Researchers continue to identify evidence-based interventions (NAC, 2009,, 2015) that can offer safe, success-oriented, cost-effective, and generalizable results for individuals with autism spectrum disorder (ASD). Providing a multi-sensory experience that stimulates a myriad areas in the brain may improve working memory and subsequent learning for individuals with ASD (Berger, 2002). While visual supports and video modeling (NAC, 2009,, 2015) are best-practice approaches used to communicate with and teach individuals with ASD, there is a lack of empirical inquiry concerning the presentation of the information to be learned. As many music therapists work with individuals with ASD and approximately 87% of music therapy clinicians are female (AMTA, 2018), investigating if the gender of the care provider impacts client learning is warranted. In addition to the care provider’s gender, visual and auditory aspects of the presentation of information may also impact recall. Therefore, the purpose of this study was to examine the effects of instructor gender and visual and auditory melodic instruction on working memory in individuals with ASD.

Researchers from the National Center for Education Statistics have investigated teacher gender discrepancies. During the 2015 – 2016 school year, they concluded that approximately 77% of public school teachers were female (National Center for Education Statistics, 2017). Due to the gender difference in the teacher workforce, researchers have investigated same versus different gender pupil-teacher interactions. In elementary public schools, Ehrenberg, Goldhaber, and Brewer (1995) concluded that female students’ test scores in mathematics and science did not increase more rapidly when the teacher was a female than when the teacher was a male. Mancus (1992) concluded that while elementary aged girls and boys attributed authority to male teachers, elementary aged girls and boys attributed academic competence of the teacher most often to female teachers. Boys tended to follow an egalitarian pattern of positive attributions, with slightly more made to female teachers. Dee (2005) asserted that both male and female students were more likely to be perceived as disruptive by an opposite gender teacher. In a longitudinal study involving 54,000 students, Bettinger and Long (2005) concluded that female instructors might positively influence female freshman college students’ course selections and major choices, thus supporting a possible role-model effect. The researchers also noted that male faculty may positively impact same-gender student interest in a subject of study.

Medically-oriented researchers have investigated the influences of care provider gender and care receiver gender and have concluded that preexisting stereotypes, expectations, or actual differences in physicians’ behaviors, and the tone and content of the medical visit might be different depending on physician gender. Hall and Roter (2002) conducted a meta-analysis and concluded that patients, regardless of gender, spoke more to female physicians than to male physicians and disclosed more biomedical and psychosocial information. Similarly, Bhati (2014) asserted a general “female effect” and concluded that the female and male clients matched with female therapists reported a higher therapeutic alliance, collaborative role enactment, and empathetic resonance than when the female and male clients were matched with male therapists. In a related investigation, Pikus and Heavey (1996) concluded that the majority of female clients preferred working with female therapists. Female clients specifically commented that they felt more comfortable talking with someone of the same gender while most male clients expressed no preference for therapist gender. In addition to gender matching potentially influencing therapeutic alliance, gender matching also appears to be a factor in determining treatment retention. Wintersteen, Mensinger, and Diamond (2005) and Shiner, Westgate, Harik, Watts, and Schnurr (2017) reported that female patients who were treated by female therapists had the highest retention rate while male patients who were treated by male therapists had the lowest retention rate.

Individuals with ASD often present with deficits in cognitive processing (Bauman & Kemper, 2005; DiCicco-Bloom et al., 2006). These deficits are specifically apparent in the frontal lobe, the area of the brain primarily responsible for executive functioning (Geurts, Verte, Oosterlaan, Roeyers, & Sergeant, 2004; Verte, Geurts, Roeyers, Oosterlaan, & Sergeant, 2006). Researchers have also concluded that hyper-connectivity appears to exist between the prefrontal and parietal cortices and a hypoconnectivity exists between the sensory-motor regions (Holiga et al., 2019). Researchers have labeled this difference in neural connectivity as the “underconnectivity theory” (Just, Cherkassky, Keller & Minshew, 2004; Just & Varma, 2007). Proponents of this theory have asserted that inter-regional connective in the frontal lobe of the brain is disrupted in autism due to poor frontal-posterior connectivity (Just, Keller, Malave, Kana, & Varma, 2012). Holiga and colleagues (2019) concluded that understanding brain connectivity alterations in ASD might help the development of better diagnostic and therapeutic tools.

Working memory is the ability to simultaneously store and process information (Baltruschat et al., 2011). Pennington and Ozonoff (1996) concluded that working memory functions as an organizational aspect of memory and has a role in goal-directed behavior. Responsible for aspects of executive functioning, working memory is integral to linguistic processing (Elliot, 2003) and is primarily processed in the dorsal and lateral pre-frontal cortex (Nolte, 2002, p. 549). As a result of the structural differences in the neural connectivity of the brain of individuals with ASD, individuals with ASD regularly demonstrate deficits in working memory that can lead to challenges in understanding social cues, academic progress, and independent living skills.

In order to improve cognitive processing for individuals with ASD, experts have identified modeling and visual supports as two of the 11 established evidence-based practices (NAC, 2009,, 2015). Video modeling is a combination of both modeling (Bandura, 1977) and visual supports (Quill, 1997) and can be an effective approach for teaching social skills, self-care skills, and motor skills (Bellini & Akullian, 2007; Charlop-Christy & Daneshvar, 2003; Charlop-Christy, Le, & Freedman, 2000; Sherer et al., 2001). Video modeling may also be considered a form of dual coding (Paivo, 1991), wherein the target information is delivered and received through both the auditory and visual channels. To assist with video modeling, clinicians and teachers commonly used electronic recording devices such as the iPad® as an accessible and visually stimulating reinforcement of teaching. Since the advent of the iPad® in 2010, researchers have demonstrated the efficacy of the technology for academic, social, communication, and emotional regulation skill growth. Allen, Hartley, and Cain (2016) concluded that the iPad may be a tool to assist children’s ability to generalize academic skills outside of the formal school environment.

Due to the importance of utilizing visual and auditory supports as effective enhancements to the educational and clinical environments of neurodiverse individuals, the use of the iPad® as an instructional tool has become more prevalent over the last decade. Therefore, researchers have investigated the effectiveness of this technology on academic and social skill achievement. Allen, Hartley, and Cain (2016) recommended that iPads® might motivate children to engage with learning. Maich and Hall (2015) offered suggestions for using iPads® for educational purposes, choosing appropriate applications, and integrating the technology into the inclusive classroom environments. Researchers have also investigated the use of iPad®-based video modeling to teach numeracy skills (Jowett, Moore, & Anderson, 2012), iPad® instruction on challenging behaviors and academic engagement for children with ASD (Neely, Rispoli, Camargo, Davis, & Boles, 2013), and the use of video self-modeling on an iPad® to teach functional math skills to adolescents with ASD (Burton, Anderson, Prater, & Dyches, 2013). El Zein et al. (2016) concluded that teacher directed instruction was more effective for increasing the accuracy of responding to curriculum-based measure probes than iPad® instruction. The researchers also recommended using the iPad® to teach students skills that would aid in enhancing their reading comprehension. Moreover, they identified that iPad® applications should incorporate modeling, prompting, visual supports, and positive reinforcement. As motivational processes directly impact knowledge acquisition and transfer, it would seem that the integration and usage of the iPad® in educational and therapeutic environments should be further explored (Wang, Teng, & Chen, 2015).

Care providers often utilize music for social and academic skill attainment (Brownell, 2002; Schwartzberg & Silverman, 2013). Researchers have used melody to assist with the immediate recall of information for individuals with neurologic disabilities (Schwartzberg & Silverman, 2012; Thaut, Peterson, McIntosh, & Hoemberg, 2014). McElhinney and Annett (1996) concluded that there was a better overall recall of familiar words correctly recalled in a song condition than in a reading condition. Silverman and Schwartzberg (2014a) studied the effects of voice timbre (male versus female instructor) on the sequential working memory recall of university students and found better recall accuracy during the male voice conditions. Researchers have also concluded that music conditions were more effective than speech conditions on short- and long-term memory recall (Schwartzberg & Silverman, 2012). In a related study, researchers investigated the effects of presentation style and musical elements on the working memory of individuals with and without ASD (Schwartzberg & Silverman, 2018). Participants demonstrated significantly more accurate recall during the live conditions than the recorded conditions.

Although music and iPads are frequently used in an attempt to augment learning, no researcher has investigated the effects of instructor gender and video recorded music-based instruction on the sequential working memory of individuals with ASD. These data would be important to determine if instructor gender and aspects of video instruction paired with music will have differing effects on the sequential working memory of individuals with and without ASD. Therefore, the purpose of this study was to examine the effects of instructor gender and visual and auditory melodic video recorded instruction on working memory in individuals with ASD. Specific research questions included:

The overall model of the three-way repeated measures ANOVA was not significant, F(1, 54) = 0.008, p = .928, partial n²= .000.

Research question one: There was no significant difference in sequential recall between male and female instructors, F(1, 54) = 1.432, p = .237, partial n² = .026. Although not significant, the mean recall for the male instructor (M = 3.59, SE = 0.17) tended to be slightly higher than for the female instructor (M = 3.35, SE = 0.18).

Research question two: There was no significant recall difference between visual + auditory stimuli condition and the auditory only condition, F(1, 54) = 1.824, p = .182, partial n²= .033. Although not significant, the mean recall tended to be slightly higher for the visual + auditory stimuli condition (M = 3.62, SE = 0.20) than for the auditory only condition (M = 3.32, SE = 0.16). A summary of the descriptive statistics and pairwise comparisons is reported in Tables 1 and 2, respectively.

Research question three: There was a significant between-group difference concerning group, F(1, 54) = 66.576, p < .001, partial n²=.552. The NT group demonstrated higher recall accuracy than the ASD group (mean difference = 2.36, p <.001, 95% CI = 1.78, 2.94).

Research question four: More accurate working memory recall is typically observed in sequential positions of primacy and recency and numerous interactions between serial position and other variables have been previously reported (Schwartzberg & Silverman, 2012,, 2018; Ward, 2002). Therefore, the researchers did not statistically analyze recall data by serial position. Rather, the researchers graphed these data in Figures 1 and 2. Mean recall scores tended to be more accurate in serial positions of primacy and recency.

According to the American Music Therapy Association, approximately 87% of music therapy clinicians are female (AMTA, 2018). Moreover, many care providers pair music with information to be learned in an attempt to augment working memory. Therefore, the purpose of this study was to examine the effects of instructor gender and visual and auditory melodic instruction on working memory in individuals with ASD.

The mean recall of information presented by the male instructor tended to be slightly higher. Traditionally, male teachers have been perceived as more authoritative and female teachers as more academically competent (Mancus, 1992). Moreover, these factors may be further challenged when an individual presents with deficits in perspective taking. Identifying how to demonstrate these perceived leadership traits, which can lead to enhanced rapport and therapeutic alliance, might be helpful for the achievement of targeted goals. However, as instructor gender results did not reach statistical significance and more males participated in the study, readers should be cautious regarding the conclusions. Care provider gender may not be an influential variable on the success of the client when music is integrated into the learning environment.

As demonstrated through the results of research question three and congruent with previous research (Schwartzberg & Silverman, 2012,, 2018), there was a significant between-group difference with the NT group demonstrating higher levels of recall accuracy. The difference in age between the two groups may be one rationale for the significant difference in mean scores. While the mean ages of the two groups was only separated by one year, the participants in the ASD group ranged from ten to 32 and the participants in the NT group ranged from 18 to 24 years. Developmentally, the younger participants with ASD had less time to develop their working memory skills and compensatory strategies to assist with working memory recall than the NT college students. The neurological difference between the two groups is another potential rationale for this significant difference.

A limitation of the study was the access to participant health records as participants’ cognitive functioning was not obtained through personal health information or formal assessment. Therefore, participants’ memory recall was not analyzed according to cognitive functioning or other demographic factors. Another limitation was the use of a convenience sample for both groups as there was a disproportionate number of males in the ASD group and females in the NT group. Finally, the attrition that occurred in the ASD group represents an additional limitation.

Recall is a necessary cognitive function required for all aspects of cognitive, communication, motor, and social skills. Although within-group differences were not significant and generalizations are not warranted, results tended to be consistent with existing literature. As individuals with ASD may have unique learning challenges, information paired with music may be delivered in multi-sensory ways to increase the likelihood of recall and subsequent learning. Future research is warranted to continue to determine the preferred learning style and approaches that may yield the best immediate recall and enhance subsequent learning in individuals with ASD.

The authors do not have any actual or potential conflicts of interest including any financial, personal, or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work.

Edward T. Schwartzberg (M.Ed., MT-BC) is a Senior Teaching Specialist and Clinic Coordinator in the Music Therapy Program.

Michael J. Silverman (Ph.D., MT-BC) is Professor and Program Director of Music Therapy.