Background – the number of which might be

Background

 

 

Starting
with genetic factors and going all the way through to vaccines, the proposed
causes of autism spectrum disorder (ASD) have been widely based on educated
guesses at best. Autism spectrum disorder is classified by the National
Institute of Mental Health as a developmental disorder exhibiting a wide range,
or “spectrum” of symptoms (1). According to the
CDC (Centers for Disease control and prevention) in the U.S.A, 1 in 68 children
have already been diagnosed with ASD – the number of which might be higher if
it were possible to diagnose every single case including those without access
to healthcare professionals (2). Additionally, those
statistics favor male patients who are 4.5 times more likely to be diagnosed
with ASD when compared with female patients (2). Lastly, it is important to
note that about 44% of people on the ASD spectrum have average to above average
cognitive capabilities (2); which is why studies that exclude patients with a
lesser IQ might propose results that are not entirely representative. Hence the
issue with this particular disorder: the wide variety of symptoms and
day-to-day experiences is so vast that no single study can be
representative – treatment must be somewhat individualized.   

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            The exact definition of ASD, as it stands, is
understandably very broad. Some notable signs an individual with ASD might show
are lack of emotional responses, lack of eye contact, physical contact, light
and/or sound sensitivity, extreme discomfort to any disruptions in their
routine, 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 no
known cure, treatment options exist in order to better the general quality of
life of patients, as well as their families’ (3). The main recourse
is usually to start behavior therapy in an effort to help the child with
building relationships: with others, family and therapists. Evidently, due to
the spectrum of symptoms, treatment must be individualized; for instance, a
patient suffering from light sensitivity or discomfort due to touch might be
advised sensory integration therapy (4). Others might need
speech and language therapy, or social skills therapy.

 

            A relatively new form of treatment for patients with ASD
in the past few years has been music therapy, which is said to aid in
communication and relaxation (5). A review paper from
2014 looked at 12 studies concerning music therapy for the treatment of ASD
patients and reported that 58% of those studies were conclusively effective but
that “additional research is warranted” (6).

Research
Objective

 

 

The aim of this systematic
review is to corroborate results of previous literature regarding the
effectiveness of music therapy in treating patients with autism spectrum
disorder. As studies have seldom resulted in a definitive answer, the
advantages of music therapy in this particular instance are relatively obscure.

Although this study might not corroborate past findings, it may formulate a
trend in potential progress due to treatment in addition to elucidating any
areas of improvement.

            Ultimately, the purpose of this study is to contribute in
providing better care for patients with ASD as well as their families.

            Possibly, raising concerns about to which extent
individualizing therapy for patients is beneficial could lead to further
considerations: should we narrow the scope further when it comes to patient
genders, socioeconomic or ethnic backgrounds, or ages? Knowing that progress is
likely to occur in response to therapy and everyday lifestyles, how much
weight does the latter hold?

 

Hypothesis: Music
therapy aids children with ASD with emotional, cognitive and communicative
growth.

 

 

Research Design

 

 

This
systematic review will require resources allocated to research and will be
time-demanding. However, no questionnaires or interviews will be conducted.

On the one hand, some advantages
of a systematic review include exhaustive research, a wide reach and collection
of scattered data which help in making conclusive, definitive statements on
whether a medical practice is generally beneficial to the health of the
population (7).

On the other hand,
disadvantages include the fact that some reviews quickly become outdated within
a few years due to the ever-growing medical progress. Additionally, systematic
reviews might not be selective enough in the types of studies accepted,
decreasing the viability of the outcome (7).

 

 

Methodology
and Data Collection

 

 

A
team of 3 to 4 individual researchers will be recruited (with research
experience) in order to asses the quality of each paper and whether or not it
should be included in the study. The “quality” refers to implications of any
biases, inadequate sampling methods, issues with consent or conclusions
provided. Each reviewer would work independently of the others, to ensure
complete autonomy. In order to assess this quality, the standardized JBI
Critical Appraisal Tools will be used (8). The different
templates are to be used in accordance to the type of study being appraised by
the reviewers. A couple of examples are in Appendices A and B.

It is important to note that
upon any disagreement between members of the research team, a third person (also
in the team) is to be assigned as the “tie-breaker”; insuring as little bias as
possible.

 

 

Inclusion Criteria and Sampling

 

This
systematic review will include studies which examine the relationship between
music therapy and autism spectrum disorder in children between the ages of 0
and 6 years old.

Participants of any sex or
background can be selected, and exhibiting any of the broad spectrum of
symptoms of ASD. This implies that this review is to assess the general quality
of music therapy as treatment as a general trend, instead of narrowing the
scope to an individualized basis.

The literature selected can
consist of randomized control trials or studies using a qualitative
methodological approach.

A synthesis of this
collection will be provided in a PRISMA flow diagram (an example of which can
be found in Appendix C) (9).

 

 

 

 

 

Data Collection

 

 

            The
search for studies will be conducted using databases and thus readily available
information. 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 key
words. Additionally, the studies’ references might be looked at, as well as
other works by authors as most researchers specialize in a field and might have
published similarly useful papers.

            Papers will only be selected if they have been published
within the past 15 years, i.e as of 2003.

            Most of the effort will go towards obtaining data from
online resources.

Examples of online
resources include PubMed, ReseachGate, MedLine, UCC libraries, Web of Science.

Templates for the study
will be extracted from renown institutions or approved guidelines such as the
Joanna Briggs Institute or the PRISMA statement (8)(9).

 

 

Data
Analysis

 

 

            Although
some results will be analyzed narratively due to the possible qualitative
nature of included studies, statistical evidence will also be provided.

Meta-analyses of results will indicate a general trend of potential progress
noted in participants.

            The program Review Manager will be used to help provide
statistical results. It will generate information regarding effect size (with a
95% confidence interval) (10),
which is defined as the determinant of strength of correlation between two
phenomena – in this case: music therapy and improvement of symptoms of ASD (11). In addition, the
program generates forest plots, an example of which can be found on appendix D.

            Those resources, along with the qualitative data to be
collected, will facilitate analysis efficiently and in bulk.

 

 

 

 

 

Logistics

 

 

The
proposed timeframe for this study will be 12 months. A tentative Gantt chart is
attached in appendix E.

            The study appears to be feasible, albeit time-consuming
and demanding.

            The first couple of months will be dedicated to
recruiting research members on the team and assessing the best fit for which
person would be the deciding one in case of disagreement on literature
selection. The next 3-4 months will be focused on compiling a list of papers
relevant to our research which have been deemed quality-worthy. Following that,
another 5 months should be dedicated to data extraction and analysis. The last
3 months of the study would be to review all steps, write the report, and
finally present the findings.

 

 

Ethical
Considerations

 

 

            Due
to the nature of this systematic study, no obvious ethical issues are present.

There will be no patient interaction, questionnaire, or stress imposed on
subjects. Data extracted will never contain any identifiable markers for
participants, especially due to the fact that this study will examine cohorts
of individuals instead of a person-to-person basis.

            Furthermore, each study selected for
the review will be assessed for ethical inconsistencies or insufficiencies.

There are
no conflicts of interest to declare.

 

 

 

 

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