Music therapy and music-based support for autistic children: a neurodiversity-informed systematic review and meta-analysis.

Abstract

Background: Music-based interventions, including music therapy, are widely used to support autistic children, but reductions on autism-related scales do not fully represent communication, participation, quality of life, or autonomy. We retained clinically interpretable outcomes while using a neurodiversity-informed framework to organize intervention goals and interpretation.

Methods: Web of Science, CNKI, Wanfang Data, VIP, PubMed, the Cochrane Library, Embase, Wiley Online Library, EBSCOhost, and Google Scholar were searched from inception to August 5, 2026. Randomized, quasi-randomized, crossover, and controlled studies involving autistic participants younger than 18 years were eligible. Outcomes were grouped as social communication/interaction, language, adaptive function/participation, quality of life/well-being, and autism-related characteristics and support needs. Positive Hedges' g values favored the music-based condition. Random-effects models used restricted maximum likelihood estimation and modified Hartung-Knapp inference. Comparator intensity, technique, duration, and parent involvement were examined as exploratory moderators.

Results: Thirty-three independent studies, representing 1,880 participants in the selected quantitative comparisons, were included and contributed at least one outcome. Social communication/interaction showed a significant pooled effect (k = 10, g = 0.64, 95% CI 0.25 to 1.03, p = 0.0046; I² = 59.6%); the primary evidence layer also remained significant (k = 7, g = 0.57, 95% CI 0.02 to 1.12, p = 0.043). Language showed a significant small pooled effect (k = 11, g = 0.32, 95% CI 0.10 to 0.54, p = 0.009; I² = 0%), whereas the primary evidence layer yielded g = 0.19 (95% CI -0.17 to 0.55). Autism-related scale outcomes showed a significant pooled effect (k = 16, g = 1.23, 95% CI 0.93 to 1.53, p < 0.001; I² = 77.0%) and remained significant among studies reporting a reproducible randomization method (k = 6, g = 0.95, 95% CI 0.29 to 1.61). Adaptive function and quality-of-life estimates did not reach statistical significance. No between-group moderator test was significant. Duration was not associated with effect size (β = -0.034 per month, p = 0.552), and Egger's regression did not detect funnel-plot asymmetry (p = 0.591).

Conclusions: Music-based support produced favorable average effects on social communication/interaction, language, and autism-related scale outcomes.