The Effects of Improvisational Music Therapy on Joint Attention Behaviors in Autistic Children: A Randomized Controlled Study

  • Jinah KimEmail author
  • Tony Wigram
  • Christian Gold
Original Paper


The purpose of this study was to investigate the effects of improvisational music therapy on joint attention behaviors in pre-school children with autism. It was a randomized controlled study employing a single subject comparison design in two different conditions, improvisational music therapy and play sessions with toys, and using standardized tools and DVD analysis of sessions to evaluate behavioral changes in children with autism. The overall results indicated that improvisational music therapy was more effective at facilitating joint attention behaviors and non-verbal social communication skills in children than play. Session analysis showed significantly more and lengthier events of eye contact and turn-taking in improvisational music therapy than play sessions. The implications of these findings are discussed further.


Improvisational music therapy Joint attention Play sessions with toys 



This study was a part of the first author’s PhD study and was supported by a PhD scholarship, the Graduate School of Music Therapy, Institute for Communication and Psychology, Aalborg University, Denmark. We wish to thank the children and families who participated in the study, and also the clinical research team (Yenok Song, Eunyoung Lee, Kyungsook Kim, Jiyen Jang, Mijung Kwon) for their contribution over the period of the trials (2004–2005) at Jinah Kim Music Therapy Clinic, Seoul, Korea. We are also grateful to Soochurl Cho, Minsup Shin and Sejin Joo, Ira Cohen, Peter Mundy, Michael Siller variously for their expert help.


  1. Alvin, J. (1978). Music therapy for the autistic child. London, UK: Oxford University Press.Google Scholar
  2. Bakeman, R., & Adamson, L. (1984). Coordinating attention to people and objects in mother infant and peer-infant interaction. Child Development, 55, 1278–1289.PubMedCrossRefGoogle Scholar
  3. Bono, M., Daley, T., & Sigman, M. (2004). Relations among joint attention, amount of intervention and language gain in early autism. Journal of Autism and Developmental Disorders, 34, 495–505.PubMedCrossRefGoogle Scholar
  4. Brown, S. (1994). Autism and music therapy; is change possible and why music? British Journal of Music Therapy, 8(1), 15–25.Google Scholar
  5. Bruner, J. (1995). From joint attention to meeting of minds: An introduction. In C. Moore, & P. Dunham (Eds.), Joint attention: Its origins and role in development (pp. 1–14). Hillsdale, NJ: Nawrence Erlbaum Associates.Google Scholar
  6. Bunt, L. (1994). Music therapy, an art beyond words. London: Routledge.Google Scholar
  7. Cicchetti, D. V. (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290.CrossRefGoogle Scholar
  8. Cicchetti, D. V., & Sparrow, S. S. (1981). Developing criteria for establishing interrater reliability of specific items: Applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86, 127–137.PubMedGoogle Scholar
  9. Cohen, J. (1990). Things I have learned (so far). American Psychologist, 45(12), 1304–1312.CrossRefGoogle Scholar
  10. Cohen, I. L., & Sudhalter, V. (1999). Pervasive Developmental Disorder Behavior Inventory (PDDBI-C). NYS Institute for Basic Research in Developmental Disabilities.Google Scholar
  11. Cohen, I. L., Schmidt-Lackner, S., Romanczyk, R., & Sudhalter, V. (2003). The PDD behavior inventory: A rating scale for assessing response to intervention in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 33(1), 31–45.PubMedCrossRefGoogle Scholar
  12. DeMyer, M. K., Alpern, G. D., Barton, S., DeMyer, W. E., Churchil, D. W., & Hingtgen, J. N. (1972). Imitation in autistic, early schizophrenic, and non psychotic subnormal children. Journal of Autism and Childhood Schizophrenia, 2, 264–87.PubMedCrossRefGoogle Scholar
  13. Edgerton, C. L. (1994). The effect of improvisational music therapy on the communication behaviors of autistic children. Journal of Music Therapy, 31(1), 31–61.Google Scholar
  14. Escalona, A., Field, T., Nadel, J., & Lundy, B. (2002). Brief report: Imitation effects on children with autism. Journal of Autism and Developmental Disorders, 32(2), 141–144.PubMedCrossRefGoogle Scholar
  15. Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autistic spectrum disorder (Cochrane Review), The Cochrane Library, Issue 2, 2006. Chichester, UK: John Wiley & Sons, Ltd.Google Scholar
  16. Heal Hughes, M. (1995). A comparison of mother–infant interactions and the client–therapist relationship in music therapy sessions. In T. Wigram, B. Saperston, R. West (Eds.), The art & science of music therapy: A handbook (pp. 296–308). Harwood Academic Publishers.Google Scholar
  17. Holck, U. (2002). Music therapy for children with communication disorders. In T. Wigram, I. N. Pedersen, & L. Bonde (Eds.), A comprehensive guide to music therapy (pp. 183–187). London: Jessica Kingsley Publishers.Google Scholar
  18. Holck, U. (2004a). Interaction themes in music therapy—definition and delimitation. Nordic Journal of Music Therapy, 13(1): 3–9.Google Scholar
  19. Holck, U. (2004b). Turn-taking in music therapy with children with communication disorders. British Journal of Music Therapy, 18(2), 45–54.Google Scholar
  20. Kasari, C., Sigman, M., Mundy, P., & Yirmiya, N. (1990). Affective sharing in the context of joint attention interaction of normal, autistic and mentally retarded children. Journal of Autism and Developmental Disorders, 20, 87–100.PubMedCrossRefGoogle Scholar
  21. Kim, T. (1995). Ewha—psycho educational profile. Ewha Women’s University Press.Google Scholar
  22. Kim, T. & Park, L. (1995). Korean version of childhood autism rating scale. Seoul. Special Education.Google Scholar
  23. Kim, J (2006). The effects of improvisational music therapy on joint attention behaviors in children with autistic spectrum disorder. Unpubl. Ph.D thesis. Denmark: Aalborg University.Google Scholar
  24. Lewy, A. L., & Dawson, G. (1992). Social stimulation and joint attention in young autistic children. Journal of Abnormal Child Psychology, 20(6), 555–566.PubMedCrossRefGoogle Scholar
  25. Lord, C., Rutter, M., DiLavore, P., & Risi, S. (1999). The ADOS-G (Autism Diagnostic Observation Schedule-Generic). Los Angeles: Western Psychological Services.Google Scholar
  26. Malloch, S. (1999). Mother and infants and communicative musicality. In “Rhythms, musical narrative, and the origins of human communication”. Musicae Scientiae, Special Issue, 1999–2000 (pp. 29–57). Liège: European Society for the Cognitive Sciences of Music.Google Scholar
  27. McArthur, D., & Adamson, L. B. (1996). Joint attention in preverbal children: Autism and developmental language disorder. Journal of Autism and Developmental Disorders, 26(5), 481–496.PubMedCrossRefGoogle Scholar
  28. Mundy, P. & Sigman, M. (2006). Joint attention, social competence and developmental psychopathology. In D. Cicchetti & D. Cohen (Eds.), Developmental Psychopathology (2nd ed., pp. 293–332), Volume one: Theory and methods, Hoboken, NJ: Wiley.Google Scholar
  29. Mundy, P., Sigman, M., & Kasari, C. (1994). Joint attention, developmental level, and symptom presentation in autism. Development and Psychopathology, 6, 389–401.CrossRefGoogle Scholar
  30. Mundy, P., Delgado, C., Block, J., Venezia, M., Hogan, A. & Seibert, J. (2003). A manual for the abridged Early Social Communication Scales (ESCS). University of Miami.Google Scholar
  31. Mundy, P., Sigman, M., Ungerer, J. A., & Sherman, T. (1986). Defining the social deficits in autism: The contribution of nonverbal communication measures. Journal of Child Psychology and Psychiatry, 27, 657–669.PubMedCrossRefGoogle Scholar
  32. Nadel, J., Guérini, C., Pezé, A., & Rivet, C. (1999). The evolving nature of imitation as a format for communication. In J. Nadel, & G. Butterworth (Eds.), Imitation in Infancy. Cambridge: Cambridge University Press.Google Scholar
  33. Nordoff, P., & Robbins, C. (1977). Creative music therapy. New York: John Day Company.Google Scholar
  34. Oldfield, A. (2006). Interactive music therapy in child and family psychiatry. London: Jessica Kingsley Publishers.Google Scholar
  35. Pavlicevic, M. (1997). Music therapy in context; music, meaning and relationship. London: Jessica Kingsley Publishers.Google Scholar
  36. Plahl, C. (2000). Entwicklung Fördern durch Musik. Evaluation Musiktherapeutischer Behandlung (Development through Music. Assessment of Music Therapy Treatment) Unpublished. PhD thesis, 1999. Münster: Waxman.Google Scholar
  37. Robarts, J. Z. (1996). Music therapy for autistic children. In C. Trevarthen, et al. Children with Autism: Diagnosis and interventions to meet their needs (pp. 132–160). London: Jessica Kingsley Publishers.Google Scholar
  38. Saperston, B. (1973). The use of music in establishing communication with an autistic mentally retarded child. Journal of Music Therapy, 10(4), 184–188.Google Scholar
  39. Siller, M., & Sigman, M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders, 32(2), 77–89.PubMedCrossRefGoogle Scholar
  40. Stern, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. Basic Books.Google Scholar
  41. Trevarthen, C. (2001). Intrinsic motives for companionship in understanding: Their origin, development, and significance for infant mental health. In A. Schore (Ed.), Infant Mental Health Journal (Vol. 22(1–2), pp. 95–131). (Special issue—Contributions from the Decade of the Brain to Infant Mental Health).Google Scholar
  42. Trevarthen, C. (2002). Autism, sympathy of motives and music therapy. Enfance, France. (1/2001), 86–99.Google Scholar
  43. Trolldalen, G. (2005). Sharing through affects: The role of ‘affect attunement’ in musical improvisation. Unpublished paper presented at the 11th World Congress of Music Therapy, Brisbane, Australia.Google Scholar
  44. Upton, G., & Cook, I. (2002). Oxford dictionary of statistics. Oxford University Press.Google Scholar
  45. Venables, W. N., & Ripley, B. D. (2002). Modern applied statistics with S. New York: Springer.Google Scholar
  46. Watson, L.R. (1998). Following the child’s lead: Mothers’ interaction with children with autism. Journal of Autism and Developmental Disorders, 28(1), 51–59.PubMedCrossRefGoogle Scholar
  47. Wigram, T. (1995). A model assessment and differential diagnosis of handicap in children through the medium of music therapy. In T. Wigram, B. Saperston, & R. West (Eds.), The art & science of music therapy: A handbook (pp. 181–193). Harwood Academic Publishers.Google Scholar
  48. Wigram, T. (2002). Indications in music therapy: Evidence from assessment that can identify the expectations of music therapy as a treatment for autistic spectrum disorder (ASD); meeting the challenge of evidence based practice. British Journal of Music Therapy, 16(1), 11–28.Google Scholar
  49. Wigram, T. & Elefant, C. (2008). Therapeutic dialogues in music: Nurturing musicality of communication in children with Autistic Spectrum Disorder and Rett Syndrome. In C. Trevarthern, & S. Malloch (Eds.), Communicative Musicality. Oxford University Press, in press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Aalborg UniversityAalborgDenmark
  2. 2.Department of Arts TherapyJeonju UniversityJeonjuKorea
  3. 3.The Grieg Academy Music Therapy Research Centre, Unifob HealthBergenNorway

Personalised recommendations