“That looks like fun!” Many may comment as they watch a group of clients in the pavillion beating out rhythms on bucket drums during The George Center’s summer Bucket Drumming program. It certainly is fun, but is that the only purpose it serves?
Ga Eul Yoo and Soo Ji Kim recently published an article in the Journal of Music Therapy addressing that very question, “Dyadic Drum Playing and Social Skills: Implications for Rhythm Mediated intervention for Children with Autism Spectrum Disorder.”
As I read this article, I was excited to see that Yoo and Kim comment on the reclassification of ASD as a a motor disorder rather than a social disorder, justifying the use of rhythm as a tool for treatment. This is a reassuring sign that music therapists as far as South Korea are embracing the new concept of ASD as a neurodevelopmental condition rather than a social disorder. Now, the focus is shifting to how best to treat it as a neurological condition. Because rhythmic cueing - defined as “the provision of regularly paced external stimulation” such as to a metronome or steady beat - has been so effective with other neurological conditions, Yoo and Kim hypothesize that it can be helpful in improving the social skills of clients with ASD through scaffolding their movements with rhythm in drumming.
Drumming is a great tool for working on social skills through rhythm. Dyadic drum playing is defined as when “two individuals coordinate their movements in time with each other” (p. 344). For clients with ASD, this behavior is significant! The client must connect with their partner, perceive their movement, and coordinate his/her own movement to synchronize within the musical context. This type of motor control and joint attention is essential for engaging in social interactions on a daily basis.
Yoo and Kim conducted two studies that are discussed in the article. Study 1 investigates the question, “What is the relationship between dyadic drum playing and social skills performance in children with and without ASD?” (p. 345). Study 2 investigates the next question, “Are there changes in social skills of children with ASD after participating in the developed rhythm-mediated intervention?” Participants in both studies were measured on an electronic drum pad for how closely they could synchronize with another person’s rhythm at varying tempos as well as with and without external rhythmic cueing.
In comparing the results of experimental and control groups for Study 1, Yoo and Kim labelled “factors” to describe the different skill sets required to accurately imitate rhythmic patterns in dyadic drumming. Three “factors” were identified for the control group: (1) Embodied intersubjectivity, (2) Motor representation, and (3) Anticipatory adjustment. Yet, in addition to these three factors, the experimental group received a fourth “factor”: self-regulation (p. 356). Before they could begin to give attention to the other three factors, children in the experimental group had to gain and maintain control over their body movements, just as it is necessary when trying to interact and communicate on a daily basis.
It is interesting to note that the ASD group synchronized most closely during tapping to rhythmic cueing and synchronized the least during interpersonal synchronization without rhythmic cueing. Yoo and Kim point out that fast tempos increase demand on motor planning, but too slow makes equally makes it harder to plan movements without the presence of a clear beat. A slower tempo with rhythmic cueing enables clients with ASD to synchronize best.
In the second study, Yoo and Kim put these conclusions to the test in individual music therapy sessions with 8 children with ASD.They observed the greatest increase with engagement in joint action and increases in the presence of target behaviors. They conclude that the use of music and rhythmic structure is very effective and immediate in facilitating joint action and engagement, but continued and consistent treatment with the intervention is required to maintain the ability and transfer the effects.
Interestingly, in study 2, the parent-reports on the effects on clients with different levels of functioning varied. Parents of children who were lower functioning expressed a great appreciation for the intervention and remarked a notable difference in their children’s stereotyped behaviors (decreased hand flapping and wandering) and attention to others’ actions. Parents of children who were higher functioning remarked that their children enjoyed music more after the intervention, but some expressed a desire for “more direct changes in social behavior and communication skills.”
As I reflect on how this article can affect my clinical work, I am amazed by how many contexts this article can apply to. I conduct rhythm and drumming activities with all of my individual clients, but normally addressing the motor and cognitive domains of functioning. I also teach a whole drumming class to a group of high-functioning students, many of whom are on the spectrum but are working towards appropriate social skills and behaviors. Yoo and Kim provide interesting suggestions on how to approach designing dyadic rhythm interventions, such as by beginning with exploring rhythmic movement and then beginning a joint activity in rhythmic movements with a partner. Slower tempos with rhythmic cueing will prove the easiest for clients with ASD to synchronize with, but steadily removing supports and increasing the difficulty will challenge them and help them grow over time. Within the design of a single activity, changing the tempo is also an excellent way to assess the client’s engagement with their partner while maintaining the rhythmic structure that supports gross and fine motor planning.
Based on the parents’ responses, I believe a great lesson from this study is how an intervention that has significant and notable effects for one level of functioning may not have as great an impact for another. Yet this is not a reason to abandon the intervention all together. In many cases, augmentation is required to make it more challenging and beneficial for higher functioning students.
Overall, this article renews my confidence that the activities we bring to our clients can have a positive effect in ways that other therapies or lessons may not. How many activities involve every group member doing the exact same thing at the same time, connecting to each other through careful attention and coordinating the motor planning to synchronize with peers? The required careful attention to the other people in the room and the rhythmic framework of the activity make drumming a valuable tool for therapeutic success in the social domain.
Yoo, G. E & Kim, S. J. (2018) Dyadic Drum Playing and Social Skills: Implications for Rhythm-Mediated Intervention for Children with Autism Spectrum Disorder. Journal of Music Therapy. 55 (3). 340-372.