Music improves social communication and auditory-motor connectivity in children with autism

Abstract

Music has been identified as a strength in people with Autism Spectrum Disorder; however, there is currently no neuroscientific evidence supporting its benefits. Given its universal appeal, intrinsic reward value and ability to modify brain and behaviour, music may be a potential therapeutic aid in autism. Here we evaluated the neurobehavioural outcomes of a music intervention, compared to a non-music control intervention, on social communication and brain connectivity in school-age children (ISRCTN26821793). Fifty-one children aged 6-12 years with autism were randomized to receive 8-12 weeks of music (n = 26) or non-music intervention (n = 25). The music intervention involved use of improvisational approaches through song and rhythm to target social communication. The non-music control was a structurally matched behavioural intervention implemented in a non-musical context. Groups were assessed before and after intervention on social communication and resting-state functional connectivity of fronto-temporal brain networks. Communication scores were higher in the music group post-intervention (difference score = 4.84, P = .01). Associated post-intervention resting-state brain functional connectivity was greater in music vs. non-music groups between auditory and subcortical regions (z = 3.94, P < .0001) and auditory and fronto-motor regions (z = 3.16, P < .0001). Post-intervention brain connectivity was lower between auditory and visual regions in the music compared to the non-music groups, known to be over-connected in autism (z = 4.01, P < .00001). Post-intervention brain connectivity in the music group was related to communication improvement (z = 3.57, P < .0001). This study provides the first evidence that 8-12 weeks of individual music intervention can indeed improve social communication and functional brain connectivity, lending support to further investigations of neurobiologically motivated models of music interventions in autism.

Fig. 1. CONSORT study diagram.

CONSORT study diagram study comparing neurobehavioural outcomes of a music intervention compared with a non-music intervention for children with Autism Spectrum Disorder

Fig. 2. Behavioural outcomes.

Line graphs represent effects of Music (MT) vs. Non-music (NM) intervention at baseline and post-intervention timepoints for primary (top panel) and secondary (bottom panel) behavioural outcomes. a Higher CCC-2 composite scores for Music Group at Post-intervention (group×timepoint: β = −1.35, P = .01). b, c No significant interactions for SRS-II (β = −0.04, P = .92) and PPVT-4 (β = 0.15, P = .78). d Better FQoL (family quality of life) in the Music Group at post-intervention (group×timepoint: β = −1.90, P = .01). e Reduced VABS Maladaptive Behaviours for both MT and NM post-intervention (β = 0.22, P = .01). MT is shown in red and NM in blue; darker shades represent observed values and lighter shades represent predicted values. Errors bars represent standard error (SE)

Fig. 3. Brain functional connectivity outcomes and correlation with behavioural improvement.

The top panel shows regions of increased resting-state functional connectivity (RSFC) post-intervention in the Music (MT) vs. Non-music (NM) groups between a Right Heschl’s gyrus seed and subcortical regions such as the hippocampus and thalamus (z = 3.94, P < .0001) and b left Heschl’s gyrus seed and fronto-motor regions (z = 3.16, P < .0001). c Connectivity between auditory and subcortical thalamic and striatal regions post-intervention is directly related to improvements in communication measured using the change in CCC-2 composite score in MT (z = 3.57, P < .0001). The bottom panel shows regions of decreased RSFC post-intervention in MT vs. NM groups between d right temporal pole seed and occipital regions (z = 4.01, P < .00001) and e left Heschl’s gyrus seed and bilateral calcarine and cuneus regions (z = 3.39, P < .00001). f Connectivity between auditory and visual sensory cortices post-intervention is inversely related to improvements in communication measured using the change in CCC-2 composite score in MT (z = 3.64, P < .001). MT is shown in red and NM in blue. Errors bars represent standard error (SE). All brain images are presented in radiological convention and coordinates are in MNI space