From Melody to Pragmatics: A Randomized Controlled Trial of Melodic Intonation Training for Pragmatic Communication in ASD

Abstract

Autism spectrum disorder (ASD) is marked by enduring difficulties in social communication, particularly in the pragmatic use of language. Standard speech-language therapies for school-aged children often bring only limited gains in this area. In contrast, music-based methods—especially those that employ melodic intonation—have shown encouraging effects on related skills such as prosody and social engagement, yet their impact on pragmatic language has not been thoroughly tested. To address this gap, we carried out a randomized controlled trial (RCT) with 60 verbally able children with ASD aged six to eleven, all presenting significant pragmatic language impairments. Participants were randomly allocated either to a Melodic Intonation Training (MIT) program or to a control condition that provided conventional pragmatic language therapy of equal duration. Over eight weeks, the MIT group practiced singing and intoning common social phrases, while the control group received the same amount of standard therapy without musical elements. Pragmatic communication was evaluated before and after intervention using the Pragmatic Language Skills Inventory (PLSI) together with structured observational measures. Children who underwent MIT achieved markedly greater improvements than those in the control group. After the eight-week program, the MIT group gained on average about 8.7 points on the PLSI compared with a 1.8-point mean gain in the control group, yielding a large between-group effect size (d≈0.8) and a significant group-by-time interaction (p<0.001). Moreover, within the MIT group, the extent of pragmatic improvement correlated positively with increases in vocal intonation during speech. These results demonstrate that melodic intonation training can produce meaningful, measurable gains in pragmatic communication for children with ASD, outperforming conventional therapy alone. By weaving melody and prosody into language practice, such programs may recruit alternative neural pathways and foster more natural social-communication skills. Larger trials with extended follow-up will be important to confirm the durability of these benefits and to refine the training protocol for broader clinical use.