ADD, ADHD

Using REI to Reduce Aggressive Behavior and Anxiety in an Adult with Autism

In this newsletter, I share a case example of one client in the autism spectrum, a 35 year-old male with autism whose main issues were aggressive behavior and anxiety. This example is part of a larger study on adults with autism conducted at a group home setting. You can read the entire study here.

Subject 4: Carl. – Male, age 35.

According to records, Carl had lived in a group home since he was 14 years old. He was placed there due to his family being unable to care for him and to manage his anxiety and aggressive outbursts. This facility was his fifth group home and, due to his volatile behavior, the director reported that she was concerned that he wouldn’t be able to remain in this facility.

The director described that he was responsible for 3-4 violent outbursts each week that resulted in someone begin injured. These were not so seriously as to put anyone in the hospital but significant enough that these incidents needed to be reported to the state agency responsible for the facility’s license. As of the beginning of the REI Study, the facility was under pressure to reduce his aggression or find him a different home that could better manage his behavior. His aggression often manifested when he was directed to perform an activity that he didn’t want to do such as clean up after a horse.

Due to this non-compliance and behavioral reaction, Carl was not involved in many of the day-to-day activities that many of 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.

The staff reported that, aside from these aggressive behaviors, Carl’s anxiety also manifested in the form of self-stimulatory vocalizations and sleeplessness. The vocalizations were often threatening. Although he could speak clearly with excellent grammar and vocabulary, he only talked in this aggressive manner.

When I was first introduced to Carl, he went into great detail how he was going to hurt me – punch me in the face, kick me in the groin, elbow me in the chest, for example – if I crossed him. He related this to me at a high volume without making eye contact. By my observation, he didn’t seem like he really intend to do these things because he had the characteristic monotone, lack of eye contact and overall flat affect that characterizes many with autism. He also lacked the usual intensity that typically precedes such an attack. None-the-less, given his history of unprovoked aggression, I was careful not to get too close or to provoke him in any way. I did, however sit down and pick up my drum, which he regarded curiously, and play, which prompted him to sit next to me and touch the drum’s shell. He held onto it as I played with his ear cocked toward the sound. His gaze was unfocused and at no point did he actually look at me.

I played calming type rhythms (at the characteristic REI 8-beats-per-second pace) for a few minutes while he held the drum and quietly sat next to me. After approximately 4 minutes I began a series of more intense rhythms to see if his behavior would change (this is a common approach used by traditional practitioners to invoke a response in a listener and to gauge their level of engagement in the rhythms). Within less than 30 seconds, Carl 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 back from it, though he stayed in his chair. I began playing it again using the rhythms I started with. He settled down in his chair while I continued playing for another 10 minutes or so. I was careful to not play rhythms that tend to provoke and he noticeably calmed during this time. When I stopped playing, he continued sitting quietly until I left the room.

The staff later reported that Carl remained calm for the rest of the afternoon, until dinnertime when he got into a scuffle with another resident (Subject 3: Billy) over food. Separating Carl and Billy during dinner diffused this incident. The staff noted that an altercation at dinnertime wasn’t unusual and that Carl was obsessive about food, taking as much as he could and eating fast and messily.

One of the other issues that the director related to me with Carl was that he had difficulty sleeping – both with falling asleep and with waking at night. She reported that if not supervised, he would sometimes attempt to leave the facility at night. He liked to wander around outside. On several occasions he was observed walking off the facility grounds and wandering onto neighboring properties. In one case he entered a neighbor’s house. Fortunately, the neighbors knew and recognized him and called the facility director to retrieve him. In order to avert an incident of this sort again, there was a staff member positioned within eyesight of his door throughout the night.

Results after listening to the REI recording

After four weeks of Carl listening to his REI recording once day, met I him in the corral where he was quietly brushing a horse. He had no reaction to me when I approached him – a much different experience for me than the first time I met him, He was clearly calm and focused on rhythmically brushing the horse.

I said hello to him and asked if he remembered me. He responded that I was “that guy with the funny drum” (the drum I use is very usual and shaped unlike any other drum, so this observation intrigued me. Of course it could mean that any drum was funny to him, or my playing was funny, or that he was observant enough to see the drum was different – this would mean he had some previous knowledge of drums and their common shapes. I didn’t explore this with him). I asked if he liked the drumming, to which he simply said, “yeah”. I asked if I could play for him again. His response was, again, simply, “yeah.”

I found a log to sit on about 20 feet away outside of the corral to play and began beating a calming rhythm for him. I noted no discernable response as he continued to brush the horse. After a while I began playing a regular rhythm that employed a steady accented pulse (this rhythm was a traditional Brazilian Samba rhythm with 16th notes playing two quiet notes and two accented notes, with the second accented note louder than the first every-other time through this pattern, making the loud accent occur once every second. This rhythm created a pulsing, forward-moving feel. This rhythm is different from a traditional Samba, however, because every other time through the pattern I cut the rhythm short by two notes, changing the time signature into 7/8, giving the entire rhythm pattern a 15/8 time signature). After a few minutes I noticed that he was brushing the horse to the rhythm, with his stroke following the louder of the accented notes.

I changed rhythms to something more typical of an REI rhythm (more complex and variable) and noticed that his brushing strokes slowly reduce in speed. I stopped playing at approximately 15 minutes, packed up my drum and left. He was still brushing the horse and made no notice of my departure. The staff reported that this was the longest amount of time he’d brushed a horse. They reported that he seemed content to do this. He offered some minor resistance when asked to stop this activity, though didn’t put up a struggle or react aggressively.

The director reported to me with some enthusiasm that they had noted no aggressive incidents from Carl since the first week of his listening to the REI recording. She related that he was much calmer and compliant overall. The staff described that he was more engaged in activities, especially those involving the horses. He hadn’t hit one since beginning listening to the REI recording. He also was more responsive to direction and would stop his vocal stimming when asked. He was still repeating phrases but they were less aggressive in nature.

The staff reported that mealtime was much calmer and noted that his eating had slowed down and he hadn’t gotten into any struggles with other residents over food.

As I instructed, the staff played the recording at bedtime. They noted that he often asked for the recording before going to bed. The tracking notes indicated that he fell asleep much quicker by the second night and was usually asleep by the time the REI recording ended (approximately 20 minutes). The staff noted that he had been sleeping well and hadn’t been observed getting up since then and hadn’t wandered at night. His tendency to wander was still apparent, though, as he did this during the day but he stayed within boundaries of the facility.

The staff also noted that Carl was beginning to engage in conversational speech when prompted. Contrary to what I experienced in my interaction with him at the corral, the staff reported that he was often able to respond with 2-3 sentences to the staff’s questions and directions. He rarely initiated conversations.

After twelve weeks, the facility still reported no incidents of aggression and noted that he was much less aggressive than he was before beginning the study. They described that he was still sleeping well and continuing to show improvements in compliance and listening ability. The director related that mealtimes had become a relaxed time since starting REI and they found that playing a calming REI recording (a precursor to REI Calming Rhythms) reduced anxieties during what used to be a stressful time at bay.

The staff also reported at this twelve-week check-in that Carl’s self-stimulatory vocalizations had decreased significantly. On the occasion that he did engage in these vocalizations, they were no longer aggressive and he would stop when asked. The staff reported that he began initiating conversation with others. This was evidenced by him approaching me and saying, “You’re the drummer guy. Where is your drum?” to me when I arrived for this visit. I answered that I didn’t bring my drum this time and would he like it if I brought it next time. He said, simply “Yeah”.

After 6 months the facility director reported that Carl continued to listen to his REI recording every day and requested it when the staff forgot to turn it on.  He still hadn’t exhibited any aggressive behavior since the first week of beginning REI. Tracking notes indicated that he was still sleeping well and hadn’t gotten up in the night. The staff reported that he was much more pleasant to be around and continued to enjoy his horse-relate activities without incident.

C.ick here for more information on the REI Custom Program

Quantitative Data Shows that Listening to Complex Drumming can Increase Attention.

Several years ago we created a Continuous Performance Test (CPT) to see if listening to complex drumming rhythms can improve focused attention.

We created this test to follow-up on two independent studies showing that REI drumming can increase focused attention. One study compared BSR music to the AD/HD stimulant medication, Ritalin, using a Continuous Performance Test (the T.O.V.A.) for an adult with Attention Deficit Disorder while the other study used a blinded placebo-controlled format for elementary-age children in a classroom setting.

Complex REI Drumming Beats Ritalin for Sustaining Attention in an Adult with ADD

This study (1) compared BSR’s music to two different doses of the ADD stimulant medication, Ritalin (10mg and 20mg). Using quantitative measures of scores from the Test of Variables of Attention (T.O.V.A.), four conditions were examined: Baseline (no meds or music), 10mg of Ritalin taken 90 minutes before the test, 20mg of Ritalin taken 90 minutes before the test, and while listening to REI music rhythms.

The subject’s baseline score was -12.74, putting him squarely in the AD/HD camp (anything below a score of 0.00 suggests attention problems).

His score with 10mg of Ritalin was a slightly improved -6.60 while his 20mg Ritalin score showed a significant improvement with a score of -3.47. 

His score when listening to the REI focusing music, the same tracks you will find in the Focus category of Brain Shift Radio, were a near normal score of -1.87.

This improvement was nearly 50% greater than the better of the Ritalin scores.

These results suggest that REI offers a strong alternative to Ritalin (and other stimulant medications used for ADD).

The advantages of BSR music include an absence of side-effects, individual customization to achieve the optimal stimulation level for each person, and improved sustained attention.

REI Drumming Improves Concentration in Elementary School Children

This study (2) examined 100 elementary-aged children in a double-blind, placebo-controlled format. Students performed four separate CPTs (Continuous Performance Tests), consisting of two tests with no music and two tests with either a placebo music recording or REI music tracks. Children were randomly assigned to the placebo or REI test group.

The results showed a significant improvement in attention for those who listened to the REI recording over both the silence and placebo conditions.  The silence group produced an average score of 23, the placebo group scored at 31, and the REI Rhythm group scored an average of 68.

These results have been encouraging enough that Brain Shift Radio has invested tremendous time and energy developing a next-level study to further explore the efficacy of REI rhythms and the delivery of BSR music.

BSR’s Attention Tests Move Music Research a Step Forward

With Brain Shift Radio’s Continuous Performance Test we are moving music research forward by conducting the largest study ever done on music for focusing.

Our attention tests were built using standardized, quantitative testing methods on an expanding platform which will allow us to collect and analyze limitless data with a goal of using this data to not only determine whether music can improve focused attention but also which techniques offer the most significant results for each population group.

Thousands of Tests = Some amazing results 

Since we launched the BSR CPT initiative thousands of people have taken the test. The results we’ve seen are 3.6 times better than the most popular study on music for cognition (and the number of people who have taken our test is hundreds of times more than this study) (3). 

As an overview, the average error-rate reduction was 36.73% with improvements falling fairly consistently across the three error types.

These are significant numbers and suggests that listening to Brain Shift Radio when you need to focus may help you sustain your attention.

We saw reductions in all three error rates – detection, commission and omission – with the BSR music (stimulated) condition compared to the silence (control) condition.

Detection errors (Detect): The silence (control) condition error rate was 12.42. The BSR music (stimulated) condition showed an error rate of 8.69. This is a 3.73 or 30.0% reduction of errors.

Commission errors (Comm): The silence (control) condition error rate was .73. The BSR music (stimulated) condition showed an error rate of .39. This is a .34 or 46.5% reduction of errors.

Omission errors: The silence (control) condition error rate was 11.58. The BSR music (stimulated) condition showed an error rate of 7.67. This is a 3.91 or 33.7% reduction of errors.

Fastest click: For the silence (control) condition the fastest click speed was 383 ms. The BSR music (stimulated) condition showed an average click speed of 355 ms (milliseconds). This is a 28 ms or 7.3% slower click-time.

Slowest click: For the silence (control) condition the slowest click speed was 968 ms. The BSR music (stimulated) condition showed an average click speed of 932 ms. This is a 36ms or 3.7% faster click-time.

Average click: Of the three click speeds the average offers us the best data. For the silence (control) condition the average click speed was 608 ms. The BSR music (stimulated) condition showed an average click speed of 579 ms. This is a 31 ms or 5.1% faster click-time.

Note: Data used for these studies are anonymous and complies with IRB and HIPAA requirements for client privacy and research integrity. 

Sources:

1. A Study for Improved Concentration by Acoustic Drum Rhythms Music Medicine Therapy

2. REI Rhythms Beat Ritalin for Adult with Attention Deficit Disorder

3. Mozart Effect

Exploring the Connection Between Drumming and Attention

Aside from the stress-reducing effects of drumming (and playing music in general), drumming activates the brain and can increase focused attention.

The following is an excerpt from my book, Different Drummer, which explores my inspiration for using fast, complex drumming to help with sustaining focused attention. I describe how I stumbled upon the core technique that would be the basis for the stimulation in all our programs and CDs.

You can learn more and order the book here

You can learn more about the REI Custom Program here

DD-Front-cover-25

I’m a drummer and a tapper. I drum on everything. All the time. It drives many people crazy. I always thought that my need to drum was just because of my obsession with music and rhythm; but as I was doing some research for an upcoming study on ADHD, I discovered that I’m not alone in my need to tap. 

“Have you ever heard of ‘fidget-to-focus’?” David asked as we were talking about our study. David was a neuropsychologist. He worked at a progressive clinic in San Diego and he was also a drummer. Although ADHD wasn’t his specialty, he was excited about exploring whether my drumming can impact attention. We were planning a study using a Continuous Performance Test (CPT) to collect quantitative data. 

“No, what is it?” I replied.

“It’s based on a study done years ago on coping strategies people with ADHD develop to help them focus. This study was exploring why it was believed that ADHD was considered a childhood disorder that people grow out of as they reach adulthood. It turns out that people don’t necessarily grow out of ADHD. Instead, many people develop strategies to help them function better. The ADHD is still there.”

“So what does fidgeting have to do with it?”

“Well, it seems that fidgeting is one of the most common strategies people with ADHD use to keep their attention. Most are simple things like rocking, shaking a leg, playing with a pen or pencil, anything that uses a motor movement to keep them engaged.”

“Like drumming.”

“Perhaps. Do you suppose there is a higher prevalence of drummers with ADHD than other musicians?”

“I don’t know. That’s an interesting idea, though. Most of the drummers I know are kind of like me. In fact, I don’t know any drummers who are not at least a little distracted, impulsive or hyperactive.”

“That would be an interesting study to do someday. But for now, if we consider fidgeting to help with attention, musical or not, perhaps the rhythm impacts the brain in a positive way.”

“It seems like the case to me, but what does fidgeting mean for our study?”

“Probably nothing, but maybe we can use the concept of fidget-to-focus as a basis for our hypothesis. Didn’t you say that you started developing your therapy from your experiences playing the drums and feeling more focused?”

“Yes. I guess that would be like fidgeting-to-focus. Only I wasn’t doing it solely to help focus. The drumming exercises were homework. And I wasn’t just focusing better while I drummed, I felt more focused afterward. The residual focusing effect was the basis of exploring the drumming for focus. My goal was to see if listening to syncopated drumming rhythms provided the same focusing effect as playing my homework exercises.”

I described to David that one of my challenges while attending the Musician’s Institute was being able to keep up with the pace of my classes. The most difficult for me, and many percussionists, was music theory and composition. I spent a lot of time analyzing music, digging deep into the structures that were being used in rock and jazz music (to this day I can’t listen to the Beatles and enjoy their music for what it is. I always find myself remembering the many hours spent dissecting their songs). As someone with ADHD, focusing on the mundane analysis of music theory and composition was nearly impossible. Contrasted with this was my favorite class, sight-reading, where it was always interesting and, as a result, easy for me to focus on.

Because I wanted to avoid music theory and instead work on sight-reading, I decided that I would reward myself for my theory and composition work by doing my sight-reading exercises before going back to some of the mundane work I was assigned. As someone who was somewhat impulsive and hated delayed gratification, I quickly decided to reverse this plan. Instead of theory first, I would allow myself to spend a half hour or so doing my sight-reading exercises then dig into theory for 30 minutes, followed by another bit of sight-reading. 

The reason I preferred sight-reading was that I was able to play continually unique patterns. One basic exercise consisted of reading rhythm patterns from a book on syncopation, calledProgressive Steps to Syncopation For the Modern Drummer, by Ted Reed. The patterns were random combinations of 8th and 16th notes written across the page, page after page throughout the book.

My assignment was always to choose a page and read it in varying ways. Left to right, top to bottom, bottom to top, right to left, diagonally, whatever. The goal was to always be reading one or two measures ahead of where I was playing. This got me accustomed to reading ahead, therefore when confronted with a new piece of music, I could read, comprehend, and interpret it right away and convincingly perform it the way the composer intended. I loved these exercises. They gave me a rush.

Imagine my surprise when I also discovered that these exercises made doing my theory and composition work easier. After 30 minutes of sight-reading, I’d switch to theory and, to my amazement, could focus. The analysis was easier and the musical structures started making sense. I could even begin to appreciate the simple predictability of the Beatles’ music (especially since I never really liked listening to it – still don’t).

And analyzing more complex music of some of the progressive jazz-fusion bands like the Mahavishnu Orchestra or Weather Report became rote. My grades for the semesters after discovering this sight-reading-then-theory pattern confirmed what I felt. I was focusing better and grasping complex concepts better.

Case Study: REI for 11 year-old with tics, anxiety, and sleep

Michael is an 11-year-old young man with vocal and motor tics. His vocal tics included grunting and throat-clearing while his motor tics consisted of lip-smacking and picking, neck-rubbing, and finger-bending.

At the beginning of his REI Custom Program, Michael’s tics were present most of time, usually starting just an hour or so after waking in the morning and continuing until bedtime. The degree and intensity of his tics seemed to be related to his anxiety and energy level. If he was tired, he exhibited more tics. Likewise, when he was anxious, his tics were more pronounced.

Aside from his tics, Michael also had difficulty sleeping, both falling asleep and waking at night. Generally, it would take him 1 to 2 hours to fall asleep and he would often wake once at night, usually between 3 and 4 am. Most of the time he was able to fall back asleep by having a parent lay with him. Other times, approximately 1 or 2 times per week, he would not be able to go back to sleep. Days after this were often times when his tic behavior was much worse.

Michael also exhibited high levels of anxiety. This was centered around fear of new places, unexpected events, and separation from parents. On a good day, he was able to go to school without clinging and displayed only minor trepidation toward new or unexpected situations, such as an unscheduled trip to the store or an event outside his normal routine. His anxiety exhibited itself as clinginess, crying, and tic behavior, most notably vocal tics.

In addition to the tics, anxiety, and sleep issues, Michael also showed classic signs of attention deficit hyperactivity disorder (AD/HD, ADD, ADHD). These symptoms included restlessness, inattention, impulsive behavior, and low frustration tolerance. It is not uncommon for ADHD symptoms and tics to occur at the same time. In fact, many refer to Tourette’s Syndrome (a severe form of tic disorder) as ADHD with tics. In Michael’s case, the tics were very pronounced whereas his ADHD-type symptoms were less significant than is usually the case when tics and ADHD are combined. This was evidenced by the fact that he was not diagnosed with ADHD.

The goal for Michael’s REI Custom Program was to improve his sleep and reduce his tics and anxiety. Additionally, we intended to improve his ADHD symptoms. This was a lot to accomplish with the program, so the key was to prioritize the focus of his program. We decided to focus on his anxiety and sleep first. This is because:

Sleep: Sleep is essential in moderating any of these symptoms, so improving his sleep would likely also improve some of his other symptoms. As well, according to Michael’s intake, his tics were more frequent and intense when he was tired.

Anxiety: Anxiety was a major issue for him in general and also exacerbated his tic behavior. Reducing his anxiety should not only help with the clinginess and crying incidents but should also help with the tics.

Track #1: Michael began listening to his track at bedtime. The first night he was calmed while the recording played, but he didn’t fall asleep right away. According to his parent’s feedback, he was calm enough that his dad was able to leave the room and turn off the light without incident, even though he took a while to fall asleep. This pattern continued for most of his first week. At about day 8 he fell asleep while the recording played and slept through the night.

During this first track, Michael exhibited less anxiety over everyday changes, such as going to school or therapy sessions, where he is separated from his mom. His vocal tics were slightly less frequent, while his motor tics remained pretty much the same.

Tracks #2 and #3: These tracks continued to improve his sleep and reduce his anxiety. He was able to consistently fall asleep while the recording played and only woke up two nights. He was able to fall back asleep both nights that he awoke. This was a significant improvement over his historic sleep patterns. His anxiety was better than before the program started but still manifested as separation anxiety in some situations.

His tic behavior was variable, with some days being better than others. Overall, his vocal tics were less than before the program according to the tracking documents completed by his parents. His motor tics were largely yet unchanged.

Track #4: For most REI Custom Programs there is a significant jump in the stimulation level of Track #4 as we adjust the focus of the client’s program. This was the case with Michael. Because he showed improvements in sleep and some changes in anxiety, it was determined that this REI Track would focus more on his tics, particularly the motor tics, which up to this point had only marginally improved.

The first three days went well – his tics, both vocal and motor, decreased significantly in frequency. He had periods during these days when there was no visible tic behavior. Unfortunately on day 4, he began waking up at night again (something he had not done for almost 3 weeks). This trend of improved tic behavior and night-waking continued for the remainder of Track #4 (6 more days).

Track #5: Because of Michael’s change in sleep patterns, we chose to reduce the stimulation level of this track. This was a trade-off between his improving tic behavior and his sleep patterns, but it was chosen because good sleep is important not only to functioning well in general but also because his tics often get worse when he is tired. As well, disrupted sleep patterns during the REI Custom Program usually indicate over-stimulation and the best way to counteract this is to reduce the level of the stimulation.

As expected his sleep improved, but also as expected we observed an increase in his motor tics. His vocal tics remained nearly non-existent. His motor tics, though higher than they were toward the end of Track #4, were still below the level that they were at the beginning of the program, so we were encouraged by his overall progress.

Tracks #6 through #8: We continued the dance between uninterrupted sleep and reduced tics during this three-week period. At times his sleep was off (Track #6) while his motor tics abated. And at times his sleep was good but the motor tics increased (Track #7). This was an interesting development because we always felt that good sleep always contributed to fewer tics. The problem was that it appeared that the type of stimulation needed to help with the tic behavior was disrupting his sleep.

By Track #8 we decided to go with the stimulation that would help with the tics and add a track to play at bedtime for sleep. We asked Michael’s parents to play Track #8 (and the rest of his REI Tracks) during the day and a special REI Program Sleep Track at bedtime. After a few days settling into a schedule that worked – they chose to play the Custom REI Track during breakfast – Michael’s sleep returned to where it was after track #3, with him falling asleep with 30 minutes of turning off the light (and turning on the REI Program Sleep Track) and staying asleep most nights.

Based on his parents’ observations, his motor tics remained somewhat variable, but their frequency overall was down from the beginning of the program. Stressful situations, as expected, increased tic activity. Because his anxiety overall was lower than when he began the program, he seemed to be less bothered by situations that used to be stressful for him. There was no observance of vocal tics during Track #8.

Tracks #9 through #12: Michael’s tic behavior was variable but showed steady progress. The vocal tics were essentially absent and there were longer periods of time with few, if any, motor tics. At one point during this period he caught a cold and his tics increased. They reduced again once his cold was over. This demonstrated more overall improvements but also suggested that stress on his system, both physically and psychologically, still had an impact on his tic behavior.

Michael’s anxiety remained low and his sleep was good, with only the occasional bad night’s sleep. Over the last 6 tracks or so he also improved in some of his ADHD symptoms – he seemed less restless and exhibited a greater ability to handle new situations and life’s frustrations.

The end of the 12-Track program: Michael made significant gains in his sleep, anxiety, and tic behavior during the 12-track program, with minor changes in some of his ADHD-type symptoms.

Sleep: Before beginning the REI Custom Program, he often took 1 to 2 hours to fall asleep. He awoke at night several times per week and many times was unable to fall back asleep again. By the 8th day of the Program, his sleep had improved significantly. This made an impact in many ways, including reducing his tics and lowering his anxiety and frustration intolerance.

Anxiety: At the beginning of the Program, Michael’s day was ruled by anxiety. He was clingy with his mother and fearful of new and unexpected situations and events. Within just a few tracks, his anxiety was noticeably lower. He exhibited less clinginess and became more relaxed in general.

Tics: Before REI, Michael’s tics were near-constant and impacted his life significantly. The vocal tics – grunting and throat-clearing – were especially bothersome because they impacted him negatively in social situations. With these gone and the motor tics much reduced, he is now more comfortable interacting with his peers and is receiving less negative peer attention.

ADHD-type symptoms: Even though the focus of Michael’s REI Custom Program was not directed to his ADHD-type symptoms of restlessness, inattention, impulsivity, and frustration intolerance, he did show some improvements in some areas. As his tics decreased, his restlessness also appeared to reduce. This is likely due to the tic behavior appearing as restlessness or fidgeting.

Michael also showed some improvement in frustration tolerance. This coincided with his improved sleep and reduced anxiety, suggesting that this symptom was caused, at least in part, by his poor sleep and high anxiety levels. Likewise, as his sleep, anxiety, and tic behavior improved, so did his attention. There was no observable change in his impulsivity.

Based on his progress it was decided that Michael continue receiving tracks until there was less variability in his tics and anxiety. We also were ready to begin a more direct focus on his attention and impulsivity.

REI for an Adult with ADHD

A large percentage of our clientele are adults with ADHD. Given that our program was created by an adult with ADHD, we are particularly adept at and excited to help other adults. This client, a 33 year-old male had the classic symptoms for AD/HD (ADD, ADHD) such as difficulty sustaining focused attention, restlessness, trouble getting started on projects, and impulsivity. He also had significant anxiety, addictive behavior and mood issues. According to his REI intake form he described himself as:

laid back personality, good sense of humor, creative, spiritually inclined, can have a hot temper, high energy, symptoms of difficulty falling asleep, restlessness, and problems focusing when reading, distractible, impulsivity, difficulty starting tasks, difficulty stopping activities, procrastination and delay, addictive behavior, and overall anxiety.

Due to his symptom make-up, age and gender Jim’s REI Custom Program consisted of 16 progressively-created REI Audio Tracks with each track scheduled to change every seven days.

Jim did very well on the program, the details of which you can read here

You can also get an in depth look into REI for attention and other issues related to ADHD in Strong Institute Director Jeff Strong’s book, Different Drummer. Learn more here

Jim, a 33 year old male, had the classic symptoms for AD/HD (ADD, ADHD) such as difficulty sustaining focused attention, restlessness, trouble getting started on projects, and impulsivity. He also had significant anxiety, addictive behavior and mood issues. According to his REI intake form he described himself as:

laid back personality, good sense of humor, creative, spiritually inclined, can have a hot temper, high energy, symptoms of difficulty falling asleep, restlessness, and problems focusing when reading, distractible, impulsivity, difficulty starting tasks, difficulty stopping activities, procrastination and delay, addictive behavior, and overall anxiety.

Due to his symptom make-up, age and gender Jim’s REI Custom Program consisted of 16 progressively-created REI Audio Tracks with each track scheduled to change every seven days.

In his first week on track one he found that he had a more stable energy and mood throughout week. He still had some anxiety and depressed negative thinking (due to circumstances and life changes). But he was less impulsive in his decisions and was able to refrain from addictive behavior (internet use and playing music loudly). He also found some improvement in focus, but still some difficulty focusing in meditation and schoolwork. He did not see any improvement in his ability to fall asleep.

Week two, on track two, Jim saw improved focus when reading, but still had some focusing problems when practicing meditation and contemplation. He found improved focus when writing. He was able to start assignments and work on them without frustration. He had fewer feelings of anxiety this week and found it easier to redirect himself and refrain from addictive behavior (internet and listening to music). Still, there was occasional difficulty falling asleep at night.

Week 3’s track three provided less anxiety and better focus when reading and in meditation. Yet he struggled a bit with some impulsive decisions that drew him into addictive behavior. His sleep was still so-so.

Week 4 offered JIm some improvement in sleep. For a few nights this week he did not feel stuck in a tired state of being unable to fall asleep. He continued with better focus when reading. And had fewer addictive thoughts and actions compared to the previous week. He seemed to be less anxious overall, but noticed some anxiety over the weekend.

His negative Response: “Still some anxiety. Experienced some intense anger, frustration moods and thoughts with resentment and bitterness with highly charged emotions to the point of physical movement. Some depression as well. Still some impulsive, addictive behaviors – internet and loud music, but not as bad as last week.”

As is common with the REI Custom Program, Jim seemed to really make headway in his symptomatic improvement in week 5.

Week 5 Jim continued the gains from last week. Not many addictive thoughts and he was able to redirect. By the end of the week, it was easier for him to refrain from impulsive, addictive behavior. He said it was “easier to redirect my mind”. He had less anxiety overall but it was still present. He stated that “I realized this week that I have had long term anxiety problems in addition to ADHD (my father also has had anxiety problems). Intense feelings of frustration, anger and resentment earlier in the week, was significantly reduced by the end of this week.” His focus when meditating and reading has improved, but he stated that there was still room for improvement. He also stated that he feels, “my mind has slowed down, with less racing thoughts and intense moods.” He was able to fall asleep this week.

Week 6 he had an improved ability to fall asleep and was waking up at a good time. He also had better focus when reading and meditating.
His thoughts and feelings of resentment and anger did return this week, but not with as much intensity as the previous week. His feelings of anxiety were most often in the morning. He had some restlessness and frustrated moods and some difficulty concentrating. And he was more inclined to impulsive and addictive behavior this week.

Week 7 Jim had significant improvements in anxiety and mood. And he had no harsh feelings and thoughts of resentment. He found it much easier to get to sleep – no restlessness or rampant thinking when lying in bed to go to sleep. He also had a better overall and more stable mood throughout the day and week. (During this time he moved and registered for school, which resolved some problems.)
There were addictive thoughts this week, but not as frequent or intense as earlier weeks where it was a problem. Still had some restlessness and hyperactivity — and listening to music with headphones at night and during the day when he wanted to be doing other things.

Week 8 Jim noticed he was better able to focus when reading. He also experienced far less fear based anxiety. He did find it harder to get to sleep at night this week, even though he had just listened to the audio. He also had a bit of regression for restlessness and frustration. This week also included a lot of time spent with addictive music listening (to relieve anxiety or restlessness?). This seemed to be triggered by a “difficult relationship incident” that he experienced at the beginning of this track. In spite of this incident he described having, “better moods upon realizing what I need to do and responding. But there was some negative imagination and frustration going on…”

Week 9 Jim saw continued improvement in focus and also noticed improvements in sleep. He also saw some changing moods this week: frustration with negative thoughts and charged feelings. He stated he is “Probably still experiencing anxiety.”

In week 10 Jim reported, “Significant improvement in mood this week compared to before. Very little anger, frustration, and resentment. More stable mood and energy throughout week. Improved sleep and rest. No problems waking too early and getting back to sleep.”

He still experienced some impulsive decisions into addictive behavior at night after work, still listening to music with headphones but with less frequency and duration.

Week 11 Jim reported, “Starting to see an overall consistency in all areas. Less anxiety, more solid sleep, more stable moods, better focus, and attention. Almost no feelings of anger, resentment, and frustration compared to a few weeks ago. Did not see any clear regression in any areas. Still having some problems with impulsivity towards addictive behavior (listening to music and internet activity). A couple of nights it was harder to fall asleep. Better focus when reading, but my mind will wander off. Focus could be better in meditation.”

He also reported a drastic shift in routine: He moved out of state and enrolled in a graduate program, which brought about a resolution to a long difficult period of change.

Week 12 Jim wrote, “Less restlessness and anxiety. Saw less of an impact from consuming sugar in juice and cookies over holidays. Stable moods and energy. No frustration or angry moods. Felt more “centered” emotionally and mentally over the week, even though in new environments. More overall focus and calmness.”

He did have some difficulty with attention when reading and some impulsivity. He still exhibited some impulsive behavior to addiction (listening to music w/ earphones and internet). And he saw some difficulty focusing in mediation/contemplation. During this time he traveled for the holidays.

Week 13 Jim reported, “No anxiety this week. Pretty stable moods for the most part. I have noticed better ability to learn and focus when reading. I can move through the text at a slower, more concentrated pace. However, my mind may still wander off. Some impulsive decisions towards addictive behavior. A few nights it was harder to fall asleep. No problems waking early and getting back to sleep. Some difficulty focusing in meditation/contemplation. Routine Change: No, but still adjusting to change and being at home where I grew up which has had an impact on mood and behavior.”

Week 14 Jim wrote, “Really the first major test of my focusing abilities this week, being in a classroom and studying afterwards. Able to remain calm and focused during work and class. A very noticeable difference and change from earlier time periods doing school work. I do not recall any anxiety and my moods were quite stable overall. Generally more calm and centered.”

From Jim’s Week 15 notes: “Some improvements in impulsivity. No anxiety from what I recall. Overall much more centered and focused mind, stable moods and energy compared to the beginning of the program. Ability to fall asleep easily on nights when audio was not played too loud.”

Throughout his entire Program, his daily feedback consistently states that his current track “calmed me down and helped me focus” while it played.

At the 15 week point Jim had progressed well enough that it was determined that he should use each track for a 4 week period to help with his long-term focusing and to solidify the changes he had achieved so far.

At this point he has had 2 further adjustments and is progressing along well with the improvements he has seen and is seeing progressively better long-term focusing effects.

You can also get an in depth look into REI for attention and other issues related to ADHD in Strong Institute Director Jeff Strong’s book, Different Drummer. Learn more here

REI Improves Trantrums And Transitions

Note: 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.