Sensory Processing

Case Study: 5 year old female with Sensory Processing Disorder and PDD-NOS

Abby was a happy, energetic and friendly five-year-old female with Sensory Processing Disorder and PDD-NOS. She was adopted at 15 months and, according to the limited medical records available, may have had a minor brain injury or been sensorily deprived during her time at the orphanage. Since being adopted Abby received therapy services to address her sensory issues.

When Abby completed the REI Custom Program intake her issues were as follows:

  • Anxiety: Abby was anxious over transitioning from one activity or environment to another and afraid of loud and stimulating public places. She tended to lash out (scratching, hitting) others when over-stimulated or anxious. She would rock her body back and forth and engage in other repetitive behaviors to self-soothe. She was also notably fearful of the dark and of monsters.
  • Inattention: Her mother reported that Abby had difficulty focusing and staying on task. She was easily distractible and restless and fidgety when asked to attend to a task. She would often act impulsively, though she was not a thrill-seeker.
  • Language delay: Abby had difficulty expressing herself. She often repeated words or phrases, had difficulty with pronunciation and enunciation, often reversed her pronouns, and had problems finding the right words to say even if she knew them.
  • Sensory seeking behavior: Abby was a highly energetic child who would seek highly stimulating activities. She often craved pressure to self-soothe. She had difficulty with motor planning and didn’t know where she was in space, frequently bumping into others.
  • Sensory aversion: In spite of her sensory seeking behavior, Abby was also often sensory aversive. She was easily startled, reacted aggressively to light or unexpected touch, and disliked physical contact.
  • Social interaction difficulties: Abby prefered to interact with her family and had difficulty knowing how to engage with other children. She required prompts to interact unless it was a high-energy activity, such as playing tag.

Abby listened to her REI Custom Program recording once a day at various times based on her schedule. Times were generally between 8am and 10am or between 6pm and 8pm.

Many people ask about the best time of day to play their REI recording. In the long run it doesn’t matter – we can achieve the same net results as long as the current recording is played once a day. In the short run, the time of day you play the REI recording can have an impact on behavior for that day.

Abby’s varying schedule illustrates this concept really well. For example, she seemed calmed by the recording when it was played. In the evening this made the transition to bedtime easier. Even on the first day of listening, her mother reported that she was more compliant with her routine of brushing her teeth and putting on pajamas when she listened at 7pm.

When listening in the morning (8am) Abby also demonstrated calm from her REI recording. She dressed without complaint and allowed her mother to comb her hair without fidgeting. This calm effect seemed to last: According to teacher reports, Abby did a better job following directions and staying on task on the days she listened in the morning.

These immediate effects of listening can help you decide what time of day to play an REI recording. For most of our clients we recommend bedtime for three reasons:

  1. The evening transition is often difficult because the client is tired therfore is often more resistant. Calming can only help this resistance.
  2. Most of our clients have a hard time falling asleep. Turing on the recording when the light is turned off generally helps with falling asleep.
  3. The evening routine usually ends with some quiet time and it’s often easy to fit the REI recording into this time. 

Abby benefited well from the calming effect of her recording regardless of when it was played, so the best schedule for her was one in which her mother could find the time to play the recording.

After 2 weeks Abby showed improvements in:

  • Eye contact. This was noticed not only by Abby’s parents but also her teacher, who in one instance, remarked how Abby looked her in the eye and said she understood when her teacher explained that Abby could play with her friends after school if she followed directions during the day. She complied and was able to follow directions.
  • Transitions. She was less reactive/resistant to going to bed and school.
  • Language: Began using full sentences.
  • Sensory defensiveness. She was less bothered by having hair combed and would sit quietly rather than fidget or pull away.

Abby was clearly getting a fair amount of stimulation from her REI recording, which allowed for some good initial gains. On the flip side, she also craved more sensory input such as jumping on a trampoline and running around.

For her next recording we chose to address her sensory seeking behavior, knowing we would be slowing the progress of her language improvements, as sensory modulation and language development require two different types of REI stimulation. Her other issues, anxiety and attention, generally didn’t require this shifting focus since we can address them in each context. Over the remainder of her REI Custom Program we alternated the focus of Abby’s program between language/social and sensory.

This meant that each new track pushed one area forward while stalling, and some cases slightly back-tracking, the other. For example, during track #5 Abby showed significant improvements overall in her ability to appropriately interact with other children and her language showed improvement. While at the same time, she still needed to seek sensory input by jumping and swinging and she exhibited anxiety, particularly over loud noises, the dark, and monsters. 

On the other hand during track #4, when we focused on the sensory processing, Abby showed improvement in sensory seeking activities such as running and jumping and engaged in more quiet activities including pretend play. Her langauge, however, regressed. She returned to repeating words and phrases, something she stopped doing once she began her program. Her mother felt that some of the vocal perseveration was due to anxiety over her school situation – there was a new student in the class that was impulsive and loud – but this behavior matches the give and take that can happen when switching the focus of an REI Custom Program.

Over the next several months Abby made progressive gains across the board from this alternating pattern in REI stimulation levels. Most notable from the start of the program were:

  • Language: She was now using pronouns properly more consistently. The fluidity and composition of her sentences also improved significantly.
  • Social: She was interacting more appropriately with other children. She was more talkative with them and was able to engage without needing prompts from adults.
  • Anxiety: Overall Abby was less resistant to transitioning to and from school and with her bedtime routine. She still exhibited some anxiety when she was tired or over-stimulated.
  • Attention: Abby was more compliant with directions from her parents, therapists and teachers and was better able to attend and stay on a task asked of her.
  • Sensory seeking behavior. She was less compulsive about seeking sensory input from running, jumping or swinging. During the last three tracks of her program she exhibited some self-stimulatory behaviors, such as rocking and jumping, but the timing of this matches with her returning school where there are other children who are anxiety provoking to her (crying and screaming)
  • Sensory Aversion. This area improved most notably in her reduced resistance to having her hair combed. She was also better able to handle noisy environments, though she could still get over-stimulated by them if she is tired.

Abby continues to listen to REI recordings as we adjust her recordings to further her progress.

REI for Sensory Processing: Two helpful resources

Most of our clients have sensory processing issues, whether its hyper-sensitivity to sound or poor grading of movement (or a host of others). In this blog post, I share two great resources for understanding how REI can help with sensory processing.

1. Video. Here is a video on how we approach sensory processing using complex drumming

2. Article: A Look at Rhythmic Entrainment Intervention by Its Creator

51P3J+XBKNL._SX385_BO1,204,203,200_

Published in: Insights into Sensory Issues for Professionals: Answers to Sensory Challenges, edited by Kathleen Morris. MS CCC/SLP. 2010.

by Jeff Strong

Director, Strong Institute

Auditory rhythm has a long history of use for affecting neurological function, with the earliest uses being documented tens of thousands of years ago. These original techniques are some of the most pervasive therapeutic practices known to man, existing on every continent even among people who had no contact with one another (Harner, 1990). As an ethnomusicologist I was fascinated by the commonality in the techniques within such disparate cultures. I spent over a decade trying to understand how the same basic therapeutic approaches developed when so many other aspects of these societies were vastly different.

The answer, it appeared, was that the physiological mechanisms at work are so powerful that experimentation by each culture resulted in a common finding: You can affect consciousness, cognition, and behavior by employing only two specific rhythmic techniques. One consists of a repetitive pulse while the other employs complex rhythmic structures.

Discovering such commonality among traditional therapeutic rhythm practices prompted another, perhaps more important, question: Can these therapeutic effects sustain themselves outside of the cultural context in which they developed? I believed so, but many of my colleagues did not, believing instead that the rhythm was secondary to the rituals they were imbedded in (and is often attributed to the placebo effect). This led to an odyssey that began in 1992 and has continued to this day, culminating in the development of Rhythmic Entrainment Intervention™ (REI).

REI is a music-medicine therapy (Spintge & Droh, 1992) that stimulates and synchronizes the listener’s brain. REI is available as some generalized CDs (Calming RhythmsFocusing Rhythms and the SI Series CDs), and the REI Custom Program™. This is a custom-made, program that optimizes neurological function.

Auditory Rhythm to Stimulate the Brain

REI is unique in several ways. First, REI employs auditory rhythm to directly stimulate the listener’s brain. Other auditory programs use modulated frequency (Tomatis, 1992), binaural beats (Oster, 1973), or simply classical-based music (Rauscher, Shaw, and Key, 1993).

Auditory Driving

As I developed REI, my first step was to identify the core mechanisms of the traditional techniques. It turns out that these mechanisms are simple, powerful, and easily understood. First, human consciousness can be directly affected by an auditory stimulus. This is called “auditory driving” (Goldman, 1992). Auditory driving states that a listener’s brain wave activity will synchronize with the pulsation of an auditory rhythm (provided certain conditions are met).

Traditional practitioners would employ a four-beat-per-second rhythm, which would in turn facilitate a corresponding four-beat-per-second pulsation in the listener’s brain, resulting in bilateral neurological synchronization and a shift in consciousness to a theta state (this is a meditative state)(Maxfield, 1994).  With REI we double the tempo to synchronize a listener’s brain into a relaxed neurological state called alpha. This is the state of consciousness where sensory processing is optimized.

Complex Rhythms

The second core mechanism involved in traditional therapeutic rhythm techniques consists of using complex rhythms to activate the brain (Scartelli, 1987; Shatin, Koner, Douglas-Longmore, 1961; Parsons, 1996). Here complex auditory rhythms stimulate the Reticular Activating System (RAS), a part of the brain that controls sensory input (Scartelli, 1992). Applying rhythm – especially complex rhythm – to activate the brain is one level of the stimulation provided by REI. As we conducted research we discovered another dimension to the rhythms: One that appears to be more important than just complexity. It seems that each rhythm produces a different response.

Once the core mechanisms were discovered the next step was to determine the best way to deliver the correct stimulus to aid in the areas in which I was interested. Traditional practitioners performed the rhythms live for each person and adjusted their rhythms based upon the responses they saw in their patient.

Daily Listening for Long-Term Change

This is where I started — the first 1,000 people that REI was used for experienced this one-on-one, live stimulus. They also listened to a recording of one of their live sessions daily in their home. Daily listening was a departure from the traditions, but I felt that people needed the stimulation repeated consistently for a length of time in order for any long-term change to be expected.

One of the first children that I worked with in this manner was a seven-year-old girl on the autism spectrum. In this case, the girl, let’s call her Stephanie, was referred to me because of extreme anxiety. This anxiety impacted every aspect of her life: She wasn’t able to sleep in her own room and needed to be in constant contact with her mother; transitions and even minor changes in her environment were a point of crisis for her throughout the day.

She also had significant language and social delays. Her language consisted largely of repeating rote words and phrases. Although she had a large vocabulary, she was unable to communicate beyond her basic needs and desires. Socially, she lacked eye contact and wasn’t able to interact appropriately with her peers.

She calmed down within minutes during the first live session, and after the second session she remained calm and was able to sleep in her own room from that night on. Stephanie listened to a recording of her third live session everyday for eight weeks. At seven weeks she spontaneously described events in proper sequence for the first time. She was also developing social connections and had begun making friends.

She was mainstreamed at school (she was in a classroom with non-autistic children and had a one-on-one aide) and at 10 weeks the school psychologist evaluated Stephanie in her classroom and noted that she was “indistinguishable from the “normal” children in the class.” She continued listening to her recording for several more months and eventually no longer required her one-on-one aide.

Universal Calming Effects

This, and many other cases studies, led to a formal study conducted in a public school setting (Strong, 12). This study consisted of 16 children from age 6 to 12 who were on the autism spectrum. The results of this study showed almost universal calming effects (only one child was not calm most of the time, and this child ended up not being on the autism spectrum).

Long-term change was significant for anyone who heard the recording at least four times per week.  This study caught the attention of several prominent autism professionals and led to a paper of this study being presented at several professional research conferences (including one organized by The Center for the Study of Autism led by Dr. Stephen Edelson, who went on to design all of our double-blind, placebo-controlled studies).

At this point my interest in exploring the therapeutic application of auditory rhythmic stimulation techniques deepened. I formed the REI Institute with Beth Kaplan with no intention of creating a “therapy” that would be available outside of a research environment.  Our goal was simply to try to understand how auditory rhythmic could be used to enhance neurological function.

Over the next 10 years the REI Institute conducted numerous studies and presented dozens of scientific papers on what we were learning. Two of the key discoveries of this period were that synchronization was universal when certain techniques were applied and that each rhythm used elicited a definite, observable response over time.

Specific Rhythms’ Observable Effects

In other words, we found that we could introduce specific rhythms to have a pre-determined effect on each listener. To date, we have documented over 600 rhythms that seem to correspond to symptoms and combinations of symptoms. As a result we found it was critical to use just the right rhythms for each person in order to have the greatest positive benefits for that person.

During the 1990s, the REI Institute conducted a series of double-blind, placebo-controlled studies to try to understand the best approaches to take in balancing auditory stimulation and synchronization. What we learned in a nutshell was that the custom-made CDs are more effective than CDs created for a broad user base.

Custom-made, Revisable CDs

This leads to the second unique aspect of REI: The REI Custom Program™ is custom-created for each person based on his unique characteristics. By custom-making each CD we can ensure that the correct level of stimulation is used for that person. In the event that we aren’t seeing the results we’ve come to expect, we also revise the CDs until we see the results we are looking for. The practice of revising the custom-made CDs is the third unique aspect of REI.

Because the REI Custom Program™ is created for each person, we are able to focus the CDs on the three or four main issues someone faces. As a result, everyone responds differently to his CDs, but we see the most significant benefits in some general categories. These include anxiety, sleep, self-stimulatory behaviors, language skills, sensory sensitivities and defensiveness, socialization, attention and focus, and aggressive or oppositional behaviors.

Another example of the results with the REI Custom Program™ (and one most relevant to this article) can be seen with a 10-year-old boy with severe sensory issues. Gerald, as I’ll refer to him, saw significant improvement within just a few days. Before he began the REI Custom Program™ he refused to wear shoes or socks, covered his ears whenever music was played, couldn’t tolerate headphones, and socially isolated himself from others, often retreating to a dark, quiet room.

Within the first week of listening to his CDs, Gerald was more tolerant of everyday sounds. He also spontaneously joined his extended family outside and began  interacting with them. By the second week he was interacting with his siblings and cousins much more frequently, and by week four, according to his REI Provider, “… He is wearing socks and tennis shoes every day. He now not only allows mom to listen to music in the car, he often goes to his room and ‘rocks out’  to his own pop music.  He has been more interactive and engaged in activities as well as initiating appropriate play with other children.”(Strong, 1996) He was also able to tolerate headphones for the first time.

Open-Air Environment

This leads to the fourth thing that distinguishes REI from other auditory programs: REI is designed to be used in an open-air environment. That is, we don’t use headphones for the implementation of the therapy. The CDs simply need to play quietly in the background once a day (with the exception of the third week where the CDs are used twice a day). Having the stimulus in the background while the rest of the sensory input of life goes on forces the brain’s RAS to work hard to decipher the pattern in the stimulus while also ensuring that the listener doesn’t become over-stimulated by the rhythms.

In 2004 we began offering REI Custom Program™ through trained providers -– we now have hundreds across the U.S. This represented a monumental shift after 22 years of research — research that simply started from my desire to understand why traditional therapeutic rhythm practices were so prevalent around the  world.

In spite of our growth and the expansion of REI beyond just research, I am still personally involved in the creation of all the REI Custom Program™ CDs that leave our office and am still impassioned by learning more about how auditory rhythmic stimulation can impact individuals with neurological issues.

References
Goldman, J. (1992). Sonic entrainment. In R. Spintge & R. Droh (Eds.), MusicMedicine (pp. 194-208). St. Louis, MO: MMB Music, Inc.
Harner, M. (1990). The Way of the Shaman (3rd ed.). New York: Harper San Francisco.
Maxfield, M. (1994). The journey of the drum. ReVision, 16(2), 157-163.
Oster, G. (year, month). Auditory beats in the brain. Scientific American, 229, 94-102.
Parsons, L. M. (1996, October). What components of music enhance spatial abilities? Paper presented at the VI International MusicMedicine Symposium. San Antonio, TX.
Rauscher, Shaw, & Key (1993, October 14). Music and spatial task performance. Nature, volume, pages.
Scartelli, J. (1987, November). Subcortical mechanisms in rhythmic processing. Paper presented at the meeting of the National Association for Music Therapy. San Francisco, CA.
Scartelli, J. (1992). Music therapy and psychoneuroimmunology. In Spingte & Droh, (pp. 137-141).
Shatin, L., Kotter, W. L., & Douglas-Longmore, G. (September 1961). Music therapy for schizophrenics. Journal of Rehabilitation, 27, 30-31.
Spintge, R., & Droh, R. (1992). The International Society of Music in Medicine (ISMM) and the definition of MusicMedicine and music therapy. In Spintge & Droh, (pp. 3-5).
Strong, J. (1996, October). Rhythmic Entrainment Intervention (REI) as applied to childhood autism. Paper presented at the VI International MusicMedicine Symposium.
Tomatis, A. (1992). The conscious ear: My life of transformation through listening. Barrytown, NY: Station Hill Press.

Using REI Drumming to Improve Sensory Discrimination

In this video, I play complex rhythms at 8 beats-per-second to stretch your sensory system and improve your ability to understand the subtleties in the sensory input.

Learn more about REI for sensory issues here: reicustomprogram.com
Learn to play the drum for healing here: drumhealing.com
Listen to more of my music for free here: brainshiftradio.com

Custom Stimulation is the Key to Improving Sensory Processing

This is an excerpt from Jeff Strong’s Different Drummer book describing how he approaches sensory processing.

​You can learn more about our REI Custom Sensory Processing Program here

Sensory processing issues are common among the people I work with. In fact, sensory challenges are part of nearly everyone who falls into the developmental disability spectrum, including people with ADHD and autism. Sensory processing issues come in three basic forms: sensory-defensive, sensory-seeking, and poor sensory discrimination.

Sensory defensiveness is characterized by being easily overstimulated by sensory input. This is the child who recoils to touch, won’t wear shoes, covers his ears in response to loud noises, gets dizzy easily, or throws up in the car.

Easily overstimulated people constitute most of my clients with sensory issues. I work to reduce their sensitivity to stimulation by giving their brains more stimulation.

“What do you mean by stimulation?” Laurel asked. “Emily is always overstimulated. Why would you add more, and how could it calm her down?” This was one of the first questions she asked me after I began to work with her daughter, Emily.

From her very first track, Emily responded immediately and decisively to the drumming. After just one listening, her emotional outbursts increased and her sleep, already poor before the Program, deteriorated further. Upon her first night on the Program she needed to be held by her mother to calm down.

Laurel and I quickly discovered that Emily needed less stimulation, far less than a Program usually begins with. In fact, I had to step down the level of stimulation on her tracks to a point lower than what was on our ‘stimulation low enough for anyone’ Calming Rhythms CD. Once we determined a stimulation level she could tolerate, we were then able to slowly begin adding more stimulation and progressively build her tolerance to address her sensory issues.

“Stimulation is related to the complexity of the rhythms on the track,” I described to Laurel. “I have built a series of rhythmic structures, varying in their length and complexity, for each symptom.

“By complexity, I mean the difficulty needed to decipher the rhythm’s pattern. Think of the brain as a computer whose central job, when dealing with sensory stimulus, is to decipher and categorize the stimulation.

“Emily takes in sensory stimulus at a very high level. It’s as if her volume control is turned way up. Everything comes at her with an intensity that is higher than for you or me. And she can’t turn down the volume. A light touch may feel like a hard squeeze, or a normal voice level may sound like a shout. Our goal with the REI tracks is to teach her sensory system to turn the volume down and to learn to distinguish important from unimportant sensory input.

“With each track, we want to increase the level of stimulation we can give her so that she becomes used to it. Over time, she’ll develop the skills to be able to moderate the stimulation she receives.”

Before I made her first Program track, Emily, who was four at the time, wouldn’t wear clothes, preferring to only wear undies. Sometimes she would wear shorts or a skirt but she was never okay with a shirt. And don’t even think about a coat. She also slept poorly, often waking at night or early in the morning, unable to get back to sleep. Emily was also anxious, and Laurel needed to be with her at all times lest she have a melt down.

Laurel was one of my favorite parents. She was engaged and inquisitive. And the two years I spent working with her extremely sensitive daughter was one of the most satisfying—and sometimes perplexing—experiences of my career.

Emily mirrored many challenges exhibited by a six-year-old boy I worked with a few years before. Gerald had both tactile and auditory sensitivities. He wouldn’t wear shoes or socks and would cover his ears, or sometimes cry or scream, when someone turned on music, even if the volume was low.

He also tended to isolate himself from his family, preferring to be in his room alone, playing with toys by himself. If a sibling or cousin came in his room, he’d have a meltdown.

For Gerald, the Program was pretty straightforward. He responded within the first two weeks in all areas.

“Gerald is doing great with the Program,” said Jenna, his REI provider. Jenna, an occupational therapist in south Texas, was our first active provider and this was one of her first clients. We were both excited by Gerald’s progress, especially by his quick response to REI.

“He’s been wearing socks and shoes everyday, since the end of the first week. Yesterday he joined his extended family outside and played with his brothers and cousins. He now lets his mom turn music on in the car and he has also been rocking out to his own pop music in the house.”

“That’s pretty quick progress. Is he using CD #2 yet?”

“He just started the other day. So far the transition is going well.” The transition from CD #1 to CD #2, at this time in the history of the REI Custom Program, was sometimes difficult because of the jump in stimulation.

The first CD (and first track with the current Program) generally focuses on reducing anxiety and sets the foundation for improving sleep issues, if there are any. The subsequent tracks progressively build stimulation and broaden their focus to include other areas of concern.

When sensory sensitivities reduce during the first track, it usually means that they are related to anxiety. This was my assumption with Gerald.

I had no such assumption with Emily when she started the Program. This is because, even though she had a similar symptom makeup, she also had sleep issues and a more heightened response to overstimulating environments.

“We’ll start with trying to help Emily’s sleep,” I said to Laurel when we started the Program. “If she can fall asleep more easily and not wake up, we may also see some improvement in her sensitivities. Sometimes being tired, especially chronically, can increase the presence of these symptoms. Her overreaction to things in general suggests that this may be the case.”

“So, do I play the track at bedtime, then? Can I play it all night long to help her stay asleep or turn it on again if she wakes up?” asked Laurel.

“Yes, turn it on at bedtime. Just play it once through. If she wakes up, it’s okay to turn it on again, but only once. With any luck, she’ll be able to stay asleep after a couple of weeks of this pattern.”

Many of our clients wake up at night. In fact, falling asleep is often not a problem. It’s the night waking. And this is probably one of the most difficult things for a parent to deal with. Having your night interrupted, night after night, becomes wearing and leads to a host of problems.

The kids who wake up at night often wake up ready to go for the day. Getting them back to sleep can be exhausting. So, the first and most important thing for us to focus on is to help the child sleep so the parents can sleep, too.

“Emily slept all night the fifth night,” Laurel told me at her two week check in. “She slept through the night for the next week and started waking up again the last couple of nights. Do you think we need to change tracks?”

“It sounds like it.” I made a new track and waited to hear from Laurel again in another two weeks.

“Emily slept through the night again when we started the new track, but she started waking up again the last couple of days.”

And so a pattern started to emerge for Emily. Sleep was a barometer to how a given track was working for her. Every time I made a new track, Emily would sleep well for a while and then she’d start waking up again.

“How are her anxiety and sensory issues?” I asked after the third track, hoping that we’d now start seeing some changes there.

“Oh, I forgot to mention this because I’ve been so focused on her sleep, but she’s now letting me put on a shirt,” Laurel added, sounding like it’s not a big deal.

“Wow, that’s great! When you started, she’d melt down if you tried that,” I added, trying to help her see what a big change this was. When we first talked, Laurel was much more concerned with Emily’s tactile sensitivities than she was by her sleep, but our focus on the sleep issue seemed to make her not as aware of Emily’s tactile improvements.

“Yeah, I guess it is a big change. And come to think of it, she hasn’t been melting down as much,” she said as we talked about where Emily was before the Program started.

This isn’t uncommon. Many times people are so focused on playing the track and dealing with whatever is up that it’s hard for them to see the big picture, unless it’s pointed out to them.

This is one of the most helpful things about our REI providers. Since they can’t make the CDs or even mix-and-match pre-recorded CDs as is common in other auditory programs, many providers feel like they don’t have an important role in REI. The key to their role is their relationship with their clients: It is valuable not only to help me see what the real issues are, but also to help the client gain perspective on how much progress they’ve made.

Laurel didn’t always need to be reminded where Emily started. She became keenly aware. In fact, she was one of the most astute observers of her daughter’s progress with the REI Program.

“Emily has been weepy the last few days in this track,” Laurel told me a few more weeks into her Program. “She did fine for the first week then she started crying for no reason. It’s not like a melt down. She’s not reacting to anything going on around her. She’ll just stop and cry. Could it be the track?”

“I don’t know. It could be, I suppose. How is she sleeping? How are her sensitivities?”

“She’s sleeping okay. She has been a little fussy about clothes. She’ll only wear one particular shirt and she doesn’t want to wear shoes anymore. Do you think we should try a new track?”

“That’s what I’m thinking. I’d guess that this track is probably too stimulating for her.”

I made a new track. Laurel called a week later.

“She’s not weepy anymore and she wearing shoes again. What did you do with the new track?”

“I went back to rhythms we used in Track #2 and rearranged them. I looked at your current track (#3) and noticed that it had changed databases and drums. The Udu drum is much more stimulating than the Gonga, and I’m guessing that had an impact on her.”

“I noticed it sounded like a different drum. Why would that matter?”

“The Gonga drum has a pretty soft, rounded tone. The Udu is really sharp. As well, on the Gonga I tend to use rhythms that are less complex and carry a longer structural flow than those played on the Udu. The Udu tracks tend to be much more stimulating than the Gonga tracks because the drum’s sound is more pointed and the rhythms more complex. Someone as sensitive as Emily may find the Udu uncomfortable to listen to.”

An REI Custom Program will draw from eight databases and switch back and forth between the Gonga and Udu. Even though the Udu drum rhythms tend to be more stimulating, the stimulation is presented on a scale. So a particular database of Gonga rhythms may be more stimulating than another database of Udu rhythms. In fact, each database used for the Custom Programs are progressively more stimulating;, so even though database two is an Udu, the rhythms are less stimulating than the rhythms played on the Gonga in database three.

We discovered that Emily was never able to handle the Udu tracks. I had to alter her Program so that we never drew from the Udu databases. She could handle fairly high intensity Gonga rhythms, but not lesser stimulating Udu drums. Fortunately, I was able to accommodate her.

Over the course of almost two years, Emily made significant progress in her anxieties and sensory issues. Then Laurel offered me another opportunity.

“Are you ready to work with my other daughter?” she asked. “Lila is the polar opposite of Emily. She is a sensory sponge. She could spend all day in the swing.”

“Okay, let’s give it try.”

Like Emily, Lila was four-years-old when I started working with her. Unlike Emily, who withdrew from sensory stimulus, Lila was a classic sensory seeker. She was high energy, high activity.

Her response to her Program was also harder to track than Emily’s. For instance, Emily’s sleep would change when she was ready for a new track. She also made steady progress, as long as we changed tracks on her schedule.

Lila, on the other hand, could stick with the same track forever without showing any negative effects. With Lila, we needed to be more vigilant in changing her tracks on time in order to move her forward. She soaked up all the stimulation her Program would offer.

In some ways, a client like Lila is easy because I never have to contend with, or even worry about, overstimulation. Overstimulation generally causes sleeplessness, anxiety and agitation. Once we see overstimulation in a client, we tread pretty carefully from that point forward to ensure that she doesn’t become overstimulated again.

Someone like Lila, though, doesn’t react as strongly. Because she can handle so much stimulation, it takes more intense rhythms and more frequent changes to the tracks to ensure that she makes progress. If I’m not seeing tangible progress by Track #3, then I step up the stimulation further. If progress doesn’t happen even after adding more stimulating REI tracks, I’ll sometimes also ask that the REI tracks be played more than once a day.

Lila didn’t need these contingencies. Her sensory-seeking became less pronounced during her second track, about three weeks into her Program. She was sleeping better and was less anxious overall. Other than that, Lila was a hard to read. She didn’t react strongly to a track like Emily did. She showed a slow, steady pace. Laurel was used to reacting to Emily’s response to a track and felt a little lost when it came to knowing how Lila was responding.

“Lila is different than Emily in many ways, but the curious thing about the REI is that she just goes with the flow.”

“Sensory seekers tend to be more consistent than sensory defensive people,” I described. “I think that someone who is seeking sensory input tends to run at a pace that keeps them stimulated. They may not react to sensory input as much because they are still seeking more.

“A sensory defensive person, on the other hand, has a threshold that may change depending on how they feel. Different types of stimulus have different effects on them. So, unless they experience the same type and level of stimulation, you’re going to see some variability in their response to stimulus and, in turn, in their behavior.”

“That makes sense. I really see that with Emily. There are days when she can handle going to the grocery store, but there are other days when she melts down. Same thing with school. That’s the most difficult thing about Emily’s sensory issues: I can’t predict how she is going to respond to something. Just when I think she’ll be okay with going somewhere, she’ll have a meltdown.

“Lila, on the other hand, is always busy. This consistency, although it’s hard, is easier to handle because I can plan for how she’ll react to something.”

Though I see quite a few people who are sensory-seeking like Lila, more clients are on the sensory defensive side, like Emily. Either way, because I can fine-tune the stimulation for each person, I can accommodate their sensory needs and hopefully help them learn to more efficiently process sensory input.

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.

####

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.

>