Journal of Music Therapy, 51(3), 2014, 250–275

doi:10.1093/jmt/thu012
© the American Music Therapy Association 2014. All rights reserved.
For permissions, please e-mail: [email protected]

Effects of a Music Therapy Group

Intervention on Enhancing Social Skills in
Children with Autism
A. Blythe LaGasse, PhD, MT-BC
Colorado State University

Background:  Research indicates that music therapy can improve social

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behaviors and joint attention in children with Autism Spectrum Disorder
(ASD); however, more research on the use of music therapy interven-
tions for social skills is needed to determine the impact of group music
therapy.
Objective:  To examine the effects of a music therapy group interven-
tion on eye gaze, joint attention, and communication in children with
ASD.
Method:  Seventeen children, ages 6 to 9, with a diagnosis of ASD were
randomly assigned to the music therapy group (MTG) or the no-music
social skills group (SSG). Children participated in ten 50-minute group
sessions over a period of 5 weeks. All group sessions were designed to
target social skills. The Social Responsiveness Scale (SRS), the Autism
Treatment Evaluation Checklist (ATEC), and video analysis of sessions
were used to evaluate changes in social behavior.
Results:  There were significant between-group differences for joint
attention with peers and eye gaze towards persons, with participants
in the MTG demonstrating greater gains. There were no significant
between-group differences for initiation of communication, response to
communication, or social withdraw/behaviors. There was a significant
interaction between time and group for SRS scores, with improvements
for the MTG but not the SSG. Scores on the ATEC did not differ over time
between the MTG and SSG.
Conclusions:  The results of this study support further research on the
use of music therapy group interventions for social skills in children with
ASD. Statistical results demonstrate initial support for the use of music
therapy social groups to develop joint attention.
Keywords:  autism spectrum disorder, group intervention, music ther-
apy, social skills

The author would like to acknowledge the research assistants, music therapists, teach-
ers, and children who participated in this study. Project funded through the Arthur
Flagler Fultz Research Fund of the American Music Therapy Association.
Address correspondence concerning this article to A. Blythe LaGasse, 1778 Campus
Delivery, Fort Collins, CO 80524. E-mail:[email protected].
Vol. 51, No. 3 251

Background
Autism Spectrum Disorder (ASD) is a neurodevelopmental dis-
order that is affecting an alarming number of individuals, with esti-
mates of 1 in 88 children in the United States (Centers for Disease
Control and Prevention [CDC], 2012). Theories regarding the
cause of autism are numerous and highly debated, as the disorder
affects persons from every racial, ethnic, and socioeconomic group
without any identifiable pattern. Furthermore, there is no known

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cure for autism, meaning that persons with autism will face contin-
ual challenges over their lifespan. Due to the pervasiveness and the
life-long implications of ASD, there is a need for evidence-based
treatment methods that can produce predictable outcomes for the
development of functional skills in children with autism.
A hallmark characteristic of autism is a deficit in social and
communication skills, including difficulty reciprocating social
interaction, problems establishing and maintaining relationships,
and abnormal communication behavior (American Psychiatric
Association, 2013). Social skills are required for relationships,
independence, and vocation; moreover, an inability to develop
these vital skills may have lifelong implications for persons with
ASD. In fact, the National Research Council’s Guidelines for
Educating children with ASD state: “Appropriate social interac-
tions may be some of the most difficult and important lessons a
child with autism spectrum disorders will learn” (2001, p. 213) and
that educational objectives should include “Social skills to enhance
participation in family, school, and community activities” (p. 218).
Existing research indicates that social skill needs do not naturally
resolve in persons with ASD; rather, social skills may improve less
than other impacted skills in ASD (Walton & Ingersoll, 2013).
Given the lifelong importance of social skills to education and daily
functioning, there is a need to establish effective interventions for
targeting social skills in children with ASD.
Many different interventions address social skills in persons with
ASD, including video modeling, peer-mediation, structured teach-
ing, and social skills training programs (National Autism Center,
2009; Walton & Ingersoll, 2013). The NAC’s National Standards
Report lists peer training, behavioral packages, and joint attention
interventions as “established” treatment whereas social skills pack-
ages were considered an “emerging” area of practice. In contrast
252 Journal of Music Therapy

to the 2009 NAC report, Reichow and Volkmar (2010) stated that
only video modeling and social skills group interventions had the
requisite research to be considered evidence-based treatment
interventions. In a subsequent Cochrane review, Reichow, Steiner,
and Volkmar (2013) found initial evidence that social skills groups
can improve overall social competence in persons 6 – 21 with ASD;
however, other researchers caution that the review did not ade-
quately address study bias and generalizabity of outcomes (Gillies,

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Carroll, & Loos, 2013). Although the literature includes several
interventions that directly or indirectly target social skills, there is
no conclusive evidence that one method of treatment is particu-
larly effective over other methods (Reichow & Volkmar, 2010).
Despite social skills being a hallmark deficit in ASD, the literature
demonstrates a continued need for evidence supporting effective
treatment interventions, with some authors calling for research
that better addresses the neurological factors and needs that have
been identified in ASD (Trevarthen & Delafield-Butt, 2013).
Recent developments in autism research indicate that persons
with autism have different neural organization, leading to an over-
load of sensory information and motor regulation difficulties that
ultimately can impact daily functioning including social and com-
munication skills (Robledo, Donnellan, & Strandt-Conroy, 2012;
Torres, Yanovich, & Metaxas, 2013). The notion that persons with
ASD do not want to be involved in their environment is being chal-
lenged as self-advocates with autism indicate that it is not a mat-
ter of wanting to interact; rather, they have an inability to follow
through or tolerate the desired interaction (Goddard & Goddard,
2012; McGinnity & Negri, 2005). Social skills demand interplay
of perceiving multiple sources of sensory stimuli, placing context
to understand the intentions of others, formulating a response,
and then carrying through with the response. Disruption in neu-
ral organization could have an impact on one, if not all, of these
elements.
Tomchek and Dunn (2007) found that over 90% of children
with ASD demonstrate behaviors related to poor sensory modula-
tion including self-stimulation (rocking or hand flapping), audi-
tory/tactile defensiveness (hands over ears, avoiding touch), sen-
sory seeking (crashing, creating sounds), and “tuning out” (not
responding to name or environmental cues). These behaviors can
directly compete with social interaction opportunities. For example,
Vol. 51, No. 3 253

persons who are sensory seeking may be in constant motion in the

room, making it hard to engage in a social experience. Persons
who are under-responsive may not respond to their name being
called or the interactions occurring in the environment (Miller,
Anzalone, Lane, Cermak, & Osten, 2007). Researchers in occu-
pational sciences have investigated self-regulated arousal, sensory
tools (weighted blankets), or modulation of the sensory environ-
ment; however, there are limited studies supporting use of these

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practices in the applied setting (Case-Smith, Weaver, & Fristad,
2014). From a neurological perspective, Torres, Brinker, and col-
leagues (2013) propose sensory difficulties are due to “noise” in
kinesthetic reafference. These researchers found that movement
patterns in response to the environment could be adapted when
persons with ASD were provided with the opportunity to explore
in relation to external stimuli. The researchers suggested that the
difficulties might be best mediated with external cues that provide
an anchor for movements within a meaningful and flexible experi-
ence that promotes self-discovery of behaviors (Torres, Brincker
et al., 2013).
Music therapy encompasses elements of a “meaningful and
flexible treatment” modality, as music experiences are inherently
structured, yet creative. Many children respond positively to music
experiences, potentially increasing engagement for learning. This
may be particularly true for children with ASD, as researchers have
demonstrated different musical processing skills in children with
ASD (Lai, Pantazatos, Schneider, & Hirsch, 2012). For example,
persons with ASD are demonstrated to have enhanced pitch and/
or melodic perception (Bonnel et al., 2010; Ouimet, Foster, Tryfon,
& Hyde, 2012; Stanutz, Wapnick, & Burack, 2012). Lai and col-
leagues (2012) demonstrated that children with ASD ages 5 to 22
had stronger activations of the cortical speech and auditory areas
when exposed to song, exceeding activations in neurotypical chil-
dren. These areas coincided with a greater activation of frontal-
posterior networks, suggesting that musical stimuli may more effec-
tively engage children with ASD (Lai, 2012). If persons with ASD
can better process musical stimuli, then music may assist learning
in areas of deficit, including social skills.
The rhythmic and structural components of music stimuli may
provide an external cue or anchor to further help children with
ASD to organize, predict, and respond to their environment.
254 Journal of Music Therapy

Several researchers have suggested that a lack of neural organiza-

tion in children with ASD prevents them from responding to their
environment due to underlying motor deficits leading to an ina-
bility to plan, initiate, and complete a motor sequence (Robledo
et  al., 2012; Torres, Yanovich, et  al., 2013). This lack of motor
organization could affect social skills, as social interactions require
the ability to plan, initiate, and complete movements (motor and
speech). Hardy and LaGasse (2013) suggested that rhythm and

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music provides an accommodation for these deficits, as music stim-
ulus has been widely shown in the rehabilitation literature to help
with motor planning and execution. Structured musical experi-
ences may be utilized to provide clear cues to anticipate a response,
giving time to plan and sequence a series of actions, as needed for
social interaction. Within this clear time-based musical structure,
there is also flexibility in the experience, as elements of the musical
experience can be changed to prompt, encourage participation,
or provide a framework for creative musical/nonmusical response.
This allows for the skill of social interaction to be practiced within
a structured experience that provides accommodations to promote
success.
The extant literature demonstrates that many need areas of
children with autism can be improved with music therapy treat-
ment. Music therapy interventions have been shown to have posi-
tive effects on behaviors including an increase in engagement
behavior (Carnahan, Musti-Rao, & Bailey, 2009), a decrease in
autistic-like behaviors (Boso, Emanuele, Minazzi, Abbamonte,
& Politi, 2007), and changes in behaviors targeted by social sto-
ries with music (Brownell, 2002). Music therapy interventions
have also been documented to improve emotional understand-
ing (Katagiri, 2009) and increase emotional engagement (Kim,
Wigram, & Gold, 2009). Specific to social competency, research
has indicated that music therapy can increase social skills includ-
ing joint attention behaviors (Kalas, 2012; Kim, Wigram, & Gold,
2008), social greeting routines (Kern, Wolery, & Aldridge, 2007),
communication skills (Kaplan & Steele, 2005; Lim, 2010; Lim &
Draper, 2011), peer interactions (Kern & Aldridge, 2006), and
cognitive social skills (Ulfarsdottir & Erwin, 1999). These studies
provide emerging evidence indicating that music is a powerful
tool that can promote measurable changes in the behaviors of
persons with autism.
Vol. 51, No. 3 255

Music therapy interventions have also been demonstrated to

improve social behaviors within groups of children. Music ther-
apy improved sustained attention to peers, especially with the
use of a musical object in a play-based setting (Sussman, 2009).
Furthermore, children’s attraction to music improved interaction
with peers in an outdoor play setting (Kern & Aldridge, 2006).
Children also engaged better to group academic learning (interac-
tive reading materials) when paired with music (Carnahan et al.,

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2009). Carnahan et  al. (2009) proposed that it is not the mere
presence of music that improves social behaviors of children with
autism, but the use of music within other interventions including
structure, preferred activity, visual supports, and social stories. The
aforementioned evidence supports additional research in music
therapy for social skills with children with autism and provides
directional conclusions in order to establish a more prominent
research-base in this area of treatment.
The purpose of this study was to measure the effect of a music
therapy group intervention on the social skills of children with
ASD, compared to typical group social skills training. To this effect,
the following research questions were asked: (a) will there be
any difference in parental report of social skills improvements in
children who receive the music therapy intervention when com-
pared to children in a no music social skills group and (b) will
there be any difference in eye gaze, joint attention, or initiation of
or response to communication in children who receive the music
therapy group intervention when compared to children in a no
music social skills group.

Methods
Participants
Twenty-two participants were recruited via word of mouth and
flyers in a large metropolitan area. Participants were randomized
to either the MTG (n = 10) or the SSG (n = 12) using a computer-
ized random numbers table. Participants met the inclusion criteria
consisting of a formal documentation of ASD, primary language
of English, negative report of dual disability diagnosis, negative
report of group music therapy treatment over the prior two years
and ability to commit to five weeks of twice-weekly treatment with
256 Journal of Music Therapy

fewer than two absences. Sample size estimates were generated

from an a priori power analysis of the difference score effect size
data from Kim et al. (2008), where an ANOVA indicated that there
was a significant interaction of group and time for joint attention
skills (p = 01; d = .63) and scores after the intervention (d = .97).
The power analysis indicated a range of 15 – 22 participants would
be needed to detect a meaningful difference. Participants who
met the inclusion criteria gave their verbal assent and their legal

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guardian signed a consent form. Colorado State University Human
Subjects Committee approved all study procedures.
The Childhood Autism Rating Scale – second edition (CARS2)
was used to determine each participant’s level of functioning. The
CARS2 is a rating scale developed by Schopler and colleagues
(2010) that assess behavior across 15 areas including relationships,
imitation, adaptation to change, and communication. The CARS
was administered using a script from a neuropsychologist, who also
scored all measures while masked to the participant’s group.
Of the 22 participants enrolled, two were taken off the study and
three withdrew, for a final sample of 17 participants (see Figure 1).
The 17 participants included four females (2 in the MTG, 2 in
SSG) and 13 males (7 in MTG, 6 in SSG). Children ranged from 6
to 9 years of age (M = 7.58, SD = 1.06). Three t-tests of independent
samples were conducted for CARS scores (M  =  34.5, SD  =  5.11),
attendance, and participant ages. No statistically significant
between-group difference was found in these measures (p > .05).
There were no statistically significant score differences between
the pretest scores of participants that were taken off/withdrew and
participants that completed the study.
Measures
Recommendations to improve outcome measures in studies
with children with ASD include the use of multiple tools that can
measure specific and general performance (Lopata et  al., 2010;
Lord et al., 2005). For this reason, the Social Responsiveness Scale
(SRS) and the Autism Treatment Evaluation Checklist (ATEC)
were used in combination with behavioral observation and coding
methods.
The Social Responsiveness Scale (SRS) (Constantino & Gruber,
2005) is a 65-item standardized rating scale that specifically deter-
mines the level of impairments in the social domain of children
Vol. 51, No. 3 257

22 participants met
inclusion criteria

Randomization

10 assigned to music 12 assigned to the social

therapy group (MTG) skills group (SSG)

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2 withdrew when
1 taken off for
randomized to SSG
exceeding absences
1 withdrew due to
9 participants 8 participants schedule issues
completed study completed study 1 taken off for
exceeding absences

7 participants completed 6 participants completed

follow-up measures follow-up measures

9 included in analysis 8 included in analysis

Figure 1. 
Participant flow chart.

ages 4  – 18. The SRS has been used in studies of social skills in
children with ASD (Ben-Sasson, Lamash, & Gal, 2013; Freitag et al.,
2013; Reszka, Boyd, McBee, Hume, & Odom, 2014). Lower scores
on the SRS indicate higher social functioning. The child’s parent/
caregiver completed this tool before and after the 5-week interven-
tion period.
The Autism Treatment Evaluation Checklist (ATEC; Rimland &
Edelson, 1999) was used to track changes in child progress over
the duration of the study. This tool was designed to evaluate new
treatments through questions on speech and language skills, social
skills, physical wellbeing, and sensory/cognition. The checklist
has four areas including speech and communication (14 items),
sociability (20 items), sensory/cognitive awareness (18 items),
and health/physical behavior (25 items). The ATEC was found
to be appropriate for the monitoring of progress in children with
ASD undergoing interventions (Magiati, Moss, Yates, Charman,
& Howlin, 2011). Lower scores on the ATEC demonstrate higher
functioning. Parents completed the ATEC before the study began,
after Sessions 2, 4, and 6, 3 days following the final session, and 3
258 Journal of Music Therapy

weeks after session completion. Parents completed the ATEC in

the waiting room while their child was involved in the group ses-
sion. The lead therapist also completed the ATEC after Sessions 2,
4, 8, and 10.
In order to quantify occurrences of eye gaze, joint attention, and
communication (i.e., initiating and responding to communication)
that occurred in the group, video recordings of children in both
groups were taken during the third and tenth sessions and were

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analyzed for instances of group communication and social inter-
action attempts. The third session was selected in order to allow
the children one week to adapt to the new environment before
recording their behaviors. Two trained music therapy research
assistants completed the coding of predefined behaviors (see
Table 1). Coding was completed on interventions targeting social
skills. These interventions were extracted from the larger session in
order to exclude sensory breaks and setup time. Five-minute clips
were randomly selected from each session for each child. The ses-
sion order was concealed from the coders. Although coders could
determine if they were watching video A or B due to the children’s
clothing, they remained unaware of whether the video shown was
the third or tenth session.

Table 1 
Predefined behaviors

Eye gaze Instances where the child directs their eye gaze toward
another person in the room.
Joint attention Instances of gaze checking (looking at another person,
looking at where their gaze is directed and back)
and shared attention (jointly attending to an object),
or showing/pointing for others. Joint attention was
coded for adults vs. peers. Initiated joint attention
bids were counted only as joint attention and not as
initiation of communication.
Initiation of Making a statement or using AAC* to communicate
communication with another individual in the room. Communication
was coded for adults vs. peers.
Response to Responding nonverbally, verbally, or with AAC to a
communication communication bid from another individual in the
room.
Withdrawal/ Any instances of hitting, biting, screaming, or removing
behaviors self from group.

Note. *AAC = Augmentative and Alternative Communication.

Vol. 51, No. 3 259

Study Design/Procedure
This study employed a nonblinded randomized control trial
design, where participants were randomly selected for the social
skills group (n = 8) or music therapy group (n = 9) using a random
numbers table. All participants received vouchers for individual-
ized music therapy sessions following the completion of the study.
Small groups (3–4 children/group) were formed. Children were
placed in a group in the order that they consented to the study.

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Each group met for 50-minutes, twice a week, for 5 weeks. The
lead therapist for each group worked in the same facility, employ-
ing the same philosophy of treatment in ASD. The music therapy
group (MTG) was led by a Board-Certified Music Therapist with
Neurologic Music Therapy training and experience working with
children who have autism in the group setting. A certified educa-
tor employed at a school for children with ASD and experience
leading social skills groups led the social skills group (SSG) without
music or rhythmic interventions. Both groups had two additional
support staff members who were also employed at the facility and
had experience working with children with ASD. The support staff
members were present to help with logistics (e.g., holding props,
bathroom breaks, & helping with session transitions such as getting
out equipment) and were instructed to not prompt children unless
asked by the lead therapist.
Groups were held in a large treatment room, with video cameras
hanging from ceiling mounts. Group sessions consisted of similar
exercises in the social and music group, with the addition of music
in the music group (see Table 2). All selected social experiences
specifically targeted social skills including promoting eye gaze
towards others, communication (receptive and expressive), and
joint attention. Lead therapists and assistants followed the manual-
ized intervention that defined exercises, levels of support, fidelity
measures, and duration of exercises. Groups consisted of a wel-
come exercise, followed by a rotation of sensory experiences and
social experiences, and ended with a farewell exercise. Both groups
incorporated sensory breaks (see Tables 2 & 3) and supports (e.g.,
therapy balls rather than chairs, deep pressure to aid in making a
choice, etc.) to promote success.
The SSG interventions were experiences typically use in the
clinic where they study was held. This included cooperative play
Table 2 
260

Example session schedule, exercises and outcomes.

Exercise Nonmusic group Music therapy group Desired outcome(s)

Welcome Group introductions Group introductions passing • Attending to a peer in the group
passing an object and an instrument and when the peer is welcomed with eye
acknowledgement of acknowledgement of peers. gaze
peers. • Joint attention to the object being
passed between peers
• Peer to peer interaction in order to
pass the object
Sensory experience Deep pressure regiment. Deep pressure using a No social goals; exercise used to prepare
“squeeze” song for rhythmic the participant for the upcoming
input. social experience through sensory
regulation
Group interaction Participants will play a Participants will play • Joint attention to objects used in the
game as a group that instruments of different experience
requires taking turns and timbres together. MT • Response to communication bids
listening to one another. will provide overall from others
structure and prompts for • Initiation communication with peers
participants to listen to • Eye gaze toward others in the group
one another and take turns
playing.
Sensory experience Movement around clinic: Moving to musical cues around No social goals; exercise used to prepare
jumping, running, clinic: jumping, stomping, the participant for the upcoming
stomping, etc. etc. social experience through sensory
regulation
Journal of Music Therapy

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Table 2
Continued

Exercise Nonmusic group Music therapy group Desired outcome(s)

Vol. 51, No. 3

Cooperative play Participants will be broken Participants will be broken • Joint attention to objects used in the
into smaller groups into smaller groups and will experience and to their peer
and will practice social practice social skills while • Response to communication bids
skills by sharing a small playing an instrument. Each from others
game/toy. Each group group will have one staff • Initiation communication with peers
will have one staff member facilitating the • Eye gaze toward their peer
member facilitating the interaction, while the lead
interaction, while the music therapist facilitates
teacher facilitates the the entire group. This will
entire group. This will help to ensure success
help to ensure success within the small groups.
within the small groups.
Farewell Participants say goodbye to Participants say goodbye to • Attending to a peer in the group with
peers. peers within a musical eye gaze
structure.

Note. Each session consisted of different exercises, beginning with exercises to build trust and relationships, and then moving into exer-
cises with higher social demands.
261

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262 Journal of Music Therapy

Table 3  
Example Music Therapy Exercises

Exercise Description

Welcome The lead therapist led a hello song, welcoming each

participant. Participants would have the opportunity to
play an instrument while they were being welcomed.
The lead therapist would then sing a cue to pass the
instrument to a friend.

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Sensory The lead therapist played a clear rhythmic pattern on the
experience guitar while singing a song about getting “squeezes” from
the assistants. The rhythmic song would serve to help the
client anticipate when the deep pressure would occur.
The song would lead the assistant through different body
parts including feet, legs, hips, back, shoulders, arms,
hands, and head.
Group music The lead therapist played a structured song leading the
participants in a group musical experience that promoted
listening and communication. For example, in the
“A” section of the song, the participants might all play
different instruments together. A “B” section of the song
would follow, using lyrical cues to facilitate listening
to peers with certain instruments (i.e., drums). After a
repetition of the “A” section, the “C” section of the song
facilitated an individual participant play something for
the group to repeat. Rhythmic cues were used to aid in
initiation of the behavior, lyrical cues provided directives,
and the form and structure of the music provided
anticipation for the response.
Sensory The lead therapist would play highly structured music that
experience facilitated different gross motor movements. Cues for
each movement changed to best match the movement
(strong rhythmic playing to cue marching vs. finger
picking to cue tip toes). This provided the clients with a
structure exercise that allowed for body movement and
proprioceptive input.
Cooperative play The lead therapist led a structured experience where dyads
of participants shared an instrument such as a xylophone.
The music provided the structure for taking turns and
sharing with a peer. For example, the “A” section of the
song utilized a rhythmic strum with lyrics about playing
(or waiting for a turn) and the “B” section of the song
employed a clear change in facilitation pattern (different
strum or finger picking) with lyrics to pass the mallets to
the peer.
Farewell A goodbye song encouraged participants to look at one
another and wave or high five.
Vol. 51, No. 3 263

experiences that involved taking turns, passing cards/game pieces,

and interacting with their peers. One example of large group inter-
action was passing a ball between peers. Cooperative play included
board games and word games (i.e., Wheel of Fortune) where the
participants worked together to solve a puzzle. Group interaction
included games where the participants passed a ball to one another,
copied the movements of another peer, or told jokes to their peer
group. During these activities, the lead therapist provided cues and

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prompts to facilitate peer-to-peer interaction and joint attention to
manipulatives/peers.
Within the MTG, the Transformational Design Model (Thaut,
2000) was used to create music experiences that were functionally
similar to the nonmusical experiences, with the addition of music
experiences and cues to facilitate the desired social skills. The
primary role of the music was to provide anticipatory cues to aid
in follow-through with all tasks and to use engagement in music
making to practice the social skills (see Table 2). For example, a
prompt was provided to complete an action such as sharing an
instrument with a peer. Rhythmic cues and music structure were
used to help the child plan their response, anticipate the timing
for the response, and follow through with the response. This may
be a strong rhythmic pattern with embedded lyrics of “get ready
go” paired with harmonic changes to support the lyrics. This is
in contrast to stopping the music/rhythm to signal that the child
should respond. The children were also involved in music mak-
ing in this experience, in contrast to playing a game or another
nonmusical task. Children were encouraged to communicate in
the manner in which they were most comfortable including use
of Alternative and Augmentative Communication (AAC), gesture,
or speech.
Parents completed the first SRS prior to the first group and
within four days of the last group. The parent completed the
ATEC during the first group, second group, fourth group, within
3  days after the last group, and 3 weeks after the last group.
Parents were instructed on how to use each of the tools using a
script provided by the neuropsychologist. Parents completed the
ATEC while in the waiting room and had the option of complet-
ing the ATEC online or via a phone call after sessions ended.
The SRS was completed in person before and after the group
interventions.
264 Journal of Music Therapy

Data Analysis
Scores for the SRS were compared using a Mixed ANOVA and
behavioral observations were compared using ANCOVA. The ATEC
scores were compared using a repeated measures ANOVA. Data anal-
ysis for the SRS and observation scores were computed using SPSS
version 21. Analysis for the ATEC sores was computed using SAS sta-
tistical package, in order to allow for data imputation for missing data
points. Inter rater reliability of the behavioral coding was computed

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using an Intraclass Correlation Coefficient for all observations.

Results
Participant Completion
Children in both interventions were scheduled to meet in a
group setting twice a week for a total of 10 sessions. All participant
guardians completed the Childhood Autism Rating Scale prior to
the interventions beginning. Sixteen of the participant guardians
completed the Social Responsiveness Scale in at pretest and post-
test. One child in the MTG had inconsistent SRS scores due to
a different parent completing the pretest and posttest tool with
a large discrepancy between all items. Ten guardians completed
the ATEC at every time point (6 times). Three guardians did not
complete the ATEC at every time point, with one parent failing to
complete measures after Session 2 (MTG), 4 (SSG), and 8 (MTG).
Four guardians failed to turn in the 3-week posttest measure (two
in the MTG & two in the SSG), despite phone call reminders.

Outcome Measures
Pretest/Posttest Measures. A 2 x 2 mixed ANOVA was calculated
comparing the child’s SRS scores at pretest and posttest, with group
as a between subject factor. A significant effect at the p < .05 level
was found for the interaction of time and group for SRS scores
(F(1,14) = 5.646, p = .032, partial η2 = .287). Table 4 provides the
results of the mixed ANOVA. Means for the SRS are included in
Figure 2, illustrating the significant interaction. A paired samples
t-test indicated significant differences for the music group pretest
scores (M = 114.25, SD = 18.61) and posttest (M = 93.5, SD = 17.57),
SRS scores (t(7) = 3.091, p = .018; 95% CI = -4.88 – 36.62). There
were no significant differences for the SSG group.
Vol. 51, No. 3 265

Table 4 
Results of the 2 x 2 Mixed Analysis of Variance Comparing the Child’s SRS Scores at Pretest
and Posttest, with Group as a Between Subject Factor

Source SS Df MS F p partial η2

SRS score 427.781 1 427.781 1.672 0.217 0.107

Time x Group 1444.531 1 1444.531 5.646 0.032 0.287
Error 3582.187 14 255.871

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Figure 2. 
Interaction between Group and Time on Social Responsiveness Scale scores.
*Lower scores = better social function.

A repeated-measures ANOVA was calculated comparing the

parent-rated ATEC scores at pretest, Session 2, Session 4, Session
8, 1 week post, and 3 weeks post. Since there were a total of eight
missing data points, a SAS program unit imputation was completed
to avoid listwise deletions. There was a significant main effect for
time (F(5,68) = 2.97, p < .01); however, no main effects for group
(F(1,15) = .05, p = .8234). The interaction effect for Time X Group
did not reach significance (F(5,68) = 2.29, p = .0549). Figure 3 illus-
trates the mean scores for the ATEC at all six data collection points.
Although the interaction effect was not significant at the .05 level,
given the small sample size Tukey post hoc analyses were run and
266 Journal of Music Therapy

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Figure 3. 
Group means for parent ratings on the Autism Treatment
Evaluation Checklist across time.
*Lower scores = better function.

demonstrated significant effects for only the music group between

session one and 3 weeks posttreatment (t(68)= 3.88, p = .0031).
A repeated-measures ANOVA was calculated comparing the
teacher-rated ATEC scores at Session 2, Session 4, Session 8, and
Session 10. Mauchly’s test indicated that the assumption of sphe-
ricity was violated; therefore, the degrees of freedom were cor-
rected using the Greenhouse-Geisser estimates. There was a sig-
nificant main effect for time (F(1.714,25.71)  =  3.556, p  =  .05,
partial η2 = .192). There was no significant main effect for group
(F(1,15)  =  .402, p  =  .536). The effect for Time X Group did
not reach significance (F(1.714,25.71)  =  2.03, p  =  .157, partial
η2 = .119). These results indicate that the lead therapists in each
group observed changes in the children’s behaviors.

Behavioral Coding/Analysis
Intraclass Correlation Coefficients were calculated to determine
the average inter-rater reliability for behavioral observations within
each category. Results indicated high ICCs for eye gaze (.934), joint
attention (.841), initiation of communication (.935), response
to communication (.858), and withdraw/behaviors (.941). An
Vol. 51, No. 3 267

ANCOVA with the group as a fixed factor, data from session three
as the covariate, and data from session ten as the dependent vari-
able was used to control for error variance. There were significant
between-group differences at the p < .05 level for eye gaze towards
persons (F(1,14)  =  6.669, p  =  .022, partial η2  =  .323) and joint
attention with peers (F(1,14)  =  5.735, p  =  .031 partial η2  =  .291),
with participants in the MTG demonstrating higher means (see
Table 5). There were no significant between-group differences for

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joint attention with adults (F(1,14) = 1.244, p > .05), initiation of
communication with another child (F(1,14) = 2.712, p > .05), ini-
tiation with an adult (F(1,14)  =  .164, p > .05), response to com-
munication (F(1,14) = .018, p > .05), or social withdraw/behaviors
(F(1,14) = 1.41, p > .05).

Discussion
The purpose of this study was to measure the effect of a group
music therapy intervention on the social skills of children with ASD,
compared to typical group social skills training, with specific focus

Table 5 
Occurrence of Target Behaviors in Sessions

MTG (n = 9) SSG (n = 8)

Session 3 Session 10 Session 3 Session 10

Variable M (SD) M (SD) M (SD) M (SD)

Eye gaze 37.16 40.89 33.37 18.62

(25.67) (23.37) (16.67) (14.07)
Joint attention 10.27 18.5 9.31 2.68
w/ child (11.94) (18.49) (9.49) (2.8)
Joint attention 8.83 7.22 15.06 13.25
w/ adult (10.17) (6.36) (13.74) (7.88)
Initiation of 6 6.44 11.25 10.62
communication (6.52) (5.89) (9.52) (10.07)
with adult
Initiation of 3.39 6.61 5 2.56
communication (4.81) (8.47) (5.77) (2.54)
with child
Response to 11.83 12.38 16.75 14.5
communication (9.54) (7.59) (7.68) (12.44)
Withdraw/ behaviors 4.44 3.05 4.25 5.81
(6.41) (5.09) (3.91) (5.43)
268 Journal of Music Therapy

on eye gaze, joint attention, and communication. Both research

questions focused on changes in social behaviors, according to
parental report and observation of behaviors when comparing
children in the MTG and the SSG. There were some differences
of social behaviors according to parental report. Significant differ-
ences were found for the SRS between children in the MTG and
SSG, with greater improvements for the MTG group. These results
indicate that the parents of children in the MTG recognized more

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improvements in overall social behaviors.
Parent scores on the ATEC did not reach significance using a
repeated-measures ANOVA; however, both groups demonstrated
improvements over the treatment period, with some greater
improvements observed in the MTG. Perhaps most interesting was
that greatest reported improvements were observed after comple-
tion of the sessions, in the tenth week and three-week follow up
in the MTG. There are several potential reasons for such findings
including a decrease in parental stress post study or potential gen-
eralization of skills. The overall trends of the ATEC data do not
show a clear weekly decline in behaviors and therefore these results
must be interpreted with caution.
Compared to the SSG, participants in the MTG demonstrated
increased occurrences of joint attention and eye gaze in the 10th
intervention session. These findings are consistent with previous
research measuring joint attention (Kim et al., 2008) and eye con-
tact (Finnigan & Starr, 2010; Kim et  al., 2008). Unlike previous
studies, only instances of eye gaze toward another individual were
counted, as opposed to length of eye contact, since the number of
people in the room and wide-angle camera scopes used to catch all
of the action in the room prohibited timing of pupil fixation on an
item. Since it may be more meaningful to hold eye gaze on another
person, this factor should be examined in future studies.
Joint attention with peers increased while joint attention with
adults decreased. One possible explanation for this is that facili-
tators were instructed to shift to more peer-to-peer interactions
as the weeks progressed. Whereas the initial sessions were con-
structed to build trust, provide opportunities to model, and
respond to explicit requests for interaction, later sessions provided
opportunities for the children to interact more with one another.
Within the music therapy group, the support of the music structure
was sustained throughout all sessions; however, the larger musical
Vol. 51, No. 3 269

structure provided support while the children interacted with one

another. Children in the SSG maintained interactions with adults
but decreased peer-to-peer interaction. These data may indicate
that the children relied on the adult prompting and were not as
successful at peer-to-peer interactions without an overall support
to guide the interaction.
Behaviors related to initiating communication and respond-
ing to communication showed no improvements between groups.

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A visual analysis of the data showed that the number of times chil-
dren in the MTG initiated and responded to communication had
a small increase from Session 3 to Session 10 (see Table  5). In
contrast, children in the SSG had more instances of communica-
tion initiation and response in Session 3, with a slight decrease in
Session 10 (Table 5). Therapists for both groups were working to
facilitate more genuine peer-to-peer interactions throughout the
treatment period. Therefore, maintenance of behavior indicates
that a decrease in adult support did not negatively affect response
and initiation. A  better analysis of response behavior may be to
track the number of prompts provided in order to determine if the
ratio between responses and prompts improved. Although initiat-
ing communication did not improve significantly for either group,
this coding category was only inclusive of communication attempts
that were not coded as joint attention (see Table 1).
Frequency of eye gaze toward other persons decreased in the
SSG and slightly increased in the MTG. A possible explanation for
this decrease in the SSG is that props used during sessions may have
been distracting. A visual analysis of the video showed that when
both groups participated in a group cooperative activity involving
props (e.g., board game, sharing of items, etc.), the SSG group
appeared to maintain gaze on the manipulatives. For example, the
video captured the group playing a board game with many pieces.
Although they played the game and participated with their peers,
actual interactions were shown to decrease, possibly due to compet-
ing stimuli of the game pieces. The music group also used props,
but these were all musical in nature (i.e., musical instruments).
The musical structure provided in the MTG appeared to be more
successful at maintaining the children’s attention to their peers
even when props were used, as opposed to the SSG where only
verbal prompting was used. Although there were some decreases in
social behaviors of the SSG, negative behaviors and withdrawal did
270 Journal of Music Therapy

not increase significantly for either group. This indicates that the
children remained engaged in the experiences and did not show
increased resistance to the interventions over the 5-week period.
Visual examination of the raw data reveled high variability for
behaviors between individual children, for example in eye gaze for
all children in the MTG there was a mean of 37.16 instances of eye
gaze toward another person, with a standard deviation of 25.67.
This variability in behaviors may be explained by the individual

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differences in how children with ASD interact with their social
environment. As autism is a spectrum disorder, children with the
diagnosis will often display very different behaviors despite simi-
lar CARS rating for functioning level. Some of the children in the
study were highly verbal and would initiate speech with adults easily
but would not gaze toward the person in which they were address-
ing. Another child might be nonverbal and show no instances of
initiating communication, but would gaze at each person in the
room. These individual differences are illustrated in Table 5, where
the mean and standard deviations demonstrate variability within
the behavior measures.
This study was the first nonblinded randomized controlled trial
to examine the impact of a music therapy group intervention on
the social skills of children with ASD. Although this study supports
previous research, there are a number of limitations that highlight
recommendations for future research. Participants in the MTG
showed improvements on the SRS but not on the ATEC. This
may indicate that the ATEC is not as sensitive to changes in social
skills, as the scale covers behaviors in several areas of functioning.
Further, both the ATEC and SRS are objective measurements based
on parent perspective. Objective rating scales allow for parental
bias when rating their children’s skills. For this reason, behavioral
observations were used to determine what within-group difference
may be present. This study did not include parent or sibling train-
ing, which may have improved outcomes for generalization since
skills could be more directly practiced outside of the therapeutic
session. Furthermore, observation of social skills in a typical setting
would provide a better comparison of actual behaviors to parental
report of behavioral changes.
This study used a randomized control trial design with a small
sample. One disadvantage to this study design with the small sam-
ple size is potential low power for statistical analysis and therefore
Vol. 51, No. 3 271

statistical results must be interpreted with caution. More children

were sought in the recruitment process; however, there were dif-
ficulties in recruitment due to the selected times for the group
intervention. All interested families were required to be available
for both group times in order to be enrolled and several families
expressed interest but were not available at the selected group
times (which were back-to-back on the same days of the week).
Several families expressed that treatment two times weekly was too

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much driving, especially with groups occurring after school hours
in “high traffic” times. Furthermore, group sessions meant that
makeup sessions were not possible, as the peer group was essential
to the study
This study experienced a moderate attrition rate, with 22% of
recruited participants withdrawing or taken off the study. Attrition
was higher in the SSG group (33% attrition) and parent comments
suggest that reasons were due to dissatisfaction with randomization
status. The MTG experienced 10% attrition, with the one child
taken off the study due to illness that led to excessive absences. Kim
et al. (2008) also reported a 33% attrition with 5 out of 15 with-
drawing due to hospitalization and travel difficulties. Similarly, par-
ents in the current study mentioned that the distance traveled was
difficult, even with a gas stipend. This may indicate that the travel
component of study involvement was inconvenient and/or created
too much stress, as such conducting studies in locations more easily
accessible to parents may be a way to encourage study completion.
The higher attrition in the SSG suggests that another study design
may be more appropriate, such as a waitlist control design where
all children would receive the music therapy treatment.

Conclusion
Results from this study provide initial evidence that music ther-
apy group sessions targeting social skills may improve joint atten-
tion, and eye gaze toward other persons. Furthermore, there are
indications that the intervention improved parental perception
of social skills, with greater improvements observed in the MTG.
This is the first RCT of group music therapy intervention for
social skills in children with ASD. Although improvements were
found, more research is needed to examine intervention efficacy
through a larger trial. This study provides a basis for larger studies
272 Journal of Music Therapy

investigating the use of music therapy group interventions for

social skills in children with ASD.
Conflicts of interest: None declared.

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders – V (5th ed.). Arlington, VA: American Psychiatric Publishing.

Downloaded from http://jmt.oxfordjournals.org/ at University of Utah on November 27, 2014

Ben-Sasson, A., Lamash, L., & Gal, E. (2013). To enforce or not to enforce?
The use of collaborative interfaces to promote social skills in children with
high functioning autism spectrum disorder. Autism, 17(5), 608–622. doi:
10.1177/1362361312451526
Bonnel, A., McAdams, S., Smith, B., Berthiaume, C., Bertone, A., Ciocca, V., . . .
Mottron, L. (2010). Enhanced pure-tone pitch discrimination among persons
with autism but not Asperger syndrome. Neuropsychologia, 48(9), 2465–2475.
doi: 10.1016/j.neuropsychologia.2010.04.020
Boso, M., Emanuele, E., Minazzi, V., Abbamonte, M., & Politi, P. (2007). Effect
of long-term interactive music therapy on behavior profile and musical skills
in young adults with severe autism. Journal of Alternative and Complementary
Medicine, 13(7), 709–712.
Brownell, M. D. (2002). Musically adapted social stories to modify behaviors
in students with autism: Four case studies. Journal of Music Therapy, 39,
117–144.
Carnahan, C., Musti-Rao, S., & Bailey, J. (2009). Promoting active engagement
in small group learning experiences for students with autism and significant
learning needs. Education and Treatment of Children, 32, 37–61.
Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2014). A systematic review of sensory
processing interventions for children with autism spectrum disorders. Autism.
doi: 10.1177/1362361313517762
Centers for Disease Control and Prevention (CDC). (2012). Facts about ASDs.
Retrieved from http://www.cdc.gov/ncbddd/autism/facts.html
Constantino, J. N., & Gruber, C. P. (2005). Social Responsivness Scale. Los Angelas, CA:
Western Psychological Services.
Finnigan, E., & Starr, E. (2010). Increasing social responsiveness in a child with
autism A  comparison of music and non-music interventions. Autism, 14(4),
321–348.
Freitag, C. M., Cholemkery, H., Elsuni, L., Kroeger, A. K., Bender, S., Kunz, C. U.,
& Kieser, M. (2013). The group-based social skills training SOSTA-FRA in chil-
dren and adolescents with high functioning autism spectrum disorder–study
protocol of the randomised, multi-centre controlled SOSTA–net trial. Trials,
14, 6. doi: 10.1186/1745-6215-14-6
Gillies, D., Carroll, L., & Loos, M. (2013). Commentary on ‘Social skills groups for
people aged 6 to 21 with autism spectrum disorders (ASD)’. Evid Based Child
Health, 8(2), 316–317. Doi: 10.1002/ebch.1902
Goddard, P., & Goddard, D. (2012). I am intelligent: From heartbreak to healing –
A mother and daughter’s journey through autism. Guilford, CT: Skirt!
Vol. 51, No. 3 273

Hardy, M. W., & LaGasse, A. B. (2013). Rhythm, movement, and autism: Using
rhythmic rehabilitation research as a model for autism. Front Integr Neurosci, 7,
19. doi: 10.3389/fnint.2013.00019
Kalas, A. (2012). Joint attention responses of children with autism spectrum disor-
der to simple versus complex music. Journal of Music Therapy, 49, 430–452.
Kaplan, R. S., & Steele, A. L. (2005). An analysis of music therapy program goals and
outcomes for clients with diagnoses on the autism spectrum. Journal of Music
Therapy, 42, 2–19.
Katagiri, J. (2009). The effect of background music and song texts on the emotional
understanding of children with autism. Journal of Music Therapy, 46, 15–31.

Downloaded from http://jmt.oxfordjournals.org/ at University of Utah on November 27, 2014

Kern, P., & Aldridge, D. (2006). Using embedded music therapy interventions to
support outdoor play of young children with autism in an inclusive community-
based child care program. Journal of Musicic Therapy, 43, 270–294.
Kern, P., Wolery, M., & Aldridge, D. (2007). Use of songs to promote independence
in morning greeting routines for young children with autism. Journal of Autism
and Developmental Disorders, 37(7), 1264–1271.
Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music ther-
apy on joint attention behaviors in autistic children: A randomized controlled
study. Journal of Autism and Developmental Disorders, 38(9), 1758–1766.
Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal
responsiveness of children with autism in improvisational music therapy.
Autism, 13(4), 389–409.
Lai, G., Pantazatos, S. P., Schneider, H., & Hirsch, J. (2012). Neural systems for
speech and song in autism. Brain, 135, 961–975.
Lim, H. A. (2010). Effect of “Developmental Speech and Language Training
Through Music” on speech production in children with autism spectrum disor-
ders. Journal of Music Therapy, 47, 2–26.
Lim, H. A., & Draper, E. (2011). The effects of music therapy incorporated with
applied behavior analysis verbal behavior approach for children with autism
spectrum disorders. Journal of Music Therapy, 48, 532–550.
Lopata, C., Thomeer, M. L., Volker, M. A., Toomey, J. A., Nida, R. E., Lee, G. K., . . .
Rodgers, J. D. (2010). RCT of a manualized social treatment for high-function-
ing autism spectrum disorders. Journal of Autism and Developmental Disorders,
40(11), 1297–1310. doi: 10.1007/s10803-010-0989-8
Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M., Charman, T., . . . Yoder, P.
(2005). Challenges in evaluating psychosocial interventions for autistic spec-
trum disorders. Journal of Autism and Developmental Disorders, 35(6), 695–708.
doi: 10.1007/s10803-005-0017-6
Magiati, I., Moss, J., Yates, R., Charman, T., & Howlin, P. (2011). Is the Autism
Treatment Evaluation Checklist a useful tool for monitoring progress in chil-
dren with autism spectrum disorders? Journal of Intellectual Disability Research,
55(3), 302–312. doi: 10.1111/j.1365-2788.2010.01359.x
McGinnity, K., & Negri, N. (2005). Walk awhile in my autism. Cambridge, WI:
Cambridge Book Review Press.
Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., & Osten, E. T. (2007).
Concept evolution in sensory integration: A proposed nosology for diagnosis.
American Journal of Occupational Therapy, 61(2), 135–140.
274 Journal of Music Therapy

National Autism Center. (2009). National standards report. The National Standards
Project – Adressing the need for evidence-based practice guidelines for autism spec-
trum disorders. From http://www.nationalautismcenter.org/pdf/NAC%20
Standards%20Report.pdf
National Research Council. (2001). Educating children with autism. Committee on
educational interventions for children with autism. In C. Lord & J. P. McGee
(Eds.), Division of behavioral and social sciences and education. Washington, DC:
National Academy Press.
Ouimet, T., Foster, N. E., Tryfon, A., & Hyde, K. L. (2012). Auditory‐musical pro-
cessing in autism spectrum disorders: a review of behavioral and brain imaging

Downloaded from http://jmt.oxfordjournals.org/ at University of Utah on November 27, 2014

studies. Annals of the New York Academy of Sciences, 1252(1), 325–331.
Reichow, B., Steiner, A. M., & Volkmar, F. (2013). Cochrane Review: Social skills
groups for people aged 6 to 21 with autism spectrum disorders (ASD). Evidence
Based Child Health, 8(2), 266–315. Doi: 10.1002/ebch.1903
Reichow, B., & Volkmar, F. R. (2010). Social skills interventions for individuals with
autism: Evaluation for evidence-based practices within a best evidence synthesis
framework. Journal of Autism and Developmental Disorders, 40(2), 149–166.
Reszka, S. S., Boyd, B. A., McBee, M., Hume, K. A., & Odom, S. L. (2014). Brief report:
concurrent validity of autism symptom severity measures. Journal of Autism and
Developmental Disorders, 44(2), 466–470. doi: 10.1007/s10803-013-1879-7
Rimland, B., & Edelson, M. (1999). Autism Treatment Evaluation Checklist, Autism
Research Institute; 1999. Retrieved from https:// www.autismeval.com/ari-
atec/report1.html
Robledo, J., Donnellan, A. M., & Strandt-Conroy, K. (2012). An exploration of sen-
sory and movement differences from the perspective of individuals with autism.
Front Integr Neurosci, 6, 107. doi: 10.3389/fnint.2012.00107
Schopler, E., Van Bourgondien, M. E., Wellman, G. J., & Love, S. R. (2010). Childhood
Autism Rating Scale (CARS). (2nd ed.). Los Angeles, CA: Western Psychological
Services.
Stanutz, S., Wapnick, J., & Burack, J. (2012). Pitch discrimination and
melodic memory in children with autism spectrum disorder. Autism. doi:
10.1177/1362361312462905
Sussman, J. E. (2009). The Effect of Music on Peer Awareness in Preschool Age
Children with Developmental Disabilities. Journal of Music Therapy, 46, 53–68.
Thaut, M.H. (2000). A scientific model of music in therapy and medicine. San Antonio,
TX: IMR Press.
Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and
without autism: a comparative study using the short sensory profile. American
Journal of Occupational Therapy, 61(2), 190–200.
Torres, E. B., Brincker, M., Isenhower, R. W., Yanovich, P., Stigler, K. A., Nurnberger,
J. I., . . . Jose, J. V. (2013). Autism: The micro-movement perspective. Frontiers in
integrative neuroscience, 7, 32. doi: 10.3389/fnint.2013.00032
Torres, E. B., Yanovich, P., & Metaxas, D. N. (2013). Give spontaneity and self-dis-
covery a chance in ASD: spontaneous peripheral limb variability as a proxy to
evoke centrally driven intentional acts. Frontiers in integrative neuroscience, 7, 46.
doi: 10.3389/fnint.2013.00046
Vol. 51, No. 3 275

Trevarthen, C., & Delafield-Butt, J. T. (2013). Autism as a developmental disorder

in intentional movement and affective engagement. [Hypothesis & Theory].
Frontiers in Integrative Neuroscience, 7. doi: 10.3389/fnint.2013.00049
Ulfarsdottir, L., & Erwin, P. (1999). The influence of music on social cognitive skills.
The Arts in Psychotherapy, 26(2), 81–84.
Walton, K. M., & Ingersoll, B. R. (2013). Improving social skills in adolescents and
adults with autism and severe to profound intellectual disability: a review of
the literature. Journal of Autism and Developmental Disorders, 43(3), 594–615. doi:
10.1007/s10803-012-1601-1

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