When looking at the data from the perspective of age distribution it seems that the line is rising (Figure 1). Apart from infants under 1 year, the data reveals that there are more articles the older the children are.

One-year-old children were a minority age group in the music therapy literature. The difference between written texts between 1 and 5-year-old children was 39 texts, which is quite a lot when examining all the data.

The same tendency seems to be present when viewing the research data (Figure 2). There is clearly less research with toddlers from 0 to 2 years old than with children of 5 years of age.

The type of therapy was divided into three: individual, group, and dyadic/family work. Dyadic work was defined as work where the music therapist worked with the child and a carer. Often the carer would have been the parent but it also could have been a relative, a foster carer, a nursery nurse, or a member of care staff. As can be seen in Figure 3 it seems that the amount of individual and dyadic/family work is almost equal.

Each category is not completely separate from the other, as group work sometimes overlaps with dyadic/family work, because the groups could be for individual children and also for dyads or families. In addition, in numerous cases the same text introduces several different types of therapy. As a result, some texts are included several times in the data analysis.

When looking at research data the results seem to be somewhat different (Figure 4). The differences between types of work are smaller and group work seems to be researched most often.

Sing&Grow (Williams & Abad, 2005) was founded in Australia. It is a group based 10-week program aimed at families with young children. The program was funded for 2 years initially and then the funding was extended. In the findings of this review five Sing&Grow research papers were included (Abad, 2007; Abad & Williams, 2006; Nicholson et al., 2010; Nicholson et al., 2008; Williams et al., 2012) and one clinical evaluative paper (Williams & Abad, 2005). These have affected especially the analysis results of research articles. If the Sing&Grow papers would had been excluded from the data the amount of research texts would have been quite close to each other when comparing individual and group work. On the other hand, the family work would had been rated lower.

It was interesting to find out if the age of child had had an influence on whether work was carried out individually, in a group, or with the family. The analysis showed (Figure 5) that during the first year including the carer in therapy was almost as common as it was with 5-year-old children. Though, there were 17 articles describing individual music therapy for babies. When different types of therapy were quite the same in children with 3 years of age, the individual music therapy was clearly the most common therapy type with 5-year-old children. Again, it must be pointed out that group work was conducted with families as well as with individual children.

The number of early childhood music therapy articles increased annually between 1990 and 2012. The time brackets analysed were either 5 or 6 years long except for the last one, which was only 2 years long because that was when the data gathering stopped. This somewhat affects conclusions made. Between 1990 and 1995, 18 articles were found whereas between 2006 and 2010, 43 articles were found. Between 2011 and 2012, 40 articles were found.

When having a closer look at historical viewpoints and types of music therapy (individual, group, and family) mentioned during these 22 years it seems there have been changes not only in the amount of texts but also in the types of therapy presented. In Figure 6 it can be seen that individual work was dominant from 1990 to 1995 and between 2001 and 2005. Since then, group work and family work have been more prevalent, and during 2011 and 2012 it seems that dyadic/family approaches have been the area most written about.

The data was divided into active, receptive, and active-receptive categories. Nine texts could not be included because the relevant information was not in the text. For the rest of the material (116 texts) the analysis revealed that active methods were most common. Seventy-five percent reported using singing, playing, improvising, or other kinds of active methods. Twenty-two percent of texts described using both active and receptive methods and only three percent used solely listening and other receptive methods.

In Figure 7 it can be seen that singing was used in over 90 percent of the data detected. Playing with instruments was also very commonly used. Only a little over half of the texts mentioned using improvisation.

There were some difficulties when categorizing the client groups in the data. It seemed that the categories could be grouped in many ways and the categorizing system was different in different parts of the world. For example, ASD could be seen under communication disorders as well as under developmental delays while developmental delays and learning disabilities could be seen as the same category.

The categories were finally developed after sorting out and analysing the data by following the definitions of the writers. The following categories were decided upon: ASD, developmental delays, paediatric patients, preventive approaches, psychiatric disorders, communication disorders, hospice patients, learning difficulties, attachment issues, sensory impairment, and parenting issues. However, it should be pointed out that because of geographical divergence the terms might be presented differently in different texts. Due to this fact, there may be overlaps among categories and therefore categorizing should be seen as a rough idea rather than a definite grouping.

When looking at the client groups in Figure 8, it reveals that children with ASD are most strongly represented. When adding clients from paediatrics it seems that these client groups cover a little over half of the whole data. Children with developmental disabilities and delays and preventive music therapy approaches were quite well represented, whereas the psychiatric field and children with communication disorders were in the minority. Few texts referred to hospice clients, learning difficulties, sensory impairments, parenting, and attachment issues which can be found later in Table 1.

When looking at the different client groups in the research data (Figure 9), the same tendency can be detected. Developmental disorders and delays together with ASD are the most common client groups followed by preventive treatment and paediatric clients.

In the following table (Table 2) the texts are categorized by their client groups. Again, the selected categorizing might affect the results but gives guidelines for readers to find adequate references for their purposes.

When analysing the data from the viewpoint of reported effects of music therapy, authors mentioned effects in four different areas: a) social areas, b) emotional areas, c) physical and academic skill areas, and d) other areas. Effects in social and emotional areas were written about most, whereas physical and academic skill areas were mentioned less often.

When analysing social areas, the following subcategories emerged:

The amount of the prominent themes defined the order of listed subcategories. This means that interaction within families was pointed out most often. In the same table, it can be seen that interactions between family members were emphasized and parenting skills were also quite well represented. Conversely, supporting attachment was mentioned in only four texts and research in this field was completely lacking. Similarly, affect attunement was focused on in only one text (Levinge, 2011) even though it is known that attunement and synchronicity are crucial for well-functioning interaction.

Increased intentions and initiatives, engagement as well as turn-taking and reciprocity emerged quite strongly from the data. Non-verbal interaction was only mentioned in a few texts (Kim et al., 2008; Levinge, 2011; Oldfield, 2011; Skewes & Thompson, 1998).

General social behavior, including decreased problem behavior, decreased stereotypic behaviour, and acceptance of differences, was also in the minority when examining the effects of music therapy.

In conclusion, it seems that interaction in this data was described in a general way rather than in a more detailed way. It is mentioned that music therapy helps, supports, and creates interactions but more exact information was often not clearly forthcoming.

The analysis of data relating to emotions revealed four subcategories:

According to this data it seems that early childhood music therapy literature emphasizes the positive factors of music therapy. The importance of fun and enjoyment was underlined throughout all client groups.

Except for preventative interventions the target of music therapy is often to reduce symptoms whatever those symptoms with different client groups are. In this data, this area was clearly taken into account in only one research publication (Gold et al., 2001). Also, very specific areas like emotional synchronicity were rarely mentioned (Kim et al., 2009) and the texts remained commonly on a more general level.

Expressive and regulating qualities of music therapy were quite well represented. Both areas are important for the development of the child and regulation problems often emerge within the population of young children with difficulties. Regulation of emotions was mentioned primarily with pediatric patients (Aldridge, 1993; Ayson, 2008; Barrera, Rykov & Doyle, 2002; Hadley, 1996; Loewy, 2004) while with children with ASD it was mentioned in two cases (Berger, 2002; Lecourt, 1991), within the psychiatric field twice (Brackley, 2012; Hong et al., 1998) as well and in hospice settings (Lindenfelser et al., 2008; Lindenfelser et al., 2012).

Physical and academic skill areas were visible in only a relatively small amount of papers. For this reason, both of these areas, with 14 and 11 texts, were put together under the same category heading.

Motor abilities and language development were the largest subcategories in these areas. Motor skills were emphasized especially with children with developmental delays (Bruce & High, 2012; Duffy & Fuller, 2000; Wylie, 1996) while effects of music therapy in language development were emphasized with children with ASD and children with communication disorders (Gross, Linden & Ostermann, 2010; Guerrero & Turry, 2012; Lim, 2012; Lim & Draper, 2011).

Many of these subcategories were mentioned only once. There was only one paper written from a neurological viewpoint (Shoemark, 2004). Problems with eating were also mentioned only once (Dellatan, 2003). Language development and learning competences were more frequently written about but pre-writing and -reading competences were in the minority (Register, 2001; Standley & Hughes, 1997) as well as pain relief (Edwards, 1994; Sweeney-Brown, 2005).

These are the effects of early childhood music therapy, which did not fit into previous categories.

Assessment is an important part of therapy when setting goals for a process. There were five papers referring to this matter within this age group. Focus on this material was on experiences where music therapy could have provided some kind of information, which was not revealed through other assessment tools.

A very different kind of approach was introduced in two papers where the cost-effectiveness was the focus (Loewy et al., 2005; Walworth, 2005). Both researches examined the cost-effectiveness of music therapy in the pediatric healthcare setting aiming to reduce the amount of sedation for patients undergoing various procedures. This kind of research is rare within the music therapy field but might be one-direction researchers will be encouraged to take in the future.

In this section, the authors reflect on several aspects, which they found particularly interesting. This section is mainly descriptive rather than analytical and it is not part of the more structured analysis.

Based on the data analysis (both overall analysis and the analysis of the research data) the results showed that older children were more often written about. Once again based on the assumption that the amount of literature reflects clinical trends, the authors suggest that older children might be more likely to receive music therapy treatment than younger children. Although the exclusion of music therapy in neonatal care and with premature infants has affected the results. Also, it is possible that children under 2 years are not so often referred to music therapy because of the lack of necessary evaluation and diagnosis in such a young age.

According to the results, including the carer in therapy during the first year was almost as common as it was with 5-year-old children. Different types of therapy were quite the same in children with 3 years of age and individual music therapy was the most common therapy type with 5-year-old children.

Historically it seems that during the last 22 years there have been changes not only in amount of texts but also on the types of therapy presented. The dominance from individual work has been shifting to family/dyadic work. Conclusions might be that music therapy has grown as a profession and publishing both research and clinical material has increased. Also, there is a possibility that the interest in clinical practice has been changing somewhat in favour of small children.

The edited books undoubtedly affected the results. There were three books published in 2011-2012 (Edwards, 2011; Kern & Humpal, 2012; Tomlinson et al., 2012) of which 18 chapters matched the criteria for this research. The dominance of individual work between 2001 and 2005 cannot clearly be explained. Again there were edited books (Bunt & Hoskyns, 2002; Pavlicevic, 2005) affecting the data but not so obviously as mentioned earlier. It could be that during those years the awareness of music therapy with small children increased, resulting in more writing on the subject.

Some of the differences in types of therapy changing across the targeted time span could be related to legal and regulatory options for service for young children. In the United States, focus for treatment moved significantly from individual, clinic based work to family and group based work due to changing emphasis under the Individual with Disabilities Education Act (IDEA). In Australia, the funding for Sing&Grow could be seen as a driving force in the changing types of practice.

Looking at types of intervention, active methods were most common with singing and playing with instruments the most prevalent. Only 66 texts (from 116 texts) reported using improvisation. This could be partly because the texts did not articulate details like this clearly enough. Also, music therapy programs or group work (Aldridge, 1993; Edwards et al., 2007; Nicholson et al., 2010), which might be well structured and planned in advance seemed not to use improvisation as much as other kinds of approaches. In addition, strict research design might have limited the use of different methods (i.e. Elefant & Wigram, 2005; Finnigan & Starr, 2010; Lim & Draper, 2011).

Despite the difficulties of categorizing client groups, it seemed that children with ASD were most strongly represented together with paediatric patients and children with developmental disabilities. Preventive music therapy approaches were well represented, whereas the services for children with mental disorders and children with communication disorders were smaller in number.

This research could not evaluate different music therapy approaches in a systematic way because many writers did not name or describe their exact approach. However, when looking at those authors’ texts who mentioned some aspects, it would appear that psychodynamic approaches were in the minority and the focus when carrying out early childhood music therapy was usually on creative and improvisational music therapy. This could explain why the concepts of reflective function, mentalization, and parent´s representations were absent, even though these issues are currently an important focus for early interaction research worldwide (Fonagy, 2012; Pajulo et al., 2012; Philipp, 2012; Solbakken et al., 2011).

When analysing the data from the viewpoint of reported effects of music therapy (see tables 3,4,5,6), authors mentioned positive effects in four different areas: a) social areas, b) emotional areas, c) physical and academic skill areas, and d) other areas. Motor skills were emphasized especially with children with developmental delays, though only in a few papers, and only one text took a neurological viewpoint.

Interactions among family members were emphasized, and parenting skills were also quite well represented. Increased intentions and initiatives, engagement as well as turn-taking and reciprocity emerged quite strongly from the data. It was somewhat surprising that non-verbal interaction was only mentioned in a few texts. The authors’ assumption had been that within the population of 0 to 5-year-old children it would have been more emphasized. According to this data it also appeared that countertransference was not commonly mentioned or focused on in the texts.

Decreased problem behavior, decreased stereotypic behaviour, and acceptance of differences, was in the minority when examining the effects of music therapy. One could assume that problems within this area are not so big in this age group. Also, it might be a matter of research design and targets, as research designs might not often identify measures where decreases of behavior could be detected.

Early childhood music therapy literature emphasized the positive factors. The importance of fun and enjoyment was underlined throughout all client groups. Resilience is currently a subject, which is frequently mentioned in the literature concerning children and families (Papousek, 2011; Pasiali, 2012a; Pearce, 2011; Sawyer & Burton, 2012). Both from the viewpoints of humanity and economy, it seems it would be beneficial to focus on the strengths of clients. In this data, six articles (Darnley-Smith & Patey, 2003; Dun, 1995; Dun, 1999; Irgens-Moller, 1999; O´Callaghan & Jordan, 2011; Shoemark, 2004) wrote about resources and resilience as well as about feelings of mastery.

Specific features of the research data were investigated only in high impact research publications. The freer the framework of writing was, the more general were the conclusions.

Collecting data with such a broad inclusion criteria was very demanding and constituted a limitation to this investigation. Despite the systematic approach, it is still possible there are papers which met the criteria for inclusion but were not included in the research. On the other hand, the quite strict definition of music therapy limited the data and left some research papers out. However, the amount of data was substantive and it is reasonable to assume that single additional texts would not have impacted the overall results.

The quality of the research also suffered because of the large amount of texts. The controlled experiments and quantifiable data were not in focus, and the “critical reading” (Aveyard, 2010; Randolph 2009) was not carried out in this research. Because of the large amount of texts, the analysis was carried out more superficially than with a strictly selected, small amount of data. The qualitative data in particular, could have been analysed in a much more detailed and deeper way if the data had been less extensive.

The categorizing in this research has its limits because of overlaps between different categories (i.e. group work could be either for individual children but also for dyads or families). Also, geographical divergence of the terms and the classification regarding the clinical population has had an influence on the analysis and results. Though an objective standpoint was tried to be maintained, the authors´ own backgrounds, experiences, and standpoints have with some extent influenced the interpretations. The research would look different if the authors would have been different.

Despite the limitations of this research, the authors believe it gives an overall idea of early childhood music therapy practice and how this praxis is accomplished. It gives us guidelines of early childhood music therapy practice and a means of accomplishing it. It gives us guidelines of what kind of client groups early childhood music therapy takes place with and what the effects of this intervention are seen to be. We also gain an understanding of gaps in the literature, what is missing, and which area it would be beneficial to consider in more depth.

There are some issues for the future, which should be pointed out. From the researcher´s perspective it would be important that articles, both clinical and research articles, included precise information about a) the age of the target group (for example: ”preschool”/”kindergarten student”/”school age” referring to different age groups in different countries), b) the definition of the intervention (for example: education or therapy), c) type of work (who was present in sessions), d) duration and frequency of therapy (how many times per week, how long the sessions lasted, how many sessions all together), e) methods used. In addition, the framework of therapy and the therapist (i.e. psychotherapeutic, creative or improvisational music therapy) would be important to define. All this information should be easy to find and the structure of the article should be logical. Ideally this information should be available in the abstract of the article.

Within the context of early childhood music therapy, children from birth to 2 years of age seemed to be in the minority. Research in the fields of communication disorders and psychiatric care were low incidence and hospice care, sensory impairment, and parenting issues minimal. The research from field of attachment was missing completely. The authors suggest these areas to be researched more and written about in future. Long-term processes were in a minority and deeper information was often lacking. It was decided, for the sake of simplicity, not to distinguish between group work for individual children and group work with families. In retrospect, this might have been useful to look at in more detail and is a recommendation for future research.

More specific information is needed. In this data, the interactional and the emotional areas were described in a general way (i.e. music therapy helps, supports, and creates interaction), but more exact information was mostly not forthcoming. The profession needs more detailed knowledge, which is something for future researchers to consider. In addition, related areas of research, cross-scientific viewpoints and common fields of interests could be taken into consideration. The current world effectiveness should also be examined as well as the effects of music therapy in everyday life.

Early childhood music therapy is a multifaceted field with different client groups, types of work, approaches, and areas of emphasis. General trends have been determined, maybe it is now time to investigate deeper and in a more focused way considering our clients, our profession, and our funders.