Journal of Child Psychology and Psychiatry 45:6 (2004), pp 10541063

Effects of music therapy for children and

adolescents with psychopathology:
a meta-analysis
Christian Gold,1 Martin Voracek,2 and Tony Wigram3
1

Sogn og Fjordane University College, Sandane, Norway; 2University of Vienna, Austria; 3Aalborg University,
Denmark

Background: The objectives of this review were to examine the overall efficacy of music therapy for
children and adolescents with psychopathology, and to examine how the size of the effect of music
therapy is influenced by the type of pathology, clients age, music therapy approach, and type of outcome. Method: Eleven studies were included for analysis, which resulted in a total of 188 subjects for
the meta-analysis. Effect sizes from these studies were combined, with weighting for sample size, and
their distribution was examined. Results: After exclusion of an extreme positive outlying value, the
analysis revealed that music therapy has a medium to large positive effect (ES .61) on clinically
relevant outcomes that was statistically highly significant (p < .001) and statistically homogeneous. No
evidence of a publication bias was identified. Effects tended to be greater for behavioural and developmental disorders than for emotional disorders; greater for eclectic, psychodynamic, and humanistic
approaches than for behavioural models; and greater for behavioural and developmental outcomes than
for social skills and self-concept. Conclusions: Implications for clinical practice and research are
discussed. Keywords: Behaviour problems, developmental delay, meta-analysis, music, psychotherapy, music therapy. Abbreviations: ES: effect size; AMT: analytical/analytically oriented music
therapy; GIM: guided imagery and music; CMT: creative music therapy.

There is a wide range of mental disorders in children

and adolescents, spanning emotional, cognitive, and
behaviour problems (Remschmidt & Schmidt, 1994),
with an overall prevalence of 8% to 26% (Verhulst &
Koot, 1992; Weisz & Weiss, 1993). When considering
psychotherapeutic treatments for these problems,
there are at least 230 different approaches, only a
few of which have been empirically tested for their
efficacy and effectiveness (Bergin & Garfield, 1994;
Weisz & Weiss, 1993). As music therapy uses musical interaction as a means of nonverbal communication, it demonstrates potential as an effective
approach, particularly for patients who are not accessible through verbal language. That is, this approach may be beneficial particularly for patients
that may be unable to communicate verbally, or, at
the other extreme, use verbal language to rationalise
what they cannot address emotionally. However,
music therapy is applied to a much larger spectrum
of mental disorders.
Models of music therapy are based on various
theoretical backgrounds, including psychodynamic,
behavioural, and humanistic approaches. The techniques used in music therapy can be classified as
active vs. receptive and as improvisational vs. structured (Bissegger et al., 1998; Bruscia, 1998;
Drieschner & Pioch, 2001; Fitzthum, Oberegelsbacher, & Storz, 1997). The most prominent models of
music therapy with a psychodynamic orientation are
Analytical Music Therapy (AMT; Priestley, 1975,
1994) and Guided Imagery and Music (GIM; Bonny,
1975; Bonny & Savary, 1973). In AMT, free

improvisation is used to symbolically express inner

moods and associations; GIM involves listening to
recorded music as a means of bringing up inner
images that can then be reflected on. Both models
put a strong emphasis on the verbal reflection of inner processes that emerge through the music.
Humanistic models of music therapy are influenced
by Rogers client-centred therapy and Perls Gestalt
therapy; they use musical improvisation to highlight
experiences in the here and now and to enable
awareness of emotions (Frohne-Hagemann, 1990;
Hegi, 1988). Models of music therapy that are partly
based on humanistic theory include Creative Music
Therapy (Nordoff & Robbins, 1977) and Orff Music
Therapy (Orff, 1974, 1989), both of which use improvisation as well, but in a more structured form
than the models mentioned above. Behavioural Music Therapy is based on Skinners behaviourist theory
and uses various forms of playing and singing music
or listening to music as a contingent reinforcement or
stimulus cue to modify behaviour (Madsen, Cotter, &
Madsen, 1968). Finally, there are many forms of
music therapy where ideas and techniques from
several theoretical backgrounds are combined.
A prominent example of eclectic music therapy is
Alvins (1975) Free Improvisation Therapy (for further
information on music therapy models, cf. Bruscia,
1998; Wigram, Nygaard Pedersen, & Bonde, 2002).
Music therapy has been extensively applied to child
and adolescent populations (Wigram & de Backer,
1999); for example, approximately one-third of all
institutional positions in music therapy in Austria are

Association for Child Psychology and Psychiatry, 2004.

Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA

Effects of music therapy

ller &
oriented towards children and adolescents (Mu
Kehl, 1997). Music therapy is provided to children
and adolescents with psychopathology on a regular
basis in many countries (Aldridge, di Franco, Ruud, &
Wigram, 2001; Maranto, 1993).
While there are meta-analytic reviews on music
therapy in the treatment of dementia (Koger, Chapin,
& Brotons, 1999) and on music in general medical
treatment (Standley, 1986), a meta-analysis on the
effects of music therapy for children and adolescents
with psychopathology has not been performed.
Therefore this review was conducted to summarise
systematically previous findings on the efficacy of
music therapy in this field in the hopes of enabling
informed decisions on treatment provision. The goal
of this meta-analytic review was to examine the
overall efficacy of music therapy for children and
adolescents with psychopathology. Additionally, we
aimed to identify how the size of the effect of music
therapy is influenced by the type of pathology, clients
age, music therapy approach, and type of outcome.

Method
Literature search
All studies that focused on children and adolescents with
psychopathology, and compared music therapy with no
treatment or with a different treatment, or that compared
before and after music therapy treatment, were considered as possibly relevant. Eligible designs included
treatment versus control group pre-test post-test designs
and treatment group only pre-test post-test designs.
A systematic literature search, both computerised
and manual, was undertaken. Databases were
searched for the term music therap*, crossed with
child*, effect* or synonyms of these. Issues of relevant
journals were browsed by hand. Documents in any
language were considered, as were unpublished and
published articles. Searched databases included
Medline (19662000), Psyndex (19772000), PsycInfo
(18872000), the Cochrane Library (2001, issue 3),
Music Therapy Info CD-ROM 1 (1996), 2 (1999), and 3
(2001), a printed register of music therapy studies
(Jellison, 2000), various databases for ongoing and
unpublished studies, and programmes of music therapy conferences. The hand-searched journals included
Music Therapy (19811996), Journal of Music Therapy
(19642000), Music Therapy Perspectives (19822000),
British Journal of Music Therapy (19682000), Nordic
Journal of Music Therapy (19922000), Musiktherapeutische Umschau (19802000), and Revista
Internacional
Latinoamericana
de
Musicoterapia
(19952000). Reference lists of the included studies
were also checked to identify any additional studies.
Twenty-nine potentially relevant studies were identified
via these search strategies.

Inclusion and exclusion criteria for studies

Studies were excluded if they addressed effects of
music alone (Braithwaite & Sigafoos, 1998; Cripe,
1986; Underhill, 1974) or effects of music education

1055

(Standley & Hughes, 1997) rather than music therapy

as defined above. Since the focus was on clinically
relevant changes in the individual, studies addressing
interactions between group members rather than
individual outcomes (Gunsberg, 1988; Humpal, 1991)
were deemed ineligible. One study (Parker Hairston,
1990) could not be included because it addressed
combined effects of music therapy with another therapy, without separate therapeutic results being reported. Two studies were excluded where the presence of a
psychopathology was not clear (Harding & Ballard
1982; Ulfarsdottir & Erwin, 1999). Studies with only
one subject (Bruscia, 1982; Wimmer-Illner, 1996) were
excluded because their results would not allow for
effect size computation. Two studies (Krout, 1987;
Wylie, 1996) were excluded because the measured
outcome was too similar to what was done in therapy
sessions to expect unbiased results. Papers were not
included if they failed to report results of a complete
outcome study (Standley & Hughes, 1996; Steele,
1977), or if complete results were not reported and
efforts to retrieve the missing information directly from
authors failed (Henderson, 1983; Lerner, 2001;
Roskam, 1979). Eleven studies remained for inclusion
in the meta-analysis (see Table 1 for study characteristics). These studies were conducted between 1970
and 1998. Eight of them were conducted in the USA,
and the remaining three in Austria, Germany, and the
UK. A wide range of clinical diagnoses ranging from
developmental disorders to conduct disorders were
addressed. Outcomes included behavioural observations, tests of development, and self-reports of selfesteem. Music therapy was provided either in group or
in individual settings, and based on one of several
music therapy models or a mixture of them. Between
eight and twenty-six subjects were in each study.

Data extraction and analysis

The included studies were coded systematically. Child
age and gender, type of pathology, type of intervention,
type of comparison group, type of outcome, and
publication status were extracted and categorised.
The different psychopathologies were categorised into
behavioural disorders (externalising disorders, e.g.,
conduct disorders, F91 in ICD-10), emotional disorders (internalising disorders, e.g., affective disorders,
F3, and emotional disorders of childhood and adolescence, F93), developmental disorders (mental retardation, F7, disorders of psychological development,
F80F83, pervasive developmental disorders, F84), and
into a group of mixed disorders (when subjects with
different diagnoses were included in one study; this
could also include comorbid conditions).
Treatment effects were extracted separately for posttest and follow-up. Effect sizes were calculated as
standardised mean differences (Cohens d) at post-test,
and were corrected for pre-test differences.1 When a
1
Correction for pre-test values was performed by subtracting
the difference at pre-test from the difference at post-test, in
order to obtain more precise estimates. In our sample, this led
to more conservative estimates than without such correction:
in four of the five two-group studies, the effect sizes were
diminished by this procedure.

1995

1991
1994

1989

1989

1989

1981

1992

1975

1970
(1973)

1998

Aldridge et al.

Clendenon-Wallen
Edgerton

Eidson

Gregoire et al.

Haines

Johnson

Laserer-Tschann

McQueen

Michel & Martin

(Michel & Farrell)

Montello & Coons

USA

USA

UK

Austria

USA

USA

USA

USA

USA
USA

Germany

Country

parallel groups, all

received music
therapya

no-treatment control;
non-randomised,
matched age, ability
and pre-test score

music therapy vs.

verbal therapy;
non-randomised,
matched age and
pathology
music therapy vs.
other music
activities; randomised
music therapy
plus functional
training vs. functional
training; quasirandomised
(order of intake)
no-treatment control;
allocation unclear

no-treatment control;
non-randomised,
matched age and
ability level
no control group

crossover design,
both groups received
music therapya
no control group
no control group

Design

learning and
behaviour
problemsb

emotional
disturbances,
learning
disabilities,
and/or attention
deficit disorder

1012 yrse

1114 yrse

26

16

disorders of
psychological
development

juvenile
delinquentsg

affective
problems in
gifted children
emotional
disturbance

mentally
handicapped

610 yrs

juvenile

1116 yrse

4th grade

emotionally
handicappedf

1116 yrse

eclectic

behavioural

psycho-dynamic
and humanistic

problem
behaviour

self-esteemc

cognitive abilityh

I. HamburgWechsler
Intelligence
Test
II. Marburg
Behaviour List
informal test
(identification
of pictures)
I. Coopersmith
Self-Esteem
Inventory
II. Coopersmith
Behaviour
Rating Form
Achenbach
Teacher
Report Form

I. intelligenceh
II. problem
behaviour

Orff

Interpersonal
Checklist

self-concept

behavioural

Piers-Harris
Childrens
Self-Concept Scale
Coopersmith
Self-Esteem
Inventory

Griffiths
Developmental
Scale
Adjective Checklist
Checklist of
Communicative
Responses/Acts
Score Sheet
behaviour
observation

Instrument

self-esteemc

self-concept

self-confidencec
communicative
responses and
acts in music
therapyd
social
behaviour in
classroomd

development

Type

Outcome

eclectic

GIM, Orff

behavioural

eclectic
CMT

sexual abuseb
autism

1419 yrs
69 yrs

children

24

14

26

16

11

25

11
11

Approach
CMT

46.5 yrs

Diagnosis

Therapy

developmental
delay

Age

valid n

Subjects

teacher;
blinding
unknown

independent;
blinding
unknown
I. self-report
II. teacher;
blinding
unknown

I. independent;
blinding
unknown
II. parent;
not blind

self-report

self-report

self-report

independent;
not blind

self-report
independent;
not blind

independent;
blind

Rater

Note: aClassified as a one-group pre-test post-test design. bClassified as mixed disorders. cClassified as self-concept. dClassified as social skills. eClassified as adolescents. fClassified as
emotional disorder. gClassified as behavioural disorder. hClassified as development.

Year

Author

Study

Table 1 Characteristics of studies on music therapy with children and adolescents

1056
Christian Gold, Martin Voracek, and Tony Wigram

Effects of music therapy

study had more than one outcome measure, the average

of all outcome measures was calculated to avoid inappropriate multiple weighting of these studies. Cohens d
is the most widely used effect size index in psychotherapy research and was used for the sake of comparability. However, since Cohens d produces biased
estimates in small samples, the effect sizes were also
transformed into Hedges g for an unbiased, conservative estimate. Effect sizes were weighted for sample size
(see Appendix) and combined using a fixed effects
model. We used Q tests to examine the degree of heterogeneity between studies (cf. Borenstein & Rothstein,
1999; Cooper & Hedges, 1994).
We decided to include one-group studies in the
meta-analysis because of the limited number of
studies. The comparison of their results with those
of two-group studies could be criticised if there was a
systematic change in control groups, because the effects of one-group studies would include both treatment effects and changes over time which might have
occurred without music therapy. Therefore, the
changes over time in experimental and control conditions were examined using within-group effect sizes
(Becker, 1988; see Appendix). In this procedure, the
correlation between pre-test and post-test values
needs to be known to estimate an effect sizes variance.
In studies where this correlation was not known, the
average of all known correlations in the respective
condition was used. The influence of moderator variables was examined through sub-group analyses and
analysis of variance (ANOVA) Q tests (Borenstein &
Rothstein, 1999).

Study

Eidson (1989)

25

-0.17

0.50

Laserer-Tschann (1992)

14

0.25

0.54

Haines (1989)

16

0.30

0.51

Gregoire et al. (1989)

11*

0.30

0.43

Michel & Martin (1970)

26

0.32

0.40

Clendenon-Wallen (1991)

11*

0.53

0.43

8*

0.77

0.52

Aldridge et al. (1995)

SE

Johnson (1981)

26

0.78

0.41

McQueen (1975)

24

0.86

0.49

Montello & Coons (1998)

16*

1.43

0.40

Edgerton (1994)

11*

4.56

0.81

Combined (all studies)

188

0.99

0.13

Combined (excl. outlier)

177

0.61

0.14

1057

Results
Average effect of music therapy
The overall mean effect size of all included studies at
post-test was d .99 (SE .13). Following Cohens
(1988) benchmarks for interpretation and evaluation, this is a large effect, and the effect was significantly different from zero (t 7.47; df 243;
p < .001). However, it was not statistically homogeneous, as indicated by a significant Q test for
homogeneity (v2 88.02; df 10; p < .001). Inspection of the results (Figure 1) clearly showed that
the heterogeneity was caused by one extreme outlying value. The study was therefore excluded from the
analysis. The remaining studies provide a consistent
indicator of the effects of music therapy, as can be
seen from Figure 1.
The overall mean effect size after exclusion of
Edgertons study was d .61 (SE .14), which can
be interpreted as a medium to large effect. The biascorrected, conservative effect size index Hedges g
was .56 (SE .14). The results remained statistically
significant (t 4.37; df 221; p < .001), and they
were statistically homogeneous after the exclusion of
Edgertons study (v2 10.31; df 9; p .48). The
observed effect size is attenuated by imperfect
reliability of outcome measures (cf. Hunter &
Schmidt, 1990). No reliability correction was performed, thereby making our effect size estimate a

-5.0

-2.5

0.0

2.5

5.0

Figure 1 Music therapy with children and adolescents overall results

Note: The graph displays effect size estimates of each study as boxes and their 95% confidence intervals as whiskers.
The effect size estimate of the combined result with its confidence interval is displayed as a rhombus. Samples
marked with an asterisk indicate one-group studies. See Appendix for computational details.

1058

Christian Gold, Martin Voracek, and Tony Wigram

Table 2 Changes over time in children and adolescents under

different conditions

Table 3 Effect sizes of music therapy with children and adolescents, grouped by study characteristics

Study

Variable

Music therapy
Haines
Eidson
Gregoire
Michel
Clendenon
Laserer
Johnson
McQueen
Aldridge
Montello
(Edgerton1)

SE

9
20
11
14
11
6
13
18
8
16
(11)
126

NA
NA
.93
NA
.81
NA
.42
.82
.93
NA
(.39)

.09
.12
.30
.36
.53
.58
.59
.71
.77
1.43
(4.56)
.54

.19
.13
.11
.15
.19
.23
.30
.14
.13
.14
(.33)
.05

Other treatment
Haines
Johnson
Laserer
No treatment
McQueen
Michel
Eidson
All control groups

7
13
8
28

NA
.6
NA

).21
).14
.33
).01

.29
.25
.27
.16

6
12
5
23
51

.8
NA
NA

).12
.04
.29
.03
.01

.26
.22
.34
.16
.11

Note: NA not available. Average values were substituted for

missing values. For computational details see Appendix. 1Not
used for calculation of average.

conservative one. In Figure 1, it can also be seen that

while most of the primary studies found a positive
effect, few of them were statistically significant because test power was low in these small-sample
studies. The summary effect size, in contrast, is
highly significant because the larger total sample
size of the meta-analysis resulted in much greater
power.
To examine whether control groups improved over
time, in which case the inclusion of one-group studies
would lead to biased results, effects under different
conditions were examined (Table 2). The weighted
averages of the three types of conditions suggest that
music therapy clients improved, while subjects in the
control groups did not improve, regardless of the type
of control condition. Inspection of types of pathology
(Table 1) did not reveal any systematic differences
between severity or perseverance of the pathology
and study designs. Therefore, the inclusion of the
one-group studies appeared justified.

Moderator variables
The absence of statistical heterogeneity suggested
that the average effect size mentioned above was
representative for all conditions. However, clinical
heterogeneity between the included studies could
not be denied, and therefore the influence of moderator variables was examined for exploratory purposes (Table 3). The interpretation of these
comparisons requires caution because test power

Diagnosis
emotional
developmental
behavioural
mixed
Age
children
adolescents
Approach
behavioural
psychodynamic/
humanistic
mixed
Outcome
social skills
self-concept
development
behaviour

n (studies)

n (subjects)

SE

3
3
1
3

52
46
26
53

.16
.65
.78
.82

.27
.29
.39
.22

4
6

57
120

.54
.64

.24
.17

3
4

77
57

.38
.54

.24
.24

43

.89

.24

1
5
3
2

25
90
46
30

).17
.46
.76
.96

.50
.19
.29
.30

Note: Q tests for homogeneity revealed no significant heterogeneity either between or within any of the above groups. One
study (Laserer-Tschann) had two outcome measures. The
associated effect sizes were used separately in the sub-group
analysis by outcome, while in all other analyses the average of
both measures was used.

was low, moderator variables may be confounded,

and interactions of variables could not be included
due to the small number of studies. Music therapy
had the largest effect for subjects with mixed diagnoses (d .82). Large effects were found for developmental (d .65) or behavioural problems
(d .78). Subjects with emotional problems appeared to benefit least (d .16). Music therapy was
equally effective for children (d .54) as for adolescents (d .64).
Measures of the childrens overt behaviour, including their development (d .76) and problem behaviour (d .96) were associated with larger effects
than measures of subjective experiences, such as
self-concept (d .46) or social skills (d ).17). This
difference is consistent with findings from metaanalyses of child psychotherapy (e.g., Casey & Berman, 1985). Clearly, overt behaviour is easier to
assess than subjective experiences. Thus, there
might be an increased amount of random error in the
latter measures, thereby artificially deflating the effects. Reliability of outcome measures was not reported in most of the studies and hence, could not be
considered. Eclectic approaches of music therapy
showed the largest effects (d .89), and the smallest
effects were found in behavioural approaches
(d .38). None of these moderator variables (age,
type of psychopathology, type of music therapy, and
type of outcome measure) had a statistically significant influence on the effect. Follow-up data were only
reported in one study (McQueen, 1975; data not
shown). The findings of this study were that effects of
music therapy are more enduring when more sessions are provided.

Effects of music therapy

The presence of a publication bias was examined

with a funnel plot where effect size was plotted
against sample size. If studies with significant findings were more likely to be published than others, a
funnel plot would show an asymmetry and a tendency for smaller effects in larger samples. The funnel
plot showed no such asymmetry, suggesting that
there was no publication bias.

Discussion
This study was the first comprehensive meta-analytic review on the effects of music therapy for children and adolescents with psychopathology. The
study showed that music therapy with these clients
has a highly significant, medium to large effect on
clinically relevant outcomes. This finding remained
when sources of positive bias were examined and
eliminated.2 Alternatively, sources of negative bias
were not eliminated, making the observed effect size
a conservative estimate of the true effect (cf. Hunter
& Schmidt, 1990).
Because of the comprehensive literature search, it
is likely that this meta-analysis contained all relevant studies that have been conducted in the field.
It is possible that there are unpublished studies of
which we were not aware, but it is doubtful that their
existence would significantly alter our findings as we
did not observe a publication bias. Therefore, our
sample of studies can be considered as a representative sample of all studies conducted.
A particularly large effect was found for children
who suffer from either developmental or behavioural
disorders. The reason for this might be that music
therapy, especially active music making, helps these
children to focus and sustain attention. The noninvasive, non-judgmental setting in music therapy
gives them opportunities to show capacities that may
be hidden in other situations. Music therapy brings
them into a situation where they are set up to succeed. Music making is a highly motivational factor
for many of these children, as is documented in
anecdotal evidence (e.g., Wigram & de Backer, 1999).
Our results suggest that eclectic approaches to
music therapy, where techniques from different
models or theories are mixed, are particularly effective. As an interpretation of this finding, it may be
important that therapists have a flexible attitude and
openness to what a child brings into the music
therapy situation. Individualised music therapy
treatment, where a therapist chooses from a variety
of music therapy techniques to match the individual
2

The outlying result of the Edgerton study might have been

influenced by its specific outcome measure. First, the outcome
addressed behaviour within the music therapy situation which
may be more subject to change than behaviour in other situations. Second, raters were probably not blinded to therapy
status, and the rating of communicative acts may be influenced
by rater expectancy more than other outcomes.

1059

clients needs, may be more helpful than a fixed

treatment regimen. Behavioural models of music
therapy showed smaller effects than other approaches. This contrasts with findings of psychotherapy meta-analyses (e.g., Casey & Berman, 1985).
Effects were larger when overt behaviour rather
than subjective experience was used as the outcome
measure. While the American tradition of music
therapy emphasises a more controlled and experimental style both in practice and research, and has
therefore often looked at changes in behaviour,
European music therapy researchers have focused
much more on the value of music therapy as seen
from the patients and the therapists subjective
experience. Our findings highlight the importance of
evaluating behavioural changes even in treatments
that focus mainly on subjective experiences.

Limitations
The strength of a research reviews findings is
necessarily limited by the quality of the included
primary studies. Some of the most rigorous inclusion
criteria, such as concealed random allocation to
experimental and control groups, blind ratings, and
standardised measures (Cooper & Hedges, 1994;
The Cochrane Collaboration, 2002) could not be
applied in this review because of the small number of
studies and the limited quality of some of them.
Several studies included in this review were not
randomised, and in others randomisation procedures were not adequately reported. In some studies,
diagnoses and music therapy procedures were described with less than the desired precision and detail. In other studies the data were inadequately
reported for the calculation of effect sizes. Most of
these problems are likely to cause random error rather than bias, i.e., they are unlikely to have a systematic influence on our findings. Lack of
randomisation, however, may have a tendency of
inflating effect sizes, although there is generally good
agreement between prospective non-randomised and
randomised studies (Ioannidis et al., 2001).
The small number of studies did not permit an
analysis of interactions between diagnoses, types of
music therapy interventions, and outcomes. It is
quite possible that the effect of music therapy in
general may depend on the specific combination of
diagnosis, type of music therapy, and type of outcome. For example, scales of self-esteem were found
to produce small effects, and these scales were often
used in children with emotional disorders. Therefore,
the small effect found for music therapy with emotional disorders might actually be an artefact of
study design. The findings concerning specific types
of music therapy and clinical subgroups should be
interpreted with caution and considered very preliminary. Studies that include multiple diagnoses,
interventions and outcomes would be needed to
examine these influences.

1060

Christian Gold, Martin Voracek, and Tony Wigram

The application of the findings of this meta-analysis is restricted to settings that are similar to those
in the primary studies. Most of the included studies
were conducted in the United States, and the
majority of studies examined the effects of an
experimental treatment rather than clinical practice.
Music therapy models used in Europe tend to be
more improvisational and less structured than those
used in America (cf. Wigram, 2002). Also, clinical
practice in psychotherapeutic interventions differs
from experimental therapy in various aspects. For
example, patient populations in clinics tend to be
more diverse, more severely disturbed, and more
often comorbid, therapists have higher caseloads
and less intense supervision, and the goals of therapy and techniques used may cover a broader range
than in experimental therapy (Weisz & Weiss, 1993).

While we would like to see larger-scale studies on

music therapy emerge in the future, this does not
mean that small-scale studies will be worthless.
Studies with small sample sizes formed the basis for
this review and will continue to contribute to our
knowledge if effect sizes are reported. Tests of
statistical significance might be less useful for smallscale studies and may be misleading if their low test
power is not considered.
The primary question of the current study has
been met; music therapy is an effective treatment for
children and adolescents with psychopathology. The
next, more complex and clinically relevant question
to be addressed is: which form of music therapy in
which setting is most effective for what child to
achieve what kind of outcome?

Author note
Conclusion
The clinical implication of this meta-analysis is that
music therapy is an effective intervention for children and adolescents with psychopathology. Music
therapy produces a clinically relevant effect of a
considerable size and is therefore recommended for
clinical use.
Specifically, clients with behavioural or developmental disorders, or with multiple psychopathologies, may benefit from music therapy. Music
therapy for children and adolescents with psychopathology appears to be especially helpful when
techniques from different music therapy approaches
are combined.
Our review suggests the need for studies on the
efficacy of models of music therapy that are currently
practised in Europe, and the effectiveness of music
therapy in clinical settings. If the findings can be
replicated for varying models and settings, this will
strengthen their clinical applicability. Our findings
provide an empirical basis for planning and conducting larger-scale studies on music therapy with
children. Studies with larger sample sizes will not
only have the advantage of increased statistical
power, they will also help to answer the question of
how the different variables involved influence each
other. Further, it is important to use multiple outcome measures to reflect the various dimensions
that are involved in the disorders and addressed in
music therapy. Scales that address overt behaviour
and were successfully used in previous studies (such
as the Child Behavior Checklist) are very valuable
tools that can facilitate comparisons of research results across studies in a growing culture of music
therapy research. However, irrespective of the
measure, research results can be used most efficiently if design and reporting of music therapy
studies are in compliance with the general standards
for clinical trials (cf. Moher, Schulz, & Altman,
2001).

Christian Gold, Faculty of Health Studies, Sogn og

Fjordane University College, Sandane, Norway;
Martin Voracek, Department of Psychology, Division
of Research Methods and Differential Psychology,
University of Vienna, Austria; Tony Wigram,
Department of Music and Music Therapy, Aalborg
University, Denmark.

Acknowledgements
Christian Gold was supported by Aalborg University,
Denmark, Andreas Tobias Kind Foundation, Hamburg, Germany, and Viktor Frankl Foundation,
Vienna, Austria; Martin Voracek was supported by
the Austrian Steering Committee for Psychotherapy
Research. We thank Maryanne L. Fisher and Elisabeth Jandl-Jager for valuable comments on an earlier version of this paper.

Correspondence to
Christian Gold, Faculty of Health Studies, Sogn og
Fjordane University College, 6823 Sandane, Norway;
E-mail: christian.gold@hisf.no

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Appendix
The variance of an effect size estimate d is given by

vi

1
1
d2

n1 n2 2n1 n2

(Cooper & Hedges, 1994) in the case of two

independent samples with n1 and n2 subjects,
respectively, and by

Effects of music therapy

vr

21
r
n

(Becker, 1988) for two related samples with n

subjects and correlation r between pre-test and
post-test. The inverse variance is used for weighting effect sizes. If r is large, a one-group study will
have a much smaller variance and will get a much
larger weight than a controlled study of the same
sample size. Therefore, it would not make much
sense to use these two formulas together when
combining effect sizes from both design types.
However, if r is set to zero and n n1 n2, vi is
equal to vr plus a correction term which is usually
small:

1063

2 14d 2 21
0
1 1
d2

vr


n n 2n n
n
n
Therefore, vi can be applied for both design
types, and the relation between sample size and
weight is retained. As the most reasonable choice
from both the clinical and the statistical perspective, vi was used in all analyses where effect
sizes from both design types were combined (all
analyses except those in Table 2). In the analyses
in Table 2, vr was used because all effect sizes
were from related samples. The sample size
displayed is always the number of subjects (i.e.,
n1 + n2 in controlled studies, n in one-group
studies).
vi