Articles and Research on Rhythmic Entrainment Intervention (REI)

Rhythmic Entrainment Intervention (REI) Drumming Rhythms Reduce Anxiety and Improve Language, Eye Contact and Socialization in a Child with Autism

Rhythmic Entrainment Intervention (REI) Drumming Rhythms Reduce Anxiety and Improve Language, Eye Contact and Socialization in a Child with Autism.

By Jeff Strong


Complex drumming rhythms have been used to influence brain activity (Harner, 1990; Jilek, 1975) and to reduce anxiety and improve behaviors for generations in tribal societies around the world (Diallo and Hall, 1989; Neher ,1962). Rhythmic Entrainment Intervention draws from this long history of therapeutic rhythm-making, most specifically from three techniques that can be traced back over 20,000 years to the earliest forms of spiritual practice and healthcare (Harner, 1990; Diallo and Hall, 1989; Jilek 1975; Neher, 1962).

Research on drumming has shown that it can both drive the brain and increase neurological activity (Shatin, et al, 1961). Pulsating drum rhythms have a synchronizing effect on the brain which occurs through a mechanism called auditory driving where the speed of the brainwaves matches the tempo of the rhythms (Hink et al, 1980; Scartelli, 1987; Oster, 1973). Additionally, complex and unpredictable rhythms can stimulate and activate the brain, resulting in increased cognitive abilities (Rauscher, et al, 1993; Parson, 1996; Rossignol and Melvill Jones, 1976).

Method and Results

Stephanie's mother called me because she had heard that I could calm children by playing a drum for them. She described that Stephanie had been displaying extreme anxiety for the past several weeks; none of the calming tactics they tried had eased her anxiety level. The cause of her anxiety was unknown, but over the previous two weeks she had become anxious about being away from her mother and became very agitated when she was left alone. She had gone from sleeping through the night by herself to insisting on sleeping in her parent’s bed with the light on. 

Stephanie was diagnosed on the autism spectrum, with PDD-NOS (pervasive developmental disorder, not otherwise specified). She was generally highly anxious (though not as high as she had been the previous few weeks), avoided eye contact, exhibited socially inappropriate behavior, and lacked verbal communication skills, though she had a large vocabulary. She tended to stand too close to others while verbally repeating words or phrases, often from movies or TV shows (referred to as echolalia). She had no friends and had difficulty tracking sequences in events, such as being able to remember or describe what happened at school.

For the previous 10 years I had been researching traditional therapeutic techniques that used drums and complex drumming rhythms to influence the listener's behavior. Early on in my studies I witnessed my teacher's work with a young girl who was non-verbal and highly anxious. He used a conga drum, a barrel-shaped drum played in South America and the Caribbean islands such as Trinidad where my teacher as from. As he played different rhythms the girl responded by becoming calm with one rhythm, animated and lively with another, and clearly agitated with yet another. This technique, he told me, had been around for hundreds of years and could be traced to to his ancestors in Nigeria.

During my studies, my teacher showed me the traditional rhythms he used and guided me in playing with many children and adults. I got to know how even subtle changes in the rhythms, tempos, and orchestrations impacted listeners. These experiences, coupled with other research I was doing on traditional forms of therapeutic rhythm-making, led me to begin clinical research on a technique that blended these various approaches into what I and one of my early collaborators called Rhythmic Entrainment Intervention (REI).

Stephanie was part of this early clinical research. Documenting each session, as well as her overall progress, was critical. So, aside from my drum, I had a portable DAT (digital audio tape) recorder, a cassette recorder, and an assistant who was present to document each moment of my performance and Stephanie's responses.

At our first meeting, Stephanie was friendly but lacked eye contact and seemed tense. She was obviously uncomfortable and clung to her mother’s side while I talked with her. I asked Stephanie’s mother to sit with her and play quietly while I began drumming. I started softly and gradually, over several minutes, played louder. I used traditional rhythms that my teacher had used while playing for various children. I blended these rhythms together while slowly building the intensity with the tempo and volume. 

I also varied these rhythms by adding or dropping beats. This was always important because even a rhythmic pattern that elicits a deep calming effect initially can become agitating to the listener if it's repeated too much. This seems especially true for children on the autism spectrum. 

After about twelve minutes I heard Stephanie's sister say “Stephanie’s back”. Stephanie looked much more relaxed and began giggling. I played for about eight more minutes before stopping. At the end she was noticeably calmer and was content staying in the room with her sister while her mother went to answer the phone.

I met with Stephanie again two days later. I immediately noticed that she was much more at ease. She didn't hide behind her mother when they answered the door and she reached to help me carry my drum into the living room. Of course, she could have just been more comfortable with me. However, when I began playing, Stephanie sat on the floor close to me and paged through a picture book. Stephanie's mother left the room almost immediately upon my beginning to drum. Stephanie paid no attention to her mother's absence. She remained calm as I played and said goodbye as I left.

After another two days I met with Stephanie a third time. This time when I arrived Stephanie met me at the door by herself and actually looked directly at me as I said hello. Her mother was on the phone and Stephanie and I (and the assistant) went to the living room and she helped set up my equipment. She placed the microphone on the stand and set it in front of my drum. She then sat down a few feet away on the floor and drew while I played. 

Because she was calm to begin with, I didn't really notice much change in her as I played. I played for a little over 20 minutes, using much more complex and stimulating rhythms than I played the first time we met. These were rhythms that sometimes became agitating for a listener, but Stephanie remained calm the entire time. 

Stephanie's mother was off the phone by the time I stopped playing. She was excited to tell me that Stephanie was much calmer overall and had slept by herself in her own room with the light off the previous night. This was the first time she slept in her room by herself in over 3 weeks. I mentioned that Stephanie made eye contact with me when I entered the house and she said that several times in the last couple of days she had done that with family members and her care-giver.

I gave her the cassette of the session I just played and asked her to play it for Stephanie once a day for the next 8 weeks. 

Stephanie's mother called me after 7 weeks, excited by an event that occurred the night before. She reported that Stephanie had a sleep-over at a new friend's house, a first for her on several levels: First, Stephanie had never been invited to a sleep-over before, second, she was able to separate from her mother to actually to on the sleep-over, and third, the next morning she was able to describe in proper sequence what she did at the sleep-over. These were major milestones for her.

Stephanie was also perseverating less and engaging in more appropriate conversation. She was also making eye contact more often. After roughly 10 weeks, she was observed in class by the school psychologist who noted that, based on her behaviors, Stephanie was "indistinguishable" from the typical children in the classroom. As a result she was mainstreamed into the regular (non-special education) classroom. 


Stephanie was calmed almost immediately by the REI rhythms. During her 8 weeks of consistent exposure to the rhythms, she showed improvements in sleep, eye contact, socialization, perseveration/echolalia, and language. These results, along with case studies conducted to date, suggest that children with autism can achieve positive gains by listening to REI drumming rhythms. For future studies, it would be important to examine a larger population and to focus on a single attribute, such as anxiety.

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