Common characteristics of improvisational approaches in music therapy for children with autism spectrum disorder: Developing treatment guidelines

Background: Improvisational methods of music therapy have been
increasingly applied in the treatment of individuals with autism spectrum
disorder (ASD) over the past decades in many countries worldwide.
Objective: This study aimed at developing treatment guidelines based
on the most important common characteristics of improvisational music
therapy (IMT) with children affected by ASD as applied across various
countries and theoretical backgrounds.
Methods: After initial development of treatment principle items, a survey
among music therapy professionals in 10 countries and focus group
workshops with experienced clinicians in three countries were conducted
to evaluate the items and formulate revised treatment guidelines.
To check usability, a treatment fidelity assessment tool was subsequently
used to rate therapy excerpts.
Results: Survey findings and feedback from the focus groups corroborated
most of the initial principles for IMT in the context of children with
ASD. Unique and essential principles include facilitating musical and
emotional attunement, musically scaffolding the flow of interaction, and
tapping into the shared history of musical interaction between child and
therapist. Raters successfully used the tool to evaluate treatment adherence
and competence.
Conclusions: Summarizing an international consensus about core principles
of improvisational approaches in music therapy for children with
ASD, these treatment guidelines may be applied in diverse theoretical
models of music therapy. They can be used to assess treatment fidelity,
and may be applied to facilitate future research, clinical practice, and
training.