula) networks. Motion was corrected following guidelines in Power et al, 2012. Effects of MT vs. NM were evaluated by comparing the RSFC in each seed, pre- and post-intervention, using mixed-effects ANOVA. Results were considered significant when there was a group-by-time interaction at p<.05 (cluster-corrected using random field theory; RFT). RSFC at post-intervention was correlated with change in communication skills to study the link between the brain mechanisms underlying social-communication.

Results: Previously reported behavioural results (Figure1a) showed significant improvements in social-communication after 12 weeks of MT. We also found changes in RSFC pre- to post-intervention, in MT compared to NM, in networks seeded from left IFG (decrease in RSFC) and right fronto-insula (increase in RSFC; p<.001, RFT-corrected, Figure1b,c). Additionally, decreased RSFC in the left IFG network post-intervention was related to increases in CCC-2 score in MT participants who improved post-intervention (p=.04, Figure1d).

Conclusions: Children with ASD who underwent 12 weeks of music therapy had more typical RSFC in fronto-temporal brain regions compared to those who underwent a non-musical intervention. Changes in RSFC were further related to behavioural improvements in standardized measures of social communication suggesting neurobiologically-mediated improvements in social communication as a result of music intervention. These results provide neurobiological support for use of music as a therapeutic tool for children with ASD to improve social-communication.