Abstract
Recent estimates indicate that, conservatively, up to 5% of children in the United States have sufficient
behavioral and cognitive effects due to prenatal alcohol exposure that they qualify for a fetal alcohol spectrum
disorder (FASD). Children with an FASD experience a range of effects, including deficits in sensory, motor,
and executive functions, which are in turn related to poor long-term outcomes. However, few evidence-based
interventions are available for children with an FASD and, of these, only two target academic or cognitive skills.
Music training (MT) targets a complex array of skills including auditory and visual perception, multisensory
integration, attention, and working memory. These MT targets align well with the deficits experienced by
children with FASD and, therefore, MT may be well-suited for improving outcomes for these children. In this
project, we hypothesize that MT improves brain function and targeted skills via improvement in predictive
coding. The predictive coding framework posits that a primary role of the brain is to predict the environment
and optimize outcomes through identifying and correcting prediction errors. MT provides direct practice of
predictive coding when participants regularly produce sounds (environment) and adjust their behavior to
correct any errors (fix incorrect notes/timing). We further posit that this bottom-up training will help optimize
sensory, motor, and cognitive function relative to top-down strategies, leading to better outcomes.
Our pilot MT intervention in children with an FASD provided exciting evidence for acceptance of MT by
children and parents and for the occurrence of pre-/post-MT changes at the neural and behavioral level in
children with MT vs. those without MT. In the R61 phase, we will conduct a randomized cross-over study of a
12-week MT intervention relative to a music listening (ML) control period in a larger sample to examine
neurophysiological changes in predictive coding and behavioral effects due to MT in FASD in children 8-16
years of age. We will assess changes in 1) brain function using magnetoencephalography and
electroencephalography, 2) brain structure using structural magnetic resonance imaging and diffusion tensor
imaging, and 3) cognition and behavior using neuropsychological assessment and questionnaires at three time
points (pre-trial (week 1), cross-over (week 13), and post-trial (week 28)). In the R33 phase, we will again
implement a randomized cross-over design in 8-16 year-olds with an FASD to: a) compare MT effects relative
to a cognitive training (CT) control and b) evaluate dose effects by comparing 12- vs. 24-weeks of intervention.
We hypothesize that the bottom-up approach of MT, which improves sensory (auditory) and motor functioning,
will lead to changes in brain connectivity, which in turn will improve cognitive functioning relative to the top-
down approach of CT. We have assembled a strong multidisciplinary team to implement a music training
intervention and assess the outcomes using objective neuroimaging, cognitive, and behavioral measures.
Future studies will explore how MT can contribute to a strengths-based intervention approach for FASD.