Enhancing Predictive Ability in Autism through Music

Autism is a lifelong neurodevelopmental condition characterized by pervasive social interaction and communication challenges, which affects up to 1-2% of the population. The limited understanding of the and the high variation within the spectrum contribute to a situation that leaves affected individuals and healthcare professionals with poor treatment options. The predictive processing account of autism suggests that the difficulties observed in the condition may arise from an impaired ability to generate predictions, which are expectations over time that help us make sense of the world. There is some evidence indicating that children with ASD perform lower on predictive tasks and that these differences in prediction are associated to clinical symptoms. However, results are still mixed and in need for replication. Notably, no study has investigated whether it is possible to aid the impairment in predictive processing through therapeutic intervention. The proposed project will take this initial evidence a step forward and investigate whether predictive processing abilities might be mediating changes in behavioral and neurophysiological outcomes through music therapy (MT) in children with autism. Music is considered a special case of predictive processing, designed to stimulate curiosity, systematically build and violate expectations, and generate pleasure through correct predictions. Therefore, MT can provide a safe environment that offers a balance between predictability and opportunities for prediction errors, uncertainty, surprise, and play. In a randomized crossover clinical trial, children between 6-12 years old with a diagnosis of ASD will undergo MT and playbased control therapy, delivered by licensed music therapists. The first intervention will take place over 3 months followed by a washout period of 3 months and then 3 months of the second intervention. Clinical and neuroimaging outcomes are assessed on the behavioural prediction tasks before and after each intervention period. A comparison with a neurotypical children group will serve to establish the normalization of such changes. We expect that 1) the effects of MT on clinical and neurophysiological outcomes are linked to changes in prediction abilities over time and 2) initial differences in prediction abilities are associated with stronger effects of MT on such outcomes. Overall, given the urgent need to identify and understand mechanisms of therapeutic action and to tailor interventions to individual abilities, the project will be able to identify how and why MT can be beneficial, therefore contributing to the advancement of therapeutic approaches for ASD.