Adult Autism Study

By Jeff Strong
Director, REI Institute

Rhythmic Entrainment Intervention is music-medicine program (Spintge and Droh 1992) that uses musical rhythm to stimulate and synchronize the listener’s brain. REI employ custom-made recordings developed for each client based upon an extensive intake process using variations on the standardized rating scales generally used to diagnose these conditions (the Aberrant Behavior Checklist, among others). REI is based on the idea that auditory rhythm can have synchronizing effect on the listener’s brain (Maxfield, 1994) and complex rhythms can have an activating effect on the brain even in people with severe neurological disorders (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 an auditory rhythm daily for 10 weeks often results in improvements with many of the symptoms associated with autism (Strong 1998).

Previous studies have shown that Rhythmic Entrainment Intervention (REI) provides positive gains for children with autism (Strong 1996). 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 in northern Arizona. The study consisted of five adult males, ages 23-38 living in the residential facility. 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.

Thousands of people have used an REI recording and no observances of long-term negative reactions have been demonstrated. Any negative responses to the recordings have been alleviated by not hearing 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. 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 2-CD REI Custom Program of today is substantially more directed to each person and the practice of revising CDs when results aren’t observed by 6 weeks or when negative responses are seen, results in a more consistent and significant overall improvement for each person.

Subject descriptions:

Subject 1: J.S. – Male, age 26.

J.S. had been living in an institutional setting since age 5 and had been diagnosed with autism as well as low-functioning M.R. He was non-verbal, compulsive, and characterized as stubborn and antagonistic. He had a low-tolerance for change and would pick on new staff for several months until he was comfortable with them. He needed constant supervision because he was obsessed with playing with garbage and dirty laundry, often throwing it in the toilet.  

Subject 2: J.L. – Male, age 23

J.L. had a seizure disorder as well as autism. For the year previous to this study he had been having an average of one seizure a day (grand mall type) and began taking Tegritol within one week of starting the REI recording.  J.L. had a near normal vocabulary, could read well, follow rules, but due to seizure activity was unable to engage in many activities. He also hallucinated often - he loved to dance and sing with imaginary friends, generally performing both sides of a conversation.

Subject 3: B.M. – Male, Age 27.

B.M. had low-moderate functioning autism. His communication skills were very poor - his language development was assessed to be at about age 18 months. He was compulsive about food and would take others when he could, so he needed supervision during meals to ensure other could eat their food. He was emotionally volatile and often screeched and yelled when others express aggression. When he engaged in self-injurious behaviors, including biting himself. He often exhibited self-stimulatory behaviors, either rocking back and forth while sitting or twisting his torso when standing.

Subject 4: C.P. – Male, age 35.

C.P. lived in a group home since age 14. He exhibited self-stimulatory vocalizations most of the time. These were very loud, fast and threatening. He was able to speak clearly with correct grammar, however he rarely communicated verbally with others. He was highly aggressive and violent and generally had 3-4 incidents per week that were serious enough to need to be reported to the state. He would act out violently when asked to do anything for more than a few minutes. We was generally noncompliant, impatient, and characterized as being lazy by the staff. He enjoyed riding horses but would hit them occasionally. His sleep was poor. He often woke throughout the night and tried to get out of facility. If not constantly watched, he would wander the neighborhood and enter nearby homes. He was obsessive about food and had poor table manners generally eating as much food as he could as fast as possible.

Subject 5: R.A. – Male, age 38.

R.A. exhibited severe self-stimulato   ry and self-abusive behavior. He also experienced bipolar disorder. When he was in a manic part of his cycle he would be highly anxious and would have difficulty sleeping. When he was in a depressed part of his cycle he would be lethargic and self-abusive. This depressed side of his cycle would often last 2-3 weeks.  His self-injurious behaviors included scratching his forehead until bleeding, head-banging, and anal digging. His weight regularly fluctuated by ten pounds with his manic/depressive cycle due to his not eating while depressed.

Results:

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

Subject by subject results were as follows:

Subject 1: J.S. – Male, age 26

J.S. demonstrated an “uncharacteristically high tolerance” for listening to the REI rhythms. The staff reports that he hears both sides everyday (a total of 40 minutes) and is often asleep halfway through the second side (after approximately 30 minutes of listening). He seems to be calmed by the rhythms as they play and, overall, has shown an increase in his ability to focus and to handle a change of staff.

After sixteen weeks he was no longer listening everyday, but didn’t object when it’s turned on for him (apparently, the new staff hadn’t been as diligent in playing the recording for the previous several weeks). He was noticeably calmed whenever the recording was played. His behaviors overall remained the same with the addition of observable improvement in focusing ability and tolerance to change.

Subject 2: J.L. – Male, age 23

J.L. seemed to enjoy his recording and was consistently calmed by it. He turned on the recording himself and was often asleep within 30 minutes of turning it on. His seizure activity was down significantly, but a change in medication at about the same time as starting listening to the REI rhythms makes it impossible to determine if REI was contributing to this improvement.

Subject 3: B.M. – Male, Age 27.

B.M. 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.

After six months   B.M. was still noticeably calmed by the rhythms and didn’t engage in self-stimulatory or self-injurious behavior when the rhythms played. He showed no other significant changes in overall behavior.

Subject 4: C.P. – Male, age 35.

After one month he was much less aggressive–the    facility had no incident reports after the first week of the study. He would often request the tape at night. He began sleeping through the night starting second day and was no longer trying to get out. He still sometimes wandered during the day, but he stayed within the facilities boundaries. He was much more compliant and showed improved ability to listen. His self-stimulatory vocalizations continued, but he would stop when told to do so. He was starting to use conversational speech and would say 2-3 sentences when asked questions.

After eight weeks he still had no incident reports and was much less aggressive. He was still sleeping well and still showing improvements in compliance and listening ability. His self-stimulatory vocalizations decreased and he began initiating conversation with others.

After 6 months C.P. continued to exhibit non-aggressive behavior and uninterrupted sleep. His improvements in other areas remained with only slight progress.

Subject 5: R.A. – Male, age 38.

After four weeks he was noticeably calmed by the rhythms and was sleeping much better overall. R.A.’s depressed states seemed to last a shorter length of time. Some days when he was really down he refused listening to the tape but when it was turned on it seemed to improve his mood and he often became more active. His self-abusive behaviors lessened in frequency and intensity.

After 6 months R.A. 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. He was no longer listening to the tape everyday but when he did listen before bedtime he would sleep deeper and wake more rested.


Conclusions:

The REI Custom Program rhythms seem to provide positive impacts on the subjects in this study. Most consistently among the 5 subjects is the noticeable calm that listening to the rhythms elicits. As a result the entire facility was easier to manage, each subject was sleeping better and was more rested. Overall change beyond calm varied according to subject. Three subjects demonstrated significant overall change in one or more areas, while two showed only an increase in overall calmness. There is no pattern to the changes and who saw what.

This study employed a single REI recording. Currently the REI Custom Program consists of 2 initial CDs with revisions when we don’t achieve the results from the first two CDs. 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 study along with numerous case studies since implementing out multiple CD format, further study is warranted. It is suggested that future study of REI for adults with autism should employ the multiple CD format and include a larger sample of adults - using a control group - on the autism spectrum.

References:

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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.
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