Front. Psychiatry Frontiers in Psychiatry Front. Psychiatry 1664-0640 Frontiers Media S.A. 10.3389/fpsyt.2025.1611182 Psychiatry Review Effect of music therapy on children with autism spectrum disorders in the Chinese population: a systematic review and meta-analysis Yang Yajing 1 Wang Yu 2 Li Wenhui 2 Su Li 3 * 1 School of Film, Xiamen University, Xiamen, China 2 Health Management Center, Xiang’an Hospital of Xiamen University, Xiamen, China 3 School of Art, Xiamen University, Xiamen, China

Edited by: Fabrizio Stasolla, Giustino Fortunato University, Italy

Reviewed by: Weijia Yang, Yonsei University, Republic of Korea

Ferdinando Suvini, Conservatorio di Musica Girolamo Frescobaldi, Italy

*Correspondence: Li Su, lisuscience@outlook.com

25 07 2025 2025 16 1611182 13 04 2025 26 06 2025 Copyright © 2025 Yang, Wang, Li and Su 2025 Yang, Wang, Li and Su

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 Objectives

This study aimed to investigate the efficacy of music therapy (MT) in children with autism spectrum disorder (ASD) in the Chinese population through a meta-analysis.

 Design

Systematic review and meta-analysis.

 Setting

We performed a systematic review according to the PRISMA guidelines. A systematic and comprehensive search was conducted across five databases: PubMed, Web of Science, Chinese Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, and Wanfang Database, up to the end of September 2024, that administered MT to children with ASD. Continuous variables were reported as standardized mean differences (SMD) accompanied by 95% confidence intervals (CIs). All analyses were carried out using the Stata statistical software package version 16.0.

 Results

Twenty-three studies were included in our meta-analysis. The results showed that MT significantly decreased the total ATEC (autism treatment evaluation checklist) score (SMD = -2.52, 95% CI: -3.69 ~ -1.35, P < 0.001), ABC (autism behavior checklist) (SMD = -1.07, 95% CI: -1.52 ~ -0.61, P < 0.001), and CARS (childhood autism rating scale) score (SMD = -1.50, 95% CI: -2.26 ~ -0.74, P < 0.001). Specifically, MT significantly improved communication skills (SMD = -1.10, 95% CI: -1.54 ~ -0.66, P < 0.001), social interaction skills (SMD = -1.69, 95% CI: -2.59 ~ -0.78, P < 0.001), language ability (SMD = -1.15, 95% CI: -1.56 ~ -0.74, P < 0.001), and cognitive function (SMD = -1.80, 95% CI: -2.73 ~ -0.87, P < 0.001) compared to the control group.

 Conclusion

MT can improve communication skills, social interaction skills, language ability, and cognitive function in children with ASD disorders in the Chinese population.

 music therapy children autism spectrum meta-analysis ATEC CARS section-in-acceptance Autism Introduction

Autism Spectrum Disorder (ASD), commonly referred to as autism, is a neurodevelopmental disorder that typically appears before the age of three and is characterized by challenges in social communication, as well as repetitive behaviors and restricted interests (1, 2). ASD includes a variety of disorders with different causes and symptoms, characterized by significant challenges in social interaction and communication, a broad spectrum of severity, and the potential for co-occurring issues such as intellectual disabilities, anxiety, depression, sleep disturbances, epilepsy, and exceptional talents in specific areas, often referred to as savant abilities (3).

Epidemiological surveys reveal a global median prevalence of ASD at 62 per 10,000 individuals, with the 2010 Global Burden of Disease study estimating approximately 52 million people affected worldwide, translating to a prevalence of about 1 in 132 (4). In China, the Second Epidemiological Sample Survey of the Disabled identified around 41,000 children aged 0 to 6 with ASD (5). Furthermore, a recent comprehensive study involving over 120,000 children aged 6 to 12 from eight representative cities in China reported an estimated prevalence of 0.70% (6). The significant increase in ASD prevalence observed over the past two decades raises serious public health concerns.

Music therapy (MT) is a cost-effective and noninvasive adjunct to standard treatment, demonstrating effectiveness in addressing psychiatric disorders across a variety of settings and patient demographics, and it is generally easy to implement (7). Moreover, MT has been shown to enhance cognitive functions such as attention and memory (8). Notably, many children with autism, despite their limited engagement with the external world and occasional language challenges, often exhibit a keen interest in music and may even possess exceptional musical perception and superior sound discrimination skills (9). This unique connection makes MT particularly prominent among interventions for autism.

Therefore, this meta-analysis was conducted to assess the effects of MT on children with ASD in the Chinese population.

 Materials and methods

This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting and has been prospectively registered in the PROSPERO database under registration number CRD42015029643.

Search strategy and selection criteria

In accordance with the Cochrane Collaboration guidelines, a systematic and comprehensive search was conducted across five databases: PubMed, Web of Science, Chinese Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, and Wanfang Database, up to the end of September 2024. The PubMed search combined the terms (“music therapy”[Title/Abstract] OR MT[Title/Abstract]) AND (“autism”[Title/Abstract] OR “autism spectrum disorder”[Title/Abstract]) AND (“children”[Title/Abstract] OR child*[Title/Abstract]) AND (“autism treatment evaluation checklist”[Title/Abstract] OR ATEC (autism treatment evaluation checklist) [Title/Abstract] OR “autism behavior checklist”[Title/Abstract] OR ABC (autism behavior checklist) [Title/Abstract] OR “childhood autism rating scale”[Title/Abstract] OR CARS (childhood autism rating scale) [Title/Abstract]). In Web of Science we applied the analogous query TS = (“music therapy” OR MT) AND TS= (autism OR “autism spectrum disorder”) AND TS = (children OR child*) AND TS = (“autism treatment evaluation checklist” OR ATEC OR “autism behavior checklist” OR ABC OR “childhood autism rating scale” OR CARS). Equivalent strategies using the same concepts translated into Chinese were applied in CNKI, the China Science and Technology Journal Database and the Wanfang Database. Initially, all articles published in English or Chinese were considered for inclusion in the analysis.

 Inclusion and exclusion criteria

Inclusion criteria: (1) Studies published in peer-reviewed journals investigated the effects of MT delivered by credentialed therapists following established therapeutic protocols on children with ASD; (2) specifically measuring at least on of outcomes using ATEC, ABC, or CARS; (3) Only articles published in English or Chinese and conducted up to September 2024 will be considered. Exclusion criteria: (1) Studies that are not empirical research, including reviews, meta-analyses, case reports or case series; (2) Studies focused on populations other than children with ASD or that do not specifically address MT as an intervention will also be excluded; (3) studies involving non-human subjects.

 Data extraction

Duplicate publications were removed using EndNote 21 software, and manual searching of grey literature (e.g., conference abstracts) to reduce publication bias. Two authors independently extracted the data using standardized forms and resolved any discrepancies through discussion until a consensus was reached. Any disagreements were resolved through discussion; if needed, a third author arbitrated. The extracted information included the following: author names, publication year, study location, sample size, age, sex, intervention methods, and duration of intervention.

 Quality assessment

The quality of the studies included in this review was assessed by two independent reviewers using the Newcastle-Ottawa Scale (NOS) (10), which evaluates three key parameters: selection, comparability, and exposure, resulting in a score ranging from 0 to 9. Studies received classifications based on their scores, with those scoring 0 to 3 deemed low quality, scores of 4 to 6 categorized as moderate quality, and scores of 7 or higher recognized as high quality. To ensure the integrity of the findings, only studies with NOS scores of 6 or above were included in the analyses, thereby enhancing the reliability of the review’s conclusions and ensuring that they are based on high-quality evidence.

 Statistical analysis

All analyses were carried out using the Stata statistical software package version 16.0. Continuous variables were reported as standardized mean differences (SMD) accompanied by 95% confidence intervals (CIs). To assess heterogeneity, either the Chi-square test or the Cochrane Q test was employed, with I² < 50% and P > 0.10 indicating no significant heterogeneity. A fixed-effects model was used when these criteria were satisfied; otherwise, a random-effects model was applied. Furthermore, funnel plots along with the Egger test were utilized to investigate publication bias, where a p-value of < 0.05 was taken as evidence of statistically significant publication bias.

 Results General results of the included studies

Following the specified inclusion and exclusion criteria, a total of 1,730 articles were initially obtained. After eliminating 115 duplicates and disregarding 950 articles classified as irrelevant, an additional 177 articles were excluded upon full-text assessment. Finally, 27 articles were chosen for qualitative analysis, with 23 retained for meta-analysis ( Figure 1 ).

PRISMA flow chart. Showing the article selection process.

Flowchart illustrating a selection process for data synthesis and meta-analysis. Initial identification: 1730 records. After removing 115 duplicates, 1615 records remain. Screening excludes 1588, leaving 27 full-text articles for eligibility assessment. Four articles are excluded, resulting in 23 articles for synthesis and meta-analysis. Characteristics of included studies

The cohort of the studies that evaluated the included articles comprised a total of 1,684 participants, with 840 individuals in the observation group and 844 individuals in the control group. The quality assessment of the 23 selected articles was conducted using the NOS scale. Among these, 20 articles received a NOS score of 8, while the remaining 3 articles scored 7. This indicates that the overall quality of the articles included in this study is relatively high ( Table 1 ).

Characteristics of included studies.

Authors Year Sample size Age Sex(M/F) Intervention measure Duration (week) NOS
MT Ctrl MT Ctrl MT Ctrl MT Ctrl
Duan et al. (11) 2019 45 45 5.30 ± 2.00 5.20 ± 2.20 33/12 32/13 MT (IMT) + language training Language training 12 8
Wu et al. (12) 2019 33 32 4.51 ± 0.72 4.48 ± 0.70 29/4 29/3 MT (Receptive methods) + general rehabilitation training General rehabilitation training 24 8
Sui et al. (13) 2017 35 35 5.41 ± 1.77 5.36 ± 1.75 19/16 21/14 MT (Mixed methods) + analytical therapy Analytical therapy 12 8
Zhou et al. (14) 2017 53 55 3.79 ± 1.12 3.72 ± 1.08 40/13 43/12 MT (IMT) + routine rehabilitation training Routine rehabilitation training 24 8
Fu et al. (15) 2016 45 45 4.50 ± 0.50 3.50 ± 0.50 22/23 20/25 MT (Receptive methods) + language training Language training 24 8
Li et al. (16) 2016 40 40 3.32 ± 1.23 3.45 ± 1.30 27/13 31/9 MT (Mixed methods) + medical education Medical Education 10 8
He et al. (17) 2016 30 30 4.20 ± 0.30 4.30 ± 0.20 25/5 26/4 MT (Community MT) + routine training Routine training 12 8
Sun et al. (18) 2014 22 21 4.02 ± 3.14 3.78 ± 4.05 19/3 19/2 MT (Receptive methods) + acupuncture therapy Acupuncture therapy 12 8
Zhang et al. (19) 2014 40 40 4.23 ± 1.10 4.38 ± 1.05 28/12 30/10 MT (Receptive methods) + routine training Routine training 12 8
Liu et al. (20) 2011 30 40 NA NA 27/3 33/7 MT (Receptive methods) + language cognitive training Language cognitive training 10 8
Wang et al. (21) 2009 26 26 4.20 ± 5.68 4.20 ± 5.68 8/18 8/18 MT (Receptive methods) + routine basic care Routine basic care 24 8
Liu et al. (22) 2006 29 28 5.89 ± 2.08 5.93 ± 2.46 26/3 24/4 MT (Receptive methods) + integrative treatment Integrative treatment 24 8
Chen et al. (23) 2022 46 50 4.20 ± 1.10 3.90 ± 0.80 26/20 28/22 MT (Mixed methods) + rehabilitation treatment Rehabilitation treatment 24 8
Hu et al. (24) 2021 25 25 4.80 ± 1.30 4.90 ± 1.40 14/11 15/10 MT (IMT)+ comprehensive intervention comprehensive intervention 12 8
Zhao et al. (25) 2020 38 30 8.30 ± 4.00 8.60 ± 4.30 22/16 21/9 MT (Community MT) + routine treatment Routine treatment 15 8
Li et al. (26) 2020 33 33 3.46 ± 1.02 3.33 ± 0.99 24/9 23/10 MT (IMT)+ floor time therapy Floor time therapy 24 8
Zhou et al. (27) 2019 37 36 4.35 ± 1.46 5.52 ± 1.02 31/6 26/10 MT (Receptive methods) + integrative therapy Integrative therapy 8 8
Niu et al. (28) 2019 30 30 4.62 ± 0.25 4.55 ± 0.34 24/6 23/7 MT (Mixed methods) + language training Language training 8 8
Zhou et al. (29) 2018 48 48 4.13 ± 1.20 3.94 ± 1.02 31/17 32/16 MT (Mixed methods) + general rehabilitation training General rehabilitation training 10 7
Tian et al. (30) 2018 43 43 3.51 ± 1.38 3.23 ± 1.32 25/18 23/20 MT (Community MT) + analytical therapy Analytical therapy 12 7
Li et al. (31) 2018 47 47 5.94 ± 1.38 6.31 ± 1.52 26/21 28/19 MT (IMT)+ routine rehabilitation training Routine rehabilitation training 48 7
Nie et al. (32) 2017 35 35 2.20 ± 0.80 2.40 ± 0.70 28/7 26/9 MT (Mixed methods) + language training Language training 24 8
Huang et al. (33) 2015 30 30 5.10 ± 1.30 4.70 ± 1.20 22/8 25/5 MT (Mixed methods) + medical education Medical Education 8 8

M/F, male versus female; MT, music therapy; IMT, Improvisational MT; NA, not available.

 The effect of music therapy on ATEC score

Six studies reported the total ATEC score, encompassing 464 cases, with 230 in the experimental group and 234 in the control group. MT significantly decreased the total ATEC score (SMD = -2.52, 95% CI: -3.69 ~ -1.35, P < 0.001) compared to the control group, with high levels of heterogeneity across studies (Tau² = 2.00, Chi² = 120.67, I² = 96%, P < 0.001) ( Figure 2A ). Subgroup analyses by intervention duration and modality were conducted to explore heterogeneity sources. MT significantly reduced total ATEC scores in both the >12-week subgroup (SMD = -2.20, P < 0.001; I² = 97.5%, P < 0.001) and the ≤12-week subgroup (SMD = -2.87, P < 0.001; I² = 94.6%, P < 0.001). Similarly, high heterogeneity accompanied the significant benefits observed in both MT + rehabilitation training and MT + language training subgroups. Specifically, eight studies evaluated communication skills, finding that MT significantly improved these skills (SMD = -1.10, 95% CI: -1.54 ~ -0.66, P < 0.001) compared to the control group, with considerable heterogeneity among studies (Tau² = 0.34, Chi² = 46.86, I² = 85%, P < 0.001) ( Figure 2B ). Seven studies assessed social interaction skills, three of which utilized a subscale of the ATEC. MT significantly improved social interaction skills (SMD = -1.69, 95% CI: -2.59 ~ -0.78, P < 0.001) compared to the control group, with high levels of heterogeneity (Tau² = 1.42, Chi² = 123.43, I² = 95%, P < 0.001) ( Figure 2C ). Additionally, seven studies examined language ability. MT significantly enhanced language ability (SMD = -1.15, 95% CI: -1.56 ~ -0.74, P < 0.001) compared to the control group, with high heterogeneity across studies (Tau² = 0.24, Chi² = 29.60, I² = 80%, P < 0.001) ( Figure 2D ). Furthermore, seven studies assessed cognitive function, three of which employed a subscale of the ATEC. MT significantly improved cognitive function (SMD = -1.80, 95% CI: -2.73 ~ -0.87, P < 0.001) compared to the control group, with substantial heterogeneity across studies (Tau² = 1.49, Chi² = 125.11, I² = 95%, P < 0.001) ( Figure 2E ). Funnel plot asymmetry did not reveal any potential for publication bias (P>0.05) ( Supplementary Figure S1 ).

The effect of music therapy on ATEC score [(A) total ATEC score, (B) communication skills, (C) social interaction skills, (D) language ability, (E) cognitive function].

Forest plot with five panels (A, B, C, D, E) showing meta-analysis results for different studies. Each panel lists studies with experimental and control group data, standard mean differences, and confidence intervals. Heterogeneity and overall effect results are included. Graphical representation of results with diamond markers indicates favor towards experimental or control groups. The effect of music therapy on ABC score

Thirteen studies reported the total ABC score, encompassing 815 cases, with 406 in the experimental group and 409 in the control group. MT significantly reduced the total ABC score (SMD = -1.07, 95% CI: -1.52 ~ -0.61, P < 0.001) compared to the control group, with high levels of heterogeneity observed across studies (Tau² = 0.58, Chi² = 116.29, I² = 90%, P < 0.001) ( Figure 3A ). Subgroup analyses by intervention duration were conducted to explore heterogeneity sources. MT significantly reduced total ABC scores in both the >12-week subgroup (SMD = -0.87, P < 0.001; I² = 71.0%, P = 0.002) and the ≤12-week subgroup (SMD = -1.58, P < 0.001; I² = 94.6%, P < 0.001). Specifically, eleven studies focused on the sensory dimension. MT significantly improved sensory outcomes (SMD = -0.84, 95% CI: -1.25 ~ -0.44, P < 0.001) compared to the control group, again with high levels of heterogeneity across studies (Tau² = 0.41, Chi² = 76.91, I² = 87%, P < 0.001) ( Figure 3B ). Twelve studies evaluated the social and self-help dimensions, finding that MT significantly improved these areas (SMD = -0.45, 95% CI: -0.90 ~ -0.01, P = 0.05), despite high heterogeneity across studies (Tau² = 0.55, Chi² = 112.89, I² = 90%, P < 0.001) ( Figure 3C ). Eleven studies assessed body and object use, showing a significant improvement with MT (SMD = -0.88, 95% CI: -1.19 ~ -0.57, P < 0.001), along with high levels of heterogeneity (Tau² = 0.21, Chi² = 43.66, I² = 77%, P < 0.001) ( Figure 4A ). In terms of language skills, eleven studies also reported significant improvements due to MT (SMD = -1.57, 95% CI: -2.21 ~ -0.94, P < 0.001), with high heterogeneity across studies (Tau² = 1.15, Chi² = 190.54, I² = 94%, P < 0.001) ( Figure 4B ). Furthermore, seven studies assessed the relating dimension; however, no significant difference was found between the experimental and control groups (SMD = -1.67, 95% CI: -2.77 ~ -0.58, P = 0.003), with high levels of heterogeneity evident (Tau² = 2.08, Chi² = 186.23, I² = 97%, P < 0.001) ( Figure 4C ). Funnel plot asymmetry did not reveal any potential for publication bias (P>0.05) ( Supplementary Figure S2 ).

The effect of music therapy on ABC score [(A) total ABC score, (B) sensory, (C) social and self-help].

Three forest plots labeled A, B, and C, compare the experimental and control groups across several studies. Each plot shows the standard mean differences with confidence intervals. Plot A indicates a mean difference of -0.88 favoring experimental; plot B, -1.57 favoring experimental; plot C, -1.67 also favoring experimental. Heterogeneity metrics: A is 77%, B is 94%, C is 97%. Each plot includes a diamond representing overall effect size and a vertical line for no effect at zero.

The effect of music therapy on ABC score [(A) body and object use, (B) language skills, (C) relating].

Forest plot showing three panels labeled A, B, and C, each analyzing experimental and control groups' standard mean differences across various studies. Each panel includes a summary effect size with confidence intervals and heterogeneity statistics. Panel A shows a total effect favoring experimental groups. Panels B and C display less pronounced effects with overlapping confidence intervals. Each study is listed with corresponding statistical data, including means, standard deviations, weights, and confidence intervals. The effect of music therapy on CARS score

Five studies reported the total CARS score, containing 815 cases with 192 cases in the experimental group and 203 in the control group. MT significantly decreased total CARS score (SMD = -1.50, 95% CI: -2.26 ~ -0.74, P < 0.001) compared to the control group, with high levels of heterogeneity across studies (Tau² = 0.68, Chi² = 43.74, I² = 91%, P < 0.001) ( Figure 5 ). Subgroup analyses by intervention duration were conducted to explore heterogeneity sources. MT significantly reduced total CARS scores in both the >12-week subgroup (SMD = -2.09, P < 0.001; I² = 49.9%, P = 0.136) and the ≤12-week subgroup (SMD = -0.62, P < 0.001; I² = 0%, P=0.788). Weights were calculated by the inverse‐variance method, with each study’s contribution proportional to the inverse of its effect-estimate variance. 14 carries the highest weight (21.0%), reflecting its larger sample size more precise estimates are given more influence in the overall effect size calculation. Leave-one-out sensitivity analysis demonstrated that the total results remained unchanged after excluding each study separately. Funnel plot asymmetry did not reveal any potential for publication bias (P>0.05) ( Supplementary Figure S3 ).

The effect of music therapy on CARS score.

Forest plot showing the standardized mean differences of five studies comparing experimental and control groups with 95% confidence intervals. Studies include Duan 2019, Liu 2006, Liu 2011, Sui 2017, and Zhou 2017. The overall effect size is -1.50, favoring the experimental group. Heterogeneity statistics: Tau squared equals 0.68, Chi squared equals 43.74, degrees of freedom equals 4, P is less than 0.00001, I squared equals 91%. Test for overall effect: Z equals 3.87, P equals 0.0001. Discussion

The aim of this meta-analysis was to estimate the effectiveness of music therapy (MT) for children with Autism Spectrum Disorder (ASD) in the Chinese population. Our review of twenty-three studies showed that MT was effective in reducing autism-related symptoms as assessed by various standardized tools. Specifically, MT demonstrated significant improvements in key areas such as communication, social interaction, language skills, and cognitive function when compared to control groups. The significant reduction in ATEC scores suggests that MT effectively improves core autism symptoms, including communication, social interaction, and behavioral functioning, reinforcing its potential as a valuable intervention for addressing the multifaceted challenges of ASD. The concurrent decrease in ABC scores further supports MT’s role in reducing maladaptive behaviors, though the comparatively smaller effect implies a stronger impact on socio-communicative domains than behavioral regulation alone. These findings highlight the promising role of MT as an intervention that can enhance various aspects of functioning in children with ASD.

The science of MT represents a multifaceted interdisciplinary field that combines psychology, medicine, music, and education, highlighting music’s vital role in healing and well-being (34). Music’s complexity arises from its ability to engage multiple areas of the brain simultaneously, leading to various proposed mechanisms for its effects. One such mechanism is neuroplasticity, which refers to the brain’s capacity to form new connections and its association with feelings of reward(T. 35). Another important principle is Hebbian theory, which suggests that when two neurons fire together, they are more likely to establish a new connection (36). Key concepts in MT include neuroendocrine theory, resonance theory, psychological mechanisms, and the energy spectrum of music wave theory (37, 38). The acoustic properties of music interact with the limbic system and the reticular formation in the brainstem, enhancing nerve cell excitability. Through rhythm and melody, music produces complex auditory stimuli that can evoke emotional responses, enriching therapeutic experiences. MT is particularly beneficial for promoting brain development in children, aiding in the enhancement of various skills such as attention, memory, imagination, abstract thinking, and language (39, 40). Within the therapeutic framework, musical and emotional attunement fosters synchronization, supports sensory integration and emotional regulation, and enables the sharing of feelings, leading to the creation of a shared narrative among participants (41).

Music interventions can significantly enhance the engagement of children with ASD in learning and social activities. Activities such as singing, playing instruments, rhythm training, music games, and listening to music serve to rebuild, sustain, and promote both mental and physical health while simultaneously fostering language and social skills, improving mood, and enhancing cognitive abilities in children with ASD (42). These findings align with the research conducted by Ghasemtabar et al. (43), which demonstrated an increase in social skills among children who received MT. Similarly, the study by Vaiouli et al. (44) showed improvements in social skills through improvised MT. When implementing MT with children with ASD, careful consideration should be given to the selection of music. Appropriate compositions and rhythms should be chosen based on the child’s age and specific needs, and a blend of group therapy with individualized approaches is often beneficial. The physical movements and musical interactions in MT parallel the musical exchanges typically seen in early childhood, facilitating spontaneous moments of attunement and bodily synchronization (45). Moreover, various elements of music have a profound impact on human physiology; for instance, the tempo of a musical piece can influence cardiovascular responses, while harmonic consonance activates areas of the paralimbic system and cortex, whereas dissonance can evoke feelings of roughness (46). Children who experience disorganized sensory perception, restricted interests, or heightened emotional responses may particularly benefit from methods that focus on sensory integration and affect regulation, laying the foundation for the development of cross-modal perception, body coherence, and self-regulation-key intrapersonal components critical for developing intersubjectivity (47, 48). Thus, greater emphasis should be placed on the bodily-affective regulation of each child during MT sessions. Musical rhythm training challenges children to encode, maintain and update temporal sequences in real time, repeatedly engaging fronto-parietal circuits that underlie working memory (49). Sustained entrainment drives plasticity in executive pathways, enhancing the capacity to hold and manipulate information (50, 51). As working memory improves, children also gain in attention control, language processing and problem-solving, accounting for the robust cognitive benefits of music-based interventions (52, 53).

Recent fMRI research indicates that musical stimulation can simultaneously strengthen under-connected intrinsic networks and dampen hyper-reactive limbic responses in children with ASD. For instance, exposure to structured musical excerpts has been shown to increase functional connectivity among core hubs of the default mode network, such as fronto-temporal brain networks, and auditory and subcortical regions (54, 55). Emotional music also activates the parahippocampal gyrus extending into the amygdala regardless of whether it is happy or sad, and engages the thalamus and adjacent midbrain regions associated with arousal and the processing of temporal complexity (56, 57). By engaging both large-scale social networks and conserved emotional arousal circuits, music therapy may drive the social interaction, communication, and emotional regulation improvements seen in ASD.

Several limitations exist in our study. Firstly, only articles published in English and Chinese were considered, which may introduce publication bias. Additionally, there has been a decline in the number of published studies in recent years, suggesting the possibility of selective publication. Some trials combined music therapy with other interventions, such as language training, making it difficult to isolate the effects of music therapy alone. The broad age range across studies limits our ability to draw conclusions about age-specific efficacy. Most included studies did not report the music therapists’ credentials or training levels, limiting our ability to assess the influence of therapist expertise on intervention outcomes. The primary outcomes assessed varied significantly among studies, and the lack of consistent measures of interaction further adds to the heterogeneity observed. To establish the effectiveness of MT for children with ASD, future research needs to feature large sample sizes, employ rigorous methodologies, and implement long-term observation and follow-up periods. Furthermore, adopting standardized research designs is essential for drawing more robust conclusions regarding the benefits of MT in the treatment of children with ASD.

 Conclusions

The results of the meta-analysis indicate that music therapy significantly enhances the overall symptoms of autism spectrum disorder in children from the Chinese population, particularly by improving communication skills, social interaction, language abilities, and cognitive function within existing high-quality studies. These robust findings support the integration of structured music therapy into pediatric rehabilitation protocols. However, the heterogeneity among the studies included and the low methodological quality of some research underscore the necessity for further well-designed randomized controlled trials with larger sample sizes to confirm and solidify these findings.

 Author contributions

YY: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Visualization, Writing – original draft, Writing – review & editing. YW: Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing. WL: Data curation, Formal analysis, Methodology, Visualization, Writing – original draft, Writing – review & editing. LS: Conceptualization, Project administration, Supervision, Validation, Writing – original draft, Writing – review & editing.

 Funding

The author(s) declare that no financial support was received for the research and/or publication of this article.

 Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

 Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

 Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

 Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1611182/full#supplementary-material

References Lord C Brugha TS Charman T Cusack J Dumas G Frazier T . Autism spectrum disorder. Nat Rev Dis Primers. (2020) 6:55. doi: 10.1038/s41572-019-0138-4, PMID: 31949163 Willsey HR Willsey AJ Wang B State MW . Genomics, convergent neuroscience and progress in understanding autism spectrum disorder. Nat Rev Neurosci. (2022) 23:323–3415. doi: 10.1038/s41583-022-00576-7, PMID: 35440779 Hirota T King BH . Autism spectrum disorder: A review. JAMA. (2023) 329:157–1685. doi: 10.1001/jama.2022.23661, PMID: 36625807 Baxter AJ Brugha TS Erskine HE Scheurer RW Vos T Scott JG . The epidemiology and global burden of autism spectrum disorders. Psychol Med. (2015) 45:601–13. doi: 10.1017/s003329171400172x, PMID: 25108395 Wang L Peng JL Qiao FQ Cheng WM Lin GW Zhang Y . Clinical randomized controlled study of acupuncture treatment on children with autism spectrum disorder (ASD): A systematic review and meta-analysis. Evid Based Complement Alternat Med. (2021) 2021:5549849. doi: 10.1155/2021/5549849, PMID: 34349825 Zhou H Xu X Yan W Zou X Wu L Luo X . Prevalence of autism spectrum disorder in China: A nationwide multi-center population-based study among children aged 6 to 12 years. Neurosci Bull. (2020) 36:961–9715. doi: 10.1007/s12264-020-00530-6, PMID: 32607739 Solanki MS Zafar M Rastogi R . Music as a therapy: role in psychiatry. Asian J Psychiatr. (2013) 6:193–9. doi: 10.1016/j.ajp.2012.12.001, PMID: 23642975 Ho YC Cheung MC Chan AS . Music training improves verbal but not visual memory: cross-sectional and longitudinal explorations in children. Neuropsychology. (2003) 17:439–50. doi: 10.1037/0894-4105.17.3.439, PMID: 12959510 Shi Z-M Lin G-H Xie Q . Effects of music therapy on mood, language, behavior, and social skills in children with autism: A meta-analysis. Chin Nurs Res. (2016) 3:137–1415. doi: 10.1016/j.cnre.2016.06.018 Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. (2010) 25:603–5. doi: 10.1007/s10654-010-9491-z, PMID: 20652370 Yi D . A study on the effect of music therapy combined with language training on autism. Pract Clin J Integrated Traditional Chin Western Medicin. (2019) 19:45–6. doi: 10.13638/j.issn.1671-4040.2019.11.021 Li W Li Z Zhou G Ni Z . Research on the efficacy duration of auditory integration training in the treatment of children with autism spectrum disorder. Chin J Child Health Care. (2019) 27:565–5675. Guanghong S . Effect of Music Therapy on Autistic Children. Tianjin: Tianjin Medical University, Cnki (2017). Zhou Q Jing Y Gan X Gu J Song M . Rehabilitation effect of music therapy on children with autistic spectrum disorders. Chin Primary Health Care. (2017) 31:68–69+76. Fu Y Zhang F Wang F . Study on the influence of music on the treatment of autism in children. J Clin Med Literature. (2016) 3:8505+8508. Li R Xiaoyan Y Chunhong C . The efficacy observation of music therapy combined with speech training in the language rehabilitation of autistic children. Chin Sci J Hearing Speech Rehabil. (2016) 14:220–2235. Hui H . Observation and empirical research on the clinical effect of music therapy intervention on children with autism. China Rural Health. (2016) 02):27. Sun Yuyan HC Jian L Shunying P Guoling Z Yan L Yuanyue Z . Effects of auditory integrative training and psychological nursing on low-functional autistic children. China Modern Doctor. (2014) 52:37–39+42. Zhang J Zhang Q . Effect of auditory integration training on the rehabilitation of children with autism. Chin J Child Health Care. (2014) 22:321–4. Liu Z Li N . (2011). Music therapy combined with scalp acupuncture for autism, in: The 10th Annual Academic Conference of the Chinese Music Therapy Association, Guangzhou, China, (Gunagzhou: Proceedings of the 10th Annual Academic Conference of the Chinese Music Therapy Association). Wang J Zhang X Zhang J . The effect on childhood autism with melodic intonation therapy. J Henan University(Medical Science). (2009) 28:60–615. Gang L . Clinical observation and experimental study on acupuncture combined with music therapy in the treatment of autism. Guangzhou: Guangzhou University of Chinese Medicine, Cnki (2006). Chen Y Zeng L Zhang Y . Effects of visual music training on children with autism spectrum disorders. Med J Chin People's Health. (2022) 34:58–605. Hu S Wu J Yinjia Z . Effect of language cognitive training combined with music therapy on improving language expression and comprehension abilities in children with autism. Modern Pract Med. (2021) 33:802–8045. Zhao Y Wen C Qi Y Shi N Li E . Clinical sffects of group music therapy on children with infantile autism. J Pract Traditional Chin Internal Med. (2020) 34:23–265. Li P . Application of music care in the care of autistic children. Henan Med Res. (2020) 29:549–51. Fan Z . Analysis of the clinical application of music therapy in the rehabilitation of autistic children. Renowned Doctor. (2019) 11):71. Yuan N . The application value of music therapy in the rehabilitation of autistic children. Northern Music. (2019) 39:248–9. Yuhang Z . Effect of music therapy combined with language training on the rehabilitation of language function in children with autism. Chin J Convalescent Med. (2018) 27:1157–9. Liyuan T . Analysis of the rehabilitation effect of music intervention therapy on language disorders in children with autism. Clin Res. (2018) 26:108–9. Li Q Chao G . Observation on the effect of music therapy in the rehabilitation treatment of children with autism. Med J Chin People's Health. (2018) 30:69–70. Li NM . The effect of music therapy on rehabilitation training of childhood autism. China Continuing Med Educ. (2017) 9:192–3. Lingyi H . Rehabilitation applications of music therapy in children with autism. China Continuing Med Educ. (2015) 7:153–4. Shalit L Elefant C Roginsky E . Exploring music in the everyday lives of autistic women: An Interpretative Phenomenological Analysis. Nordic J Music Ther. (2024) 34(3):225–44. doi: 10.1080/08098131.2024.2396105 Zaatar MT Alhakim K Enayeh M Tamer R . The transformative power of music: Insights into neuroplasticity, health, and disease. Brain Behavior Immun - Health. (2024) 35:100716. doi: 10.1016/j.bbih.2023.100716, PMID: 38178844 Talukdar S Ghosh S . Biophysics of Brain Plasticity and Its Correlation to Music Learning. In: Advances in Speech and Music Technology: Computational Aspects and Applications, edited by Anupam Biswas, Emile Wennekes, Alicja Wieczorkowska and Rabul Hussain Laskar, 269-282. Springer International Publishing, Cham (2023). Bowling DL . Biological principles for music and mental health. Trans Psychiatry. (2023) 13:374. doi: 10.1038/s41398-023-02671-4, PMID: 38049408 Sun Y Zhang Y Li R Cai D Zhang W Yang Z . Intracranial dissemination in a primary small cell carcinoma of the brain: a case report and literature review. Front Oncol. (2023) 13:1222961. doi: 10.3389/fonc.2023.1222961, PMID: 37771442 Xiao X Chen W Zhang X . The effect and mechanisms of music therapy on the autonomic nervous system and brain networks of patients of minimal conscious states: a randomized controlled trial. Front Neurosci. (2023) 17:1182181. doi: 10.3389/fnins.2023.1182181, PMID: 37250411 Sun Y Zhang Y Cai D Zhang W Yang Z . Middle ear neuroendocrine tumor with multiple brain metastases: a case report and literature review. Front Oncol. (2024) 14:1392610. doi: 10.3389/fonc.2024.1392610, PMID: 38884081 Daniel S Wimpory D Delafield-Butt JT Malloch S Holck U Geretsegger M . Rhythmic relating: bidirectional support for social timing in autism therapies. Front Psychol. (2022) 13:793258. doi: 10.3389/fpsyg.2022.793258, PMID: 35693509 Kossyvaki L Curran S . The role of technology-mediated music-making in enhancing engagement and social communication in children with autism and intellectual disabilities. J Intellect Disabil. (2020) 24:118–38. doi: 10.1177/1744629518772648, PMID: 29724139 Ghasemtabar SN Hosseini M Fayyaz I Arab S Naghashian H Poudineh Z . Music therapy: An effective approach in improving social skills of children with autism. Adv BioMed Res. (2015) 4:157. doi: 10.4103/2277-9175.161584, PMID: 26380242 Vaiouli P Grimmet K Ruich LJ . Bill is now singing: joint engagement and the emergence of social communication of three young children with autism. Autism. (2015) 19:73–83. doi: 10.1177/1362361313511709, PMID: 24254638 Birnbaum JC Kandler Z Aslan M Fu JHY Turry A . Music therapy with autistic children: creating an intersubjective field of play through improvisation. Psychoanalytic Inq. (2023) 43:232–2465. doi: 10.1080/07351690.2023.2185070 Schaefer H-E . Music-evoked emotions—current studies. Front Neurosci. (2017) 11:600. doi: 10.3389/fnins.2017.00600, PMID: 29225563 Trevarthen C . The concept and foundations of infant intersubjectivity. (1998). (Cambridge). Meltzoff AN . Foundations for developing a concept of self: The role of imitation in relating self to other and the value of social mirroring, social modeling, and self practice in infancy. (1990). (Chicago). Zanto TP Johnson V Ostrand A Gazzaley A . How musical rhythm training improves short-term memory for faces. Proc Natl Acad Sci U.S.A. (2022) 119:e2201655119. doi: 10.1073/pnas.2201655119, PMID: 36191231 Yurgil KA Velasquez MA Winston JL Reichman NB Colombo PJ . Music training, working memory, and neural oscillations: A review. Front Psychol. (2020) 11:266. doi: 10.3389/fpsyg.2020.00266, PMID: 32153474 Thaut MH Peterson DA McIntosh GC . Temporal entrainment of cognitive functions: musical mnemonics induce brain plasticity and oscillatory synchrony in neural networks underlying memory. Ann N Y Acad Sci. (2005) 1060:243–54. doi: 10.1196/annals.1360.017, PMID: 16597771 Rodriguez-Gomez DA Talero-Gutiérrez C . Effects of music training in executive function performance in children: A systematic review. Front Psychol. (2022) 13:968144. doi: 10.3389/fpsyg.2022.968144, PMID: 36003104 Bentley LA Eager R Savage S Nielson C White SLJ Williams KE . A translational application of music for preschool cognitive development: RCT evidence for improved executive function, self-regulation, and school readiness. Dev Sci. (2023) 26:e13358. doi: 10.1111/desc.13358, PMID: 36511452 Sharda M Tuerk C Chowdhury R Jamey K Foster N Custo-Blanch M . Music improves social communication and auditory-motor connectivity in children with autism. Transl Psychiatry. (2018) 8:231. doi: 10.1038/s41398-018-0287-3, PMID: 30352997 Padmanabhan A Lynch CJ Schaer M Menon V . The default mode network in autism. Biol Psychiatry: Cogn Neurosci Neuroimaging. (2017) 2:476–4865. doi: 10.1016/j.bpsc.2017.04.004, PMID: 29034353 Koelsch S Fritz T Schlaug G . Amygdala activity can be modulated by unexpected chord functions during music listening. Neuroreport. (2008) 19:1815–9. doi: 10.1097/WNR.0b013e32831a8722, PMID: 19050462 Gebauer L Skewes J Westphael G Heaton P Vuust P . Intact brain processing of musical emotions in autism spectrum disorder, but more cognitive load and arousal in happy vs. sad music. Front Neurosci. (2014) 8:192. doi: 10.3389/fnins.2014.00192, PMID: 25076869