Monthly Archives: March 2015

REI Improves Trantrums And Transitions

DD-Front-cover-25Note: This article is an excerpt from Strong Institute Director Jeff Strong’s book, Different Drummer: One Man’s Music and Its Impact on ADD, Anxiety, and Autism.

This case study includes Jeff playing live for a client, Timmy. These results don’t require a live performance, however. Timmy’s improvement in tantrums and transitioning from one activity to another was due to listening everyday to his REI Custom Program.

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Many of the people I work with who experience anxiety manifest it through other types of behaviors. Ten-year-old Timmy tantrummed when he became anxious. This anxiety was most prominent when he was asked to change what he was doing. Transitions always elicited an emotional outburst: He would scream and lash out at whoever was close.

“This is our special needs room,” described Sara as we walked into a classroom ringed by cubicle dividers. Each cubicle area was furnished with a small table and a couple of chairs. Some also contained a beanbag chair or a carpet on the linoleum floor. There was a large table in the center of the room with a dozen small chairs and two couches in the cubicle space directly across from the door.

“Why the cubicles?” I asked.

“We work with each student one-on-one for most of the day,” she explained as she led me to the couches where we sat down.

I unpacked my drum, threw it on my lap and give it a quick tune as Sara explained, “Timmy will be coming back to the classroom any minute. He’s usually pretty agitated.”

She paused, then said, “There, you can hear him now.”

Hearing a commotion coming from the hall, I started playing my drum. I jumped into a series of calming rhythms at a pretty high volume, not feeling a need to start quietly because Timmy wasn’t in the room. Instead, I wanted Timmy to hear it from the hallway.

I was playing loud enough that I could no longer hear what was going on outside the classroom. I watched the door for him, ready to adjust my rhythms based on how he acted as he came into the room.

It took less than two minutes for Timmy to peek into the room. He did this by standing across the hall from the door. He seemed to look everywhere but at me. I ignored him as I played, waiting for him to get the courage to enter the room.

Timmy stayed in the hallway for a while, alternately standing where he could see me and moving out of range. I ran through a series of calming rhythms, hoping that he would come into the room. Eventually he did, slowly migrating from the doorway and around the perimeter of the room until he came to the couch. As he navigated closer to me, I dropped my volume until I was playing at barely a whisper as he stood before me.

I continued playing for another minute or two without looking his way. He remained planted a couple of feet from me.

I stopped.

Timmy surprised me by approaching me and touching the drum. He very gently put one hand on each side and looked past me. I tapped the head with my index fingers, creating a syncopated patter, still not looking at him.

His hands moved to the edge of the drum, then onto my hands while not disturbing my playing. I kept playing with just my index fingers, but edged-up the rhythms a little, increasing in speed and complexity. Timmy’s hands gripped my two last fingers, which were hanging off the sides of drum.

As I morphed my rhythms over the next few minutes, Timmy’s grip changed with each permutation. Harder, then softer. Back and forth in different intensities as the rhythms rose and fell. We were dancing the rhythms. This dance lasted several minutes until he abruptly let go and sat down on the floor. The connection was gone.

I dropped my volume and faded out. Timmy was playing with legos, his back to me. I packed up and left the room.

Sara followed me out and said, “That was cool. He doesn’t like physical contact and here he initiated it with you.”

“Yeah, it was cool,” I replied. This connection, no matter how fleeting, was one of the reasons I loved playing live for kids and was something I never really got tired of. It was also something that didn’t happen that often. However, as gratifying as it was, I didn’t allow myself to spend much time on it. I was focused on what I needed to do in order for Timmy to become less emotionally reactive.

“Did he settle down quicker today than usual?” I asked, trying to get a sense of whether the rhythms I had chosen had contributed to his calming after the change in rooms and activities.

“Yes. He is usually pretty agitated for a while. But he seemed to connect with you. That calmed him.”

“That was fun,” I said as I wondered if this connection could be helpful in reducing his anxiety overall. Other kids I had played with seemed to carry that connection to their relationship with their REI recording. My work with past clients showed that this connection wasn’t necessary, but I felt it always helped.

Sara and I talked more about Timmy’s anxiety and she assured me that his parents were on board with him listening to an REI recording.

Sara felt comfortable using our online system, saying she preferred to play the track through her phone. I entered Timmy’s intake data into our system and Sara was able to begin playing his recording in school the next day. She would enter Timmy’s progress into her account and I would only lightly monitor it, letting our software take the lead in creating the tracks for Timmy.

The goal was for Timmy to become less emotional during the many transitions he experienced throughout the day.

Over the course of sixteen weeks, Timmy listened to eight progressively-created, custom-made REI recordings, each used once a day for two weeks during the school week. Making the recordings one after another, based on Timmy’s responses, was the key to making overall changes to his ability to handle change.

Timmy responded immediately with his first REI recording. Sara chose to play Timmy’s recording first thing in the morning because this was generally one of his most difficult times. The transition to school nearly always caused a meltdown. She also hoped that listening first thing would make the rest of the day easier.

The first day it took about five minutes for Timmy to settle in. Ordinarily he could be agitated for up to an hour. His calm lasted until lunchtime, when he had a meltdown in the cafeteria. I asked that Sara not play Timmy’s recording more than once a day because I wanted to ensure that he didn’t get overstimulated from the drumming.

Timmy’s first two weeks continued with him listening first thing in the morning, calming quickly and remaining calm until lunchtime. At the two-week point, Sara called me to ask whether another time of day would be better from Timmy. She described that he seemed to adjust to the day easier and he was arriving at school less agitated. We decided that playing his recording right before lunch might be worth a try.

Timmy again responded immediately with this new schedule. Sara turned on his recording about ten minutes before it was time to go to the cafeteria and let it play as he got his food and began eating. She described from the first day that he stayed calm as he went through the transition from classroom activities to lunchtime.

It was obvious from the outset that Timmy would calm when the REI recording played. At the beginning of the Program, he would remain calm until another transition took place. Then he would get anxious. This pattern changed over the course of about six weeks. At first Timmy had the occasional time when he handled a change without issues, but after six weeks he would tolerate most transitions without a problem.

“Timmy is now self-regulating,” described Sara at our eight-week check-in. “You can see him begin to get stuck in his pattern and almost have a meltdown, but then he collects himself. He never used to be able to do that.”

Given that he was calmer and beginning to learn to calm himself and tolerate change, we had Timmy return to listening first thing in the morning. This was an easier time for Sara to play his track and we wanted to see how well he could navigate the day’s changes without using the track during a transition.

The goal of reducing anxiety with REI is to get to the point where the listener is able to learn to self-regulate. As with Timmy, it can be helpful to use the REI recording when the anxiety is at its worst, but eventually it can become a crutch. The switch back to listening when a client isn’t having an emotional reaction to change removes this crutch.

Timmy handled this change well. For the first few days, Timmy was agitated when transitioning to lunch; but by the end of the first week he was able to transition as smoothly as he did when he listened during this transition.

The last seven weeks of the Program were designed to integrate his self-regulation skills solidly enough that he would not need to listen to his REI recording everyday. He did this successfully. I talked with Sara a couple of weeks after he stopped listening to his last REI recording.

“Timmy is a new kid. He no longer tantrums when asked to move on to a new activity. His resistance has melted over the last couple of months and now all I need to do is let him know a minute or so before we make a change that he needs to get ready to do something else. You can see him preparing himself. He stops what he’s doing for a few seconds and gets quiet. Then, when we ask him to switch activities, he does it without hesitation. He hasn’t had a meltdown in several weeks.”

Timmy illustrates the REI Custom Program path that many clients struggling with anxiety follow. The first track provides an immediate, temporary calm. Each progressive track extends the amount of time the listener remains calm after listening until we see some level of self-calming in situations that caused anxiety before beginning the Program.