The impact of drum training on behavior and brain function in autistic adolescents

In a recent study published in PNAS, researchers investigated the impact of drum training on behavior and brain function in autistic adolescents with no prior drumming experience.

Background

Autism spectrum disorder (ASD) is a permanent neurodevelopmental disorder characterized by deficits in social interactions and a range of repetitive and restricted behaviors and activities. There exists a need for developing interventions that could offer new perspectives and insights to help autistic individuals.

Learning to drum involves musicality and aids in developing multimodal skills such as sensorimotor integration, cardiovascular exercise processes, and body coordination. Previous studies have demonstrated that drumming improves attentional focus and motor control and reduces emotional problems among children with ASD. However, none of the studies have explored how behavioral changes translated at the neurological level.

About the study

In the present study, researchers investigated the impact of a drum-based intervention on behavioral and neural outcomes among autistic adolescents.

For the study, 36 adolescents with the diagnostic and statistical manual, fifth edition-based ASD diagnosis were enrolled and divided into two age- and sex-matched groups viz. the drum group (n=19) and the control group (n=17). The drug group received drum tuition based on the Rockschool drumming syllabus (two lessons weekly for eight weeks), whereas the control group did not.

Each session comprised 20-minute drumming assessments, 45-minute functional magnetic resonance imaging (fMRI) scans, neuropsychological tests, and parent-completed questionnaires relating to the participants’ behavioral difficulties. The drumming assessment comprised nine drumming exercises performed at 60 beats per minute (bpm), 90 bpm, and 120 bpm.

Improvements in drumming were quantitatively assessed as the decrease in onset errors after the drumming sessions. The absolute and non-absolute differences between the actual drumming note and the expected note for the nine exercises performed at the three tempi were referred to as the timing error and the relative timing error, respectively. Further, the team investigated if the timing error was due to delay or anticipation.

The team assessed the behavioral outcomes related to drum practice among the study participants and comparatively assessed the functional connectivity (FC) changes between the drum group and the control group and the FC changes before drum training versus after drum training. The social skills improvement system (SSIS) rating scale and the repetitive behavior scale-revised (RBS) were used, and seed-to-voxel and voxel-to-voxel multivariate pattern analysis (MVPA) were performed.

Despite the recruitment of 36 autistic adolescents, the performance of drumming was analyzed for 32 participants only (17 and 15 drummers and controls, respectively) since the remaining participants either could not attend the post-drumming assessment session (n=1) or misunderstood the instructions during the drumming assessments (n=3).

Results

Considerable time*group interactions were noted for the hyperactivity/inattention subscale with substantially reduced attention difficulties and hyperactivity among the drummers compared to controls. Drummers exhibited substantial improvements in anticipation errors and timing errors over time, whereas the controls did not.

Substantial decreases in externalizing and behavioral problems (stereotyped behaviors, sameness behaviors, and repetitive behaviors) were observed after drum lessons compared to before drum training. This indicated improvements in social relationship management ability, cognitive flexibility, the release of physical tensions, and reductions in physical and verbal aggression with improved social and mental well-being after drumming.

The fMRI scans showed elevated FC values for sites of inhibitory control, self-regulation, and action outcomes monitoring in the brain. Improvements in drumming were closely associated with improved anticipation measures that reflect improved abilities to delay motor responses. The seed-to-voxel analyses showed higher FC values for the right dorsolateral prefrontal cortex (rDLPFC), precuneus, posterior cingulate gyrus, and the right inferior frontal gyrus (rIFG) of the brain. The findings indicated that drumming improved observation, imitation of actions, and integration of body-based senses.

Substantial changes were also observed in the right and left paracingulate cortex, left nucleus accumbens, medial frontal cortex, subcallosal cortex, left frontal pole, and caudate. Post drumming, FC values also improved for the cuneal cortex, intracalcarine cortex, superior lateral occipital cortex, superior parietal lobule, and the supracalcarine cortex on the left side of the brain. The findings reflected improved motor learning, spatial orientation, visualization, exploration of objects, communication skills like mentalizing, language development, and face perception after drumming. No substantial FC changes were noted among the controls.

The voxel-to-voxel analysis showed four clusters of enhanced FC connectivity that overlapped with the dorsal attention network among drummers. Cluster 1 comprised the frontal medial cortex and the left and right paracingulate gyrus and the; cluster 2 comprised the subcallosal cortex and the medial frontal cortex; cluster 3 comprised the frontal medial cortex and frontal pole of the left side; cluster 4 comprised the left nucleus accumbens, subcallosal cortex and the caudate.

Conclusion

Overall, the study findings showed that drumming improved ASD outcomes among autistic adolescents, such as reduced hyperactivity and improved attention, behavior, inhibitory control, self-regulation, and functional connectivity across regions of the brain. The findings highlighted the potential usage of drum-based interventions for individuals with behavioral and emotional difficulties and inhibition-associated disorders.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.