Music Therapy: Helping Children in the Autism Spectrum - Research Paper Example

? MUSIC THERAPY: HELPING CHILDREN WITH THE AUTISM SPECTRUM DISORDER I. MUSIC THERAPY Music therapy refers to deliberate and systematic utilization ofmusic or sound to cause health improvement or healing (Woodham & Peters, 1997, p. 181). The soothing impact of music has been known to mankind since long irrespective of language and geographical differences. Considered as the universal language, man has always turned to music for relaxation and comfort. Because of its simplicity, comprehension, universal impact, dynamicity and non-invasiveness, the therapeutic procedure is as effective for children and adolescents as adults. Definitions A general definition of music therapy encompassing its therapeutic use as well as target was provided by Wigram (2000, p. 29): Music therapy is the use of music in clinical, educational and social situations to treat clients or patients with medical, educational, social or psychological needs. Music therapy has been formally defined to include three aspects of therapy; music, interpersonal relationship between the patient and the therapist, and finally the health outcomes of the use of music as a therapeutic procedure. Thus music therapy can be defined as “the prescribed use (by a qualified music therapist) of music, and the relationship that develops through shared musical experiences to assist or motivate a person to achieve non-musical goals” (Brunk, 2004, p. 7). Munro and Mount (1978, p. 1029) have defined music therapy as “controlled use of music and its influence on the human being to aid in physiological, psychological and emotional integration during treatment of an illness or disability” Aspects of music therapy The three critical aspects determining the efficacy of music therapy include the type of music, the nature of relationship between the therapist and the client, and finally the health outcome of the therapy (Brunk, 2004, p. 11). A. The Music Music has varied influences on different individuals, on the same individual the impact varies with type of music and time. Thus a therapist needs to use a wide variety of music with a child to study his response. The therapist primarily uses live music so that the variations in the song can elicit maximum range of responses. B. The Relationship A therapist uses music to make a connection with the client, the nature of the connection being completely non-verbal. Once trust has been established the therapist can use music to present share difficult experiences and tasks can be designed accordingly. The client then explores and establishes relationship through music. C. Achieving Goals Improvement in communication and language skills, communication skills and emotional modulation are the targeted goals that are to be achieved by music therapy. History History provides abundant evidences along with myths and lore for the use of music as a therapeutic tool (Gouk, 2000, p. 5). However research connecting modern scientific basis of modern therapeutic uses of music with the traditionally practiced music therapy are insufficient. Medical science in its early days of development, i.e. since the time of Hippocrates, was skeptical about the principle and practice of music therapy. Music is definitely not a part of the two prominent British works covering the history of medicine and psychiatry (Horden, 2000, p. 28). Healing powers of music are described in De Institutione Musica (circa AD 600) a book which has been quoted repeatedly in medial music literature. According to this the music-medicine link is based on four basic assumptions (Gouk, 2000, 85; Horden, 2000, p. 26): The harmonic vibrations of music have been interpreted as microcosmic reflections of vibrations and as proportions present in macrocosmos in the (Neo)Platonic Theory. The medical theory based on the interbalance of the four bodily fluids or humours considers the origin of disease as a consequence of the disturbance of this balance. Musical vibrations have the power to bring about the balance of the humours. The ethos doctrine is based on the premises that particular characteristics of different modes of music have the ability to influence the human brain. Health is influenced by the mind or the conscious; while music has power to influence the mind through its impact on the susceptible mind. In the classical medical syllabus of European history, music forms an integral part and has been studied based on the classical doctrines as well as the medical theories of the times i.e. the humoral pathology. However with the development of natural sciences, the study of anatomy, music therapy lost its significance to be revived only in the latter half of twentieth century with the advent of ‘New Age” philosophy and the integration of disciplines of physics, psychology, music and medicine. The major cause of its revival was the advances in modern quantum physics which demonstrated the existence of physical matter as wave as well as a particle (Bruscia & Grocke, 2002; Ruud, 2000). The theory that music has a significant impact on body and brain has now been established; and forms the scientific basis of modern music therapy. Technique Music is perceived by the brain through auditory senses. During the therapeutic use of music, it is played to bring about positive changes in the behavior, emotional attributes and physiological responses of the client. It is a form of complementary medicine that is used in combination with other medical procedures and has been reported to be effective in enhancing participation of the client and thereby accelerating the recovery procedure (White & Duncan, 2002, p. 140). Techniques employed in music therapy can broadly be classified into two groups: active and receptive. Active techniques involve the recreation, improvisation and composition of the music by the patient himself; while in receptive techniques, they only listen to music. While the former is popularly used in USA, the latter are more frequently in use in European countries (Maratos et al., 2009). The probable mechanism of action of receptive music therapy is based on the induction of physical and emotional changes as a consequence of varied musical stimuli. These techniques are based on cognitive behavioral or humanistic traditions and involve additional activity while listening to the music such as meditation, relaxation exercises, drawing, dancing or other forms of movement. The active techniques involve the use of clinical improvisation to stimulate or guide the patient. Improvisational and psycho-analytical model are used for active techniques. The probable mechanism in this case involves the development of co-created musical relationship between the therapist and the client; allowing the therapist to gain an insight in to the persona of the client. It also provides an opportunity to the client to express himself musically. Any or a combination of these techniques can be used for therapeutic purposes depending on the client requirement, situational needs and therapist’s training. The duration and intensity of the therapy also vary. Individual or group therapy both are used depending on need (Maratos, 2009). Mechanism Several theories have been proposed over the years to explain the mechanism of action of music therapy. Moranto (1993) has proposed the entertainment process to be the basis of music therapy. According to this theory, two objects vibrating at equivalent frequencies bring about a resonating effect. A similar explanation was provided by Guzzetta (1995, p. 617) who suggested that the pitch and the rhythm of music influenced the psychophysiologic response as a consequence of their effect on the limbic system. Music is known to stimulate neurotransmitters that bring about responses in form of chemical changes in body (White, 2000, p. 237). Use Music therapy finds use with diverse medical problems and situations. It can be used in case of immobilized clients waiting for diagnostic procedures, for adolescent clients to help them relax, during labor pain or as palliative care procedure. In the aging population, music therapy has been found to be affective against Alzheimer’s cerebrovascular diseases, Parkinson’s and dementia (Freeman, 2004, p. 23). Music-thanatology or palliative care involving music aims to bring about a smooth transition to death by lowering stress levels and bringing about relaxation (Schroeder-Shecker, 1994). It improves mental health (Wigram & Gold, 2006), reduces stress (Lichtman, 2006), and has specific therapeutic abilities such as pain alleviation, improving physical, mental and social functioning, improving interpersonal relationships and emotional strength (Guzzetta, 2005, p. 617). On the basis of its application, music therapy can be classified as clinical, behavioral, psychotherapeutic and educational music therapy. Bruscia lists the following areas of practice with respect to use of music as therapeutic tool: didactic, medical, healing, psychotherapeutic, recreational and ecological. In accordance four levels of interventions relating to music therapy have been defined: auxiliary, augmentative, intensive and primary levels (Daykin et al., 2006). II. MUSIC THERAPY AND THE COGNITIVE PROBLEMS Cognition and cognitive development Cognition is a set of skills that includes such elements as attention, memory, learning, language and executive functions including goal setting, planning, decision taking, judgment etc. These elements are responsible for the human attributes of sensation, perception, thinking, awareness and consciousness; and hence are essential for the sustenance of life. Impairment in any of these either as a consequence of again or due to a disease or disability renders the individual incapable of performing basic life functions (Kruse et al., 2006). Cognitive development begins within the child since its birth beginning with identification and differentiation of visual and auditory cues. Some children however, are recognized with cognitive deficits and are diagnosed to have attention deficits, learning disabilities, communication disorders etc. that may arise due to genetic factors or environmental factors prior to, during or after birth. Common disorders in children characterized by cognitive deficits include attention deficit hyperactivity disorder (ADHD), dyslexia, autistic spectrum disorders (ASD) etc (Kruse et al., 2006). Music Therapy for Cognitive Problems Music therapy has since long been recommended for motor disabilities and speech language disorders. However the same was not used for cognitive deficits till much later. Stress on the emotional and relaxation benefits of music therapy and lack of non-invasive tools for cognitive brain research contributed to the slow researches in the field of cognitive efficacy of music therapy. Wide availability of brain imaging technology post 1990s led to the development of research involving music cognition, cognitive rehabilitation and gave birth to the technique of neurological music therapy (NMT) (Thaut, 2010). Several researches in recent decade have established that the therapy can bring about improvement in the concentration and attention spans; social and interpersonal skills; and emotional development of these children. Evidences are available for music therapy to be helpful for children with ADHD, cerebral palsy and sexual abuse and other developmental, behavior and emotional disorders (Koopsen et al., 2009, p. 249). The physiological responses to music that form the basis of music therapy includes the following (Priesnitz, 2006; Goldman, 2002, p. 5): Music obscures unpleasant noises and sounds, and therefore helps overcome associated feelings. Different types of brain waves have been recognized to be affiliated with various levels of brain consciousness. Beta waves (14 to 20 Hz) are associated with ordinary consciousness, alpha waves (8-13 Hz) with periods of calm and heightened awareness; theta waves (4-7 HZ) with peak creativity, sleep and meditation; and finally delta waves (0.5-3 Hz) with during deep sleep, deep mediation or unconsciousness. Specific musical compilations have the ability to manipulate the brain state of consciousness by exposing it to different types of waves. Music brings about calmness by inducing deep and slow respiration. Variations in the properties of musical notes bring about changes in the rates of heart beat, pulse, blood pressure etc. It reduces stress and improves body movements and coordination, and affects body temperature. It regulates the levels of stress related hormones and endorphins. It boosts the immune system. The psychological responses to music include: Reduction of anxiety and fear (Guzzetta, 2005) Hypometabolic response Pain alleviation and speedy post surgical recovery (Cabrera & Lee, 2000) Alleviates nausea and emesis (Schweitzer, Giplin, & Frampton, 2004). Neurological Music Therapy (NMT) NMT is an important and recent subfield of musical therapy that focuses on disorders involving the brain. NMT is defined as ‘therapeutic application of music to cognitive, sensory and motor dysfunctions due to neurological disease of the human nervous system (Thaut, 2010). Researches in the field of NMT provide significant evidences for the efficacy of music therapy for cognitive deficits. Rhythmic auditory stimulation (RAS) as a specific technique of music therapy has been effectively utilized for patients suffering with Parkinson’s disease. Effect of RAS on gross and fine motor skills training for these patients has been investigated and found to be effective by del Olmo and associates (2006). Imaging techniques studying higher cognitive activities within the human brain in vivo and advances in the study of impact of music on human brain have provided adequate ground for the use of NMT for cognitive rehabilitation. Several links have been reported between music and cognitive functions such as temporal order learning, spatiotemporal learning, attention and auditory verbal memory. In accordance several models have been proposed to explain the mechanism by which music can help in overcoming cognitive deficits (Thaut, 2010). The following modulating factors affect the impact of music therapy on cognitive rehabilitation (Koelsch, 2009): Attention Modulation. Music has the ability to capture attention. And therefore has been effectively used for overcoming attention deficits. Memory Modulation. Music influences recognition, analysis, comprehension and memory and therefore has been used treatment of diseases that involve memory deficits such as dementia and Alzheimer’s. Behavior Modulation. Cognition is an important determinant of action and behavior with current evidences establishing that the neural codes involved in both overlap significantly. Mirror neurons are activated both during perception and action; sensorimotor codes responsible for maintaining and encoding information are also involved in auditory working memory; promoter cortex is equally involved in multiple cognitive tasks such as serial prediction, sequencing and working memory. Perception Modulation. Musical therapy and music training has significant impact on perceptual processes which are also involved in language comprehension. Since language comprehension is a major problem associated with reading and writing difficulties; music therapy finds use in enhancing perception. Evidences Sarkamo and associates (2008) during a study on victims of middle cerebral artery stroke established that music activates the bilateral regions of brain that are responsible for attention, semantic processing, memory, motor functions and emotions. During the single blind random controlled trial involving 60 participants assigned to a music group, language group and control group for two months, the impact of music on cognitive functions and mood was investigated. During the three month and six month follow extensive neurological assessments and results of cognitive tests revealed that the music group exhibited significantly higher improvement in both verbal memory and focused attention. The mood too was better with less depression and confusion in the music group compared to rest two. The authors base their results on the arousal and mood hypothesis; which states that any pleasurable activity heightens arousal and has a positive impact on cognitive performance (Thompson et al., 2001). Studies involving animals and the functional neuroimaging studies on human subjects have shown that listening to music results in activation of subcortical and cortical brain regions that include nucleus accumbens, ventral striatum, amygdala, insula, hypothalamus, hippocampus, ventral tegmental area (VTA). VTA is the source of dopamine while locus ceruleus and hypothalamus mediate arousal. Enhanced dopamine levels have been associated with raised levels of alertness, information processing, and memory. Thus music enhances arousal, motivation, memory, attention and executive functioning through the positive effect involving the dopamine producing and mesocorticolimbic regions of the brain (Srakamo et al., 2008). III. MUSIC THERAPY AND THE EMOTIONAL PROBLEMS ASSOCIATED WITH AUTISM Autism Spectrum Disorder (ASD) or Pervasive Developmental Disorder refers to a developmental disability that affects children by the age of three and is characterized by deficits in social interactions, and identifying social relatedness, communication and language deficits, and a highly limited range of interests and activities. The individual suffering with ASD has a requirement of completely consistent and predictable routine (Prizant et al., 2003). The core elements forming the diagnostic criteria for autism according to DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) include Qualitatively impaired social interactions exhibited by any two of the following characteristics: Marked deficits in non-verbal behaviors such as facial expressions, gestures etc. Lack of ability to develop peer relationship in accordance with the developmental stage Lack of spontaneous ability to share joys, interests, accomplishments with others Inability to respond socially or emotionally Deficits in communicational ability established by the presence of any one of the following characteristics: Lack of or insufficient development of spoken languages not accompanied by an endeavor to compensate by use of gestures or signs to communicate. Inability to initiate or continue a conversation Repetition of a particular word or phrase or use of strange language Lack of involvement in play activities consistent to developmental stage Involvement in a particular repetitive activity or pattern of behavior or complete and abnormal preoccupation with a specific interest, repetitive motor behavior (such as continuous finger tapping etc). Thus autistic spectral disorders are characterized by deficits in three core skills of social interaction, language and communication, and imagination and behavior. Further they lack perception and are therefore unable to recognize or understand other’s feelings; emotions etc and hence are incapable of responding appropriately (Gold et al. 2010). The co morbidities commonly associated with ASD include impairments in sensory processing, motor deficits, lack of emotional regulation and arousal modulation, and behavioral problems. ASD is also characterized with specific learning patterns with autistic children exhibiting relative strength in rote memory, object knowledge and visuo-spatial processing; and significantly poorer social knowledge, semantic and conceptual memory, and abstract problem solving ability (Prizant et al., 2003). One of the major disabilities associated with ASD, often unrecognized, is the lack of ability to modulate emotions. The root cause of this inability has been traced to be the lack of cognitive and/or affective ability of these individuals. Self regulation in varied social circumstances is determined by an individual’s ability to perceive other’s thought process, situations etc on the basis of non-verbal cues. The second determinant of social regulation is the ability to modify one’s behavior in accordance with the perceived information. This sequence of perception and action is repeatedly interrupted in autism resulting in lack of emotional regulation (Bachevalier & Loveland, 2006). During the recent decades a significant rise in the incidences of autism has made it the third most prevalent developmental disorder globally. In accordance there has been a rise in the development of treatment approaches. Several methods including educational, clinical, biomedical and alternative therapies have been investigated and have reported to be reasonably effective for the management of ASD (Prizant et al., 2003). Music therapy has been investigated in context to ASD since its modern day re-inception. ASD was one of the first disorders investigated for treatment by the pioneers of music therapy. Music was one of the obvious choices since one of the major problems associated with ASD was lack of language and communication skills. Thus active music making was seen as a suitable medium for interaction between the therapist and the autistic individual. The rationale for the use of music therapy for ASD has found further support from recent researches establishing musical characteristics of mother infant communication in early years (Gold, 2011). The basic premise of music therapy for ASD involves at the psychological level an opportunity to the therapist to involve and encourage the individual for a two way interaction. Using the musical attunement the therapist then matches and correlates his musical expression with the individual’s musical as well as non-musical expression, sensitively and sympathetically. The term musical attunement in itself represents a gradual, step by step process of tuning in to the feelings and expressions of the autistic individual. The therapist needs to be sensitive and empathetic to the individual’s cues. The music of the therapist should also match the individual’s pulse, his rhythmic movement patterns during musical performance and the melodic contour of his music so as to develop a feeling of oneness in terms of musical expression. This interaction is then expected and endeavored to grow in to a relationship that offers sympathy and security and facilitates freedom in form of musical expressions. The autistic individual must develop the feeling that the music of the therapist reflects the individual’s beliefs. A common foundation is built in terms of music. Thus the individual joins in or at times even initiates a non verbal and musical interaction with the therapist (Kim, 2008). The therapy further aids the development of communication skills through development of such sub skills as joint attention, imitation and variation, communication of beliefs, recognition and expression of feelings etc (Trevarthen, 1996, p. 172). Music therapy is now recognized as a suitable method to aid the development of emotional communication and social interaction abilities in autistic individuals. In this context, music therapy like other similar interventions focuses on two aspects of ASD; reflective (immediate) and delayed (mid-term) conditioned adaptive accommodation. Music facilitates repeated stimuli in form of music and music related activities that target the brain circuits causing them to re-pattern themselves. As a consequence of these continuous disturbances, brain is encouraged to generate functionally more accommodating interpretations of the stimuli; in this case music. The goals of music therapy in ASD are similar to other training programs that aim to teach the brain to recognize and respond to previously unavailable stimuli, enable the sensory system to focus on and interpret the new stimulus, and adapt to it. This involves condition training of the paleoencephalon in the brain. Paleoencephalon refers to the part of brain responsible for monitoring and interpreting the sensory information received by the brain. Reception of the information, followed by its interpretation elicits a suitable response from the brain. Whether this information would further be available to the higher cortical processes and for cognition, is decided by the paleoencephalon (Berger, 2002, p. 130). Thus music therapy involves designing the stimuli so as to target the conditioned adaptive physiologic accommodation for sensory interpretation of available stimuli or re referencing for a changed and desired pattern of responses. Once the new information is supplied to paleoencephalon and the neo-cortex, sensory information can be better understood through gradual development of ‘correction’ coding mechanisms. This gradual development requires repeated and continuous presentation of the new stimuli so as to elicit improved response from the brain. This leads to a better organization of brain functions which can then lead to cognitive and social learning. The relaxing and distressing effect of music further aids the process of organization (Berger, 2002, p. 166). Holck and Bakeman & Adamson have presented two techniques through which joint attention and hence emotional problems associated with ASD are dealt with by the therapists (Kim et al., 2008). Holck suggests a response evoking technique according to which aims to develop a mutual interaction characterized by a meaningful and enjoyable sharing of common musical themes. This leads to the establishment of a joint activity involving equal and deliberated participation of the autistic individual. Bakeman & Adamson proposed a caregiving/scaffolding model that leads to the development of joint attentional skills as it is established during infancy between the child and the mother (Kim et al., 2008). IV. EVIDENCES FOR MUSIC THERAPY AS AN EFFECTIVE TREATMENT MODALITY FOR AUTISM The efficacy of music therapy for ASD has been based on evidences from the clinical practice of the therapists themselves and there was a lack of substantial and quantitative evidences in the form of controlled trials for a long time. The practitioners claimed that each individual is unique and therefore requires a unique therapeutic regime, and also has a specific set of responses. Thus generalizations over the efficacy of music therapy for ASD cannot be drawn from individual studies, neither can it be rejected. Several quantitative and qualitative assessment tools for estimating the efficacy of music therapy have been developed by researchers such as Pavlicevic and Trevarthen, and by Aldridge as a consequence of these objections (Trevarthen, 1996, p. 183). In recent years evidences have also been made available for the establishing the efficacy of Music therapy for ASD through scientific investigations involving controlled trials and meta-analyses. These studies investigate the efficacy of music therapy in improving the skills that are known to deficient in ASD such as communication and language skills; behavioral skills and also the sub skills essential for proficiency in the aforementioned skills such as joint attention deficits, inattention, memory etc. One of the initial studies investigating the impact of music therapy on communicative skills of 11 autistic children conducted by Edgerton in 1994 reported a gradual and consistent improvement in the communicative skills of all the participants. Long term music therapy and its impact on the relationship patterns in children with autism have been qualitatively investigated by Schumacher (Gold et al. 2010). The two prominent reviews available for the impact of music therapy on ASD symptoms provided contradictory results. Whipple in 2004 concluded a positive impact of music therapy on ASD, but the interventions and designs of the study were inadequate and unsuitable for deriving a clear conclusion. The review by Ball (2004) provided evidence for the lack of any effect of music therapy on ASD, however this study failed to included many significant and valid studies investigating the same (Gold et al. 2010). Kim and associates (2008) studied the effect of improvisational music therapy on joint attention behavior in a group of 15 pre-school autistic children (age 3 to 5 yrs). A 12 weekly 30 minute music session was compared against a 12 weekly 30 minute play session. The assessment scales used were PDDBI (Pervasive Developmental Disorder Behavior Inventory) and the ESCS, a toy play based assessment tool for non-verbal communication based on initiation of joint attention and response to joint attention bids. The overall results from both tools were remarkably significant for music therapy compared to play sessions with most prominent results observed for initiation of joint attention. The study demonstrated the role of music therapy in improving social interactions in ASD by improving coordinated listening, visual referencing, response and engaging. Though the study was limited due to small sample size, yet the results establish the efficacy of music therapy in overcoming deficits in ASD. Boso and associates (2007) investigated the impact of long term interactive music therapy on both behavioral and musical skills of eight participants with severe autism. The intervention employed was a 52 weekly therapy session of 60 minutes each involving active music therapy. Thus wide ranges of musical activities such as singing, playing piano, drumming etc were included in these sessions. The clinical rating scales used to assess the outcomes included CGI (Clinical Global Impression) and BPRS (Brief Psychiatric rating scale). Remarkable improvements in both the scales were observed as a consequence of the therapy along with improvement of musical skills. Thus the study successfully established the efficacy of active music therapy sessions in enhancing the improvement in behavioral skills in individuals with severe autism. Another significant study involving 40 participants in the varied age range of 2-49yrs and diagnosed with ASD, was conducted by Kaplan and Steele (2005). Long term impact of 2 year music therapy interventions, with varied session lengths, session type, and formats were used for these individuals. Individual, partners, small and large group as well as a combination of these sessions were used. The interventions used included interactive instrument playing, musical instrument instruction, interactive singing, instrument choices, and song choices. There were also variations in the nature of symptoms of the participants as well. The outcome goals were selected to be language and communication skills, behavior and psychosocial skills, cognitive and musical skills; ranking 41%, 39%, 8% and 7% respectively. It was reported that irrespective of the type, intensity and frequency of the sessions or interventions; all the participants were able to achieve the initial objectives within a year; almost three fourth could achieve intermediate objectives during the same period. Finally the efficacy of music therapy session in improving skills was also reported by parents and care-providers. Gold et al. (2010) conducted a review of three small studies that investigated the short term impact of music therapy interventions involving a daily session extending for a week. All the three studies used placebo as control and found music therapy to produce better outcome compared to placebo both with respect to verbal and non-verbal communication skills. The impact on the behavioral deficits in ASD, however was not found to be significant. The first study included in the review by Gold and associates (2010) was conducted by Brownell (2002) and involved four participants in the age range of 6 to 9. The study involved a quasi-randomized unblended controlled trial. As a consequence of 5 individual daily sessions of structured receptive songs with social stories a repetitive behavioral outcome was observed post therapy sessions. The same was lacking for control groups with story therapy sessions or no interventions. In the next randomized study by Buday (1995), 10 participants in the age range of 4-9 yrs were involved. In the third study by Framer (2003), a randomized control trial involving 10 participants (age range 2-5 yrs) was conducted. A five day 20 minutes individual therapy session was compared against a control involving placebo. The review made an exhaustive analysis of impact of music therapy on various skills in children with ASD. Non verbal as well as verbal communication skills showed definite improvement significantly higher compared to placebo. Music therapy was also established to be effective for behavioral problems though the effect was not as prominent as for communication skills. CONCLUSION Evidences supporting the significant positive impact of music therapy on communication skills, both verbal and non-verbal in ASD are sufficient to establish its efficacy. It can also be stated to be more effective for improvement of behavioral skills compared to play or story therapy. However there are two limitations to this form of therapy. Therapists trained both in music therapy as well as clinical application of the therapy can only execute their roles effectively. The therapists also need to have an attractive personality and sensitivity. Music therapy as a technique of treatment for ASD is beginning to gain recognition. Further researches involving larger sample sizes and investigating the long term impact of music therapy need to be conducted in order to further evaluate its outcome and establish music therapy as an effective treatment modality for ASD. Academic training for professional music therapist needs to be designed and provided to make available competent and sufficient number of therapists. REFERENCES 1 Bachevalier, J., & Loveland, K. A. (2006). The orbitofrontal-amygdala circuit and self regualtion of socio emotional behavior in autism. Neuroscience and biobehavioral reviews , 97-117. 2 Berger, D. S. (2002). 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