Background Startingwith genetic factors and going all the way through to vaccines, the proposedcauses of autism spectrum disorder (ASD) have been widely based on educatedguesses at best.
Autism spectrum disorder is classified by the NationalInstitute of Mental Health as a developmental disorder exhibiting a wide range,or “spectrum” of symptoms (1). According to theCDC (Centers for Disease control and prevention) in the U.S.A, 1 in 68 childrenhave already been diagnosed with ASD – the number of which might be higher ifit were possible to diagnose every single case including those without accessto healthcare professionals (2). Additionally, thosestatistics favor male patients who are 4.
5 times more likely to be diagnosedwith ASD when compared with female patients (2). Lastly, it is important tonote that about 44% of people on the ASD spectrum have average to above averagecognitive capabilities (2); which is why studies that exclude patients with alesser IQ might propose results that are not entirely representative. Hence theissue with this particular disorder: the wide variety of symptoms andday-to-day experiences is so vast that no single study can berepresentative – treatment must be somewhat individualized.
The exact definition of ASD, as it stands, isunderstandably very broad. Some notable signs an individual with ASD might showare lack of emotional responses, lack of eye contact, physical contact, lightand/or sound sensitivity, extreme discomfort to any disruptions in theirroutine, particularly focused interests such as numbers, shapes, and many more (1).A diagnosis is often made in the first few years of life and while there is noknown cure, treatment options exist in order to better the general quality oflife of patients, as well as their families’ (3). The main recourseis usually to start behavior therapy in an effort to help the child withbuilding relationships: with others, family and therapists. Evidently, due tothe spectrum of symptoms, treatment must be individualized; for instance, apatient suffering from light sensitivity or discomfort due to touch might beadvised sensory integration therapy (4). Others might needspeech and language therapy, or social skills therapy.
A relatively new form of treatment for patients with ASDin the past few years has been music therapy, which is said to aid incommunication and relaxation (5). A review paper from2014 looked at 12 studies concerning music therapy for the treatment of ASDpatients and reported that 58% of those studies were conclusively effective butthat “additional research is warranted” (6). ResearchObjective The aim of this systematicreview is to corroborate results of previous literature regarding theeffectiveness of music therapy in treating patients with autism spectrumdisorder. As studies have seldom resulted in a definitive answer, theadvantages of music therapy in this particular instance are relatively obscure.
Although this study might not corroborate past findings, it may formulate atrend in potential progress due to treatment in addition to elucidating anyareas of improvement. Ultimately, the purpose of this study is to contribute inproviding better care for patients with ASD as well as their families. Possibly, raising concerns about to which extentindividualizing therapy for patients is beneficial could lead to furtherconsiderations: should we narrow the scope further when it comes to patientgenders, socioeconomic or ethnic backgrounds, or ages? Knowing that progress islikely to occur in response to therapy and everyday lifestyles, how muchweight does the latter hold? Hypothesis: Musictherapy aids children with ASD with emotional, cognitive and communicativegrowth. Research Design Thissystematic review will require resources allocated to research and will betime-demanding. However, no questionnaires or interviews will be conducted. On the one hand, some advantagesof a systematic review include exhaustive research, a wide reach and collectionof scattered data which help in making conclusive, definitive statements onwhether a medical practice is generally beneficial to the health of thepopulation (7). On the other hand,disadvantages include the fact that some reviews quickly become outdated withina few years due to the ever-growing medical progress.
Additionally, systematicreviews might not be selective enough in the types of studies accepted,decreasing the viability of the outcome (7). Methodologyand Data Collection Ateam of 3 to 4 individual researchers will be recruited (with researchexperience) in order to asses the quality of each paper and whether or not itshould be included in the study. The “quality” refers to implications of anybiases, inadequate sampling methods, issues with consent or conclusionsprovided. Each reviewer would work independently of the others, to ensurecomplete autonomy. In order to assess this quality, the standardized JBICritical Appraisal Tools will be used (8). The differenttemplates are to be used in accordance to the type of study being appraised bythe reviewers. A couple of examples are in Appendices A and B. It is important to note thatupon any disagreement between members of the research team, a third person (alsoin the team) is to be assigned as the “tie-breaker”; insuring as little bias aspossible.
Inclusion Criteria and Sampling Thissystematic review will include studies which examine the relationship betweenmusic therapy and autism spectrum disorder in children between the ages of 0and 6 years old. Participants of any sex orbackground can be selected, and exhibiting any of the broad spectrum ofsymptoms of ASD. This implies that this review is to assess the general qualityof music therapy as treatment as a general trend, instead of narrowing thescope to an individualized basis.The literature selected canconsist of randomized control trials or studies using a qualitativemethodological approach. A synthesis of thiscollection will be provided in a PRISMA flow diagram (an example of which canbe found in Appendix C) (9). Data Collection Thesearch for studies will be conducted using databases and thus readily availableinformation.
Using simple key words first (i.e: music therapy and autism),the preliminary list of studies will be selected. After initial appraisal,papers found to be included in the study will help in expanding the list of keywords. Additionally, the studies’ references might be looked at, as well asother works by authors as most researchers specialize in a field and might havepublished similarly useful papers. Papers will only be selected if they have been publishedwithin the past 15 years, i.e as of 2003. Most of the effort will go towards obtaining data fromonline resources.
Examples of onlineresources include PubMed, ReseachGate, MedLine, UCC libraries, Web of Science.Templates for the studywill be extracted from renown institutions or approved guidelines such as theJoanna Briggs Institute or the PRISMA statement (8)(9). DataAnalysis Althoughsome results will be analyzed narratively due to the possible qualitativenature of included studies, statistical evidence will also be provided.
Meta-analyses of results will indicate a general trend of potential progressnoted in participants. The program Review Manager will be used to help providestatistical results. It will generate information regarding effect size (with a95% confidence interval) (10),which is defined as the determinant of strength of correlation between twophenomena – in this case: music therapy and improvement of symptoms of ASD (11).
In addition, theprogram generates forest plots, an example of which can be found on appendix D. Those resources, along with the qualitative data to becollected, will facilitate analysis efficiently and in bulk. Logistics Theproposed timeframe for this study will be 12 months. A tentative Gantt chart isattached in appendix E.
The study appears to be feasible, albeit time-consumingand demanding. The first couple of months will be dedicated torecruiting research members on the team and assessing the best fit for whichperson would be the deciding one in case of disagreement on literatureselection. The next 3-4 months will be focused on compiling a list of papersrelevant to our research which have been deemed quality-worthy.
Following that,another 5 months should be dedicated to data extraction and analysis. The last3 months of the study would be to review all steps, write the report, andfinally present the findings. EthicalConsiderations Dueto the nature of this systematic study, no obvious ethical issues are present.There will be no patient interaction, questionnaire, or stress imposed onsubjects. Data extracted will never contain any identifiable markers forparticipants, especially due to the fact that this study will examine cohortsof individuals instead of a person-to-person basis. Furthermore, each study selected forthe review will be assessed for ethical inconsistencies or insufficiencies.
There areno conflicts of interest to declare.