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Music-based Scale for Autism Diagnostics (MUSAD)

Catalog of Assessment Tools

Music-based Scale for Autism Diagnostics (MUSAD)

The MUSAD uses the non-verbal and age-independent quality of musical-bodily interaction to assess autistic traits in adults with limited speech. Owing to the high prevalence of autism spectrum disorder (ASD) and the limited diagnostic possibilities in this specific group, the MUSAD may support a team-based diagnostic work-up according to current guidelines.

Catalog of Assessment Tools

Music-based Scale for Autism Diagnostics (MUSAD)

The MUSAD uses the non-verbal and age-independent quality of musical-bodily interaction to assess autistic traits in adults with limited speech. Owing to the high prevalence of autism spectrum disorder (ASD) and the limited diagnostic possibilities in this specific group, the MUSAD may support a team-based diagnostic work-up according to current guidelines.

TITLE (Acronym) Music-based Scale for Autism Diagnostics (MUSAD)
Author(s) Bergmann, T., Sappok, T., Dziobek, I, Ziegler, M., & Heinrich, M.
Publication date Manual in press (German version)
Publisher info Verlag Hans Huber, Bern, Switzerland
Purpose The MUSAD uses the non-verbal and age-independent quality of musical-bodily interaction to assess autistic traits in adults with limited speech. Owing to the high prevalence of autism spectrum disorder (ASD) and the limited diagnostic possibilities in this specific group, the MUSAD may support a team-based diagnostic work-up according to current guidelines.
Assessment index terms Test, observational
Population Adults (≥ 18) with intellectual disability and limited speech suspected of being on the autism spectrum.
Scores Twenty-six (26) items form the diagnostic algorithm. Each item is to be scored on a 4-point Likert scale according to ascending symptom severity. The diagnostic assessment is based on the total score. A cut-off point of 30 is proposed to indicate the presence vs. absence of ASD.
Administration Individual
Time Application in contact with the client, 30 minutes; video-based coding, 60 minutes; total, 90 minutes.
Comments
  • Published evidence
    Construct validity: A confirmatory factor analysis supported a 3-dimensional construct (F1 = social interaction, F2 = stereotyped behaviors including sensory issues, F3 = motor coordination); fit indices indicated a good model fit (CFI = 0.97, RMSEA = 0.06, 90% CI [0.05–0.07] and WRMR = 1.02); concurrent validity was supported by substantial and significant correlation with the convergent ASD screener DiBAS-R (r(111) = 0.62, p < 0.001), and negligible non-significant correlation with the discriminant aggression scale MOAS (r(56) = 0.15, p = 0.252)
    Scale reliability was high (α = 0.95).
  • Inter-rater agreement based on the sum scores across 4 raters in n = 22 cases was excellent (ICC = 0.92). Test–retest reliability in n = 9 ad hoc test repetitions was moderate (ICC = 0.73).
    Criterion validity was calculated by applying a ROC analysis. With a cut-off score of 30 points, 76.6% of all individuals assessed were classified correctly (κ = 0.52; sensitivity = 0.79, 95% CI [0.68–0.87] and specificity = 0.74 with 95% CI [0.59–0.85]. The AUC value for the overall score was 0.81, 95% CI [0.73-0.88]. These findings were replicated in a jet unpublished follow up study based on an independent sample (N = 71) by using a cut-score of 29 yielding in a sensitivity of 88 % (95%-CI [0.80-0.97]), a specificity of 89 %, and an AUC of 0.90 (95%-CI [0.84-0.97]).
  • The MUSAD can be administered by a music therapist or other professionals (psychologists, pedagogues) with basic musical skills.
  • For all users a specialized training is required.
CROSS REFERENCES Gold, C. (2018) Music in therapy and in daily life: health of musicians, concepts of aesthetics, measurement, and new media. Nordic Journal of Music Therapy 27:4, pages 257-258.
Lagasse, A. B. (2017). Social outcomes in children with autism spectrum disorder: A review of music therapy outcomes. Patient Related Outcome Measures, 8, 23–32. https://doi.org/10.2147/PROM.S106267
Martin, L., Oepen, R., Bauer, K., Nottensteiner, A., Mergheim, K., Gruber, H., & Koch, S. C. (2018). Creative Arts Interventions for Stress Management and Prevention-A Systematic Review. Behavioral Sciences (Basel, Switzerland), 8(2). https://doi.org/10.3390/bs8020028
Quintin, E.‑M. (2019). Music-Evoked Reward and Emotion: Relative Strengths and Response to Intervention of People With ASD. Frontiers in Neural Circuits, 13, 49. https://doi.org/10.3389/fncir.2019.00049
Tromans, S., Chester, V., Kiani, R., Alexander, R., & Brugha, T. (2018). The Prevalence of Autism Spectrum Disorders in Adult Psychiatric Inpatients: A Systematic Review. Clinical Practice and Epidemiology in Mental Health : CP & EMH, 14, 177–187. https://doi.org/10.2174/1745017901814010177
Reference Bergmann, T., Heinrich, M., Ziegler, M., Dziobek, I., Diefenbacher, A., & Sappok, T. (2019). Developing a Diagnostic Algorithm for the Music-Based Scale for Autism Diagnostics (MUSAD) Assessing Adults with Intellectual Disability. Journal of Autism and Developmental Disorders, 49(9), 3732–3752. https://doi.org/10.1007/s10803-019-04069-y
Bergmann, T., Sappok, T., Diefenbacher, A., Dames, S., Heinrich, M., Ziegler, M., & Dziobek, I. (2015). Music-based Autism Diagnostics (MUSAD): A newly developed diagnostic measure for adults with intellectual developmental disabilities suspected of autism. Research in Developmental Disabilities. (43-44), 123–135. https://doi.org/10.1016/j.ridd.2015.05.011
Bergmann, T., Sappok, T., Diefenbacher, A., & Dziobek, I. (2015). Music in diagnostics: Using musical interactional settings for diagnosing autism in adults with intellectual developmental disabilities. Nordic Journal of Music Therapy, 25(4), 319–351. https://doi.org/10.1080/08098131.2015.1039567
REVIEW None.
Description

The MUSAD application follows a 4-step procedure:

  1. Implementation. The assessment comprises 11 structured musical-interactional situations to prompt diagnostically relevant behaviors. Detailed step-by-step instructions are given in the manual.
  2. Observation. Video recording is recommended to support the assessor in changing role from being in playful contact with the client to being a distant observer. For each musical-interactional situation, observation priorities are given to recapitulate the assessment with note-taking in free text.
  3. Coding. Each of 46 items is coded on a 4-point scale. Each item is assigned to a situation/prompt or overall; each point is described by quantitative or qualitative behavioral markers.  
  4. Interpretation. A total score is formed by summing up the values of 26 algorithm items. The cut-off score of 30 points is the main indicator for diagnostic assignment. Especially in borderline cases (around 30 points) the diagnostic decision may be discussed.