ADD, ADHD

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.