BackgroundPlay is a fundamental aspect of children's development, fostering their cognitive, social, and emotional growth. However, children with intellectual disability (ID) experience limitations in their ability to engage in play, which can impact their relationships with caregivers. Parents of children with ID face heightened stress and reduced playfulness in their interactions with their children. Existing early interventions have primarily focused on behavioral parent training programs to manage challenging child behaviors, lacking a direct and positive approach to enhancing parent-child play interactions and relationships.ObjectiveThis study aims to develop, implement, and evaluate 'Just Play'(JP), a creative arts therapies-based dyadic early intervention to enhance the quality of mother-child interactions through positive playful engagement.MethodsA mixed-methods randomized controlled trial will be conducted with 60 mother-child dyads (children aged 3-7 with a prior ID diagnosis). Participants will be randomly assigned to either the JP dyadic intervention or to psycho-educational parent counseling control group. Quantitative data will include measures of emotional availability, mother and child playfulness, and the level of interpersonal synchrony between mothers and their children at baseline and post-intervention. Additionally, qualitative interviews with a subset of mothers in the JP group will be conducted at post-intervention and two-month follow-up to explore their experiences and identify the best practices of the intervention.Results & implicationsThis study will provide empirical evidence on the effectiveness of JP dyadic intervention in strengthening positive mother-child relationships in families of children with ID. Findings will inform future early intervention strategies, contributing to evidence-based guidelines for practitioners working with children with ID while emphasizing the unique contribution of creative arts therapies to this population.Trial registrationClinicalTrials.gov, registered August 6, 2024 (NCT06541782 || https://clinicaltrials.gov/study/NCT06541782).

Despite the potential benefits of movement-based group interventions, little research has explored how autistic individuals experience such programs, particularly within socially demanding and stressful vocational contexts. This study aimed to understand the lived experience of young autistic adults who participated in movement-based group programs embedded within a vocational training course, preparing them for military-related employment. Twelve young autistic adults were recruited from a larger mixed-methods RCT examining a synchronized movement-based program designed to promote prosocial behavior, social cohesion, and coping with work-related stress. Participants attended 60-minute weekly sessions for six to seven weeks in either a synchronized or non-synchronized program format. Following program completion, participants took part in semi-structured interviews. Data were analyzed using the framework method analysis approach. Two overarching domains were developed: intrapersonal experiences and interpersonal experiences. Participants described experiences of competence and motivation through embodiment, personalization of training, self-regulation, and body-self acceptance, alongside strengthened social relatedness, mutual support, and awareness of individual differences within the group. Similar experiences were reported across the synchronized and non-synchronized program versions. These findings suggest that both movement-based group programs may offer an accessible pathway for social participation among young autistic adults by supporting interaction through embodied and shared experiences. The study contributes to a deeper understanding of how embodied group practices can beadapted to support inclusion, emotional regulation, and vocational readiness in autistic populations.

Dance movement therapists use interventions in which participants share synchronous movement to enhance well-being and increase social skills among autistic individuals. However, there is limited research about the effects of synchronized interventions on interpersonal and intrapersonal outcomes of autistic individuals. This field study evaluated the immediate and long-term impacts of a movement-based synchronized group intervention on prosocial behavior, social cohesion, and work-related stress among young autistic adults. A randomized controlled trial was conducted to investigate two movement-based group intervention conditions: synchronous and non-synchronous. Fifty-four young adults, aged 18–22, enrolled in an innovative program integrating young autistic adults into the Israeli army workforce. One-hour-long movement-based intervention sessions took place once a week for six to seven weeks, and data was collected at three time points: before and after the intervention period, and 17 weeks after it ended. Results suggest that the synchronized intervention may be more effective than the non-synchronized intervention in enhancing cooperative behavior after 17 weeks and fostering social closeness with familiar peers post-intervention. However, the synchronized intervention may not be more effective in reducing work-related stress. A holistic approach is discussed, which integrates synchronized and non-synchronized movement-based group interventions for young autistic individuals transitioning into work environments. Trial Registration ClinicalTrials.gov (ID: NCT05846308; URL: https://clinicaltrials.gov/ct2/show/NCT05846308 ).

The purpose of the present study was to examine the experiences of homeless women participating in the Halalu Women's Choir community program, and to explore the choir's potential as a model for art-based therapeutic rehabilitation programs for underprivileged women. The study implemented a qualitative ethnographic approach involving participant observation, a semi-structured in-depth focus group interview with the choir members, and an in-depth interview with the choir conductor. Twelve homeless women and a conductor took part in the women's choir activity on a weekly basis. An Interpretive Phenomenological analysis of the data yielded four themes: a) the choir serving as a home; b) the choir serving as a social anchor; c) the choir as a place where participants can be seen and heard; and d) the development as a group. The research findings reveal the inherent potential of community music programs as meaningful therapeutic rehabilitation tools for homeless women. They highlight the uniqueness of the Halalu choir model and demonstrate the meaningfulness of the queer feminist rehabilitation approach.

More assessments in the area of music therapy and autism are needed to determine whether a change in the use of music in everyday life has occurred and demonstrate psychometric validity. This study explores the convergent validity of the Music in Everyday Life (MEL) assessment by considering the relationships between the scores of the 2 MEL subscales (Joint Activities using Music [MEL-JAM] and Routine Activities using Music [MEL-RAM]), the scores of the 5 subscales of the Autism Diagnostic Observation Schedule (ADOS) and the 5 subscales of the Social Responsiveness Scale (SRS). Data from 106 participants across four countries were analyzed using the Spearman Rank Correlation inferential test. The MEL subscales and ADOS scores were positively correlated, ranging from low to moderate. However, these correlations may need to be more clinically meaningful, given the heterogeneity between the assessment tools. No correlations were found for the MEL subscales and the SRS. Future studies should consider whether diagnostic assessments that measure symptom severity are relevant in establishing the validity of music therapy assessments. Conducting other forms of validity for the MEL assessment is warranted, such as factor analysis.

Importance Preterm children are at risk for neurodevelopment impairments. Objective To evaluate the effect of a music therapy (MT) intervention (parent-led, infant-directed singing) for premature children during the neonatal intensive care unit (NICU) stay and/or after hospital discharge on language development at 24 months' corrected age (CA). Design, Setting, and Participants This predefined secondary analysis followed participants in the LongSTEP (Longitudinal Study of Music Therapy's Effectiveness for Premature Infants and Their Caregivers) randomized clinical trial, which was conducted from August 2018 to April 2022 in 8 NICUs across 5 countries (Argentina, Colombia, Israel, Norway, and Poland) and included clinic follow-up visits and extended interventions after hospital discharge. Intervention Participants were children born preterm (<35 weeks' gestation) and their parents. Participants were randomized at enrollment to MT with standard care (SC) or SC alone; they were randomized to MT or SC again at discharge. The MT was parent-led, infant-directed singing tailored to infant responses and supported by a music therapist and was provided 3 times weekly in the NICU and/or in 7 sessions across 6 months after discharge. The SC consisted of early intervention methods of medical, nursing, and social services, without MT. Main Outcome and Measures Primary outcome was language development, as measured by the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) language composite score, with the remaining BSID-III composite and subscale scores as the secondary outcomes. Group differences in treatment effects were assessed using linear mixed-effects models using all available data. Results Of 206 participants (103 female infants [50%]; mean [SD] GA, 30.5 [2.7] weeks), 51 were randomized to MT and 53 to SC at enrollment; at discharge, 52 were randomized to MT and 50 to SC. A total of 112 (54%) were retained at the 24 months' CA follow-up. Most participants (79 [70%] to 93 [83%]) had BSID-III scores in the normal range (>= 85). Mean differences for the language composite score were -2.36 (95% CI, -12.60 to 7.88; P = .65) for the MT at NICU with postdischarge SC group, 2.65 (95% CI, -7.94 to 13.23; P = .62) for the SC at NICU and postdischarge MT group, and -3.77 (95% CI, -13.97 to 6.43; P = .47) for the MT group at both NICU and postdischarge. There were no significant effects for cognitive or motor development. Conclusions and Relevance This secondary analysis did not confirm an effect of parent-led, infant-directed singing on neurodevelopment in preterm children at 24 months' CA; wide CIs suggest, however, that potential effects cannot be excluded. Future research should determine the MT approaches, implementation time, and duration that are effective in targeting children at risk for neurodevelopmental impairments and introducing broader measurements for changes in brain development.

Tibetan bowls and monochords are millennia-old instruments used for spiritual and therapeutic purposes. In the last few decades, there has been growing interest in the use of these instruments in meditation and therapeutic settings. Nevertheless, they are still rarely used in music therapy in the Western world, either because of technical difficulties or musical or cultural biases. The purpose of this pilot study was to examine the experiences of adults with mental health conditions and intellectual disabilities during sound meditation sessions using Tibetan bowls and a monochord. In this qualitative pilot, a group of six psychiatric inpatients participated in seven weekly sound meditation sessions over eight weeks that implemented Tibetan bowls and the monochord combined with meditation. Semi-structured interviews were conducted after each session to capture participants’ reflections on their experiences. The interview data was analysed using thematic analysis. Three main themes emerged: physical sensations, experiences of emotions, and visual experiences. The sounds of the Tibetan bowls and the monochord helped participants relax and evoked a wealth of emotions and mental imagery. These findings suggest that using these instruments with adults with mental health conditions and intellectual disabilities can foster relaxation, as well as heighten their awareness of physical sensations, feelings, and previous life events. Music therapists can thus integrate Tibetan bowls and the monochord into their skillset and use them during treatment sessions.

IntroductionThis qualitative study examined the perceptions and contribution of music to the everyday lives of autistic women. It draws on the neurodiversity paradigm and feminist theories of disability. The first author's autistic lived experience may have influenced these perspectives, but it also provides a more profound and nuanced understanding of these women's experiences and culture.MethodA constructivist qualitative paradigm appropriate for research involving sensitive or underexplored populations was implemented. Semi-structured in-depth interviews were conducted with nine Israeli autistic women aged 25-55 from various social backgrounds. The data were analyzed according to the Interpretative Phenomenological Analysis (IPA) approach.FindingsFour superordinate themes were developed from the data analysis: music throughout life, music as a facilitator of participation in society, music as an expression of diversity and normalization, autistic masking and the loss of musical identity.DiscussionThe findings suggest that the participants perceived music as highly significant, as it catalyzed self-expression and resilience. Yet, they also revealed challenges stemming from societal norms and the stigma associated with autism that potentially led to identity conflicts and masking behaviors that undermined music's contribution to their lives. The study highlights the complex interplay between the participants' musical, autistic and social identities, and further illustrates how music serves as a medium for expressing these intersecting aspects of their identity.

INTRODUCTION:Few autistic adults are able to integrate successfully into the world of work given their difficulties adapting to the social and stressful aspects of work environments. Interpersonal synchrony, when two or more individuals share body movements or sensations, is a powerful force that consolidates human groups while promoting the ability to self-regulate and cooperate with others. The abilities to self-regulate and cooperate are crucial for maintaining a calm and productive work environment. This study protocol outlines research that aims to assess the effects of group interpersonal synchrony on prosociality and work-related stress of young autistic adults in their work environment. METHODS AND ANALYSIS:This mixed-methods randomized controlled trial will investigate two movement-based group synchronous and non-synchronous intervention conditions. The sample will be composed of young adults enrolled in an innovative Israeli program designed to integrate cognitively-abled 18- to 25-year-old autistic adults into the Israeli army work force. The movement-based intervention sessions will take place in groups of 10-14 participants, once a week for 10 weeks. Questionnaires, behavioral collaborative tasks and semi-structured interviews will be conducted. Quantitative data will be collected for each participant at three points of time: before and after the intervention period, and 17 weeks after the end of the intervention. Qualitative data will be collected after the intervention period in interviews with the participants. DISCUSSION:Little is known about interventions that promote successful integration into social and stressful work environments. The findings are likely to shed new light on the use of group interpersonal synchrony in autistic individuals at work. TRIAL REGISTRATION:NCT05846308.

Introduction Music therapy has growing evidence for its effectiveness in mental health. People with mental health conditions often face significant barriers in obtaining personal valued social roles and feeling a sense of belonging to their community. Overcoming these barriers is an important step in the recovery process. This pilot study investigated whether long-term group music therapy might have an impact on participants’ social skill development, group cohesion and expression of emotional states.Method The study was an exploratory, retrospective, quantitative, longitudinal single-case study (N = 8). Five video recorded sessions were selected and micro-analyzed by independent raters, who rated the Group Environmental Scale (n = 8) and Individual Behavior Observation Categorization scale (n = 4). Statistical analysis was carried out to identify trends over time. The study was registered in ClinicalTrials.gov (NCT04435405).Results A longitudinal improvement was found in the group domains of Relationship (1.6-fold), Personal growth (1.9-fold) and System maintenance (1.5-fold) along the 9-month follow-up period. On the individual level, an improvement was found over time in social skills and group cohesion (4.85-fold), affect (3.15-fold), and musical activities performances (19.9-fold).Discussion The study demonstrated longitudinal improvement trends in social skills, group cohesion and expression of emotional states (affect) in the group as a whole and in each of the four individual assessments. Future studies which will include a larger sample and longer follow-up periods are needed.

Importance:Preterm children are at risk for neurodevelopment impairments. Objective:To evaluate the effect of a music therapy (MT) intervention (parent-led, infant-directed singing) for premature children during the neonatal intensive care unit (NICU) stay and/or after hospital discharge on language development at 24 months' corrected age (CA). Design, Setting, and Participants:This predefined secondary analysis followed participants in the LongSTEP (Longitudinal Study of Music Therapy's Effectiveness for Premature Infants and Their Caregivers) randomized clinical trial, which was conducted from August 2018 to April 2022 in 8 NICUs across 5 countries (Argentina, Colombia, Israel, Norway, and Poland) and included clinic follow-up visits and extended interventions after hospital discharge. Intervention:Participants were children born preterm (<35 weeks' gestation) and their parents. Participants were randomized at enrollment to MT with standard care (SC) or SC alone; they were randomized to MT or SC again at discharge. The MT was parent-led, infant-directed singing tailored to infant responses and supported by a music therapist and was provided 3 times weekly in the NICU and/or in 7 sessions across 6 months after discharge. The SC consisted of early intervention methods of medical, nursing, and social services, without MT. Main Outcome and Measures:Primary outcome was language development, as measured by the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) language composite score, with the remaining BSID-III composite and subscale scores as the secondary outcomes. Group differences in treatment effects were assessed using linear mixed-effects models using all available data. Results:Of 206 participants (103 female infants [50%]; mean [SD] GA, 30.5 [2.7] weeks), 51 were randomized to MT and 53 to SC at enrollment; at discharge, 52 were randomized to MT and 50 to SC. A total of 112 (54%) were retained at the 24 months' CA follow-up. Most participants (79 [70%] to 93 [83%]) had BSID-III scores in the normal range (≥85). Mean differences for the language composite score were -2.36 (95% CI, -12.60 to 7.88; P = .65) for the MT at NICU with postdischarge SC group, 2.65 (95% CI, -7.94 to 13.23; P = .62) for the SC at NICU and postdischarge MT group, and -3.77 (95% CI, -13.97 to 6.43; P = .47) for the MT group at both NICU and postdischarge. There were no significant effects for cognitive or motor development. Conclusions and Relevance:This secondary analysis did not confirm an effect of parent-led, infant-directed singing on neurodevelopment in preterm children at 24 months' CA; wide CIs suggest, however, that potential effects cannot be excluded. Future research should determine the MT approaches, implementation time, and duration that are effective in targeting children at risk for neurodevelopmental impairments and introducing broader measurements for changes in brain development. Trial Registration:ClinicalTrials.gov Identifier: NCT03564184.

Introduction Music-Oriented Parent Counseling (MOPC) is a clinical way to work with parents, using musical improvisations and listening. This study examined effects of MOPC on level of stress, quality of life perception and daily use of music by the parents of autistic children. Method Fourteen parents of young autistic children received either three MOPC sessions (n = 7) or ten MOPC sessions (n = 7), parallel to either music therapy (MT) or standard care for their children. Change in parental stress, parents' perception on children's and families' quality of life and the daily use of music (routine and joint music activities) were measured with standardized assessments and parent interviews. Descriptive and inferential parametric statistics were conducted, as well as thematic analysis. Results We found little change and no significant effect on parental stress. Children's quality of life showed improvement with but not without MT and a tendency towards a larger improvement with high-intensity than low-intensity MOPC. Family quality of life showed less change but a somewhat larger improvement in high-intensity than low-intensity MOPC. Routine music activities increased in high-intensity MOPC but decreased in low-intensity MOPC; joint music activities showed less change but a similar trend. Qualitative analysis of the interviews suggested that parents participating in high-intensity MOPC felt less stressed, perceived improved quality of life, and increased music use. Discussion Findings provide preliminary support for high-intensity MOPC to help parents of autistic children increase children's and families' quality of life and music use. More research is needed to confirm these findings.

Introduction Music therapy (MT) is a part of standard care in neonatal intensive care units (NICU) in many countries, and in some countries is provided as a post-discharge service as well. However, it is rare that preterm families are offered continuous MT services from birth through their first months at home. Affiliated with a recent longitudinal, controlled trial of MT for parent-infant bonding and an associated qualitative study exploring lived experiences of MT post-discharge in an Israeli cohort of parent participants, this study aimed to understand parents' experiences of engaging in longer-term MT with their preterm infants, spanning from birth into six months in a different Israeli cohort from the main trial.Method We completed an Interpretative Phenomenological Analysis (IPA) of parents' experiences of music therapy with their preterm infants. Semi-structured interviews intertwining listening to audio recordings from MT sessions were conducted with seven participants from five families of the main trial. The interviews were transcribed and analyzed following principles of IPA.Results The analysis resulted in the construction of two super-ordinate themes: (a) MT as a therapeutic haven, and (b) MT enabling integration of music into relationship over time.Discussion Experiences of a small cohort of Israeli parents suggest that MT spanning from birth to home may play a role in supporting parental musical agency and enhancing parent-infant relationship building.

Importance:Parent-infant bonding contributes to long-term infant health but may be disrupted by preterm birth. Objective:To determine if parent-led, infant-directed singing, supported by a music therapist and initiated in the neonatal intensive care unit (NICU), improves parent-infant bonding at 6 and 12 months. Design, Setting, and Participants:This randomized clinical trial was conducted in level III and IV NICUs in 5 countries between 2018 and 2022. Eligible participants were preterm infants (under 35 weeks' gestation) and their parents. Follow-up was conducted across 12 months (as part of the LongSTEP study) at home or in clinics. Final follow-up was conducted at 12 months' infant-corrected age. Data were analyzed from August 2022 to November 2022. Intervention:Participants randomized to music therapy (MT) plus standard care or standard care alone during NICU admission, or to MT plus standard care or standard care alone postdischarge, using computer-generated randomization (ratio 1:1, block sizes of 2 or 4 varying randomly), stratified by site (51 allocated to MT NICU, 53 to MT postdischarge, 52 to both, and 50 to neither). MT consisted of parent-led, infant-directed singing tailored to infant responses and supported by a music therapist 3 times per week throughout hospitalization or 7 sessions across 6 months' postdischarge. Main Outcome and Measure:Primary outcome was mother-infant bonding at 6 months' corrected age, measured by the Postpartum Bonding Questionnaire (PBQ), with follow-up at 12 months' corrected age, and analyzed intention-to-treat as group differences. Results:Of 206 enrolled infants with 206 mothers (mean [SD] age, 33 [6] years) and 194 fathers (mean [SD] age, 36 [6] years) randomized at discharge, 196 (95.1%) completed assessments at 6 months and were analyzed. Estimated group effects for PBQ at 6 months' corrected age were 0.55 (95% CI, -2.20 to 3.30; P = .70) for MT in the NICU, 1.02 (95% CI, -1.72 to 3.76; P = .47) for MT postdischarge, and -0.20 (95% CI, -4.03 to 3.63; P = .92) for the interaction (12 months: MT in NICU, 0.17; 95% CI, -2.71 to 3.05; P = .91; MT postdischarge, 1.78; 95% CI, -1.13 to 4.70; P = .24; interaction, -1.68; 95% CI, -5.77 to 2.41; P = .42). There were no clinically important between-group differences for secondary variables. Conclusions and Relevance:In this randomized clinical trial, parent-led, infant-directed singing did not have clinically important effects on mother-infant bonding, but was safe and well-accepted. Trial Registration:ClinicalTrials.gov Identifier: NCT03564184.

In the current study, we aimed to explore the lived experience of Israeli parents who engaged in musical dialogues with their preterm infants during music therapy (MT) after being discharged from the neonatal intensive care unit (NICU), as a part of the multinational LongSTEP RCT. Seven participants of the main trial were invited to engage in semi-structured in-depth interviews intertwining listening to audio recordings from their music therapy sessions in an adapted interpersonal process recall (IPR) procedure. The interviews were transcribed and analyzed using interpretative phenomenological analysis (IPA). We understood the participants' experiences to reflect two main themes: 1) Music therapy as a potential means of transformation in communication skills, resourcefulness and sense of agency; and 2) emotional and musical preconditions for parental engagement in MT. The findings illustrate how a specific group of Israeli parents experienced MT as offering them a means of expanding their relationship with their preterm infants after discharge. Based on our findings, we recommend that music therapists consider parents' musical and emotional resources during post-discharge MT to meet the individual needs of families.

AIM:To evaluate the effects of a physical activity programme on sedentary behaviour and physical activity in ambulant individuals with Rett syndrome (RTT).METHOD:In this multicentre randomized waitlist-controlled trial, we recruited 43 ambulatory individuals with RTT in Australia and Denmark. Adequate baseline data were obtained from 38 participants (mean age 20 years, range 6-41, SD 10 years 6 months, one male). All completed the trial. Participants received 12 weeks of usual care (n = 19) or a goal-based, telehealth-supported programme in which activities occurred in their familiar environments (n = 19). Sedentary time and daily steps were assessed at baseline, post-test, and 12-week follow-up. The data analyst was blinded to group allocation.RESULTS:Sedentary time decreased in the intervention group by 2.7% (95% confidence interval [CI] -6.0 to 0.6) and increased in the control group by 1.3% (95% CI -4.8 to 7.4). Intervention and control groups increased the number of their steps per day by 264.7 (95% CI -72.2 to 601.5) and 104.8 (95% CI -178.1 to 387.7) respectively. No significant differences were found on any outcomes at post-test. There were three minor adverse events.INTERPRETATION:A goal-based telehealth intervention seemed to produce small improvements in physical activity for individuals with RTT. Families require more support to increase these individuals' extremely low physical activity levels.WHAT THIS PAPER ADDS:A telehealth-supported intervention may produce small changes in physical activity in Rett syndrome (RTT). Increasing physical activity in individuals with RTT is challenging for caregivers. Families require substantial out-of-home support to increase their children's activity levels.

Purpose People with a disability may spend more time sitting and lying ("downtime") and less time standing and walking ("uptime"). Caregivers and therapists supporting individuals with Rett syndrome were surveyed, aiming to gather insights on how to support participation in "uptime" activities. Method An anonymous online survey including open ended questions about the enablers and barriers to "uptime" was administered to parent/caregivers and therapists/health professionals in an international sample. Responses were coded to the International Classification of Functioning, Health and Disability (ICF) framework identifying barriers, enablers, and strategies for increasing uptime activities. Results Parents (N = 115) and therapists (N = 49) completed the survey. Barriers and enablers to "uptime" were identified for all ICF domains and additional data coded to enabling access to the physical environment. Strategies to promote "uptime" activities and participation particularly related to the individual's physical capacity and personal factors as well as social and physical environmental factors. Conclusions Findings can inform the design of interventions aiming to increase "uptime" in individuals with Rett syndrome. Strategies should create individualised support by considering how to build fitness using activities that are motivating, at the same time creating opportunities for social interactions within a range of environments.

The United Nations highlighted the importance of promoting the rights of people with mental health conditions (MHC) to education, employment, and citizenship. One related initiative in Israel is the Garage pre-academic music and arts school for individuals with musical and artistic abilities coping with MHC. This process–outcome study examined whether and how the Garage contributes to participants’ creative self-concept, mental health, alleviates loneliness, and promotes postsecondary education and work integration. It also probed the participants’ initial expectations and the extent to which these were fulfilled. Using a single-group pretest–posttest design, quantitative data on the outcome variables were collected, along with mid-test data on process variables from the Garage students ( N = 44). Supplementary qualitative data were collected at pretest on the students’ expectations. The results suggest a significant increase in creative personal identity and mental health, a decrease in loneliness, and promotion of postsecondary education and work integration. These findings were associated with persistent attendance, basic psychological needs satisfaction, and expectation fulfillment. A merged analysis indicated that the students’ qualitative expectations were generally congruent with the quantitative results. Overall, the findings show how the program corresponds to humanistic values, targets service users’ needs and rights, and promotes personal recovery and community integration.

BACKGROUND Social interaction and social communication are among the central areas of difficulty for autistic people. Music therapy uses music experiences and the relationships that develop through them to enable communication and expression, thus attempting to address some of the core problems of autistic people. Music therapy has been applied in autism since the early 1950s, but its availability to autistic individuals varies across countries and settings. The application of music therapy requires specialised academic and clinical training which enables therapists to tailor the intervention to the specific needs of the individual. The present version of this review on music therapy for autistic people is an update of the previous Cochrane review update published in 2014 (following the original Cochrane review published in 2006). OBJECTIVES To review the effects of music therapy, or music therapy added to standard care, for autistic people. SEARCH METHODS In  August 2021, we searched  CENTRAL, MEDLINE, Embase, eleven other databases and two trials registers. We also ran citation searches, checked reference lists, and contacted study authors to identify additional studies. SELECTION CRITERIA All randomised controlled trials (RCTs), quasi-randomised trials and controlled clinical trials comparing music therapy (or music therapy alongside standard care) to 'placebo' therapy, no treatment, or standard care for people with a diagnosis of autism spectrum disorder were considered for inclusion. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Four authors independently selected studies and extracted data from all included studies. We synthesised the results of included studies in meta-analyses. Four authors independently assessed risk of bias (RoB) of each included study using the original RoB tool as well as the certainty of evidence using GRADE.   MAIN RESULTS: We included 16 new studies in this update which brought the total number of included studies to 26 (1165 participants). These studies examined the short- and medium-term effect of music therapy (intervention duration: three days to eight months) for autistic people in individual or group settings. More than half of the studies were conducted in North America or Asia. Twenty-one studies included children aged from two to 12 years. Five studies included children and adolescents, and/or young adults. Severity levels, language skills, and cognition were widely variable across studies. Measured immediately post-intervention, music therapy compared with 'placebo' therapy or standard care was more likely to positively effect global improvement (risk ratio (RR) 1.22, 95% confidence interval (CI) 1.06 to 1.40; 8 studies, 583 participants; moderate-certainty evidence; number needed to treat for an additional beneficial outcome (NNTB) = 11 for low-risk population, 95% CI 6 to 39; NNTB = 6 for high-risk population, 95% CI 3 to 21) and to slightly increase quality of life (SMD 0.28, 95% CI 0.06 to 0.49; 3 RCTs, 340 participants; moderate-certainty evidence, small to medium effect size). In addition, music therapy probably results in a large reduction in total autism symptom severity (SMD -0.83, 95% CI -1.41 to -0.24; 9 studies, 575 participants; moderate-certainty evidence). No clear evidence of a difference between music therapy and comparison groups at immediately post-intervention was found for social interaction (SMD 0.26, 95% CI -0.05 to 0.57, 12 studies, 603 participants; low-certainty evidence); non-verbal communication (SMD 0.26, 95% CI -0.03 to 0.55; 7 RCTs, 192 participants; low-certainty evidence); and verbal communication (SMD 0.30, 95% CI -0.18 to 0.78; 8 studies, 276 participants; very low-certainty evidence). Two studies investigated adverse events with one (36 participants) reporting no adverse events; the other study found no differences between music therapy and standard care immediately post-intervention (RR 1.52, 95% CI 0.39 to 5.94; 1 study, 290 participants; moderate-certainty evidence).  AUTHORS' CONCLUSIONS: The findings of this updated review provide evidence that music therapy is probably associated with an increased chance of global improvement for autistic people, likely helps them to improve total autism severity and quality of life, and probably does not increase adverse events immediately after the intervention. The certainty of the evidence was rated as 'moderate' for these four outcomes, meaning that we are moderately confident in the effect estimate. No clear evidence of a difference was found for social interaction, non-verbal communication, and verbal communication measured immediately post-intervention. For these outcomes, the certainty of the evidence was rated as 'low' or 'very low', meaning that the true effect may be substantially different from these results. Compared with earlier versions of this review, the new studies included in this update helped to increase the certainty and applicability of this review's findings through larger sample sizes, extended age groups, longer periods of intervention and inclusion of follow-up assessments, and by predominantly using validated scales measuring generalised behaviour (i.e. behaviour outside of the therapy context). This new evidence is important for autistic individuals and their families as well as for policymakers, service providers and clinicians, to help in decisions around the types and amount of intervention that should be provided and in the planning of resources. The applicability of the findings is still limited to the age groups included in the studies, and no direct conclusions can be drawn about music therapy in autistic individuals above the young adult age. More research using rigorous designs, relevant outcome measures, and longer-term follow-up periods is needed to corroborate these findings and to examine whether the effects of music therapy are enduring.