autism

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

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 significant 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

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.

Reduce Aggressive Behavior with REI

by Jeff Strong

Strong Institute Director

The following is an excerpt from 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).

The severity and frequency of his self- injurious behaviors increased when he was on the depressed side of his bipolar cycle. The staff reported that when he was depressed he needed near-constant redirection to keep him from engaging in these self-abusive behaviors. He was also difficult to engage in activities such as doing chores and interacting with the animals. Instead, the staff described him as lethargic and moody.
 
He, they stated, preferred to sleep during the day or to sit by himself and self-stimulate until asked to stop. He would generally stop when asked to but approximately 30% of the time the staff noted that they needed to physically stop these behaviors. This was done by gently pulling his hand away from either his face or anus or by moving him from the wall that he was banging his head-on. He rarely put up much resistance and seldom expressed any agitation to this redirection.
 
The staff described that Russell hadn’t eaten yet the first day I met with him and had eaten very little in the past 2 weeks since his depressed cycle began. The staff noted that he had lost 7 pounds already since the end of his last manic period.
 
I met Russell in the main group living area where he was sitting by himself. He made no response when I said hello to him and simply sat in his chair with his hand to his forehead. He wore a bandage and was lightly scratching at it as I talked to him.  A staff member pulled his hand away and he fidgeted with it in his lap for a short while before returning it to his forehead where he started scratching again.
 
I began playing the drum. Nothing in his behavior changed for a few minutes until which time he was noticed to be scratching less on his forehead. After approximately 10 minutes he was no longer scratching his head and his hands were clasped in his lap while he sat nearly motionless. His gaze was fixed in front of him and it didn’t appear that he was looking at anything in particular. The staff mentioned that he seemed much calmer, referencing his voluntarily stopping his self-stimulation.
 
He continued to sit quietly with his hands in his lap for about 15 minutes after I stopped playing. At that point, one of the staff came to get him to take a walk outside, which he did without resistance.
 
I met with Russell a second time before making his REI recording so that I could observe him when he was in a manic state. The director called me about 2 weeks after my first visit informing me that he was now manic. When I arrived at the facility he was agitated – evidenced by his pacing back and forth while wringing his hands. I was informed that he hadn’t slept well the last few days and had, in fact, had been under constant supervision for the past 2 days for fear of him hurting himself with his self-abusive behavior.
 
I quickly got out my drum and began playing. His reaction was immediate – he stopped pacing and turned to me, frozen. He stood nearly still for the duration of my playing (approximately 12 minutes). When I stopped he turned and quietly left the room. One of the staff members remarked on how calm he seemed at that moment.
 
The director related that his bipolar cycles were pretty regular – the manic period lasted about 2 weeks and the depressed period lasted between 2 and 3 weeks. He currently wasn’t taking any medication for this because they had tried various ones that had not been successful. They were currently taking a break from medications of any kind.
 
Russell received his REI recording three days after my last visit while he was still in a manic period. Because he was having trouble sleeping it was recommended that he listen at bedtime. Upon my follow-up visit after four weeks, the staff noted that his daily REI tracking log reflected that he fell asleep while the recording played the first night and, aside from 3 nights the first 2 weeks, he fell asleep before the REI recording ended (this is within 20 minutes, a much shorter time than was typical for his manic periods).
 
When his cycle shifted to a depressed mood, the staff continued to play the REI recording at bedtime because it was the easiest time of day for them to play it. He continued to fall asleep while the recording played, though it wasn’t unusual for him to fall asleep within this timeframe when he was depressed before using the REI recording.
 
The staff instructed Russell on how to turn on the recording himself at bedtime and, except for a few days during his depressed cycle, he did so without prompting.
 
The staff had also taken to playing his REI recording during the day during his depressed period (in addition to playing it at night) and they noted that his mood seemed to elevate and he became more active throughout the day. The staff also noted that his self-abusive behavior had lessened. This change in self-abusive behaviors began being noticeable after just over 4 weeks after beginning REI.
 
For the next few months, Russell continued listening to his REI recording at bedtime and during the day during his depressed cycle. Staff tracking revealed that his frequency and intensity of self-abusive behaviors were progressively lessening. When I went to see him at the twelve-week point, he had no sores or scabs on his forehead, at a state that the staff describe as unheard of before starting REI.
 
The staff also described that his manic and depressed cycles were noticeably less severe. When he was most recently manic he was much calmer and was sleeping every night. The staff also described that when he was depressed he was less lethargic and easier to engage in activities. He was also eating three good meals a day.
 
After 6 months, the staff noted that Russell demonstrated an improvement in his symptoms of bipolar disorder – his cycles weren’t as deep, the lows weren’t as long, and he was better able to handle the depressed side when it did occur. The director said that he was no longer listening to the REI recording every day but when he did listen before bedtime he would sleep deeper and wake more rested. After talking with the staff, they agreed to try to be more consistent with playing his recording and in helping him remember to turn it on before going to bed.
 
You can learn more about the REI Custom Program by clicking the Custom Program tab above.

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.

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