Articles and Research on Rhythmic Entrainment Intervention (REI)

Rhythmic Entrainment Intervention as it Applies to Children with Autism

Paper presented at the VIth International Society for Music in Medicine Symposium. San Antonio, TX 1996

Aim of Investigation

Rhythmic Entrainment Intervention (REI) is a rhythm-based therapy that was developed at the REI Institute and consists of complex rhythmic patterns performed on a hand drum. The REI Institute has been using rhythmic drumming for several years on a variety of neurological disorders and has seen promising results in many case studies. REI was derived from techniques that use rhythmic drumming to treat psychological and physical illness. These techniques date back thousands of years and have been practiced in many parts of the world.

The goal of this inquiry was to determine (1) if listening to a recording of REI drumming rhythms would have immediate calming effects, (2) if overall changes in behavior would be present after repeated exposure to the rhythms for eight weeks, and (3) if the frequency of exposure would have an impact on these changes.


The study consisted of 16 subjects (10 male, 6 female) between the ages of 6 and 12 who were diagnosed with autism (Table 1).

Table 1: Descriptions of subjects involved in study.

Subject; Age; Sex; Behavioral characteristics

1; 12; Female; Verbal, often inappropriate, social, physically aggressive, non-compliant
2; 11; Female; Non-verbal, very withdrawn, extreme self-stim (hair pulling)
3; 11; Male; Verbal, often inappropriate, compulsive, hyperactive, non-compliant
4; 9; Female; Non-verbal, no social interaction, often unresponsive
5; 9; Male; Non-verbal, physically aggressive, hypersensitive to sounds
6; 10; Male; Verbal, no language skills, hypersensitive to sounds
7; 10; Male; Non-verbal, physically aggressive, hypersensitive to sounds
8; 9; Female; Non-verbal, very withdrawn, has seizure disorder (taking medication)
9; 9; Male; Non-verbal, very anxious and physically aggressive
10; 6; Male; Non-verbal, very anxious with many tantrums
11; 6; Male; Non-verbal, anxious, somewhat physically aggressive
12; 5; Female; Verbal, poor social skills, anxious
13; 5; Male; Non-verbal, hypersensitive to sounds, socially withdrawn
14; 7; Male; Non-verbal, physically aggressive, hyperactive, hypersensitive to sounds
15; 8; Male; Verbal, some language skills-response to questions only, withdrawn
16; 8; Female; Non-verbal, physically aggressive, very anxious, no eye contact

Each subject initially met privately with the research staff for twenty minutes and listened to a series of REI rhythms. All rhythms were performed by Jeff Strong on a 10 3/4î Gongaô hand drum. An audio cassette was then made for each subject using the REI rhythms which were deemed most appropriate for that subject based upon their private session and the REI Instituteís catalog of rhythmic patterns. All subjects subsequently listened to their recording privately on a portable tape player. Three subjects used headphones. Each subject was exposed to the recording with differing a frequency based upon their individual schedules (table 2).

Table 2: Average number of listening sessions per week.

Child 1: 10 Child 9: 3
Child 2: 8 Child 10: 2.5
Child 3: 7 Child 11: 2
Child 4: 5 Child 12: 2
Child 5: 5 Child 13: 2
Child 6: 4 Child 14: 1.5
Child 7: 4 Child 15: 1.5
Child 8: 3 Child 16: 1

Levels of anxiety and aggression were assessed before and after each listening session to determine if the rhythms were calming for the subject. After eight weeks, overall behavioral changes were assessed by the teaching staff. Assessments were made using a ten point scale in a questionnaire based upon characteristics of autism as defined by the DSM IIIR.


Results varied with each subject experiencing different levels and areas of change. Immediate calming effects were observed all of the time on 4 subjects and most of the time on 10 of the subjects while the tape was playing. Calming effects were most noticeable when the subject was in a heightened state of anxiety or aggression before the tape was turned on. Calming effects would last from 1 to 6 hours. Immediate, temporary calming effects seemed to be independent of frequency of exposure. It was observed that anxiety-based behaviors such as repetitive, self-stimulatory behaviors were also often reduced while the recording was being played.
Significant overall behavioral change was observed in 9 of the subjects. These improvements varied with each subject and were seen in the areas of anxiety, aggression, eye contact, social interaction, attention span, coordination, hyperacousis, repetitive movements, and repetitive speech.
The frequency of exposure had a significant impact on the degree of changes experienced by the subjects. In general, the more the tape was played, the greater the degree of change in behavior. Subjects who listened to the rhythms more than 3 times per week (subjects 1-9) showed significant improvement. Subjects who listened to the rhythms less than three times per week, (subjects 10-15) showed little or no change (table 3).

Table 3: Results

Subject: % sessions calmed: Areas of overall change after eight weeks (numbers identify points of change).

1: 100: anxiety (4), compliance (3), Frequency and intensity of aggression (3), attention
span (4), listening ability (3), often went to sleep while recording played.

2: 90: coordination (2), eye contact (3), withdrawal (1).

3: 82: anxiety (2), frequency of aggression (2), intensity of aggression (1), memory (2),
listening ability (3), group participation and social interaction also increased.

4: 87: anxiety (2), frequency of aggression (1), attention span (2), frequency of
repetitive movements (2), intensity of repetitive movements (-1).

5: 100: anxiety (2), sound discomfort (1), level of sound discomfort (1), intensity of
aggression (1), memory (2), withdrawal, (1).

6: 83: anxiety (3.5), sound discomfort (4), level of sound discomfort (4), frequency and
intensity of aggression (4).

7: 29: anxiety (2), sound discomfort (1), frequency of aggression (1), was agitated by
recording-- was given second set of rhythms after four weeks. Numbers reflect
second tape.

8: 100: attention span (3), listening ability (1), eye contact (3), group participation and
social interaction also increased.

9: 67: anxiety (1), was agitated by recording-- was given second set of rhythms after four
weeks. Numbers reflect second tape.

10: 79: eye contact (2), listening ability (3).

11: 80: memory (2).

12: 100.

13: 86.

14: 68: frequency of aggression (2).

15: 77.

16: 0: Dropped out of study, aggressive behavior increased--directed at one staff member


These findings suggest that listening to recorded REI drumming rhythms can have positive immediate effects for relieving anxiety and aggression in children with autism, and that repeated exposure may improve some of the overall behavioral challenges that this population faces. For overall behavioral improvement, this study suggests that the REI rhythms be used at least 3 times per week with increased exposure seeming to have a more significant impact.

Future studies should be conducted using a controlled format on a larger sample of subjects. Since only 9 subjects in this trial used the rhythms with a frequency that showed overall improvements, future studies would benefit by having all subjects use the rhythms at least 3 times per week. Daily exposure would be preferred. Future studies could also investigate the use of a common set of rhythms for all subjects.

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