Music listening for children and adolescents in health care contexts: A systematic review

Highlights

• Music listening in health care is a feasible, easily applicable, and cost effective for children and adolescents.

• Included studies are clinically heterogeneous.

• The majority of studies used researcher selected music both in music medicine and music therapy research.

• None of the studies investigated the participants’ preferred music for selecting and/or creating music as intervention.

• For future study, it will be crucial to find out differentiated effects of music selection by researcher, music therapist, and participants.

Abstract

This systematic review investigated the use and efficacy of music listening as an intervention for children and adolescents in clinical and non-clinical settings.

Database search was carried out via EMBASE, MEDLINE, PsycARTICLES Full Text, PsycINFO, PubMed together with hand-search in related journals using an age restriction of 0–18 years and the following keywords: music (therapy) AND receptive OR passive. Only original studies that were peer-reviewed were included. The searched publication period was between 1980 and up until March, 2015. In summary, 36 studies were identified as satisfying inclusion criteria, 28 being randomized controlled trials.

One half of included studies (n = 18) focused on music listening in pediatrics, indicating a significant reduction of pain, anxiety, and distress. One quarter of studies were set in mental health contexts (n = 9), and the remaining nine studies were varied in focus and contents, also supporting the beneficial effects of music listening for specific symptom reduction and enhancement of specific skills. Included studies varied with respect to diagnosis, sample size, design, choice and delivery of music and duration of interventions.

Results show that music listening in health care contexts is a feasible, easily applicable, and cost effective intervention for children and adolescents. As expected with such diversity, there was a marked variability in results. Careful consideration in interpreting the results and also in designing future studies is needed. Clinical and research implications are discussed further.

Introduction

Music listening is easily accessible and probably the most widespread and preferred activity to pass the time for many children and adolescents in everyday lifeplease change to (Kim and Kim, 2014, Miranda, 2013; Saarikallio, Gold, & McFerran, 2015; Stegemann, 2013). As music influences various aspects of a listener (psychological, physical, spiritual, cognitive and social), the application of music listening in clinical settings can be quite multifaceted depending on the needs, characteristics and preferences of the individual with whom the music is used (Grocke & Wigram, 2007). The method of focusing on the listening experiences in music therapy is defined as receptive music therapy (Bruscia, 1998) whereas music making such as singing and playing instruments within a therapeutic context is termed as active music therapy (Grocke and Wigram, 2007, Stegemann and Geretsegger, 2014).

Findings from a German survey suggest that music therapy with minors is predominantly associated with active forms of music therapy methods and techniques. Approximately 85% of music therapists working in child and adolescent psychiatry employed active music therapy whereas only 15% used receptive music therapy (Stegemann, Mauch, Stein, & Romer, 2008). However, receptive elements are still an important part of music therapy for children and adolescents due to ready availability and applicability to varied situations.

Music listening for children and adolescents is often used in hospital settings primarily for relaxation and pleasant distraction in order to reduce pain, anxiety, and distress related to the intrusive nature of medical procedures (Good, 2011; Grocke & Wigram, 2007; Klassen, Liang, Tjosvold, Klassen, & Hartling, 2008; Lathom-Radocy, 2002; Yinger and Gooding, 2014, Yinger and Gooding, 2015).

Gate theory is the core rationale for using music listening experience as a joyful distraction for children undergoing painful and distressing medical procedures (Good, 2011, Klassen et al., 2008, Yinger and Gooding, 2015). There are two systematic reviews on pain and/or anxiety on children undergoing medical procedures (Good, 2011, Klassen et al., 2008). Good (2011) focused on needle related procedures while Klassen et al. (2008) studied medical procedures, and their findings came up with overall positive effects of music interventions in reducing pain and anxiety in pediatrics. It has to be noted that these systematic reviews included both active and receptive music interventions.

Moreover, nowadays stress associated disorders are gaining increasing relevance already in childhood and adolescence. A meta-analysis by Pelletier (2004) indicated that participants under 18 years ‘receive the greater benefit’ (p. 209) than any other age group from the receptive music-based interventions on stress reduction. Music listening can also be used for affect recognition and regulation (Kim and Kim, 2014, Baker and Bor, 2008) and to improve attention and learning (Cripe, 1986, Montello and Coons, 1998).

However, unlike the specific receptive music therapy methods with adults such as Guided Imagery and Music (GIM) and Music and Imagery (MI), to the present knowledge of the authors there are no specific receptive music therapy methods for children and adolescents. Only little is known about the use and efficacy of receptive music therapy in children and adolescents. This study aims to enlighten the role and function of receptive elements of music-based intervention including not only music therapy, but also music medicine during childhood and adolescence.

Music therapy is defined by the American Music Therapy Association (2016) as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” whereas music medicine may be defined as “passive listening to prerecorded music provided by medical personnel” (Bradt et al., 2013Bradt, Dileo, & Shim, 2013; Yinger &Gooding, 2015). The core differences between the two types of interventions lie on who conducts the intervention (qualified music therapist, or medical personnel), and the present or absent role of the therapeutic relationship in the intervention. Taking the musical preference of the client into account is considered the foremost importance when selecting music in music therapy whereas in music medicine, the client’s preference in music may, or may not be considered (Grocke and Wigram, 2007, Yinger and Gooding, 2014, Yinger and Gooding, 2015). To illustrate the above differentiation between the two approaches the following examples – taken from studies included in this review – may be helpful: (1) A music therapist “positioned herself as closely to the patient as possible and began singing age-appropriate songs accompanied by a steel string guitar” (Malone, 1996, p. 24). (2) In a music medicine setting, children with refractory epilepsy “listened to Mozart K.448 once a day before bedtime for 6 months” (Lin, Lee, Wang et al., 2011, p. 490).

Therefore, the authors are focusing on receptive music-based intervention either via live performance or pre-recorded music in this systematic review. By providing pertinent research evidence to clinicians and researchers, systematic review has gained increasing popularity in the health and social science including music therapy (Hanson-Abromeit & Moore, 2014; Maratos, Gold, Wang & Crawford, 2008; Mössler, Chen, Heldal, & Gold, 2011). The number of systematic reviews for children and adolescents in music therapy is steadily growing, but publications in this area are still rare. The following publications are systematic reviews in music therapy for children and adolescents with specific clinical populations (including meta-analysis): autism spectrum disorders (Geretsegger, Elefant, Mössler, & Gold, 2014; Whipple, 2004); disabilities (Brown & Jellison, 2012); psychopathology (Gold, Voracek, & Wigram, 2004); needle related procedural pain (Good, 2011); children undergoing medical procedures (Klassen et al., 2008). In addition, there has been a considerable body of work on music therapy with premature infants, reflected in comprehensive systematic reviews and meta-analyses (Haslbeck, 2012, Standley, 2012). As there are huge differences between newborns and children/adolescents in terms of neurobiological conditions (brain maturation), and with respect to developmental aspects (e.g. the capacity to react and to respond to receptive music therapy interventions), studies from neonatology were not taken into account in this article. Further, from a methodological point of view, there is some discussion regarding the question of to what extent music therapy with premature infants should be considerered as a “receptive” approach, as interaction between therapist or caregivers and baby is commonly rather active—at least when live music interventions are applied (Haslbeck, 2012, Loewy, 2015).

To the present knowledge of the authors, there has been no systematic review of studies focusing on receptive music-based intervention for children and adolescents. Therefore this study aims to close this gap in knowledge and to provide a systematic overview of this area. This may aid to categorize different approaches and methods applied in music therapy for children and adolescents which is considered to be helpful for music therapists as well as for members of other health care professions who want to apply music in an efficient and safe way in clinical paediatric settings and beyond.