Category Archives: Autism

Case Study: 11 Year Old Male with Autism, Verbal Apraxia, and Sensory Processing Disorder

James was diagnosed with ASD (specifically, PDD NOS) with complicating diagnoses of verbal apraxia and sensory processing disorder. His most significant issues were:

  • Anxiety. Generalized anxiety as well as fear of changes in routine and unfamiliar places.
  • Sleep Problems.
  • Self-stimmulatory behaviors such as vocal noise-making, pinching, hand-flapping.
  • Poor social engagement.
  • Apraxia and lack of verbal communication.

James began listening to his custom REI recording in the evening while he engaged in quiet play. He was initially resistant to listening (sometimes he would say “no music!”) when the music was turned on. This resistance lasted less than two weeks while, during this time, he made significants gains.

During the first two weeks,  James began sleeping through the night, something that he had not been able to do for the previous few years. His anxiety also reduced profoundly, most notably he stopped compulsively asking about the the day’s schedule and worrying about his next activities.

During the third week, his mom related, “For the first time James started asking the ABA therapists to keep playing when the session was done. He also, on his own volition, chose to start playing with his trains and Rescue Heroes. Usually he only wants to draw all day.”

After four weeks on the REI Custom Program, his mom and therapists noted that James’s vocabulary was increasing, as was the length of his sentences.

After 6 weeks James was reported to show the first signs of pretend play. His mother wrote, ”The other day he said ‘elephant’ and used his arm as a trunk and stomped around the room! Also did a similar thing with ‘giant.’ Very exciting!”

At eight weeks, James’s mom reported more behavioral gains. He was doing less drawing and the drawings that he did create were of broader subjects. She noted that he was able, with prompts, to sit through his brother’s baseball game, a first. While the family was out sightseeing they got caught in the pouring rain. “James did not like it, but was okay”. To his family’s surprise he did not have the customary meltdown.

After 16 weeks of listening to his REI recordings, his mother requested a revision to his program that focused more on his issues with inflexibility and difficulty with transition. He started listening to the revised CD in mid October.

After 20 weeks, it was noted that James was continuing to make behavioral gains. His brother was having a bar mitzvah and the whole family was worried about how James would tolerate the very stimulating day. He handled the day surprisingly well, his mother reported, sitting through the entire religious ceremony and staying calm among all the guests. Most surprisingly, James allowed himself to be photographed. Until that day James would get very agitated when a camera was pointed at him and always refused to stand for a photograph. On this day, not only would he allow many photos to be taken, but even smiled on command!

Over the next month, his mother reported that James was using more spontaneous language and appeared “more connected” with his feelings. For instance, she related that when his teacher asked him what was wrong, James replied,  “I feel angy”. When asked why he was upset when he had to go to a mainstream class that he did not like (because the sound of the classroom music hurt his ears,) he replied “because there was music.”  On another occasion, he told his mother that he felt “nervous” when his school bus took another route home one day.

Fifteen months after completing the REI Custom Program, in an interview with his mother, James was reported to be doing well, with continued growth in his ability to verbally communicate his needs and to socialize more appropriately. He has maintained all of the gains he made while on the REI Custom program, including decreased anxiety, especially about his schedule, increased spontaneous play, and use of verbal communication to express his feelings.

Learn more about the REI Custom Program here

Start 2016 right with Free REI Audio Downloads

We usually send out free REI music downloads during the holidays, but this year we thought it would be more fun to make these available at the start of the new year.

This year we have three powerful new downloads:

Note: The first link may work better for mobile users

Click the links and enjoy. Please feel free to share these links. There is no email sign up needed.

REI Creator Jeff Strong Speaking at USAAA Conference in Tucson July 30th

Jeff Strong is presenting at the 2015 US Autism & Asperger Association 10th Annual World Conference in Tucson, AZ July 30-August 1, 2015

Based upon his recent memoir, Different Drummer: One Man’s Music and Its Impact on ADD, Anxiety, and Autism, Jeff will speak about calm, anxiety reduction, and the development of REI.

He writes, “When I began my exploration of therapeutic drumming in 1983, I was fortunate to study with a teacher who showed me how to calm aggressive behavior with fast, complex drumming. This experience became important years later when we were doing a study with adults on the autism spectrum.”

Jeff is joining a distinguished line up of presenters including Temple Grandin, William Shaw, and Stephen Shore. Here is a breakdown of the conference schedule

If you are attending the conference, please seek us out and say hello.

If you are unable to make it to Tucson, parts of the conference will be streamed live. Learn more about this here.

Dallas Morning News Reviews Jeff Strong’s Different Drummer book

Dallas Morning News Different Drummer reviewDallas Morning News wrote a review of REI creator Jeff Strong’s book, Different Drummer: One Man’s Music and Its Impact on ADD, Anxiety, and Autism.

Here is an excerpt from the review:

Throughout Different Drummer- “One Man’s Music and Its Impact on ADD, Anxiety, and Autism”, Strong gives numerous accounts of how well the fast pace of drumming appeals to the functions of the brain.  Intriguing stories of children with autism being changed by the fast pacing of the drum will teach readers how to assist in changing behaviors damaging to the person with a disability as well as those around him.

People with disabilities are often misunderstood as having a temper, a strong will, when in actuality it is a disorder often times uncontrollable until someone brave and caring, like Strong who finds the way to calm the beast inside.

Since William Congreve, an English playwright and poet wrote, “Music hath charms to soothe the savage beast”, no one has written and understood behaviors as well as Jeff Strong demonstrates in his newest book, A Different Drummer.

You can read the entire article here

You can also read more reviews and order the book on amazon.com

 

 

REI Creator Jeff Strong’s book Different Drummer Featured in onlinedrummer.com article

Jeff Strong at onlinedrummer.comOnlinedrummer.com has an excellent review of REI creator Jeff Strong’s book, Different Drummer: One Man’s Music and Its Impact on ADD, Anxiety, and Autism.

Here is an excerpt from the article:

Music performers and educators will of course find the book to be useful and gratifying, but parents of those with developmental disorders, mental health professionals, general practitioners, and educators across the board should also take note. In fact, they would all be wise to run out and pick up a copy of this book and consider Strongʼs other materials. If you yourself happen to have one of the conditions mentioned here, itʼs an absolute no-brainer to give this a try. If you have a friend who suffers one of these issues, your recommendation could help change their lives.

You can read the entire article here

You can also read more reviews and order the book on amazon.com

Strong Institute Director Jeff Strong Dissects an REI Rhythm in a New Video

In his book, Different Drummer: One Man’s Music and Its Impact on ADD, Anxiety and Autism, Jeff Strong mentions many of the rhythms he uses as the basis of REI. This video explores the development of one rhythm to give you an idea of the intricacy of the patterns he uses as well as the process he goes through to determine the best rhythm to use in a given situation. This rhythm is in the time signature of 21/16 and is one that he finds helpful in reducing a hand-flapping motion often seen in people on the autism spectrum.

You can also watch and comment on this video on YouTube here


 

Reduce Aggressive Behavior with REI

by Jeff Strong

Strong Institute Director

Different Drummer BookThe following is an excerpt from my my book, Different Drummer: One Man’s Music and Its Impact on ADD, Anxiety, and Autism.

I could hear the screaming as we pulled into the driveway.  I looked with concern at Lloyd, who simply raised an eyebrow.

Knowing they were expecting us, Lloyd and I walked right into the house and were immediately confronted by Ty who was running through the entryway screaming and flailing his arms.

His mother was following behind, trying to catch him.

Lloyd motioned for me to set down the drum and grab a chair for him as he took stock of the situation. Then he sat down behind the drum and began playing.

He started with a loud slap to the head. The drum’s shout filled the huge room and reverberated off the hard surfaces, drowning out Ty’s screams. Lloyd paused then gave the drum another hard slap. 

Ty turned to look, but continued screaming, hitting and pushing his mother away as she caught up to him and tried giving him a hug. 

Lloyd tapped the head with the tips of his fingers, laying down a soft patter that was barely audible in the midst of the chaos in the room. 

Once out of his mother’s arms, Ty made another lap around the room then came running toward Lloyd and grabbed at the drum. Lloyd was unfazed and kept playing, holding the drum between his legs as six-year-old Ty pawed at it.

Ty’s mother took advantage of Ty’s focus on Lloyd and the drum and was able to get a hold of him. Ty squirmed, but didn’t put up much of a fight as Lloyd raised his volume and began playing in earnest. 

I was still stunned by the difference in Ty’s behavior from the last couple of sessions with him. This was our third meeting with Ty; and although Lloyd had told me before we met Ty that he was prone to aggressive outbursts, I hadn’t seen one yet. The Ty that I had observed up until that point was a quiet boy who was intent on occupying his own world, generally oblivious to everything around him. The screaming, running, and lashing out where new to me.

These behaviors, however, were something that I became intimately familiar with in the following decades.

I thought of Ty’s screaming and physical aggression as I entered the yard of the residential facility where I was getting ready to conduct a study. Located in a rural area not far from where I was living in Arizona, this home for adults with autism had been profiled in a newspaper article. I called the home, hoping to be able to play for the residents. Only a year before, I had seen the remarkable calming effects of one of my tapes when it was tested at an adult vocational center. (I talk about that research project in Chapter 9). I was told that this facility was having troubles with its residents’ anxiety and aggressive behavior; I hoped to make customized recordings for each resident to see if my drumming could help. 

Once through the entry gate, I saw a man coming toward me. He started yelling obscenities as I approached, his pace toward me quicker than my pace toward the administrative office. I started to say hello and ask him where the director was, but he simply continued on in great detail about how he was going to hurt me—punch me in the face, kick me in the groin, elbow me in the chest—if I crossed him. 

This was Charlie, one of the residents and one of the reasons I was at this facility. 

His threats were directed to me at a high volume and without making eye contact. By my observation and experience with other men with autism, I didn’t feel that he really intended to act on his threats. He had the characteristic monotone, lack of eye contact, and overall flat affect that characterizes many with this condition. He also lacked the usual intensity and in-your-face aggressiveness that typically precedes such an attack.

Nonetheless, given his history of unprovoked aggression, I was careful not to get too close or to upset him if I could avoid it. I did, however, sit down on the bench near the garden and pick up my drum, which he regarded curiously, and begin to play, which prompted him to watch me even more closely. I was pretty confident that he had never encountered anyone entering his space and drumming. The novelty of this situation seemed to disarm him, because he stopped talking and watched me.

I began by quietly playing calming-type rhythms at the characteristic REI eight-beats-per-second pace. Over the next few minutes, I slowly built up the volume of my drumming and before long he sat down next to me. A few minutes later he put his hand on the shell of the drum. 

After approximately four minutes, I began a series of more intense rhythms to see if his behavior would change. This is what Lloyd used to do to invoke a response in a listener and to gauge their level of engagement in the rhythms. Within less than 30 seconds, Charlie grabbed the hardware lugs that tension the drum and tried to pull the drum from my lap. Because I have become accustomed to anticipate a reaction of this sort (I’d lost hold of the drum many times before), I pulled back and just barely managed to hang on.

After a short struggle, he let go of the drum and leaned away from it, though he stayed on the bench. Using the calming-type rhythms I started with, I began playing again. He settled back on the bench. I continued playing for another ten minutes or so, careful to not play rhythms that were too intense or chaotic. He noticeably calmed during this time and was sitting still, gazing off in the distance as I stopped playing and walked away.

Charlie’s response was not unlike Ty’s when Lloyd finally got into a groove. With his mother’s arms around him, Ty stood holding the drum as Lloyd played. I stood in awe as Ty was drawn into the pulse and power of Lloyd’s drumming. Lloyd played for almost ten minutes and all the while Ty stood and held the drum. Ty was calm and allowed his mother to hold him by the time Lloyd stopped playing, so we decided to call it a session and leave.

When we got to the car, I asked Lloyd what he did to calm Ty down. 

“I hit the drum with intensity to get his attention. The first slap didn’t do anything. So I played another,” he described.

“That’s when Ty looked at you,” I said.

“Yes, but he was still out of control. I needed to do the unexpected, so I played exactly the opposite way next. Instead of yelling, I whispered.”

“I could barely hear what you were playing. What rhythms were you using?”

“Nothing special. The whisper was the important thing. He needed to search for the sound.”

“And he did. He came right over to you. It was amazing.”

“He was still out of control, though.”

“Yeah, I noticed you switched rhythms or something. The sound was so, I don’t know, pleading.”

“I was talking to him. Asking him to join me. To surrender his violence.”

“Then he just stood there. His mom held him and he didn’t move. Why did that happen, and so fast?”

“He surrendered,” was all Lloyd said. I got nothing more out of him.

These experiences with my teacher and mentor Lloyd were exciting, and maddening. I couldn’t understand a lot of what he was talking about at the time. I was only 20, after all, and my life experience was limited. But somehow I learned enough to use as the foundation to grow on my own over the years.  

The drum was a curiosity and the soothing patter drew listeners in, shifting their awareness from the anxiety and aggression they were displaying while allowing their brain to entrain to the rhythms and into a calmer state (I talked about entrainment in Chapter 5 and about calm in Chapter 9). In both Ty’s and Charlie’s cases, calm occurred within a few minutes. 

While I played for Charlie, Kathleen, the home’s director, came out and watched me play. I walked over to her after I finished, and we talked as we meandered through the gardens.

“Charlie, the man you just played for, is the aggressive guy I told you about on the phone,” she described. “He’s a sweet guy at heart, but we’ve been having three or four violent outbursts a week where someone is injured.”

“That’s a lot,” I said. “How badly are people hurt?”

“Not too bad, but we have to report them and we’re getting pressure to find him a different home if we can’t reduce the incidents. We’ve tried different medications and behavioral interventions, but nothing has really helped.”

“Do you know what triggers his aggression?”

“Most of the time it’s when he’s asked to do a chore that he doesn’t want to do. Other times he gets in one of the other guy’s [resident’s] faces. It’s worse during mealtimes. We have to work hard to manage everyone while they eat. Dinner is the most stressful time of day here.” 

Kathleen described that Charlie has lived in a group home situation since he was 14-years-old. He was placed there due to his family’s inability to care for him and manage his anxiety and aggressive outbursts. This facility was his fifth group home.

Due to his non-compliance and severe behavioral reactions, Charlie was not involved in many of the day-to-day activities that the other residents enjoyed. The staff reported that he did enjoy riding and brushing the horses; but they didn’t allow him to do these activities often, due to his tendency to spontaneously hit the horse with a closed fist.

Aside from these aggressive behaviors, Kathleen described that Charlie’s anxiety also manifested in the form of self-stimulatory vocalizations and sleeplessness. The vocalizations were often threatening in nature, but there didn’t seem to be a correlation between his threats and his aggressive actions. 

“His yelling and swearing seems to be a release mechanism for him,” said Kathleen.

“It sure is disconcerting, though,” I added. “When I first heard him, I thought he had Tourette’s.”

“No, he has autism.” 

Tourette syndrome is a condition characterized by involuntary repetitive physical or vocal tics (Chapter 11 has more on Tics). Charlie’s verbal threats weren’t the result of Tourette syndrome, because his vocalizations contained form and more closely resembled perseveration (the repetition of an action, word or phrase in the absence of a related stimulus). Perseveration is a common trait of autism and is an area where I tend to see marked gains; I was eager to see if reducing Charlie’s anxiety would improve this behavior.

Charlie could speak clearly with excellent grammar and vocabulary, but he only talked in an aggressive manner. The fact that he could speak and had a vocabulary, albeit a nasty one, suggested that if I could reduce his anxiety, he may become more conversational in his speech. This wasn’t a primary goal in working with Charlie, but it was one area I intended to keep an eye on as he used his REI recording. As in the case of Jim, who I discussed in Chapter 14, I have seen the spontaneous initiation of speech occur in adults with autism as a result of reducing anxiety.

Kathleen and I talked for a couple of hours, going over the details of the study I would conduct. The plan was to create a custom-made recording for each of the residents. Each recording would focus on areas of concern specific to each resident. I would also attempt to reduce the overall level of aggression and anxiety in the facility. 

You can order the book here

REI for Adult Autism, Sleep and Bipolar – A Case Study

Even though the REI Custom Program is implemented at the listener’s home and we create the recordings based on a comprehensive intake questionnaire, I still occasionally get to play live for a client before they start their program.

In this case study, I met with the subject, Russell, in the group home where he was living and played for him twice before making the REI recordings. Russell was 38 years old and had been at this facility since its inception 11 years previously. Prior to then he was cared for at home by his family.

According to records, Russell was diagnosed with autism and bipolar disorder. He had very limited communication skills and was functionally non-verbal. The facility staff described that his communication consisted of mostly pointing, directing and vocalizing (mostly with grunts and other non-language cues). He also exhibited severe often self-injurious, self-stimulatory behaviors, the most significant of which were head-banging, anal-digging, and forehead-scratching.

The issues they were most concerned about, and the reason for wanting to do the REI Custom Program, were his self-injurious behaviors and his bipolar symptoms including, poor sleep and a starvation/binge-eating cycle (where he often gained and lost up to 10 pounds through his cycles).

Read the Rest of the case study here

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.