The link between music and autism is widely known - music has been used as a form of therapy for decades. Music therapy is one of many forms of therapy for children on the autism spectrum. This premise was the starting point for the international educational project AutisMusic, implemented as part of the Erasmus+ programme.
To begin with, a few words about the project itself. It is a two-year project (2023-2025) implemented in four European countries: Poland, Cyprus, North Macedonia and Portugal. As you can see, the countries involved differ in geographical location, cultural approach - music, however, is a universal language and in each of these countries musical interventions are known as a form of work with people on the autism spectrum.
Autism Spectrum Disorder (ASD) is a holistic developmental disorder that is still being explored. In general, it is a kind of neurobiological difference that affects an individual's communication skills, social functioning, and information processing. There are 2 major classifications of mental health: The DSM-V classification issued by the American Psychiatric Association and the ICD classification issued by the World Health Organisation (WHO), which define the criteria for diagnosing autism.
As symptoms of autism, DSM V defines two main areas of disorder:
- deficits/difficulties in social communication and interaction
- restrictive, repetitive patterns of behaviour, interests, activities¹
These symptoms must be present from early childhood and must cause difficulties in functioning².
Music therapy, on the one hand, is a branch of science and, on the other hand, also a form of therapy. It assumes that every human being can be reached through sounds. According to T. Natanson, music therapy is:
"a method of treatment that makes multifaceted use of the multifaceted effects of music on the human psychosomatic system"³
A broader definition is provided by K. Bruscia:
"music therapy is a structured intervention process in which the therapist assists the client in achieving health, using musical experiences and the relationships developed through them as dynamic forces for change"⁴
The international educational project AutisMusic is distinguished by its approach to the issue of music therapy for children on the autism spectrum. The assumption behind this project is not to popularise music therapy as one of the possible forms of therapy, but to use this method (or even sometimes only to use its individual elements) in work with children in mainstream classrooms where students on the autism spectrum are also taught.
The results of studies on music perception, cognition and learning in musically untrained children with autism have revealed a pattern of abilities that can be enhanced or spared (e.g. increased sensitivity to pitch and timbre of music can be observed)⁵. Empirical research data show that many children with autism have musical potential that can and should be developed⁶.
Why include music interventions in mainstream education (which also includes students on the autism spectrum)? There are several reasons:
- teaching music is associated with improved spatio-temporal processing⁷
- improvement of some mathematical skills⁸
- support for reading development⁹
- improvement of intrapersonal skills through understanding feelings¹⁰
- increased opportunities for social interaction through singing and playing instruments¹¹
Musical interventions in school classrooms, playing together increases the social opportunities of the pupils. Music can also be used to improve communication skills by selecting appropriate activities in the school classroom.
RESEARCH - Literature review
The first step during the project was to conduct research, both a literature review (analysis of available publications in the field of autism and music therapy) and a teacher survey.
The main objective of the literature review was to map existing frameworks and review national and international research, studies and other documents that served as a starting point for identifying the necessary competencies of teachers in the field of music when working with students with autism spectrum disorders.
The study focused on publications from the period 2013-2023. The research highlights innovative approaches in different countries (North Macedonia, Poland, Cyprus and Portugal), shows different cultural perspectives and practices in music therapy.
This research contributes to a deeper understanding of how music can profoundly affect the lives and development of children with autism, promoting inclusive and effective intervention strategies.
However, it should be noted that a review of the literature revealed that in some countries there is not much published on the use of music in working with children on the autism spectrum.
In the Republic of North Macedonia, music therapy for autism may not be as widespread or formally established as in some other countries. Nevertheless, there is growing recognition of its potential benefits.
Since 2001, there has been a Centre for Children's Artistic Expression, Music Therapy and Psycho-Physical Relaxation "Dzundzule" in Macedonia, which is part of the World Federation of Music Therapy. This centre supports children's artistic expression and music therapy for children with special needs.
Tomislav Tanevski is the only person who has worked on music therapy and children with special needs¹².
A review of articles from Poland confirms the effectiveness of music therapy in children with ASD. Music intervention positively influences their communicative, social or educational sphere¹³.
A review of articles from Poland confirms the effectiveness of music therapy in children with ASD. Music intervention positively influences their communicative, social or educational sphere¹³.
In the article *"Music therapy and its properties in improving a child with autism"*¹⁴, a study involving a group of autistic children (n = 18) aged 3 to 7 years from centres and foundations is described and selected aspects of changes are presented. The changes that occurred in all participants in the study are not described in detail, only individual cases are included¹⁵.
In the article *"Music and music-making in overcoming communication and language difficulties in children with an autism diagnosis"*¹⁶ one of several findings shows that children on the autism spectrum can be interested in movement, singing or musical instruments. They can be encouraged to play with singing accompanied by music and to actively listen to their favourite music with lively rhythm and catchy melodies¹⁷.
In another article on the case study *"Musical abilities of autistic children as a manifestation of expression revealed during the music therapy process - a case study"*¹⁸, on the basis of observations and in-depth reports, both musical and non-musical, as well as recordings of the sessions, it was found that in the three cases presented, musical abilities could be observed, which were and are a manifestation of expression and non-verbal communication. An improvement in the functioning of the cognitive sphere could be observed in three therapy participants.
Music therapy in Cyprus has shown a gradual development over the years, but considerable efforts are still needed for its further development. A milestone was the establishment of the Cyprus Music Therapy Association (CYMTA) in December 2010¹⁹.
Since 2011, as a member of the European Confederation of Music Therapy (EMTC), CYMTA has been operating with official recognition and adherence to the established regulatory framework. The association has put in place formalised statutes and regulatory rules, mandating compliance by all members. This structured approach ensures that practitioners in the field are properly aligned with professional standards, thus facilitating the legitimacy of music therapy and effective practice in Cyprus.
In May 2022, a law was passed that regulates the music therapy profession in Cyprus²⁰. This law enabled the creation of an official register of music therapists in 2024, which ensures high quality music therapy services and protects both therapists and patients²¹.
In the article *“Promoting Communication for Young Children with Autism Spectrum Disorders: A Family-centred Music Therapy Intervention”*²² we can read a study providing evidence of the potential of using music therapy interventions within a family-centred approach to improve non-verbal and verbal communication skills.
Based on Portuguese publications, we can say that music therapy has shown significant improvements in children's cognitive development, especially in attention and memory²³.
Experimental studies conducted in Portugal (in a group of 15 children with autism and 10 therapists) show that music facilitated verbal and non-verbal communication, increasing social interaction between children and their peers²⁴.
Music interventions promote children's inclusion and active participation in school activities, improving behaviour and cooperation²⁵.
An important aspect is the family context - family music therapy has contributed to children's emotional wellbeing and strengthened family bonds²⁶.
The range of selected research articles showed that music therapy influences:
- social communication
- vocalisation
- joint attention
- eye contact
- concentration
- cooperation
- interactional behaviour
- participation in games and cooperative play
- speech intelligence
- sharing
- expression of feelings
- language skills
- verbal and non-verbal communication
On the other hand, it reduces:
- undesirable forms of behaviour
- negative emotions
- obsessive behaviour
RESEARCH - results of surveys
The survey was conducted in four partner countries (Cyprus, North Macedonia, Poland, Portugal) during two months of III - IV 2024. The total number of participants was 110.
The survey was of particular interest to teachers from North Macedonia.
Of the total respondents:
- 55% were music teachers
- 26% were special education teachers
- the remainder were teachers, assistants or other school staff
More than 50% of participants from all partner countries had more than ten years' experience in their current professional role.
Incorporating music into classes
More than half of the participants in the study (52.25%) often use music in their classes.
Percentage of teachers who often use music in classes:
- Poland – 31%
- North Macedonia – 51%
- Cyprus – 80%
- Portugal – 47%
The impact of music on a child's social and emotional development
Survey participants from all countries stated that they believed that music has either a significant or very significant impact on a child's social and emotional development.
On a scale of 1 to 5, where:
- 1 = minimal impact
- 5 = very significant impact
teachers responded as follows:
Poland
- 4 – 36.8%
- 5 – 42.1%
North Macedonia
- 4 – 30.6%
- 5 – 61.2%
Cyprus
- 4 – 25%
- 5 – 75%
Portugal
- 4 – 84.2%
- 5 – 15.8%
Participants in the study sometimes use music as a teaching tool for children with autism.
They use music:
- in English lessons
- in music classes
- for relaxation
- during casual activities
- while teaching different subjects
However, some teachers do not use music during their classes:
- Poland – 10.5%
- North Macedonia – 16.3%
- Cyprus – 20%
- Portugal – 10.5%
The majority of participants believe that music is very important for improving the wellbeing of children with autism:
- Poland – 57.9%
- North Macedonia – 59.2%
- Cyprus – 80%
- Portugal – 94.7%
An important point of the study was to determine the level of confidence in one's own ability to use music effectively as a tool to engage children with autism in mainstream school activities.
The table below illustrates the results obtained.
| Country | No confident at all | Slightly confident | Moderately confident | Very confident | Extremely confident |
|---|---|---|---|---|---|
| Poland | 15.8% | 31.6% | 26.3% | 15.8% | 10.5% |
| North Macedonia | 0% | 24.5% | 42.9% | 14.3% | 12.2% |
| Cyprus | 15% | 0% | 45% | 10% | 25% |
| Portugal | 10.5% | 21.1% | 36.8% | 31.6% | 0% |
Table 1 - Confidence in ability to use music effectively as a tool to engage children with autism
Based on the results, we see that teachers answered the question very differently. This may be due to the fact that music teachers as well as subject teachers and early childhood education teachers took part in the survey.
The majority of participants in the study believe that the inclusion of music in autism therapy is very effective:
- Poland – 57.9%
- Cyprus – 65%
- Portugal – 47.4%
- North Macedonia – 32.7%
Approximately half of the participants indicate barriers and challenges to the use of music during classes:
- Poland – 42.1%
- North Macedonia – 32.7%
- Cyprus – 35%
- Portugal – 57.9%
They mention barriers and challenges such as:
- sensory sensitivity
- repetition of the same melody
- difficulty in adapting to different tones for different students
Typical music activities used by teachers
The most typical music activities practised by teachers when teaching students with autism are rhythm and movement activities:
- Poland – 26.3%
- North Macedonia – 42.9%
- Cyprus – 40%
- Portugal – 26.3%
The majority of teachers said that children on the autism spectrum react differently than children not on the spectrum when listening to music. They also mentioned the sensitivity of children with autism.
Cooperation with other professionals
A large number of respondents do not cooperate with other professionals:
- Poland – 57.9%
- North Macedonia – 87.8%
- Cyprus – 35%
- Portugal – 42.1%
Formal music training
A high proportion of teachers in the survey had received no formal training or education in music:
- Poland – 84.2%
- North Macedonia – 91.8%
- Cyprus – 75%
- Portugal – 63.2%
Need for inclusive educational programmes
According to 92.4% of all survey participants, there should be more inclusive educational programmes for children with autism.
Results by country:
- Portugal – 100%
- Poland – 100%
- Cyprus – 90%
- North Macedonia – 79.6%
According to respondents, the features necessary in an inclusive music education programme are:
- a sensory-friendly environment
- adaptive tools
- individualised instruction
The aim of the study was to identify the role of music in working with children on the autism spectrum and to assess teachers' competences in using music as a tool to support students' social and emotional development.
The survey was conducted in March and April 2024 in four partner countries, Poland, Portugal, North Macedonia and Cyprus, with 110 teachers, including music teachers, special education teachers and subject teachers.
More than half of the respondents use music in their daily teaching, and the vast majority believe that it has a significant impact on the development of children, especially those on the autism spectrum.
Despite the positive attitude, many teachers point to barriers to the practical use of music, such as pupils' sensory sensitivities or lack of appropriate competences.
As many as 92.4% of the survey participants emphasised the need for inclusive educational programmes with music therapy elements.
The results of the survey indicate the need for teacher training and building an educational environment that takes into account the individual needs of students on the autism spectrum using music as an effective support tool.
Summary
A study carried out within the AutisMusic project in four partner countries (Poland, Cyprus, North Macedonia and Portugal) shows a great interest and awareness of the potential of music in working with children with autism.
At the same time, it points to gaps in preparation and cooperation between professionals, and the need for systemic support in the form of training and inclusive programmes.