Research and ASD: Brief Statement on TIME-A Trial

Statement to AMTA Members on the TIME-A trial published by Bieleninik et al. (2017)

The August 8, 2017 study published in JAMA by Bieleninik et al., regarding the effects of an improvisational approach to music therapy for young children with Autism Spectrum Disorder (ASD) is the subject of considerable attention in the popular press and among the community of Board Certified Music Therapists (MT-BC), parents of children with ASD, other consumers with ASD, and interested stakeholders in the United States.

Execution and completion of this multisite, international clinical trial is noteworthy and an impressive accomplishment. There is no doubt that, as individuals review this study, many lessons learned will emerge. These lessons should be applied to guide and advance future research and music therapy practice for the provision of safe, high quality, evidence-informed music interventions to benefit persons with ASD.

As with any trial, study limitations exist. Large multi-site trials in particular are often challenged with respect to funding, time, language and culture, and scope. The study conclusions need to be considered in context. The findings of the TIME-A trial are narrow and specific. When reviewing findings from the TIME-A trial, several points merit the readers’ consideration.

• First, this trial examined one specific improvisational music therapy intervention. The investigators found that the specified improvisational music therapy intervention did not result in significant improvement in one outcome (social affect as measured by the ADOS, a diagnostic tool) when compared to enhanced standard treatment.
• Second, it is important to remember that music therapy is a professional therapeutic service that encompasses a wide variety of music interventions for children with ASD (AMTA, 2015). The intervention examined in the TIME-A trial represents only one intervention option.
• Third, the investigators stated the focus of their study was on symptom severity (i.e., specifically social affect) and the utility of this outcome is disputed. The outcome measure did not capture other clinical domains, functional gains, or improved quality of life outcomes that can also be the target of music therapy services.
• Fourth, the authors noted there are a wide range of developmental, familial, and quality of life outcomes that were not measured in the TIME-A trial. These outcomes may be of even greater relevance for children with ASD and their parents.
• Fifth, generalizing outcomes from this study to all music interventions provided by credentialed music therapists would be inappropriate. This is due, in part, to the variety of intervention approaches offered by board certified music therapists and the broad range of developmental and clinical outcomes being addressed that were not measured in this study.
• Finally, caution is advised in interpreting research findings. Interpretation of findings can be misleading and confusing, as demonstrated in the popular press. For example, an alternate interpretation of the findings from this study is the music intervention did as well as the enhanced care arm of the trial, which represented accepted treatment options.

AMTA supports and encourages ongoing scholarly work in music therapy research and encourages dialogue on this study and the body of research to advance knowledge and support improvements for effective, safe evidence-informed interventions for persons who may benefit from music therapy services. There is a valuable existing base of research literature supporting the use of music interventions (including improvisational interventions) when working with individuals with ASD, particularly in early childhood. ASD is an important topic in AMTA’s strategic priority on research and was a clinical focus in its guidance for future research at the Music Therapy Research 2025 (MTR 2025) symposium (AMTA, 2015b). AMTA continues its work to prepare supplemental resources for members and various audiences interested in music therapy with persons with ASD.

References

American Music Therapy Association. (2015). Fact sheet: Music therapy and Autism Spectrum Disorder (ASD). Retrieved from https://www.musictherapy.org/assets/1/7/Fact_Sheet_ASD_and_MT__8-26-15.pdf

American Music Therapy Association. (2015b). Improving access and quality: Music Therapy Research 2025. Retrieved from https://www.musictherapy.org/mtr2025_proceedings_released/

Bieleninik, L., Geretsegger, M., Mössler, K., Assmus, J., Thompson, G., Gattino, G., … Gold C; TIME-A Study Team. Effects of improvisational music therapy vs. enhanced standard care on symptom severity among children with Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial. JAMA, 318(6), 525-535. doi: 10.1001/jama.2017.9478

Broder-Fingert, S., Feinberg, E., & Silverstein, M. (2017). Music therapy for children with Autism Spectrum Disorder. JAMA, 318(6), 523-524. doi: 10.1001/jama.2017.9477.

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