nature.com

Music intervention for neurodevelopment in the pediatric population: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aim to summarize and analyze current research on the effects of MI on neurodevelopment in children of all ages and health statuses to provide a reference for music therapy (MT) and its clinical research in pediatrics. We conducted a comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library databases up to December 2023, focusing on randomized controlled trials that evaluated neurodevelopmental outcomes following MI. Our analysis, which included seven studies involving 337 participants, employed standardized mean difference (SMD) calculations to assess outcomes across multiple neurodevelopmental scales. While no significant cognitive improvements were observed on the Bayley-III scale, positive effects were noted in language, motor skills, and IQ scores when assessed via Gesell, CSBQ, and IQ scales. Our research underscores the potential of music intervention in the process of children’s neurodevelopment, including cognitive function, language, motor and IQ. Based on the limitations, researchers should carefully design their MI protocols, ensuring standardization and avoiding probable confounding factors such as regional specificity, age ranges and special populations, it will contribute to more robust results and improve the comparability of findings across studies.

Introduction

Music therapy (MT) is a well-established modality that complements standard treatments for numerous pediatric conditions1. Music and music intervention (MI) play a central role in MT, encompassing a spectrum of activities, including active forms such as creating music or playing instruments and receptive forms like listening, often conducted by certified music therapists2. MT has been recognized for its neurotherapeutic potential3, with engagement in music promoting neural plasticity4 and inducing changes in the grey and white matter5, predominantly in the frontotemporal regions. Such neurobiological impacts highlight the therapeutic efficacy of music, as evidenced by the accelerated recovery of patients post-major surgeries6,7.

Childhood represents a critical period for neural development, with various scales developed to quantitatively assess children’s neurological progress across behavioral, motor, language, and cognitive domains8. These developmental metrics emphasize the significance of early neurodevelopmental trajectories and the potential long-term implications of disruptions. Research demonstrated that the functional development of brain cells and signal transmission require stimulation from substantial amounts of appropriate information9. Specifically, external sensory stimulation (such as hearing and tactile perception) plays a vital role in neuronal growth, the establishment of synapses, and neural signal conduction within the brain10,11. At the same time, Research has consistently demonstrated that interventions during this sensitive period can significantly mitigate the risks of developmental disorders, highlighting the necessity for early and targeted interventions to ensure optimal neurological development in children12.

Currently, research on the application of MI in pediatric neurodevelopment is limited and uncertain. Existing studies mainly focus on specific subsets, such as preterm infants13, rather than overall covering the full range of ages across childhood, including children and adolescents. Therefore, our study aims to extend these insights to the entire pediatric population to obtain continuous, extensive and scientific research results. Meanwhile, evaluating the effectiveness of neurodevelopmental scales in related research was also a key objective. Expanding research subjects and results could provide a more thorough understanding of the potential neurological benefits of MI across the entire stage of childhood and serve as a significant reference for future research on MT in pediatric neurodevelopment, including patients diagnosed with neurological diseases.

Methods

Search strategy and selection criteria

Four databases, PubMed, Embase, Web of Science, and Cochrane Library, were used for studies on the effectiveness of MI in pediatric neurodevelopment, and all retrieval results from the database were completed on December 13, 2023. Using the PICOS framework according to the Cochrane Handbook for Systematic Reviews of Interventions14, we set “music intervention” as “Intervention” and “neurodevelopment” as “Outcome.” As to the “Outcome,” neurodevelopmental scales, such as Bayley-III, Gesell, and Wechsler, were included. “Participants” were set as pediatrics, including infant, toddler, and premature. Search strategies varied slightly across databases (Stable 1). Two authors (Jiang and Zhang) independently searched and screened the relevant literature. EndNote 20 software was utilized to delete duplicates and non-pediatric literature. After that, Full texts of eligible articles were independently assessed for meta-analysis by Jiang, Liu and Wang, with disagreement resolved through discussions with Lin, Wang, and Zhang.

Data extraction

A data extraction form was developed to extract the suitable data including (1) study characteristics (authors, publication year, and country); (2) participant characteristics (sample size, mean age, sex ratio, and types of neurodevelopmental assessments); (3) study design and methodological quality (random allocation, blinding, selection process of participants, loss to follow-up); (4) details of the music interventions (method, music style, and use of equipment); (5) outcome measures and statistical data (types of neurodevelopmental scales and results of neurodevelopmental assessments). Data extraction was independently conducted by two authors (Jiang, Liu and Wang), with disagreements resolved through discussions with another pair of authors (Lin, Wang, and Zhang).

Assessment of risk of bias

Three authors (Jiang, Liu and Wang) independently assessed the risk of bias in the included studies using the Cochrane Collaboration tool15. They evaluated 7 specific items for quality and bias: (1) Random sequence generation, (2) Allocation concealment, (3) Blinding of participants and personnel, (4) Blinding of outcome assessment, (5) Incomplete outcome data, (6) Selective reporting, and (7) Other bias. Each item was classified as “low risk,” “unclear risk,” or “high risk” based on the study details. Discrepancies were resolved through discussions with Lin, Wang, and Zhang.

Statistical analysis

Continuous outcome data were analyzed using standardized mean differences (SMD) with 95% confidence intervals (CIs), focusing on neurodevelopment scores post-intervention for both music intervention and control groups. The longest follow-up time point was selected for time-varied outcomes, with professional reports prioritized for multiple assessments. Missing SD or 95% CIs were estimated from available statistical measures. Statistical heterogeneity was assessed using I² statistics. A fixed-effect model was applied for low heterogeneity (I2 < 50%), whereas a random-effects model was employed when substantial heterogeneity was present (I2 ≥ 50%), interpreted as “small” (0.2), “medium” (0.5), or “large” (0.8). P-values were two-sided, with 0.05 marking significance. Publication bias was explored using funnel plots and Egger’s regression16.

Results

Identification of eligible studies

Figure 1 illustrates the result of our screening process. The titles and abstracts of all identified articles were assessed for eligibility based on the following inclusion criteria: (1) randomized controlled trials; (2) intervention group receiving music intervention with rhythm, melody, and harmony; (3) outcomes including neurodevelopmental measures; (4) participants aged under 18 years. Exclusion criteria were as follows: (1) reviews, protocols, conference papers, case reports, letters, and editorials; (2) control group received music components; (3) studies lacking sufficient meta-analysis data. We identified 8719 articles using our search strategy. Duplicate articles (n = 4506) and irrelevant abstracts (n = 4048) were excluded. Finally, 7 articles out of 165 available full-text articles were included in this meta-analysis.

Fig. 1

figure 1

Study flow diagram.

Full size image

Patient populations and study characteristics

The analysis included seven studies published between 2014 and 2023, encompassing 337 participants were included (Table 1). The sample sizes of each study ranged from 17 to 79. 4 studies included infants17,18,19,20, while 3 studies21,22,23 included preschool participants in the analysis. The studies were conducted by researchers from around the world, including Europe (n = 5), Asia (n = 1)20, and Australia (n = 1)23. We identified 6 parallel-group RCTs and 1 cross-over RCT23. All trials were single-center studies except for one multi-center trial23. Based on the particularity of MI, we identified different MI types, frequencies, and durations, including recorded music17,20,21, rhythmic form23, creative music therapy18,19, and music lessons22. Standardized care referred to the control group received routine care without any music education/training during interventions.

Table 1 Summary characteristics of included studies.

Full size table

As to the neurodevelopment measurements, quantitative scales were used in all 7 studies. Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) were primarily used in 4 studies17,18,19,21. The Stanford-Binet Intelligence Scale, Fourth Edition (TSB)22, the Gesell Development Scale20, and the Child Self-Regulation and Behavior Questionnaire (CSBQ)23 were used in different 3 studies. As to the aspects of the neurodevelopmental measurement, the 4 scales covered different aspects of neurodevelopment from cognitive scores, language scores, and motor scores to behavioral scores and general intelligence scores. As to the attrition bias, 3 studies exhibited a high risk of bias for their incomplete cohort assessment17,20,23.

Quality of the included articles

The general risk of bias in the included studies varied from “Low” to “High” risk of bias, with many areas described as “Unclear” due to missing detailed descriptions. The risk of bias is described in the overview in Fig. 2 and detailed in Fig. 3. MI was administered by professional music therapists in only two studies with a low risk of performance bias17,21, while others had a high risk of performance bias. Notably, two studies lacked standard deviation data19,21. To facilitate data analysis, we extracted the maximum and minimum values of the standard deviation in another entirely data-driven study that matched a similar population17, and in those two studies, random values of this interval were used as the standard deviation for subsequent analyses.

Fig. 2

figure 2

Risk of bias graph.

Full size image

Fig. 3

figure 3

Risk of bias summary.

Full size image

Cognitive outcomes for Bayley-III and CSBQ

No significant effect of MI on cognitive scores was observed compared to standard care by Bayley-III and CSBQ (Fig. 4, n = 122, 4 studies; MD 0.47; 95% CI −3.29 to 4.23; P = 0.81). With the scale of Bayley-III, 4 studies showed a minor change in cognitive neurodevelopment, and no significant difference was found in cognitive development either of CSBQ (Intervention 3.34 V.S. Control 3.3, n = 79). Due to differences in CSBQ23 methodology compared to Bayley-III, Fig. 4 restricted the inclusion of CSBQ results.

Fig. 4

figure 4

Comparison: music intervention versus control, outcome 1: cognitive score.

Full size image

Language outcomes for Bayley-III and Gesell

Figure 5 shows that although the MD for language scores was the lowest among comparisons, no significant decrease was observed in the language score following intervention (n = 122, 4 studies; MD -4.14; 95% CI -11.85 to 3.56; P = 0.29). One study reported a significant decrease in the language score through Bayley-III21, but the children participating in the trial were all preterm infants, and the number was less than 10. In contrast, the Gesell Development Scale20 showed a significant increase in language development (Intervention 92.29 V.S. Control 87.05, n = 21 V.S. 19, P = 0.023).

Fig. 5

figure 5

Comparison: music intervention versus control, outcome 2: language score.

Full size image

Motor outcomes for Bayley-III, Gesell and CSBQ

No significant difference was found in motor scores of Bayley-III (Fig. 6, n = 122, 4 studies; MD -0.73; 95% CI -4.77 to 3.31; P = 0.72). However, significant improvements were observed in motor scores of Gesell20, including the gross motor (Intervention 95.43 V.S. Control 91.05, n = 21 V.S. 19, P < 0.001) and the fine motor (Intervention 93.24 V.S. Control 90.32, *n* = 21 V.S. 19, *P* = 0.016). Similarly, CSBQ23 scores showed significant improvements (After intervention 3.76 V.S. Before intervention 3.29, n = 79, P = 0.003).

Fig. 6

figure 6

Comparison: music intervention versus control, outcome 3: motor score.

Full size image

General IQ outcomes for TSB

It was quite a pity that only one study measured the IQ in the MI groups22. The music lessons were treated to 30 preschool children as the MI. After the music lessons, an average increase of 5 was observed in the general IQ in the MI group. Compared to the control group, there was a significant main effect for assessment (P < 0.001).

Discussion

This meta-analysis represents the first comprehensive and overall review of the impact of MI on the neurodevelopment of children across all age groups. The study, involving 337 participants, revealed significant effects on some neurodevelopmental scales such as Gesell, CSBQ and TSB, with implications for the potential and positive effects on cognitive, language, motor skills, and IQ. Our findings indicate that MI led to significant improvements on the Gesell, CSBQ, and TSB scales in several parameters, while no significant differences were observed in Bayley-III scales.

Music therapy may play a crucial role in enhancing cognitive functions in children. Evidence suggests that MI promotes neurobiological processes by facilitating the differentiation, activation, readjustment, and growth of neurons24,25. Studies have shown that engagement with music can improve various cognitive abilities, including attention, memory, and executive functions26. This is particularly evident in tasks that require the manipulation of information in the brain, where trained musicians exhibit superior memory and organizational skills.

Our research identified cognitive function as a key index for evaluating neurodevelopment, as over half of the research studied focused on cognitive improvement. Both the Bayley-III and CSBQ scales, which assess cognitive function, revealed no significant effects of MI on the development of cognitive scores compared to standard care23. The study utilizing the CSBQ established a metered model that differs from other research, potentially obscuring the findings23, implying that consistencies in participant demographics might serve as a key factor that may influence the results and should be paid more attention during the future research design process. Future research could explore the effectiveness of MT on cognitive function.

Music therapy has a significant impact on language development. Structured musical activities enhance linguistic abilities by engaging critical areas of the brain, such as Broca’s and Wernicke’s areas, which are essential for language processing. Research has demonstrated that children participating in musical training displayed improved reading skills and phonemic awareness18, suggesting that the rhythmic and melodic aspects of music support the acquisition and development of language skills. Our study found a significant improvement in language development on the Gesell scale (n = 43, P = 0.023)20, while no difference was found in the studies with the Bayley-III scale. We considered the high heterogeneity in the language score was due to the low sample size in one study (n = 18)21, which also indicated us a larger sample size was needed and important in the future study design.

Additionally, music therapy contributes to motor skill development. Activities, such as playing an instrument, involve fine motor control, coordination, and timing, all of which are transferable to other areas of motor development. One research indicates that children engaged in regular musical training show enhanced motor abilities and structural brain changes in regions associated with movement coordination26. Our findings on the Gesell scale revealed significant improvements in both the gross motor and fine motor skills after the MI (n = 40, P < 0.001 in gross motor, P = 0.016 in fine motor), indicating the potential benefits of MI on the motor skill, the related application needs more exploration in the future.

Enhancing IQ is one of the most significant outcomes of music therapy in children. Studies have found that music lessons can lead to measurable improvements in IQ scores. However, our review revealed mixed results, which may stem from variations in study designs and the intensity of musical training. This underscores the need for more controlled studies to better understand the relationship between music therapy and IQ development.

In our research, regarding the evaluation tools that were most widely used in pediatrics with higher evaluation validity,, we further analyzed the Bayley-III and the Gesell Scale that had similar modules. The Bayley-III scale27, typically designed for infants, is an ability test of global development28. It contains 5 domains in the assessment: cognitive, language (receptive and expressive) and motor (fine and gross). The Gesell scale is a screening test for demonstrating developmental quotients in the 5 fields: gross motor, fine motor, adaptive behavior, language and personal-social behavior29. The Bayley-III, which was measured on the participants (n = 122) in our study, did not capture significant results, while the Gesell Scale demonstrated more significant results. However, as noted in related pediatric research, the Gesell Scale was mostly used on moderate or late preterm infants in hospitalization, a relatively specific pediatric group. This specialization may limit the generalizability of the findings. At the same time, in the studies with Bayley-III, it was mostly used to evaluate the growth and development of normal children. Therefore, the selection of these two scales should fully consider the applicable population and their background to improve the credibility of the results in future applied research, and the potential confounding factors such as individual status (and age differences (including factors related to growth and development ) should also be identified and excluded to eliminate the effect on results in related meta-analysis researches. Meanwhile, the variability in outcomes across studies highlights the need for more standardized population and assessment scales in research methodologies to clarify music’s role in the function of cognitive, language, motor, and IQ.

Furthermore, the stimulated effect of music on the brain system may vary between temporary and sustainable outcomes, with duration and frequency potentially influencing research consequences in the neurodevelopment of different subjects. Current intervention programs often focus on hospitalized or preterm infants with different durations and frequencies. To understand its function and mechanism, future research should consider standardizing the duration, frequency, music methods, and environment from MI or MT to verify different research. Despite ongoing progress in neuroscience regarding the interaction between music and brain electrical signals25, positive clinical outcomes will continue to support research advancement in this field.

Limitation

Our study has several important limitations that warrant emphasis. First, the included MI protocols exhibited substantial regional and cultural variability—unlike standardized tools or methods, which limited cross-study comparability. It underscored the urgent need for standardized MI protocols in future research. Additionally, while we systematically included all eligible RCTs in children, the current sample size remains small and is not enough. Although we tried to broaden the scope of research, targeting the 0–18 age range, confirmed the consistency of the subjects on age in each article. Nevertheless, there is no existing study that spanned the entired developmental period (0–18 years old), factors related to growth and development across different research may influence the results of review or meta-analysis research, and may be a breakthrough point that warrants our future exploration. Furthermore, the studies involved participants from diverse geographic regions, inherent cultural or sociocultural context across different research in our meta-analysis, it might be a probable confounding factor that had an influence on the results. By delineating these limitations, we aim to catalyze efforts toward standardized MI protocols and larger-scale, lifespan-focused RCTs, ultimately enhancing the validity and cross-study comparability of research in the future. We hope our systematic synthesis could make a reference for future research with a overall insight and basic understanding on children aged from 0 to 18 years old and encourage more robust RCTs research in this area.

Conclusion

In summary, our research underscores the potential of music intervention in the process of children’s neurodevelopment, including cognitive function, language, motor skills and IQ. Based on the limitations, future research should carefully design its MI protocols, ensuring standardization and avoiding probable confounding factors such as regional specificity, age ranges, special populations, etc.

Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

Abbreviations

CIs:

Confidence intervals

CSBQ:

Child self-regulation and behavior questionnaire

MI:

Music intervention

MT:

Music therapy

SMD:

Standardized mean differences

TSB:

The stanford-binet intelligence scale

References

Zhang, D. et al. Music therapy in pediatric asthma: A short review. J. Asthma Allergy 16, 1077–1086 (2023).

PubMedPubMed CentralMATHGoogle Scholar

Bhandarkar S, Salvi B V, Shende P. Current scenario and potential of music therapy in the management of diseases. Behav. Brain. Res. 458, 114750 (2024).

PubMedMATHGoogle Scholar

Stegemann T. et al. Music therapy and other music-based interventions in pediatric health care: an overview. Medicines (Basel) 6(1). (2019).

Chatterjee D, Hegde S, Thaut M. Neural plasticity: the substratum of music-based interventions in neurorehabilitation. NeuroRehabilitation 48 (2), 155–166 (2021).

PubMedPubMed CentralMATHGoogle Scholar

Zuk, J. et al. Neurobiological predispositions for musicality: white matter in infancy predicts school-age music aptitude. Dev. Sci. 26 (5), e13365 (2023).

PubMedPubMed CentralMATHGoogle Scholar

Karpati F J, Giacosa C, Foster N E V, et al. Dance and music share gray matter structural correlates. Brain Res. 1657, 62–73 (2017).

PubMedMATHGoogle Scholar

Sihvonen A J, Särkämö T, Leo V, et al. Music-based interventions in neurological rehabilitation. Lancet Neurol. 16 (8), 648–660 (2017).

PubMedMATHGoogle Scholar

Wang, S. The neuroscience of music; a review and summary. Psychiatr. Danub. 30 (Suppl 7), 588–594 (2018).

PubMedMATHGoogle Scholar

Blankenship A G, Feller M B. Mechanisms underlying spontaneous patterned activity in developing neural circuits. Nat. Rev. Neurosci. 11 (1), 18–29 (2010).

PubMedMATHGoogle Scholar

Sur, M. & Rubenstein, J. L. Patterning and plasticity of the cerebral cortex. Science 310 (5749), 805–810 (2005).

ADSCASPubMedMATHGoogle Scholar

Katz L C, Shatz C, J. Synaptic activity and the construction of cortical circuits. Science 274 (5290), 1133–1138 (1996).

ADSPubMedMATHGoogle Scholar

Pascal, A. & Govaert, P. Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade: a meta-analytic review. Dev. Med. Child. Neurol. 60 (4), 342–355 (2018).

PubMedMATHGoogle Scholar

Allen, K. A. Music therapy in the NICU: is there evidence to support integration for procedural support? Adv. Neonatal Care 13 (5), 349–352 (2013).

PubMedMATHGoogle Scholar

Chandler, J. et al. Cochrane Handbook for Systematic Reviews of Interventions (Wiley, 2019).

Higgins, J. P. et al. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. Bmj 343, d5928 (2011).

PubMedPubMed CentralMATHGoogle Scholar

Egger M. et al. Bias in meta-analysis detected by a simple, graphical test. Bmj 315 (7109), 629–634 (1997).

CASPubMedPubMed CentralMATHGoogle Scholar

Lejeune F. et al. Effects of an early postnatal music intervention on cognitive and emotional development in preterm children at 12 and 24 months: preliminary findings. Front. Psychol. 10, 494 (2019).

PubMedPubMed CentralGoogle Scholar

Haslbeck F B, Bucher H U, Bassler D, et al. Creative music therapy and neurodevelopmental outcomes in pre-term infants at 2 years: A randomized controlled pilot trial. Front. Pead., 9. (2021).

Haslbeck F B, Adams M, Schmidli L, et al. Creative music therapy for long-term neurodevelopment in extremely preterm infants: results of a feasibility trial. Acta Paediatr. 112 (12), 2524–2531 (2023).

MATHGoogle Scholar

Gao, H. et al. Effect of combined procedural pain interventions during neonatal intensive care on sleep, cognitive development, and internalizing behavior: a follow-up analysis of a randomized controlled trial. Pain 164 (8), 1793–1800 (2023).

PubMedMATHGoogle Scholar

Slevin, M. et al. Therapeutic listening for preterm children with sensory dysregulation, attention and cognitive problems. Ir. Med. J. 113 (1), 4 (2020).

MathSciNetCASPubMedMATHGoogle Scholar

Kaviani H. et al. Can music lessons increase the performance of preschool children in IQ tests?. Cogn. Process. 15 (1), 77–84 (2014).

PubMedMATHGoogle Scholar

Bentley L A, Eager R, Savage S, et al. A translational application of music for preschool cognitive development: RCT evidence for improved executive function, self-regulation, and school readiness. Dev. Sci. 26 (5), e13358 (2023).

PubMedGoogle Scholar

Rickard N S, Toukhsati S R, Field S E. The effect of music on cognitive performance: insight from Neurobiological and animal studies. Behav. Cogn. Neurosci. Rev. 4 (4), 235–261 (2005).

PubMedGoogle Scholar

Vuust, P. et al. Music in the brain. Nat. Rev. Neurosci. 23 (5), 287–305 (2022).

CASPubMedMATHGoogle Scholar

Forgeard M. et al. Practicing a musical instrument in childhood is associated with enhanced verbal ability and nonverbal reasoning. PLoS ONE 3 (10), e3566 (2008).

ADSPubMedPubMed CentralGoogle Scholar

Haslbeck F B, Mueller K, Karen T, et al. Musical and vocal interventions to improve neurodevelopmental outcomes for preterm infants. Cochrane Database Syst. Rev. 9 (9), Cd013472. (2023).

Bayley N. Bayley scales of infant and toddler development. Psychol. Co (2006).

Dukes L, Buttery T J. Comparison of two screening tests: Gesell developmental test and meeting street school screening test. Percept. Mot. Skills 54 (3 Pt 2), 1177–1178 (1982).

CASPubMedGoogle Scholar

Download references

Author information

Author notes

Daiji Jiang and Xiaowei Liu contributed equally to this work.

Authors and Affiliations

Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children’s Medical Center, National Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China

Daiji Jiang

Department of Traditional Chinese Medicine, Shanxi Provincial People’s Hospital, No. 256 Friendship West Road, Xi’an, Shaanxi Province, China

Xiaowei Liu

Office of Pediatrics, Pediatric College, Shanghai Jiaotong University School of Medicine, No. 227 South Chongqing Road, Shanghai, 200025, China

Qian Lin & Dandan Zhang

Shanghai Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China

Qian Lin & Dandan Zhang

Minhang Vocational and Technical College, 4080 Yuanjiang Road, Minhang District, Shanghai, 201111, China

Guyi Wang

National Center for Mental Health, No.7 Yinghuayuan west street, Chaoyang District, Beijing, 100029, China

Gang Wang

Key laboratory of artificial intelligence music therapy, Shanghai Conservatory of Music, No. 20 Fenyang Road, Shanghai, 200031, China

Dandan Zhang

Authors

Daiji Jiang

View author publications