​Rhythmic Entrainment Intervention For Adults With Autism

​

By Jeff Strong

Director, Strong Institute

Published in Zoe, Mt. Angel, Spring 2014

Rhythmic Entrainment Intervention (REI) is music-medicine program (Spintge and Droh 1992) that uses musical rhythm to stimulate and synchronize the listener’s brain. REI employs custom-made recordings developed for each client based upon an extensive intake process using variations on the standardized rating scales used to diagnose neurobiological conditions (the Aberrant Behavior Checklist and Connors’s Rating Scale, among others). REI is based on the theory that auditory rhythm can have a synchronizing effect on the listener’s brainwave patterns (Maxfield, 1994) and complex rhythms can have an activating effect on brain activity even in people with severe neurological disorders who otherwise have low brain activity levels (Ostrander and Schroeder 1994, Parsons 1996, Rossi 1986, Scartelli 1987, Scartelli 1992, Shatin, et al 1961).

Research on REI over the last fifteen years has suggested that listening to custom selected REI auditory rhythms daily for 12 weeks results in improvements with many of the symptoms associated with autism (Strong 1998, Strong 2008). Previous studies have shown that Rhythmic Entrainment Intervention (REI) provides positive gains for children with autism (Strong 1996, Strong 1998, Strong 2008). The purpose of this study is to determine if REI rhythms can have similar effects for adults as have been seen in children.

This study was conducted over a six-month period at a private residential care facility that housed of five adult males, ages 23-38. Four of the residents enrolled in the study – the fifth had just begun taking medication for a seizure disorder (Tegritol) and it was decided because of this tracking his response to the REI recording would be impossible because the effects of the medication were not et known.. Each subject listened to a single custom-made REI recording once a day at bedtime. The facility also played a generalized REI recording during the day when anyone showed signs of anxiety or agitation.

Since 1994, thousands of people have used an REI recording and no observances of long-term negative reactions have been demonstrated. Any transient negative responses to the recordings have been alleviated by withdrawing the recording for two or three days or by turning the volume down to a barely audible level.

Methods

The REI Program recordings were designed and recorded for each subject following subject observation and an intake interview with the facility Director and staff. The subjects each listened to their REI Program recording every night at bedtime. 

NOTE: The REI Program recording used in this study was the precursor to the current 2-CD set that is currently created for each client. During this study only one recording was created for each person. Subsequent research has shown that the 12-track REI Custom Program of today is substantially more effective for each person. As well, the current practice of bi-monthly track adjustments results in a more consistent and significant overall improvement for each person.

Subjects

The subjects in this study were each experiencing different issues and, because the REI Custom Program is custom-made for each person, the goals for each person we unique to them. Following is a breakdown of the issues the REI Custom Programs were addressed to for each subject (a complete description of each subject along with their responses to the REI Custom Program are detailed in the “Results” section of this paper):

• Subject 1: Jim – Male, age 26. Autism, non-verbal. Focus was on self-stimulatory behaviors, anxiety, aggression, sleep, listening ability, and compliance.
• Subject 2: Billy – Male, Age 27. Autism, non-verbal. Focus was on anxiety and self-injurious behaviors.
• Subject 3: Russell – Male, Age 38. Autism and bipolar disorder. Focus was on self-stimulatory and self-abusive behaviors, anxiety, sleep problems, and bipolar cycles, particularly the depressed cycle.
• Subject 4: Carl – Male, age 35. Autism. Focus was on aggression, self-stimulatory behaviors, anxiety, and sleep issues.

Results

On a global scale, after sixteen weeks of using the REI recordings for each of these individuals, the staff reported that there had been no violent or aggressive incidents within the facility for a period of three months. The staff reported that the residents were generally more calm and cooperative. They also reported that all residents were getting to sleep within 30 minutes of turning on their recordings and all the subjects seemed to enjoy listening to their recordings and several would turn them on by themselves.

The results of the REI recordings for the four subjects were unique to each individual and were in concordance with the issues the REI recordings were designed to address. Similarities existed in several areas. These included:

• Aggression. Aggression was a significant issue for this facility in general. The subjects who displayed aggressive tendencies stopped doing so while using the REI recordings. The facility had no incidents of aggressive incidents after the first week of the study.
• Self-stimulatory behaviors. All Subjects with this issue saw significant improvements in self-stimulation including self-abusive or self-injurious behaviors.
• Anxiety. All subjects saw observable, significant improvements either while the recordings played our long-term beyond when the REI recording was playing.
• Sleep. All subjects with this issue saw significant improvements in their sleep, both with how quickly they fell asleep and being able to stay asleep when this was an issue.
• Bipolar cycle. The subject with bipolar disorder experienced a reduction in the depth of the cycles and in the durations of the depressed cycle.

Subject 1: Jim – Male, age 26

Diagnosed at an early age as mentally retarded (M.R.), Jim was later diagnosed with low functioning autism. His family was not able to care for him and entered him into a residential institution at age 5. It was reported that Jim had lived in three previous institutions before being moved to the facility where this study was conducted. His move to this facility, the facility director explained, was predicated by the family’s dissatisfaction with the care he was receiving at the previous facility where he was largely left alone and ignored. The director described that the family felt that Jim would be better supported in a small facility such as this and they were hopeful that he would be engaged by the staff to get involved in activities with the staff and other residents. He had been living at this facility since the age of 22.

The staff reported that Jim tended to seek sensory input with one of his primary interests involving playing with garbage and dirty laundry. He would sort through it frequently, though there didn’t seem to be a pattern in the way he sorted. It appeared that he enjoyed the tactile and olfactory stimulation. He would get upset when staff members tried to stop him from this activity. The staff reported that the laundry often ended up in the toilet, where he would dunk it in and out of the water and fling it around the room. This resulted in a mess that he seemed to enjoy. According to the staff, he would often become physically aggressive toward anyone who interfered with his garbage sifting and sorting, and laundry play.

Upon observing Jim for the first time, I noted that he did not comply with directions from the staff to hand over a candy wrapper that he was playing with. When I approached and said hello, he didn’t look up from a wrapper and he continued to fold and crinkle it. A staff member then removed it from his hand at which point he became upset.  He began rocking his body, gesturing in an aggressive manner with his hands, and making a groaning sound.

At this point I sat down in a nearby chair and began playing my drum. His attention almost immediately focused on me, particularly on my hands as I played. Over the course of the next few minutes he noticeably calmed down and, after approximately 15 minutes of listening he was sitting quietly in a chair about ten feet away, moving slowly to the rhythm of the drum. His gaze was not focused on me, or the drum rather it was directed to a point on the floor in front of him. When I stopped playing, he glanced over toward, though not at me, and stopped his rhythmic movements.

I then went over to him and reached out my hand and thanked him for sitting and listening to me play. He reached up and we shook hands. His grip was soft. He made no eye contact and no sound. At this point I left to talk with the facility director and Jim.

She related that, though he didn’t speak, Jim was able to make his needs and desires known though vocalizations, mostly in the form of grunts, and through non-verbal means of pointing and physically directing the staff, such as grabbing an arm and pulling toward an object of desire such as the refrigerator. She reported that the staff had recently been trying to get him to communicate through other means such as with a facilitated communication (FC) device where he would point to pictures on a board. This was met with limited success as they observed that he had a tendency to resist new things.

The director also described that his discomfort with new things extended to staff and residents. He was resistant to staff direction in general but was much quicker to become physically aggressive toward a new staff member. It would generally take him several weeks or more to accept their direction (to the same extent of a seasoned staff member).

The staff reported that getting to sleep was a problem for him, it often taking him an hour or more to settle down and fall asleep. Once he was asleep he tended to sleep through the night. He would wake on his own, seeming rested most of the time.

Results after listening to the REI recording

Upon turning on the REI recording that was made for him, the staff reported that Jim responded in a similar manner as he had when the drum was played for him live – he sat in a chair and quietly moved to its rhythm.

Over the course of his time using the REI recording. the staff noted that he demonstrated an “uncharacteristically high tolerance” for listening to the REI rhythms. Aside from the first time listening, He heard both sides of his cassette(a total of 40 minutes) everyday at bedtime. Playing the REI recording for 40 minutes in one day is non typical and it has been observed that some people respond negatively to this much time, becoming more anxious or unable to fall asleep. The fact that he was okay with this much time, suggests that his sensory seeking nature (and evidenced by his preferred activities) is allowing him to tolerate this level of stimulus.

The schedule of playing the REI recording at bedtime was suggested because of his history of having difficulty getting to sleep and because we have observed that playing an REI recording at bedtime seems to help listeners fall asleep more quickly. The staff reported that playing the REI recording at this time significantly reduced his time to fall asleep to less than 30 minutes compared to well over an hour before beginning to use the REI recording.

Over the course of 12 weeks, tracking notes indicated a decrease in his anxiety and aggressive responses to direction. The staff also notated an increase in his ability to focus on activities they initiate such as working with the FC device or engaging in “chores” such as caring for and interacting with the animals, which was a large part of the resident’s day at this facility. The director also described that Jim didn’t have as much difficulty when a change in staff occurred during his ninth week of listening. He was noticeably more amenable to direction from a new staff member and displayed no aggressiveness toward him.

In checking in with the staff at sixteen weeks. I was informed that he was no longer listening to his REI recording every day. Even without listening to his REI recording, the staff noted that he was still falling asleep within about 30 minutes of turning off the light. He was also continuing to focus better and more able to handle changes in his routine, especially those involving changes in staff.

Tracking notes showed, however, that the days that the REI recording was played he was noticeably calmer than he was on days when it wasn’t. I suggested that the staff try to be more consistent with the recording as it seems to help calm him down.

Subject 2: Billy. – Male, Age 27

According to records, Billy had been diagnosed with low-moderate functioning autism at age 4. He was cared for by his family until he reached age 21, at which time he was moved to this group home. Billy was described by the staff as a sweet young man who was very sensitive to the environment around him. If the home was calm he was calm, but if anyone in the facility was anxious are aggressive he became very agitated. This agitation, the staff explained, was never directed toward the staff or other residents, rather he exhibited self-stimulatory behaviors, such as rocking back and forth while sitting or twisting his torso when standing. When he was extremely agitated or anxious he would become self-injurious and bite his hands and arms. He would often bite hard enough to draw blood. Other times he would screech or scream hysterically. Calming him down was difficult and generally necessitated removing him from the environment.

I witnessed his agitation the first time I saw him. This was my first visit to the facility and before I had met with anyone except for the director. She was giving me a tour of the home and we entered the main living area where 4 of the residents and 3 of the staff were gathering. I didn’t see the start of the incident, however a staff member reported to me that one of the residents grabbed an object from another resident and these two began wrestling over it (I was later told it was a snack bar).

The two residents who were wrestling only caught a fleeting glimpse of my attention because as soon as this happened, Billy began howling and twisting back and forth. His howls and screeches grew louder and louder to an ear splitting level. This noise was enough to distract one of the other residents involved in the wrestling to stop and let go.

Even with the other two residents no longer wrestling, Billy continued screeching and howling. Shortly he began biting his right hand and intensely throwing his body back and forth. The director quickly walked to him and put her arms around his shoulder and talked to him in a soothing voice. He seemed to calm a bit and the director was able to walk him outside. They spent about 10 minutes out on the patio while he slowly calmed down. The screeching reduced almost immediately upon the director’s hug, but he remained rocking and twisting for close to ten minutes. After this event, the director described that this reaction happened at least once a day. 

According to his records, his developmental age was listed at about18 months. He was able to ask for more, state a yes or no preference for known activities, and request to go outside, inside or to the bathroom, but he wasn’t able to relate how he was feeling or to express anything beyond basic needs. As well, he wasn’t able to understand others’ feelings or their own anxious behavior. 

I stayed around for dinner and observed that he ate at a table away from other residents. A staff member accompanied him but didn’t eat. The staff shared that he was obsessive with food and would grab others’ food if he could. He wasn’t aggressive about it and would comply when a staff member gently redirected. though if allowed to eat within reach of other people’s food he would need near constant redirection.

On my second visit to the home, I played for Billy on the patio when other residents were busy in the building or on the grounds. Because we were alone and there were no distractions, he was very calm, which the staff assured me would be the case and why I chose this time and place to play.

When I arrived he was sitting quietly. I approached him with my drum and asked if he minded if I played it. He made no response, though he did give the drum a good look. He continued looking at it as I tapped it a bit. Once I settled into a steady rhythm his gaze drifted and he sat looking across the grounds toward the distant mountains.

At one point during my performance I noticed a slight lift in his mouth. I tried to recall the rhythm I had just played and once I returned to it, I saw another slight change in his expression. At this point, I cycled between this rhythm and others that I typically play for people with autism. I observed that whenever I played this and a similar rhythm he seemed to smile slightly.

So, I alternated between these two rhythms only and, after about 3 minutes, he was beaming with a smile. After a short while longer, I stopped on those rhythms. He never looked my way the entire time I played, but once I stopped he looked over toward me (in a typical autistic way, he didn’t look at me, just my way as if seeing me out the periphery of his vision). His smile faded to what I would characterize as a satisfied grin and he turned away again to gaze out over the grounds toward the mountain.

I thanked him for letting me play and walked away as he sat grinning and looking out in the distance. Later the director told me that after I left she asked him if he liked the drumming and his response was a little smile and a nod as he said “boom, boom”.

Results after listening to the REI recording

Because Billy didn’t have any problems sleeping and because he often struggled during the day from any anxious, agitated, or aggressive incidents during the day, the staff was instructed to play his REI recording at the time when he most often had difficulty. This was generally mid-afternoon. The staff was also asked to play the recording if Billy asked for it as they told me that he started calling it “boom, boom music”.

When I returned to see Billy after 4 weeks he was watering the garden. I pulled out my drum and I could tell he was regarding me with interest, though he didn’t look at me, only past me. As I started, he continued looking my way and seemed to be watching my hands on the drum. He stood still for a few minutes as I played until the Director approached. She guided him over to a bench in the garden a few feet away from me and they both sat quietly as I played.

Because they were both still and not reacting in any way to the rhythms, I began playing rhythms that are traditionally used to provoke a listener. These rhythms are chaotic and loud, however, after a few minutes there was still no discernible reaction. At this point I began playing a grouping of 5 with accents on the second and third beats played as slaps (high-pitched accents played by pressing the fingers into the edge of the head near the rim). This rhythm then evolves to include the first beat of the phrase played as a bass tone (this is done by hitting the middle of the head with the bottom of the palm where the hand meets the wrist). This is an REI rhythm set that has been observed to often elicit an agitated response, especially with people on the autism spectrum.

Billy began wringing his hands in his lap after a couple of minutes of this. This reaction was what I was looking for and told me that he was listening to what I was playing. I immediately switched to a rhythm traditionally used to uplift the mood of the listeners (this rhythm is in a 12/8 time signature with a triple feel. The rhythm contained a pulse with accented slaps on the second and fourth grouping of three. A bass tone was played on the first note of the third grouping of the measure and played on the first and third notes of third grouping of the second measure). This two-measure pattern continued for several minutes. Billy stopped wringing his hands and smiled.

I altered the rhythms slightly by eliminating the last beat of the second measure and varying the accent pattern to keep it from getting to repetitive. I played these variations for approximately five more minutes and Billy progressively got more animated until he was sitting up in his seat clapping and rocking. The Director sat next to him smiling and clapping along. On this positive note, I stopped, packed up my drum and left.  

I talked with the Director the next day and she mentioned that Billy was happy all afternoon. He kept saying “boom, boom music” and got excited when they turned on his REI recording before dinner.

Overall, the staff reported that Billy immediately exhibited definite calming effects with the recording and seemed to enjoy listening to it. While the CD was playing he was less bothered by others’ behaviors and didn’t engage in body rocking or twisting or in self-injurious behaviors. When the rhythms weren’t playing there was no observable change in these behaviors.

When I checked after six months, the director reported that Billy was still listening to his REI recording in the afternoon and was noticeably calmed by the rhythms. She described that the staff tried to time the playing of his recording when all the residents were inside waiting for dinner, as this was a time that was often the most volatile. She noted that the group seemed to calm along with B.N. as the recording played.

The director described that his overall behavior remained calmer than before using the REI recording, though he would still react strongly if someone else was agitated. She also stated that it was rare that there sufficient agitation for Billy to react to since the facility had become much more calm overall.

Subject 3: Russell – Male, Age 38

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 in 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 any thing 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 where 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.

Results after listening to the REI recording

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 the 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 was progressively lessening. When I went to see him at the twelve-week point, he had no sores or scabs on his forehead, a state that the staff described 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 everyday 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 playing his recording and in helping him remember to turn it on before going to bed.

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 d ay, 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 discernible 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.

Conclusions

While each subject entered the study with unique goals and each REI recording was custom-made for each person, many similarities existed among their responses in the areas of anxiety, aggressive behavior, self-stimulatory behaviors, and sleep.

These issues are common among most people with autism and previous studies with REI have suggested that these, among other areas, can be helped using a custom-made recording of Rhythmic Entrainment Intervention. There are two important factors that may be leading to these types of improvements with REI.

• First, anxiety is a major concern for most people with autism. Anxiety is often a contributing factor in other areas such as self-stimulatory behaviors, aggressive behavior, and the ability to fall into and stay asleep. Reducing anxiety in a facility with people with autism can be the single most beneficial thing that can be done because, as this facility demonstrates, the overall calm that developed made life for everyone, the staff included, much more pleasant.

• Second, poor sleep can have a significant impact on ones (anyone, regardless of whether they have autism or not) emotional state and may further contribute to the anxiety that often exists in people with autism. Good, restorative sleep can help promote emotional stability, reduce stress (anxiety),

This study employed a single REI recording. Currently the REI Custom Program consists of multiple custom-made REI Audio Tracks that are dynamically created based upon each client's progress. This has made the results with REI more predictable and more consistent among different groups of people within our realm of experience, Autism being one of these areas.

Given the results of this initial study in combination with numerous case studies since implementing our multiple CD format, I am very interested in developing new work in the following areas: The use of multiple CDs, the use of controlled studies, and the use of brain imaging in conjunction with behavioral measures.

References

Maxfield, M. "The Journey of the Drum". ReVision Vol. 16, No.2, 1994. 157-163.

Ostrander, S; Schroeder, L. Super-Learning 2000. New York. Dell. 1994.

Parsons, L.M. "What Components of Music Enhance Spatial Abilities?" Paper presented at the VIth International MusicMedicine Symposium, Oct. 10-12, 1996, San Antonio.

Rossi, E. The Psychobiology of Mind-Body Healing. New York: Norton, 1986.

Scartelli, J. "Subcortical Mechanisms in Rhythmic Processing". Paper presented at the meeting of National Association for Music Therapy, November 1987, San Francisco.

Scartelli, J. "Music Therapy and Psychoneuroimmunology". Spingte, Droh, Ed. MusicMedicine. MMB Music, Inc. St. Louis, 1992. 137-141.

Shatin, L.; Kotter, W.L.; Douglas-Longmore, G. "Music Therapy for Schizophrenics". Journal of Rehabilitation. 27:Sep, 1961. 30-31.

Spintge, R.; Droh R. "The International Society of Music in Medicine (ISMM) and the Definition of MusicMedicine and Music Therapy". Spingte, Droh, Ed. MusicMedicine. MMB Music, Inc. St. Louis, 1992. 3-5.

Strong, J. "Rhythmic Entrainment Intervention (REI) as Applied to Childhood Autism". A paper presented at the VI International MusicMedicine Symposium, October 10-12, 1996, San Antonio.

Strong, J. “Rhythmic Entrainment Intervention: A Theoretical Perspective”. Open Ear Journal, Bainbridge Island. 2/98

Strong, J. “A Look at Rhythmic Entrainment Intervention by its Creator”. SI Focus Magazine. Fall, 2008

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