Music and Autism: Christian Gold

Music has been described as the language of emotions; as a social art; and as highly rewarding. Many mental health problems have to do with emotional problems, social relationships, and motivation, and music has therefore been used throughout human history to promote mental health.
Autism is characterised by difficulties in social interaction and communication. Since the discovery of autism in the 1940s, it has been known that many autistic individuals have a strong relationship with music. Therefore, efforts have been made to use music-based interaction and communication to help them achieve various non-musical goals. A growing body of research has documented the effects of music therapy.
A series of systematic reviews of randomised controlled trials (RCTs) have shown beneficial effects of music therapy for autism, while also highlighting limitations of existing research:
The first Cochrane review (2006) showed an indication of effects on social interaction, a core domain of impairment in autism, however based on very small studies. Updates (2014, 2022) confirmed these effects, based on more and larger studies, but also highlighted considerable heterogeneity, which may be due to participants or interventions. In addition, a changing view of autism as a personality trait rather than a disorder has highlighted the importance of mental health outcomes and social participation.
In general, a growing body of research suggests that music therapy can have beneficial effects and no or little side effects. However, a growing concern is heterogeneity in outcomes. Music therapy can mean many types of activities, settings, and goals. Finer-grained mechanistic research is needed to better understand what type of musicking (from listening to different kinds of active music-making), conducted by whom in what setting, is most helpful for what patients and goals. Functional brain connectivity measured by fMRI is one promising methodology that is beginning to be used in the field. It may have potential as a predictive biomarker. Recent and ongoing studies will be discussed in relation to theories of social motivation and predictive reward processing.