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NEUROLOGICAL MUSIC THERAPY (NMT) IN AUTISM SPECTRUM
DISORDER (ASD): EVIDENCE, INTERVENTIONS, AND MEASURABLE
CLINICAL POSSIBILITIES FOR BRAZIL
Francisco Narthagnan Chaves da Silva1
Abstract: Autistic Spectrum Disorder (ASD) involves persistent changes in communication, social
interaction and restricted and repetitive patterns of behavior. Neurological Music Therapy (Neurologic
Music Therapy - NMT) is an international therapeutic model based on neuroscience, composed of
20 standardized techniques that allow measurable interventions in the motor, linguistic and cognitive
domains. This article deepens the neurobiological mechanisms underlying the NMT and discusses its
applications in ASD, gathering recent scientic evidence that points to gains in motor coordination,
attention, engagement and functional communication. Internationally, NMT is recognized as evidence-
based practice and used in rehabilitation centers in Canada, the United States and Europe. In Brazil,
however, its diffusion is still limited. Based on the experience of the author - neuropsychologist,
neurotherapist, behavioral analyst, member of the World Federation for NeuroRehabilitation (WFNR),
autistic individual and father of autistic children - this work proposes the NMT as a valid, safe and
necessary tool in the eld of neurorehabilitation and autism.
Keywords: Neurological Music Therapy. Autism. Neuroscience. Executive functions.
Neurodevelopment.
1 Neurologic Music erapy – NMT) -7118, Neuropsychologist CRP-11/16268, Behavior
Analyst (IBAO), Master of Education, PhD in Psychology
INTRODUCTION
Autistic Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by
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persistent decits in communication and social interaction, as well as by restricted and repetitive
patterns of behavior, often accompanied by sensory, motor and cognitive changes. The clinical
complexity of ASD requires integrated interventions, based on scientic evidence and able to dialogue
with the multiple dimensions involved in child development.
Neurological Music Therapy (Neurologic Music Therapy – NMT) emerges as a systematized,
neuroscience-based clinical model that uses music – especially rhythm – to modulate neural networks
associated with motricity, language and cognitive functions (THAUT; HOEMBERG, 2014). Comprising
of 20 standardized techniques supported by neuroimaging, neurophysiology and rehabilitation studies,
NMT differs from other forms of music therapy due to its emphasis on measurement, replicability and
standardization of procedures (ACADEMY OF NEUROLOGIC MUSIC THERAPY, 2022).
The author of this article acts as a neuropsychologist, certied neurological music therapist,
behavioral analyst and member of the World Federation for NeuroRehabilitation (WFNR), with
experience in the evaluation and intervention in children with ASD. In addition, he is an autistic
individual and father of autistic children, which gives him a unique perspective on the impact of
therapeutic interventions on the daily lives of families.
In countries such as Canada and the United States, NMT is recognized as evidence-based
practice and integrates hospital services, rehabilitation centers and programs specialized in autism.
In Brazil, however, the approach remains little known, practically absent in the national scientic
literature and little explored in public health and education policies.
The aim of this article is to present the NMT as an evidence-based practice applicable to ASD,
focusing on: (a) robust theoretical foundation on brain functioning in front of music; (b) description
of empirical evidence; (c) analysis of the possibilities of intervention in language, motricity and
cognition; and (d) discussion about the need for its diffusion in the Brazilian context.
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THEORICAL FUNDING
Music as a multisystemic neurological experience
Music is one of the most complex stimuli processed by the nervous system. Its structure
involves acoustic, temporal and emotional components that simultaneously activate networks
distributed by much of the brain. Functional neuroimaging studies show that listening, producing or
imagining music triggers:
• the primary and secondary auditory cortex (analysis of sound attributes);
• the pre-motor cortex and supplementary motor areas (planning and movement
preparation);
• the motor cortex (implementation of rhythmic and synchronized movements);
• cerebellum (coordination, temporal prediction and rhythmic adjustment);
• the ganglia of the base (sequencing, internal rhythm, selection of actions);
• the limbic system (emotion, motivation and affective memory);
• attention and protrusion networks (relevant stimulus selection and focus maintenance);
• the arched fascicle and perisilvian regions (language, prosody and auditory-motor
integration).
The highly integrated nature of music allows it to act as a powerful tool for reorganization of
emotional, cognitive, motor and social functions frequently affected dimensions in ASD.
Rhythmic entrainment and temporal prediction
A central concept of the NMT is the rhythmic entry, that is, the ability of the nervous system
to synchronize internal patterns (motor, attentional, emotional) to a rhythmically stable external
stimulus. In practice, this is observed when a child claps his hands at the time of music, adjusts the
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march to a metronome or accompanies with the body the rhythmic pulse of a song.
From a neurobiological point of view, the entry involves:
• temporal prediction (precipitation of the next pulse or accent);
• coupling between auditory cortex, premotor cortex, cerebellum and base ganglia;
• oscillatory coherence (organization of neural oscillations according to external rhythm);
• reduction of motor variability;
• greater stability in behavior control.
In individuals with ASD, difculties in temporal prediction, motor timing instability and
variability in attentional responses are frequent. The musical rhythm, by providing a clear and
predictable time pattern, works as an external neurological organizer, decreasing internal processing
demand and favoring a more stable synchronization of motor and cognitive responses.
Brain differences in ASD and NMT relevance
Neuroscientic literature indicates that ASD is associated with changes in functional and
structural connectivity of the brain, particularly in networks that sustain sensory-motor integration,
timing, attention and predictability.
Atypical connectivity
Many studies describe, in ASD, a pattern of local hyperconnectivity and long-distance
hypoconnectivity, especially between frontal and posterior regions. This may hinder the integration
of sensory, motor and cognitive information, generating sensory overload, difculty in “uniting the
parts” of a situation and challenges in adapting to the context. Music, by structuring the temporal
ow of stimuli and reducing unpredictability, helps organize this sensory experience, making it more
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predictable and bearable.
Changes in cerebellum and base ganglia
Cerebellum plays a crucial role in motor coordination, temporal prediction and movement
adjustment, while base ganglia are involved in sequencing, selection of actions and internal rhythm.
In autistic individuals, morphological and functional studies report abnormalities in the cerebellum
and base ganglia, which are associated with:
• motor coordination difculties;
• increased timing variability;
• problems of movement initiation and termination;
• presence of stereotyped and repetitive movements.
These changes make interventions using rhythm and music especially relevant as a way to
stimulate and reorganize these networks.
Leaning and attentional control network
The Salience Network, responsible for detecting relevant stimuli and helping the brain to
alternate between rest states and focus states, also presents functional differences in ASD. Autistic
children often nd it difcult to keep their attention in structured tasks, to alternate focus gently or
to prioritize important stimuli in a complex environment. Music, because it is highly engaging and
predictable, activates this network intensely, facilitating the maintenance of focus, joint attention and
engagement in therapeutic activities.
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Hypo/Hyper-sensory reactivity
Many children with ASD have hyper or hyporeactivity to sensory stimuli. Music, when used
with control of intensity, time and density of information, functions as a graduated and predictable
auditory stimulus, which allows:
• reduce anxiety against sounds;
• increase sensory tolerance;
• structure the auditory experience in a less chaotic way.
Music, language and communication
Speech production depends on a complex integration between auditory perception, linguistic
processing, motor planning and temporal control of the orofacial muscles. In ASD, especially in cases
with speech apraxia, minimal speech or atypical prosody, these steps may be deeply disorganized.
Music plays a privileged role in this context by:
• intensely activate the arched fascicle, which connects receptive and expressive language
areas;
• provide a melodic contour (tonal height) and rhythmic (temporal pattern) that organizes
the syllable sequence;
• reduce the load of motor planning by turning speech into singing or rhythmic speech.
Techniques like Musical Speech Stimulation (MUSTIMTM) use songs, melodic phrases
and rhythmic intonations to stimulate propositional speech, taking advantage of the fact that many
individuals can sing excerpts from familiar songs even when they have great difculty to speak
spontaneously. The Rhythmic Speech Cueing (RSC®) apply external rhythm (metronome, percussion)
to improve prosody, uency and speech speed, being useful in cases of monotonous speech, accelerated,
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fragmented or irregular pauses.
Music, cognition and executive functions
Executive functions – attention, working memory, cognitive exibility, planning and
inhibitory control – are often affected in ASD. Musical stimuli activate prefrontal and temporal
regions involved in these functions, offering a rich context for their training.
At NMT, the Musical Attention Control Training (MACTTM) structure musical tasks to
train selective attention (reply only to a specic sound pattern), alternating attention (change the focus
between different stimuli) and sustained attention (maintain response over time). O Musical Executive
Function Training (MEFT®) it uses guided improvisation, composition and organization of musical
sequences to train planning, monitoring of behavior and cognitive exibility, requiring the individual:
• initiate actions;
• maintain sequences;
• adjusts responses to changes in rules;
Share shifts in group musical activities.
Music, emotion and motivation
The limbic system responds intensely to music, which can evoke emotions, memories and
alert or relaxation states. In children with ASD, who often have difculties in emotional regulation,
behavioral crises and resistance to traditional interventions, music:
• increases the intrinsic motivation for engagement in activities;
• reduces anxiety;
• improves tolerance to frustrations;
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• strengthens the therapeutic bond;
• creates a more predictable and welcoming environment.
Thus, NMT benets not only from the motor and cognitive effects of music, but also from its
motivational and affective impact.
NMT as standardized and evidence-based model
NMT is not an intuitive application of music in the clinic, but a structured model that:
• has 20 standardized techniques distributed in three domains (motor, language and
cognition);
• use Transformational Design Model (TDMTM) to transform non-musical objectives into
specic and measurable musical tasks;
• requires specic training and international certication;
• it is recognized in neurorehabilitation guidelines in several countries.
This standardization ensures that interventions are replicable, documentable and evaluable,
aligning the NMT with the contemporary paradigm of evidence-based practices.
Neurobiological parallels between Parkinson’s and ASD in the context of MMT
In countries like the Canada, Neurological Music Therapy (NMT) is widely recognized
as evidence-based intervention for conditions such as Parkinson’s Disease, being used in
neurorehabilitation centers due to its effectiveness in the rehabilitation of motor timing, coordination
and temporal prediction (THAUT; ABIRU, 2010). In these applications, NMT directly stimulates
structures such as the cerebellum, Base ganglia and routes pre-motors, responsible for motor
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sequencing, temporal stability and auditory-motor synchronization.
Although Parkinson and ASD are distinct conditions in their etiology, studies have shown
that many autistic children present alterations in these same neurofunctional structures. Studies show
consistent abnormalities in the cerebellum in individuals with ASD (FATEMI et al., 2012), as well as
dysfunctions in the Base ganglia, associated with difculties in motor uency, regulation of repetitive
behaviors and temporal processing (FERNANDEZ, 2018). In addition, children with ASD present
signicant decits in temporal prediction, motor variability, sequential control of actions and internal
timing, patterns that dialogue with changes observed in motor conditions such as Parkinson’s disease
(MOSCONI et al., 2015).
Grahn and Brett (2007) demonstrate that the processing of rhythm and pulse depends heavily
on the integrity of the ganglia of the base, reinforcing the idea that rhythm-based musical interventions
can modulate decits shared by different neurological conditions that affect timing.
Thus, although there are still no direct comparative clinical studies between Parkinson and
ASD in the use of MMT, the neuroscientic literature indicates structural and functional parallels
sufciently robust to support the transfer of therapeutic principles of MMT among these populations.
The mechanisms by which MTM improves gait, cadence, temporal predictability and coordination in
Parkinson’s are neurobiologically applicable to decits observed in children with ASD, such as:
• engine timing instability;
• hypotonia and dyspraxia;
• difculties in the temporal organization of speech;
• high motor variability;
• behavioral stiffness dependent on repetitive patterns;
• executive decits related to sequencing and change of task.
Thus, the strong evidence base of MTM in motor conditions such as Parkinson strengthens
the neurobiological rational for its application in ASD, justifying the investment in specic studies
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and responsible clinical implementation of this approach with the autistic population.
Author’s note:
This articulation between Parkinson and ASD is a theoretical-clinical in-
terpretation based on the literature on timing, cerebellum, base ganglia and
auditory-motor processing. Although there is convergent evidence suppor-
ting such parallels (FATEMI et al., 2012; FERNANDEZ, 2018; GRAHN;
BRETT, 2007; MOSCONI et al., 2015; THAUT; ABIRU, 2010), there are
still no studies that directly compare the effects of MMT between these two
conditions. Therefore, this analysis should be understood as a plausible and
coherent scientic inference, not as established clinical equivalence.
EMT EMPIRICAL EVIDENCES IN THEA
Neurological Music Therapy (NMT) has accumulated evidence that demonstrates its
effectiveness in the care of populations with Autistic Spectrum Disorder. Although the literature is
still expanding, recent studies point to signicant improvements in motor, cognitive, sensory and
communicational areas.
Williams et al. (2024) investigated the effects of MMT in children with ASD using nine
sessions structured by teleservice. The authors identied statistically signicant improvements in
motor skills, especially in the coordination and precision of movement, indicating that the mechanisms
of entry can be effective even in remote formats.
Cibrian et al. (2020), in a randomized pilot clinical trial, compared two forms of delivery of
MMT: (a) use of traditional instruments and (b) use of a tactile-elastic device developed for sensory-
motor support. In both groups, they observed improvements in strength, stability, timing, and
coordination, reinforcing that the effectiveness of MMT is more associated with its neuroscientic
principles than with the type of instrument used.
Mayer-Benarous et al. (2021), in a systematic review, analyzed musical interventions
based on the foundations of neuroscience and concluded that they promote consistent benets in
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communication, social engagement, adaptive behavior, motor coordination and attention in children
with ASD.
Janzen and Thaut (2018) point out that decits in temporal prediction — widely recorded in
ASD — can be partially compensated by entrinment mechanisms, capable of stabilizing motor and
social behaviors through predictable external rhythms.
When structured interventions such as NMT are observed, considering auditory-motor
stimulation, the use of rhythm, reinforcement of temporality and sensory organization, a promising
window is opened to expand evidence-based clinical interventions in ASD.
NMT INTERVENTIONS IN THEA
NMT organizes its techniques in three functional domains: language, motority and cognition.
Each technique has a clear neuroscientic rationale, which explains how music inuences specic
neural systems.
Interventions for language
In ASD, communication decits can manifest as echolalia, monotonic prosody, fragmented
speech, speech apraxia or partial/total absence of speech. NMT uses:
Musical Speech Stimulation (MUSTIMTM)
He uses family melodic phrases to stimulate propositional speech. The melody reduces the
effort of motor planning, facilitating verbal initiation.
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Rhythmic Speech Cueing (RSC®)
It uses external rhythm as a metronome to train prosody, uency and speech cadence. It benets
especially children with apraxia, accelerated speech or decits in speech temporal organization.
Motricity interventions
Individuals with ASD often have hypotonia, dyspraxia, gait difculties, coordination
problems and motor variability. NMT uses:
Pattern Sensory Enhancement (PSE®)
It uses musical elements (rhythm, dynamics, timbre, height) to guide power, amplitude and
direction of movement.
Rhythmic Auditory Stimulation (RAS®)
Improves gait, cadence and postural stability using external rhythm. Evidence suggests that
it can also benet ASD in situations of instability and variation of motor timing.
Therapeutic Instrumental Music Performance (TIMP®)
Training bimanual coordination, strength, precision and range of motion using musical
instruments in functional patterns.
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Interventions for cognition
Executive functions — attention, memory, planning, exibility — are greatly impaired in
ASD. NMT works these areas with specic techniques:
Musical Attention Control Training (MACTTM)
Trains sustained, selective and alternating attention through responses to specic musical
patterns.
Musical Executive Function Training (MEFT®)
It uses improvisation, composition and sequential organization of musical elements to train
planning, inhibitory control and cognitive exibility.
Musical Mnemonics Training (MMTTM)
It employs music as a tool for coding and retrieval of information, facilitating memorization
of sequences, routines and academic contents.
Measurable variables in TDMTM
Transformational Design Model allows you to convert therapeutic goals into quantiable
indicators:
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Domain Te ch n iq ue Clinical Purpose Measurable Indicator
Language RSC® Fluency and prosody Synchronized syllables %; cadence
Engine PSE® Amplitude and force of movement ROM; isometric force
Engine TIMP® Bi-manual coordination the number of hits;
Cognition MACTTM Selective/sustained attention latency; rate of hits
Cognition MEFT® Planning / exibility number of sequences; changes
INTERNATIONAL USE OF NMT IN TEA SERVICES
The NMT has consolidated presence in three regions:
Canada – Reference centres
Example: Con Brio Music Therapy
Application of MMT in communication programs, motor coordination and emotional
regulation in children with ASD.
United States – Specialized clinics
Example: Optimal ACCESS
It integrates MMT as a central component in the multidisciplinary treatment of autism.
Europe – Neurorehabilitation Guidelines
The World Federation for NeuroRehabilitation (WFNR) recognizes the NMT as an evidence-
based approach to neuromotor disorders — justifying its expanded application to ASD populations
due to neurobiological overlaps in the cerebellum-ganglia systems of the base.
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These international models serve as a reference for the safe and qualied implementation of
NMT in Brazil.
CONCLUSION
Neurological Music Therapy (NMT) is one of the most promising and scientically based
interventions for Autistic Spectrum Disorder. Its use of rhythm, temporal organization and auditory-
motor stimuli acts directly in neural systems frequently affected in ASD, including cerebellum, base
ganglia, arched fascicle and attention networks.
The comparison with Parkinson’s disease, widely supported by evidence, contributes to
strengthen the neurobiological rationale of MTMN in autism, since both conditions share decits in
temporal prediction, motor variability and internal rhythm stability.
The efcacy demonstrated in international studies, together with the evidence emerging in
ASD, points out that Brazil needs to advance the implementation and study of MTM as a structured,
replicable and evidence-based intervention.
The adoption of NMT in the country requires scientic investment, specialized training and
integration in public health and education policies. With its broad applicability, predictability and
strong neurobiological basis, the NMT stands as an innovative, necessary and ethical tool to support
the development of autistic children and adolescents in Brazil.
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