Chenausky Karen V, Schlaug Gottfried
Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Ann N Y Acad Sci. 2018 Mar 6. doi: 10.1111/nyas.13609.
Autism affects ∼1.5% of children under age 8; its core symptoms include impairment in social-communicative functioning and repetitive behaviors/restricted interests. Music-based interventions have been considered one modality through which to treat autism. This report discusses considerations to take into account when developing a music-based intervention for a core symptom of autism. Treatment modality must be matched to symptom both clinically and theoretically, the behavior to be treated must be carefully defined and assessed, and outcome measures must be capable of showing improvement in that behavior over the course of the study. Fidelity assessment and rater blinding reduce experimenter bias. High inter-rater reliability for perceptually determined outcome measures helps obtain accurate estimates of treatment response. Later stages of testing compare the experimental intervention to matched control treatments or other validated therapies, isolating the intervention's "active ingredients." Such systematic investigation of a new music-based intervention can provide information of different types, ranging from an assessment of whether the intervention has any effect at all to an assessment of its outcomes and risks in uncontrolled community settings. Findings ultimately compose the evidence base that clinicians and families can use to decide the most effective way of addressing symptoms of autism for particular children.
自闭症影响约1.5%的8岁以下儿童；其核心症状包括社交沟通功能受损以及重复行为/兴趣受限。基于音乐的干预措施被视为治疗自闭症的一种方式。本报告讨论了在开发针对自闭症核心症状的基于音乐的干预措施时需要考虑的因素。治疗方式必须在临床和理论上与症状相匹配，必须仔细定义和评估要治疗的行为，并且结果测量必须能够显示该行为在研究过程中有所改善。保真度评估和评分者盲法可减少实验者偏差。对于通过感知确定的结果测量，评分者间的高信度有助于获得对治疗反应的准确估计。测试的后期阶段将实验性干预与匹配的对照治疗或其他经过验证的疗法进行比较，分离出干预的“有效成分”。对新的基于音乐的干预措施进行这样的系统研究可以提供不同类型的信息，从评估干预措施是否有任何效果到评估其在不受控制的社区环境中的结果和风险。研究结果最终构成证据基础，临床医生和家庭可以据此决定针对特定儿童解决自闭症症状的最有效方法。
