Around 30% of autistic children have few or no words, not being able to communicate their everyday needs using language. Developing and evaluating effective interventions to promote communication/language skills in autism spectrum disorder (ASD) has been ranked as top 2 research priority by the James Lind Alliance Priority Setting Partnerships in the UK.
In the MAP project, we carried out a novel intervention (music-assisted programmes; MAP) targeting autistic children with no/few words to learn to speak 36 target words through song, by running a randomised controlled feasibility trial.
Twenty-seven 2-5-year-old autistic children with no/few words were randomly assigned to either the TAU (speech and language therapy; n = 14), in which sessions were given focusing on social communication strategies with focused stimulation of the target words, or the MAP (n = 13), in which a structured training method was delivered through naturalistic, interactive activities using songs to teach the target words.
Both groups undertook 36 training sessions incorporating either TAU or MAP, each lasting 45 minutes, happening twice a week over 18 weeks. Both interventions were mediated by parents/carers at home, while being coached by a research speech and language therapist online via video conferencing. Both groups completed daily 10-min homework practicing the learned strategies, while the MAP group was provided with an app containing 11 songs to facilitate the learning of the target words.
A range of outcome measures were collected at four time points (pre-, mid-, post-intervention, and 3-month follow-up), including production and understanding of the target words, expressive and receptive vocabulary, adaptive behaviour, social responsiveness, language, social communication, and number of participants retained at each time point.
Preliminary data analysis suggested positive impacts of both interventions on adaptive behaviour and words/phrases understood, as well as increased social responsiveness in the MAP group. Processing and analysis of the full set of the data is currently underway and will be written up and submitted for journal publications.
The main objectives achieved include: (1) determining the feasibility of carrying out a randomized controlled trial of MAP delivered remotely due to the COVID-19 pandemic to preschool children with minimal or no spoken language skills, (2) providing essential parameter data to calculate the sample size and the effect size estimates of a future full-scale trial, (3) optimising the MAP design through a post-intervention interview study with parents, and (4) piloting and refining an app available on smartphones for supporting and recording homework sessions alongside the MAP intervention.
In summary, our preliminary results suggest that MAP has the potential to increase communication, daily functioning, and social skills of 2-5-year-old autistic children with no/few words. Through this project, we have made a positive and meaningful impact on these children’s and their families’ lives. They have had no or only minimal support from the National Health Service (NHS) in the UK and have benefited tremendously from our MAP trial. Further funding will be sought to continue to support these children, to run a fuller trial with a larger sample of participants, and to develop individualised learning apps so as to fulfil these children’s individual intervention needs.
