Raga Therapy for Autism

  • Review Article
  • Neelima Chauhan1,*, Mahesh Kale2, Neeta Naik3
  • 1 Department of Pediatrics, University of Illinois, at Chicago, VA Healthcare System, Chicago, IL, USA. Email: nchauhan51@gmail.com
  • 2 Indian Classical Music and Arts Foundation, Mahesh Kale School of Music, San Francisco, CA, USA. Email: mahesh@maheshkale.com.
  • 3 EN1 Neuro Services Pvt. Ltd. Mumbai, India. Email: neeta.naik2@gmail.com.
  • *Corresponding author: Neelima Chauhan, Department of Pediatrics, University of Illinois at Chicago, 840 Wood Street, Chicago, Illinois 60121; Phone: 312-569-7747; Fax: 312-569-8114; E-Mail: nchauhan51@gmail.com
  • Received: 25-01-2022; Accepted: 24-02-2022; Published: 09-03-2022


Autism spectrum disorder (ASD) is a global health crisis. There is an increasing prevalence of ASD not only in US but throughout the world mainly affecting children and adolescents. ASD exhibits compromised quality of life characterized by persistent deficits in two core areas of functioning including social communication and interaction, and restricted/repetitive patterns of motor activities. These aberrances arise from overall brain underconnectivity coupled with local over-connectivity within specific brain regions. Normal brain connectivity is modulated by a neurohormone called oxytocin. Deficiencies in oxytocin either due to genetic or non-genetic causes, results in dysfunctional brain connectivity leading to the development of ASD. Based on these facts, restoration of oxytocin has been attempted considering current limitations of ASD pharmacotherapy. Oxytocin treatment by systemic or central routes of administration have produced mixed outcomes and therefore non-pharmacological oxytocin-boosting alternatives are increasingly considered. One of such alternatives is music therapy. Music therapy not only to boosts oxytocin levels but also targets the core socioemotional deficits observed in ASD. The uniqueness of North Indian Classical Music in advancing its therapeutic potential is presented.

Key Words:

Autism Spectrum Disorder, Insular Cortex, Mirror Neuron System, Large Neural Network, Classical Music, Oxytocin, Brainwaves, Brain Entrainment.


ABA: Applied Behavioral Analysis

ADHD: Attention Deficit Hyperactivity Disorder

ADDM: Autism and Developmental Disabilities Monitoring

AVP: Arginine Vasopressin

AS: Asperger's Syndrome

ASD: Autism Spectrum Disorder

ADDM: Autism and Developmental Disabilities Monitoring

CDC: Centers for Disease Control

CEN: Central Executive Network

CBT: Cognitive Behavioral Therapy

DMN: Default Mode Network

DSM: Diagnostic and Statistical Manual of Mental Disorders

Hz: Hertz

IN: Insula

IC: Insular Cortex

ID: Intellectual Disability

EEG: Electroencephalography

ERPs: Event-Related Potentials

OT: Oxytocin

MRI: Magnetic Resonance Imaging

MNS: Mirror Neuron System

MT: Music Therapy

NDD: Neurodevelopmental Disorders

NICM: North Indian Classical Music

OT: Oxytocin

OTR: Oxytocin Receptor

PDDs: Pervasive Developmental Disorders

PDD-NOS: Pervasive Developmental Disorder-Not Otherwise Specified

SN: Salience Network

SBT: Social Behavioral Therapy

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a group of developmental disabilities that can cause significant social, communication and behavioral aberrations, characterized by persistent deficits in two core areas of functioning [1] social communication/interaction, [2] restricted/repetitive patterns of motor activities [1,2,3,4]. Abnormal development is usually present before the age of 3 years showing affected children with developmental regression and loss of previously acquired skills [5]. Approximately, one third of the children with ASD tend to develop epilepsy and the rest may develop depression, anxiety, attention deficit hyperactivity disorder (ADHD), mental retardation, etc. [5,6]. Although, no unifying genetic or non-genetic causative factor(s) have been identified for ASD, deficient oxytocin (OT) signaling [7,8], and aberrant methylation or mutations in the oxytocin receptor (OTR) gene, are increasingly recognized as fundamental trigger to the development of ASD [9,10,11]. Oxytocin is a key mediator of socioemotional behavior [12], which regulates connectivity of insular cortex (IC) and large-scale brain networks [13]. The OT deficiency disrupts IC and large-scale brain network connectivity in ASD [14] leading to social, communication and behavioral [11,14,15], and neurophysiological [11,16,17] deficits typical of ASD. Thus, OT deficiency is the prime therapeutic target for ASD treatment.

Dysfunctional Brain Connectivity in Autism

Altered intrinsic dysfunctional connectivity is a hallmark of ASD [11] showing a pattern of overall brain underconnectivity, coupled with local over-connectivity within frontal and occipital regions [3], affecting sensory processing [15,18]. The functional connectivity of frontotemporal and frontoparietal regions, the amygdala-hippocampal complex, basal ganglia, cerebellum, and cingulate cortex are compromised in ASD [2]. Insular cortex acts as a “hub” in orchestrating large-scale brain network with different brain regions [14,19]. Large-scale brain network includes Salience Network (SN), Default Mode Network (DMN), and Central Executive Network (CEN) [14,19]. IC-SN detects and filters salient stimuli, integrates sensory, emotional, cognitive information and significantly contributes to social communication, behavior, and self-awareness [20]. Therefore, dysfunctional connectivity of IC-SN produces dissociation of social communication, behavior, and self-awareness [20,21]. IC-DMN is a large-scale brain network that is most active at rest and involved in various domains of social and cognitive processing [22]. Dysfunctional connectivity of ICDMN compromises social and cognitive processing in ASD [22,23]. IC-CEN is involved in sustained attention, complex problem solving, and working memory [22]. Dysfunctional connectivity of IC-CEN impairs attention, problem-solving, and working memory processing in ASD [21,22]. In summary, both hypo- and hyperdysfunctional connectivity of IN-SN/DMN/CEN, “breaks” largescale brain network circuits impairing verbal/non-verbal social communication, social and cognitive processing including parent/ peer-bonding/interaction/attachment in ASD [24-27].

Neurophysiological Aberrations in Autism

The most consistently observed pattern indicates that compared to controls that do not have ASD, individuals with ASD show a U-shaped pattern of spectral power with excessive slow (delta/δ/0.5-4Hz; theta/θ/4-8Hz) and/or fast (beta/ß/1230Hz, gamma/γ/>30Hz) frequency bands, but significantly reduced neutral/mid-range (alpha/α/8-12Hz) frequency band [11,16,17,28]. The underconnectivity of frontotemporal and subcortical networks, and overconnectivity of sensory networks underly neurobehavioral deficits observed in ASD [11,29]. Deficits in sensory processing disrupt neural inhibition/excitation and sensory gating leading to compromised emotional response, mental activity, attention, and cognitive processing in ASD [30].

Neurochemical Aberrations in Autism

Neurochemical aberrations of ASD include altered levels and mis-signaling of serotonin, dopamine, endorphins, and oxytocin [31,32,33]. Significant increases in the levels of serotonin and serotonin transporters (SERT) [34] and altered serotonin signaling [35,36] are observed in ASD. Increased serotonin reduces oxytocin levels, indirectly producing OT deficits [36]. A dysfunctional midbrain dopaminergic system [37,38,39], mutations in dopamine transporter protein [40], and perturbations in dopamine signaling [37,41,42] contribute to central executive deficits observed in ASD [43]. Endorphins (endogenous opioid system) play a key role in enhancing the rewarding properties of dopamine and therefore observed deficits of endorphin in ASD indirectly reduce dopamine, adding to the effects of dopamine deficiency in ASD [32]. Oxytocin is a key neural substrate that interacts with central dopamine systems and hence implicated in mediating mesolimbic dopamine pathways [42]. Thus, serotonin and dopamine both are linked to oxytocin deregulation, making oxytocin a key neural substrate contributing to ASD [44]. The role played by oxytocin in regulating social/affiliative behavior by mediating brain OT release in psychiatric disorders including ASD have been well recognized [45,46,47,48]. Oxytocin modulates IN-SN/DMN/CEN functional connectivity and salience processing [13,49,50], and hence regarded as prime causative factor for ASD [7,51].

Positive Effects of Music on Social Activities, Communication Skills and Key Symptoms of ASD

Music is innately present in humans and therefore regarded as a universal system for socio-emotional communication owing to its power to evoke emotions [52,53,54]. Musical emotions are processed by a large-scale network that includes insula, orbitofrontal, cingulate, prefrontal, temporal and parietal cortices, amygdala, hippocampus, and subcortical mesolimbic system [55]. Emotions emerge through a combined activation of emotional and motivational brain systems such as reward pathways, and several other areas including motor, attention, and memory [56]. In addition to the emotional impact of music on the brain, listening to music is linked to the induction of neurohormones i. e. dopamine, serotonin, endorphins, oxytocin, etc. [55]. There is a growing body of evidence showing benefits of music therapy in different neurological disorders such as Stroke [57], Parkinson’s disease [58], Alzheimer’s disease [59,60], dementia [61], epilepsy [62], and many other neurological conditions [2,63], including ASD [1,4,64]. Since music is engaging, emotional, physical, social, and persuasive tool, it promotes synchronization of various brain functions [2], it has a distinct ability to target ASD-specific core disabilities [36,65,66]. Despite altered intrinsic connectivity, individuals with ASD often enjoy music perception and can achieve a high level of music proficiency [67,68]. Given the ability of music to modify neurophysiological responses [65,69], and perceptions [64], music can be a great alternative in treating ASD. Scientists have shown that a 30-min singing lesson increased blood OT levels [70], listening to slow-tempo and soothing music increased salivary OT levels [71,72]. Besides OT elevation, music listening activated IN-SN/DMN/CEN networks [14,73]. Presentation of happy music was observed to enhance insular cortex, superior temporal lobe, and caudate putamen associated with awareness of emotions [74,75]. ASD-induced reduction of OT and suppression of neutral (alpha/α/8-12Hz) brain waves, was restored after OT treatment [51]. Although peripheral OT administration produced mixed results, direct brain targeting of OT via nasal route improved emotion, recognition [76], social cognition [77,78], eye gaze/social interaction [79,80], and social anxiety [81] in ASD. Most importantly, OT promoted physiological response to music/acoustic stimuli [82], and induced the secretion of OT [52,71,72,83], indicating a physiological link between music/acoustic stimuli and OT. The fact that music gives a sense of shared affective relationship [14], the core aspects highly compromised in ASD, along with its effects on elevating OT and other key neurotransmitters (dopamine, serotonin) [35,84], involved in reward, motivation, pleasure, and social affiliation [52], makes music a potential therapeutic alternative in treating ASD [1,4,66,85]. There have been many studies on the effects of music in autism [1,6,85]. Not all randomized controlled trials of music therapy were successful [86,87], but the observed failures are attributed to a medium/high risk of bias, small sample size and mostly male participants [14,28]. Nonetheless, recent systematic reviews confirmed benefits of music therapy in neurodevelopmental disorders (NDD) including ASD and intellectual disability (ID) [28,88,89].

Therapeutic Potential of North Indian Classical Music in Treating Autism

North Indian Classical Music (NICM), by virtue of its uniqueness of its melodic structural design and improvisation, offers added advantages over afore-mentioned conventional music therapy [90,91]. “Raga” constitutes the constructive core of NICM [84,92,93]. Ragas are composed of permutations and combinations of seven basic “natural” Swaras/notes (derived from the sounds of nature - birds, animals), called “Shuddha Swara”, and five “Modified” notes (Vikruta Swara), making a total of 12 notes/Swaras, composed in an ascending/descending order to create a melodic structure known as Raga [92,94,95,96]. Ragas are known to exert note-swara-specific, improvisation-specific, tempo/rhythm-specific, circadian-specific, and season-specific emotional effects, indirectly indicating the activation of pertinent brain regions [92,94,95,96].

Swara Effects

All Swaras used to construct Ragas play important roles in exerting Raga-specific emotional effects [92,94,95,96]. Specific arrangement of Swaras and combination of tonal intervals are capable of evoking/magnifying/modifying distinct emotions [94,95]. If the frequency of a given note is more than its mean value, then it is termed to be a Tivra Swara (Western sharp note) [90,91]. Similarly, if frequency of a given note is decreased below the mean value, then it is called Komal Swara (Western soft/flat note) [90,91,92]. Predominance of Shuddha Swaras (pure notes) makes the Raga “Happy” and “Cheerful”, while incremental predominance of Komal Swaras (soft/flat notes) makes the Raga progressively sentimental, elevating emotional seriousness from happiness to sympathy to sad/sorrow/tensed to peace and tranquility [90,91,92,93,94,95,98,99]. The use of Komal Re, creates tension and longing and Komal Dha, produces seriousness and calmness [94, 95, 99], while Komal Ga and Komal Ni, create the mood of compassion, submission, sorrow [92, 93, 97], and Tivra Ma, intensifies the inherent emotions of accompanying note(s)/Swara(s) [93]. In NICM emotional valence systematically varies along with the tonal ratios of each Raga, varying not only systematically, but incrementally, in finer gradations of emotions from happy -to- peace -to- tranquility/devotion [92, 100], rather than binary notions of “positive/negative” “happy/sad” ascribed to consonance/dissonance effects on emotion [95].

Stages of Raga and Rhythm Effects

Besides, the use of specific Raga with specific emotional signature, various stages of Raga presentation, such as an arhythmic introductory phase (Aalap), a rhythmic phase (Gat), and tempo, all are capable of modifying emotional output [84,94,97,98]. As reported by Mathur et al., the “Aalap” and “Gat” components of Raga Yaman revealed change in emotion from “Calm” (Aalap) to “Happy” (Gat) [94]. In addition, use of different tempos (Laya) i. e. Vilambit (slow), Madhya (medium), Drut (fast), have differential emotional effects within a Raga such as Vilambit Laya with calm effect; Madhya Laya with pleasant/happy/cheerful effects; and Drut Laya with excitement [84,94]. The rhythm of Raga, known as “Taal” is the cyclic patterns of beats within a rhythmic cycle that repeats on itself. The cyclic nature of Taal is another unique feature of NICM which is represented as beats per minute (bpm). Both Raga and Taal are open frameworks for creativity and allow theoretically infinite number of possibilities. By and large, the Ragas with bpm lower than the heart rate (< 70-75 bmp) produce calming/soothing effects, Ragas with bpm equal to the heart rate (=70-75 bpm) create joy/happiness/cheerfulness/pleasant feelings, while Ragas with bpm greater than the heart rate (> 7075 bpm) produce excitement or energizing effects [90,91,92].

Circadian and Seasonal Selectivity

Based on the belief that human state of mind is affected by nature’s rhythms, Ragas have circadian and seasonal selectivity, meaning certain Ragas exert more prominent effects when specifically sung/performed during specific time of the day, and certain Ragas are specific for certain seasons [90,91,92].

Improvisational Effects

An artist of NICM is not strictly confined to reproduce a fixed composition, rather an NICM artist explores beyond fixed composition to produce artistic pleasure with his/her own individual talent without changing the core features of Raga [90,91,92). Each Raga provides a musical framework within which the musician can improvise [94]. Improvisation by the musician involves creating sequences of notes allowed by the Raga while maintaining Raga-specific rules. Raga can be improvised by changing the sequence of ascending/descending Swaras (notes), emphasizing any single note, and integrating catch phrases in the Raga [90,91,92]. For example, Raga “Bhimpalasi” and Raga “Dhanashri” have the same notes and sequence, the only difference being that in Raga “Dhanashri”, Swara “Pa” (Perfect Fifth-note) is used as the tonic most sonant and important musical note, while in of Raga “Bhimpalasi”, the Swara “Ma” (F-Note) is used as the most sonant and important musical note [90,91]. Thus, NICM is an open-ended and flexible improvisational system which has an ability to modify/intensify/subdue inherent emotional effects of Raga/Swara, via neurochemical [52] and neurophysiological [51] modulations, making Raga the more personalized and tailored neurotherapy [84,94,95,98], compared to conventional music therapy. Ragas containing all/majority of consonant notes (Shuddha Swaras), along with their circadian rhythmic specificity, are known to elicit joy/happiness that tend to increase dopamine [56] and oxytocin [101]. Recently, a case study by Panda et al. showed that the Ragas containing majority of Shuddha Swaras, namely Raga Pilu, Raga Bahar and Raga Khamaj, used for treating autistic children, showed positive results [102]. In summary, Raga Therapy has great scope of customization based on its afore-mentioned unique qualities. This uniqueness makes NICM as an effective neurotherapy [84,94,96,103].


The prevalence of ASD has been increasing over past two decades and about 1 in 36 children has been identified with ASD according to the estimates from Centers for Disease Control (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network. There is no single effective therapy for treating ASD. Currently practiced pharmacological treatments include the use of psychostimulants, atypical antipsychotics, anti-depressants, and α-2 adrenergic receptor agonists for treating ASD. These medications provide partial symptomatic relief but not a complete cure and are associated with adverse side effects [14]. Given the failure of FDA-approved pharmacological treatments with limited benefits and many side effects, reliance on non-pharmacological integrative treatments is emerging [6]. Most people with ASD respond best to highly structured and specialized nonpharmacological treatments. Non-pharmacological interventions for ASD include applied behavioral analysis (ABA), cognitive behavioral therapy (CBT), social behavioral therapy (SBT) and music therapy (MT). According to the Cochrane database, MT has been postulated to be the effective therapy for ASD [28]. Presently discussed Raga therapy may be more effective based on its unique structural and improvisational ability to produce desired health effects.


s Authors wish to acknowledge the resources and support provided by the Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA.


  1. Sharda M, Silani G, Specht K, Tillmann J, Nater U, Gold C. Music therapy for children with autism: investigating social behaviour through music. Lancet Child Adolesc Health. 2019;3(11):759-61.
  2. Brancatisano O, Baird A, Thompson WF. Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model. Neurosci Biobehav Rev. 2020;112:600-15.
  3. Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet. 2018;392(10146):508-20.
  4. Bharathi G, Jayaramayya K, Balasubramanian V, Vellingiri B. The potential role of rhythmic entrainment and music therapy intervention for individuals with autism spectrum disorders. J Exerc Rehabil. 2019;15(2):180-6.
  5. Parr J. Autism. BMJ Clin Evid. 2010;2010.
  6. Sharma SR, Gonda X, Tarazi FI. Autism Spectrum Disorder: Classification, diagnosis and therapy. Pharmacol Ther. 2018;190:91-104.
  7. Moerkerke M, Peeters M, de Vries L, Daniels N, Steyaert J, Alaerts K, et al. Endogenous Oxytocin Levels in Autism-A Meta-Analysis. Brain Sci. 2021;11(11).
  8. Gregory SG, Connelly JJ, Towers AJ, Johnson J, Biscocho D, Markunas CA, et al. Genomic and epigenetic evidence for oxytocin receptor deficiency in autism. BMC Med. 2009;7:62.
  9. Uzefovsky F, Bethlehem RAI, Shamay-Tsoory S, Ruigrok A, Holt R, Spencer M, et al. The oxytocin receptor gene predicts brain activity during an emotion recognition task in autism. Mol Autism. 2019;10:12.
  10. Andari E, Rilling JK. Genetic and epigenetic modulation of the oxytocin receptor and implications for autism. Neuropsychopharmacology. 2021;46(1):241-2.
  11. Sharda M, Tuerk C, Chowdhury R, Jamey K, Foster N, Custo-Blanch M, et al. Music improves social communication and auditory-motor connectivity in children with autism. Transl Psychiatry. 2018;8(1):231.
  12. Wolfe FH, Auzias G, Deruelle C, Chaminade T. Focal atrophy of the hypothalamus associated with third ventricle enlargement in autism spectrum disorder. Neuroreport. 2015;26(17):1017-22.
  13. Jiang X, Ma X, Geng Y, Zhao Z, Zhou F, Zhao W, et al. Intrinsic, dynamic and effective connectivity among large-scale brain networks modulated by oxytocin. Neuroimage. 2021;227:117668.
  14. Nomi JS, Molnar-Szakacs I, Uddin LQ. Insular function in autism: Update and future directions in neuroimaging and interventions. Prog Neuropsychopharmacol Biol Psychiatry. 2019;89:412-26.
  15. Kirby AV, Williams KL, Watson LR, Sideris J, Bulluck J, Baranek GT. Sensory Features and Family Functioning in Families of Children With Autism and Developmental Disabilities: Longitudinal Associations. Am J Occup Ther. 2019;73(2):7302205040p1-p14.
  16. Pietto ML, Gatti M, Raimondo F, Lipina SJ, Kamienkowski JE. Electrophysiological approaches in the study of cognitive development outside the lab. PLoS One. 2018;13(11):e0206983.
  17. Yum YN, Lau WK, Poon K, Ho FC. Music therapy as social skill intervention for children with comorbid ASD and ID: study protocol for a randomized controlled trial. BMC Pediatr. 2020;20(1):545.
  18. Schoen SA, Lane SJ, Mailloux Z, May-Benson T, Parham LD, Smith Roley S, et al. A systematic review of ayres sensory integration intervention for children with autism. Autism Res. 2019;12(1):6-19.
  19. Uddin LQ, Menon V. The anterior insula in autism: under-connected and under-examined. Neurosci Biobehav Rev. 2009;33(8):1198-203.
  20. Uddin LQ. Salience processing and insular cortical function and dysfunction. Nat Rev Neurosci. 2015;16(1):55-61.
  21. Chen Q, Chen X, He X, Wang L, Wang K, Qiu B. Aberrant structural and functional connectivity in the salience network and central executive network circuit in schizophrenia. Neurosci Lett. 2016;627:178-84.
  22. Li R, Zhang S, Yin S, Ren W, He R, Li J. The fronto-insular cortex causally mediates the default-mode and central-executive networks to contribute to individual cognitive performance in healthy elderly. Hum Brain Mapp. 2018;39(11):4302-11.
  23. Kim SM, Park SY, Kim YI, Son YD, Chung US, Min KJ, et al. Affective network and default mode network in depressive adolescents with disruptive behaviors. Neuropsychiatr Dis Treat. 2016;12:49-56.
  24. Dickstein DP, Pescosolido MF, Reidy BL, Galvan T, Kim KL, Seymour KE, et al. Developmental meta-analysis of the functional neural correlates of autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. 2013;52(3):279-89 e16.
  25. Xu J, Wang H, Zhang L, Xu Z, Li T, Zhou Z, et al. Both Hypo-Connectivity and Hyper-Connectivity of the Insular Subregions Associated With Severity in Children With Autism Spectrum Disorders. Front Neurosci. 2018;12:234.
  26. Neufeld J, Hsu CT, Chakrabarti B. Atypical Reward-Driven Modulation of Mimicry-Related Neural Activity in Autism. Front Psychiatry. 2019;10:327.
  27. Nomi JS, Uddin LQ. Developmental changes in large-scale network connectivity in autism. Neuroimage Clin. 2015;7:732-41.
  28. Geretsegger M, Elefant C, Mossler KA, Gold C. Music therapy for people with autism spectrum disorder. Cochrane Database Syst Rev. 2014(6):CD004381.
  29. Murdaugh DL, Maximo JO, Kana RK. Changes in intrinsic connectivity of the brain's reading network following intervention in children with autism. Hum Brain Mapp. 2015;36(8):2965-79.
  30. Crasta JE, Gavin WJ, Davies PL. Expanding our understanding of sensory gating in children with autism spectrum disorders. Clin Neurophysiol. 2021;132(1):180-90.
  31. Marotta R, Risoleo MC, Messina G, Parisi L, Carotenuto M, Vetri L, et al. The Neurochemistry of Autism. Brain Sci. 2020;10(3).
  32. Pellissier LP, Gandia J, Laboute T, Becker JAJ, Le Merrer J. mu opioid receptor, social behaviour and autism spectrum disorder: reward matters. Br J Pharmacol. 2018;175(14):2750-69.
  33. De Luca F. Endocrinological Abnormalities in Autism. Semin Pediatr Neurol. 2020;35:100582.
  34. Abdulamir HA, Abdul-Rasheed OF, Abdulghani EA. Serotonin and serotonin transporter levels in autistic children. Saudi Med J. 2018;39(5):487-94.
  35. Dolen G. Autism: Oxytocin, serotonin, and social reward. Soc Neurosci. 2015;10(5):450-65.
  36. Muller CL, Anacker AMJ, Veenstra-VanderWeele J. The serotonin system in autism spectrum disorder: From biomarker to animal models. Neuroscience. 2016;321:24-41.
  37. Paval D. A Dopamine Hypothesis of Autism Spectrum Disorder. Dev Neurosci. 2017;39(5):355-60.
  38. Atzil S, Touroutoglou A, Rudy T, Salcedo S, Feldman R, Hooker JM, et al. Dopamine in the medial amygdala network mediates human bonding. Proc Natl Acad Sci U S A. 2017;114(9):2361-6.
  39. Paval D, Miclutia IV. The Dopamine Hypothesis of Autism Spectrum Disorder Revisited: Current Status and Future Prospects. Dev Neurosci. 2021;43(2):73-83.
  40. DiCarlo GE, Aguilar JI, Matthies HJ, Harrison FE, Bundschuh KE, West A, et al. Autism-linked dopamine transporter mutation alters striatal dopamine neurotransmission and dopamine-dependent behaviors. J Clin Invest. 2019;129(8):3407-19.
  41. Areal LB, Blakely RD. Neurobehavioral changes arising from early life dopamine signaling perturbations. Neurochem Int. 2020;137:104747.
  42. Baskerville TA, Douglas AJ. Dopamine and oxytocin interactions underlying behaviors: potential contributions to behavioral disorders. CNS Neurosci Ther. 2010;16(3):e92-123.
  43. Kriete T, Noelle DC. Dopamine and the development of executive dysfunction in autism spectrum disorders. PLoS One. 2015;10(3):e0121605.
  44. Yamasue H, Domes G. Oxytocin and Autism Spectrum Disorders. Curr Top Behav Neurosci. 2018;35:449-65.
  45. Cataldo I, Azhari A, Esposito G. A Review of Oxytocin and Arginine-Vasopressin Receptors and Their Modulation of Autism Spectrum Disorder. Front Mol Neurosci. 2018;11:27.
  46. Vanya M, Szucs S, Vetro A, Bartfai G. The potential role of oxytocin and perinatal factors in the pathogenesis of autism spectrum disorders - review of the literature. Psychiatry Res. 2017;247:288-90.
  47. Ooi YP, Weng SJ, Kossowsky J, Gerger H, Sung M. Oxytocin and Autism Spectrum Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pharmacopsychiatry. 2017;50(1):5-13.
  48. Yoon S, Kim YK. The Role of the Oxytocin System in Anxiety Disorders. Adv Exp Med Biol. 2020;1191:103-20.
  49. Brodmann K, Gruber O, Goya-Maldonado R. Intranasal Oxytocin Selectively Modulates Large-Scale Brain Networks in Humans. Brain Connect. 2017;7(7):454-63.
  50. Di Simplicio M, Harmer CJ. Oxytocin and emotion processing. J Psychopharmacol. 2016;30(11):1156-9.
  51. Ebstein RP, Knafo A, Mankuta D, Chew SH, Lai PS. The contributions of oxytocin and vasopressin pathway genes to human behavior. Horm Behav. 2012;61(3):359-79.
  52. Chanda ML, Levitin DJ. The neurochemistry of music. Trends Cogn Sci. 2013;17(4):179-93.
  53. Koelsch S. Brain correlates of music-evoked emotions. Nat Rev Neurosci. 2014;15(3):170-80.
  54. Leonardi S, Cacciola A, De Luca R, Aragona B, Andronaco V, Milardi D, et al. The role of music therapy in rehabilitation: improving aphasia and beyond. Int J Neurosci. 2018;128(1):90-9.
  55. Singh NC, Balasubramanian H. The Brain on Music. Resonance. 2018;23(3):299-308.
  56. Vuilleumier P, Trost W. Music and emotions: from enchantment to entrainment. Ann N Y Acad Sci. 2015;1337:212-22.
  57. Liu Q, Li W, Yin Y, Zhao Z, Yang Y, Zhao Y, et al. The effect of music therapy on language recovery in patients with aphasia after stroke: a systematic review and meta-analysis. Neurol Sci. 2022;43(2):863-72.
  58. Machado Sotomayor MJ, Arufe-Giraldez V, Ruiz-Rico G, Navarro-Paton R. Music Therapy and Parkinson's Disease: A Systematic Review from 2015-2020. Int J Environ Res Public Health. 2021;18(21).
  59. Jafari Z, Kolb BE, Mohajerani MH. Neural oscillations and brain stimulation in Alzheimer's disease. Prog Neurobiol. 2020;194:101878.
  60. Yang H, Luo Y, Hu Q, Tian X, Wen H. Benefits in Alzheimer's Disease of Sensory and Multisensory Stimulation. J Alzheimers Dis. 2021;82(2):463-84.
  61. Amano T, Hooley C, Strong J, Inoue M. Strategies for implementing music-based interventions for people with dementia in long-term care facilities: A systematic review. Int J Geriatr Psychiatry. 2022;37(1).
  62. Rafiee M, Istasy M, Valiante TA. Music in epilepsy: Predicting the effects of the unpredictable. Epilepsy Behav. 2021;122:108164.
  63. Currey J, Sheng D, Neph Speciale A, Cinquini C, Cuza J, Waite BL. Performing Arts Medicine. Phys Med Rehabil Clin N Am. 2020;31(4):609-32.
  64. Quintin EM. Music-Evoked Reward and Emotion: Relative Strengths and Response to Intervention of People With ASD. Front Neural Circuits. 2019;13:49.
  65. Madsen J, Margulis EH, Simchy-Gross R, Parra LC. Music synchronizes brainwaves across listeners with strong effects of repetition, familiarity and training. Sci Rep. 2019;9(1):3576.
  66. Stegemann T, Geretsegger M, Phan Quoc E, Riedl H, Smetana M. Music Therapy and Other Music-Based Interventions in Pediatric Health Care: An Overview. Medicines (Basel). 2019;6(1).
  67. Peretz I. Brain specialization for music. Neuroscientist. 2002;8(4):372-80.
  68. Sharda M, Midha R, Malik S, Mukerji S, Singh NC. Fronto-temporal connectivity is preserved during sung but not spoken word listening, across the autism spectrum. Autism Res. 2015;8(2):174-86.
  69. Nozaradan S. Exploring how musical rhythm entrains brain activity with electroencephalogram frequency-tagging. Philos Trans R Soc Lond B Biol Sci. 2014;369(1658):20130393.
  70. Grape C, Sandgren M, Hansson LO, Ericson M, Theorell T. Does singing promote well-being?: An empirical study of professional and amateur singers during a singing lesson. Integr Physiol Behav Sci. 2003;38(1):65-74.
  71. Nilsson U. Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomised control trial. J Clin Nurs. 2009;18(15):2153-61.
  72. Ooishi Y, Mukai H, Watanabe K, Kawato S, Kashino M. Increase in salivary oxytocin and decrease in salivary cortisol after listening to relaxing slow-tempo and exciting fast-tempo music. PLoS One. 2017;12(12):e0189075.
  73. Usui C, Kirino E, Tanaka S, Inami R, Nishioka K, Hatta K, et al. Music Intervention Reduces Persistent Fibromyalgia Pain and Alters Functional Connectivity Between the Insula and Default Mode Network. Pain Med. 2020;21(8):1546-52.
  74. Caria A, Venuti P, de Falco S. Functional and dysfunctional brain circuits underlying emotional processing of music in autism spectrum disorders. Cereb Cortex. 2011;21(12):2838-49.
  75. Craig AD. How do you feel--now? The anterior insula and human awareness. Nat Rev Neurosci. 2009;10(1):59-70.
  76. Guastella AJ, Einfeld SL, Gray KM, Rinehart NJ, Tonge BJ, Lambert TJ, et al. Intranasal oxytocin improves emotion recognition for youth with autism spectrum disorders. Biol Psychiatry. 2010;67(7):692-4.
  77. Aoki Y, Yahata N, Watanabe T, Takano Y, Kawakubo Y, Kuwabara H, et al. Oxytocin improves behavioural and neural deficits in inferring others' social emotions in autism. Brain. 2014;137(Pt 11):3073-86.
  78. Keech B, Crowe S, Hocking DR. Intranasal oxytocin, social cognition and neurodevelopmental disorders: A meta-analysis. Psychoneuroendocrinology. 2018;87:9-19.
  79. Andari E, Duhamel JR, Zalla T, Herbrecht E, Leboyer M, Sirigu A. Promoting social behavior with oxytocin in high-functioning autism spectrum disorders. Proc Natl Acad Sci U S A. 2010;107(9):4389-94.
  80. Higashida H, Munesue T, Kosaka H, Yamasue H, Yokoyama S, Kikuchi M. Social Interaction Improved by Oxytocin in the Subclass of Autism with Comorbid Intellectual Disabilities. Diseases. 2019;7(1).
  81. Jones C, Barrera I, Brothers S, Ring R, Wahlestedt C. Oxytocin and social functioning. Dialogues Clin Neurosci. 2017;19(2):193-201.
  82. Lin IF, Kashino M, Ohta H, Yamada T, Tani M, Watanabe H, et al. The effect of intranasal oxytocin versus placebo treatment on the autonomic responses to human sounds in autism: a single-blind, randomized, placebo-controlled, crossover design study. Mol Autism. 2014;5(1):20.
  83. Harvey AR. Links Between the Neurobiology of Oxytocin and Human Musicality. Front Hum Neurosci. 2020;14:350.
  84. Hegde S. Music therapy for mental disorder and mental health: the untapped potential of Indian classical music. BJPsych Int. 2017;14(2):31-3.
  85. LaGasse AB. Social outcomes in children with autism spectrum disorder: a review of music therapy outcomes. Patient Relat Outcome Meas. 2017;8:23-32.
  86. Bieleninik L, Geretsegger M, Mossler K, Assmus J, Thompson G, Gattino G, et al. Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder: The TIME-A Randomized Clinical Trial. JAMA. 2017;318(6):525-35.
  87. Crawford MJ, Gold C, Odell-Miller H, Thana L, Faber S, Assmus J, et al. International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study. Health Technol Assess. 2017;21(59):1-40.
  88. Mayer-Benarous H, Benarous X, Vonthron F, Cohen D. Music Therapy for Children With Autistic Spectrum Disorder and/or Other Neurodevelopmental Disorders: A Systematic Review. Front Psychiatry. 2021;12:643234.
  89. Gassner L, Geretsegger M, Mayer-Ferbas J. Effectiveness of music therapy for autism spectrum disorder, dementia, depression, insomnia and schizophrenia: update of systematic reviews. Eur J Public Health. 2022;32(1):27-34.
  90. Gajjar K, Patel M. A Matrix-Based Approach for Evaluation of Vocal Renditions in Hindustani Classical Music. Advances in Computational Intelligence and Communication Technology: Springer; 2021. p. 73-90.
  91. Gajjar K, Patel M. Computational musicology for Raga analysis in Indian classical music: a critical review. Int J Comput Appl. 2017;172(9):42-7.
  92. Kaufmann W. Rasa, rāga-mālā and performance times in North Indian rāgas. Ethnomusicology. 1965;9(3):272-91.
  93. Balasubramanian SV, Balasubramanian G, Ramanathan G. Integrative Medicine System Based on Music. Altern Ther Health Med. 2016;22 Suppl 1:14-23.
  94. Mathur A, Vijayakumar SH, Chakrabarti B, Singh NC. Emotional responses to Hindustani raga music: the role of musical structure. Front Psychol. 2015;6:513.
  95. Valla JM, Alappatt JA, Mathur A, Singh NC. Music and Emotion-A Case for North Indian Classical Music. Front Psychol. 2017;8:2115.
  96. Solanki MS, Zafar M, Rastogi R. Music as a therapy: role in psychiatry. Asian J Psychiatr. 2013;6(3):193-9.
  97. Bowling DL, Sundararajan J, Han S, Purves D. Expression of emotion in Eastern and Western music mirrors vocalization. PLoS One. 2012;7(3):e31942.
  98. Midya V, Valla J, Balasubramanian H, Mathur A, Singh NC. Cultural differences in the use of acoustic cues for musical emotion experience. PLoS One. 2019;14(9):e0222380.
  99. Moore S. A Comparative Study of the Flat Second Pitch Degree in North Indian Classical, Ottoman Or Arabian Influenced, Western, Heavy Metal and Film Musics: University of Sheffield, Department of Music; 2014.
  100. Sharma YMaAK. Effects of Music on Mental Health and Longevity. World Journal of Pharmaceutical Research. 2020;9(4):305-12.
  101. Bowling DL, Gahr J, Ancochea PG, Hoeschele M, Canoine V, Fusani L, et al. Endogenous oxytocin, cortisol, and testosterone in response to group singing. Horm Behav. 2022;139:105105.
  102. Panda MR, Nizamie SH, Pandey P, Kumar V. A Case Study: Indian Ragas Adjunct to Floor Time Therapy for of a Child with Autism. 2019.
  103. Kucikiene D, Praninskiene R. The impact of music on the bioelectrical oscillations of the brain. Acta Med Litu. 2018;25(2):101-6.