In a recent study published in PNASresearchers studied the impact of drum training on behavior and brain function in adolescents with autism without prior drumming experience.
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder characterized by deficits in social interactions and a range of repetitive and restricted behaviors and activities. There is a need to develop interventions that could offer new perspectives and ideas to help people with autism.
Learning to drum involves musicality and helps develop multimodal skills such as sensorimotor integration, cardiovascular exercise processes, and body coordination. Previous studies have shown that drumming improves attentional focus and motor control and reduces emotional problems in children with ASD. However, none of the studies explored how the behavioral changes translated at the neurological level.
About the study
In the current study, researchers investigated the impact of a drum-based intervention on behavioral and neural outcomes in adolescents with autism.
For the study, 36 adolescents with the Diagnostic and Statistical Manual, ASD Diagnosis Based on the Fifth Edition were enrolled and divided into two age- and gender-matched groups. the battery group (n=19) and the control group (n=17). The drug addict group received drum lessons based on the Rockschool drum program (two lessons per week for eight weeks), while the control group did not.
Each session included 20-minute drum assessments, 45-minute functional magnetic resonance imaging (fMRI) scans, neuropsychological testing, and parent-completed questionnaires regarding participants’ behavioral difficulties. The drumming assessment included nine drum exercises performed at 60 beats per minute (bpm), 90 bpm, and 120 bpm.
Percussion improvements were quantitatively assessed as a decrease in onset errors after percussion sessions. The absolute and non-absolute differences between the actual percussive note and the expected note for the nine exercises performed at the three tempos were called timing error and relative timing error, respectively. Additionally, the team investigated whether the timing error was due to delay or anticipation.
The team assessed behavioral outcomes related to drumming practice among study participants and compared changes in functional connectivity (HR) between the drumming group and the control group and changes in HR before training. drumming compared to after drum training. The Social Skills Enhancement System (SSIS) Rating Scale and the Revised Repetitive Behavior Scale (RBS) were used, and a multivariate seed-to-voxel and voxel-to-voxel analysis (MVPA) was performed.
Despite recruiting 36 autistic adolescents, drum performance was analyzed for only 32 participants (17 and 15 drummers and controls, respectively) because the remaining participants were unable to attend the post-drum evaluation session ( n = 1) or misunderstood the instructions during battery evaluations (n = 3).
Considerable time*group interactions were noted for the hyperactivity/inattention subscale with significantly reduced attention difficulties and hyperactivity in drummers compared to controls. Drummers showed substantial improvements in anticipation errors and timing errors over time, unlike controls.
Substantial decreases in externalizing and behavioral problems (stereotyped behaviors, similarity behaviors, and repetitive behaviors) were observed after drum lessons compared to before drum training. This indicated improvements in ability to manage social relationships, cognitive flexibility, release of physical tension, and reduction of physical and verbal aggression with improved social and mental well-being after drumming.
fMRIs showed elevated HR values for sites of inhibitory control, autoregulation, and action outcome monitoring in the brain. Improvements in percussion were strongly associated with improved anticipatory measures that reflect improved abilities to delay motor responses. Seed-to-voxel analyzes showed higher FC values for the right dorsolateral prefrontal cortex (rDLPFC), precuneus, posterior cingulate gyrus, and right inferior frontal gyrus (rIFG) of the brain. The results indicated that percussion improved observation, imitation of actions and integration of bodily senses.
Substantial changes were also seen in the right and left paracingulate cortex, left nucleus accumbens, medial frontal cortex, subcallosum cortex, left frontal pole, and caudate. After drumming, HR values also improved for the cuneal cortex, intracalcarin cortex, superior lateral occipital cortex, superior parietal lobule, and supracalcarin cortex on the left side of the brain. Results reflected improved motor learning, spatial orientation, visualization, object exploration, communication skills such as mentalizing, language development and face perception after playing of the drum. No substantial changes in HR were noted among the controls.
Voxel-to-voxel analysis showed four clusters of enhanced FC connectivity that overlapped the dorsal attention network in drummers. Group 1 included the frontal medial cortex and the left and right paracingulate gyrus and the; group 2 included the subcallosal cortex and the medial frontal cortex; group 3 included the frontal medial cortex and the left-side frontal pole; group 4 comprised the left nucleus accumbens, subcallosal cortex, and caudate.
Overall, study results showed that percussion improved ASD outcomes in adolescents with autism, such as reducing hyperactivity and improving attention, behavior, inhibitory control, self-regulation and functional connectivity between brain regions. The results highlighted the potential use of drum-based interventions for people with behavioral and emotional difficulties and disorders associated with inhibition.