Background, Supporting Literature, and Rationale
The study begins with an in-depth exploration of autism, detailing the three significant areas of impairment in communication, social interaction, and repetitive behaviours. To set the stage, the author references established literature on autism, referring to According et al. (2007), Gold et al. (2006), and Mandy and Skuse (2008). This provides an adequate foundation, highlighting the importance of communication problems in children with ASD. There is a reasonable basis for testing the effects of Relational Music Therapy (RMT) on communication skills. The reason is that the significance of music therapy in the treatment of ASD children is being increasingly recognized. In this example, references to Hillecke, Nickel, and Baolay (2005), Kim, Wigram, and Gold (2009), and Palac and Grimshaw (2006) further enhance the credibility of the choice of RMT as an intervention.
Ethical Considerations and Implications
The article glancingly mentions getting parental consent, but a more thorough consideration of ethics and their practical applications would add to the paper. Children with ASD are a particularly vulnerable part of the study population, calling for meticulous adherence to ethical standards. The article should describe what measures have been taken to guarantee the care of participants, as well as whether any special arrangements have been made for children with ASD. Studies in this area yet to be conducted should develop a more comprehensive ethical structure, looking at questions such as assent, confidentiality and the possible impact on participants.
Participant Recruitment and Bias
Twenty-four boys were recruited for the study from the Porto Alegre, Brazil, Program for Invasive Developmental Disorders. This may have been a practical way of getting participant recruits, but it does raise questions about how the results can be generalized to a larger population of children with ASD. The exclusions are reasonable, intolerable to any sounds or music, and profound hearing loss, but the homogeneity of the sample is a limitation. The study admits that the setting of the music therapy interventions in a hospital environment introduces potential bias. For children with autism, hospital procedures are always associated with pain and suffering (Andrade, 2020). This is a strength as it points to a possible source of bias, which calls for further research in more attractive places to neutralize this bias.
Study Design and Randomization
The study design, presented as a parallel randomized controlled trial with balanced randomization (1:1 reflects a praiseworthy attempt to control internal validity. However, an obvious omission in the randomization description is a need for more detail. A detailed description of how randomization was carried out, including whether important variables stratified it, would help one judge the study’s internal validity more fairly. It is essential to have a transparent randomization process so that treatment groups are comparable at baseline and there is no potential for confounding variables.
Sample Size
Justifying the sample size, the author cites Whipple (2004) and betrays an awareness of statistical power. However, with only 24 participants, the small sample size makes it problematic to detect any meaningful effects. With larger sample sizes, the statistical power would be more robust, and the results of this study would be more reliable (Andrade, 2020). In future research, larger samples should be used for greater generalization.
Measures Used
The study uses the Brazilian adaptation of the Childhood Autism Rating Scale (CARS-BR) to assess verbal, nonverbal and social communication. Using a validated instrument is praiseworthy, but the paper correctly concludes that CARS-BR fails to capture short-term changes in communication skills. This acknowledgement coincides with a principle of openness in reporting results. Nevertheless, in terms of future studies, it would be desirable at least to examine other possible measures which might provide a more complex picture of how RMT affects the ability of children with ASD to communicate.
Bias and Questionable Research Practices
The paper does not directly tackle possible biases or dubious research methods. However, an absence of information about how the randomization process was conducted and a lack of description in terms of participants ‘ characteristics makes it possible that this research is affected by some bias. In future work in this area, procedures promoting transparency, such as preregistration of study protocols and detailed reporting of participant characteristics and randomization procedures, should be adopted.
Data Analysis Plan
The statistical analysis plan involving t-tests and standard mean differences is sufficiently detailed. However, the study’s use of CARS-BR, which is at best questionably suited to detecting changes over the short term, combines with inconclusive results. The paper’s authors appropriately suggest more advanced analyses or additional countermeasures for future research. This call for better instruments goes along with the principles of best research practices and shows that they wish to take the field forward.
Communication and Interpretation of Results
The article describes the study’s methods, results, and limitations very well. The subgroup analysis reporting a statistically significant improvement in nonverbal communication among participants with autistic disorder is presented clearly. They appropriately recognize that the results are inconclusive overall, giving a balanced interpretation. The discussion critically evaluates the study’s limitations, such as its choice of outcome measures and how those. More rigorous designs in future research are a valuable contribution to the discussion.
Reference list
Andrade, C. (2020). Sample Size and Its Importance in Research. Indian Journal of Psychological Medicine, [online] 42(1), 102–103. doi https://doi.org/10.4103/IJPSYM.IJPSYM_504_19.
Gattino, G.S., Riesgo, R. dos S., Longo, D., Leite, J.C.L. and Faccini, L.S. (2011). Effects of relational music therapy on communication of children with autism: a randomized controlled study. Nordic Journal of Music Therapy, 20(2), pp.142–154. doi https://doi.org/10.1080/08098131.2011.566933.
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