Drumming: Support for OT

The literature suggests that music groups can diminish behaviors that may cause individuals to be socially isolated, and overall improve social participation (De Vries et al., 2015; Sooful et al., 2010).

The Value of Music and Occupation

In a systematic review, Cohn et al. (2017) explored the value that music can have in respect to occupation. The authors found literature that explored music in an individual and community setting. They found that music tended to be an accessible medium for many clients and gave individuals with disabilities the opportunity to develop leisure interests and social connections that they were not always granted. Community groups, or groups that do not require formal musical training also provided an increased opportunity to include people with a variety of ages and abilities. Cohn et al. also noted that occupational therapists have a chance to work with these groups in a consultative role to give the group an occupational perspective (2017). This option may be beneficial to community groups that cannot afford a full-time OT (Cohn et al., 2017).

Craig (2008) conducted a systematic review and found that music can be used to assist occupation, to prepare for occupation, and as an occupation itself. In music assisted occupation, music is used to address limitations that occur during the occupation itself. Music is considered the tool to influence performance in this case. It can also be used as a new occupation that patients can participate in to enhance their quality of life. Craig also found that music helped patients with collaborating, relating, and sharing emotions. Because of this, music enhanced interaction and communication within the groups (Craig, 2008).

A systematic review by De Vries et al. (2015), examined music as a therapeutic intervention with children with autism. After a search of the literature, the researchers found five outcomes from using music as a therapeutic intervention with children diagnosed with ASD. This study had a focus on therapeutic recreation but also included literature from all disciplines. The first theme was an increase in socially acceptable behaviors that typically lead to a lack of social acceptance. Researchers also found the themes of increased social response behaviors, increased verbal communication, decreased anxiety, and an increase in understanding emotions (De Vries et al., 2015).

Kalgotra and Warwal (2017), studied the effect of a music intervention on behavior disorders of children with intellectual disability. The music intervention used concepts from Applied Behavior Analysis and was made up of 60-minute sessions during school hours each day for 24 weeks. During the session, the children were greeted with songs, then they spent 15 minutes singing, 25 minutes playing a drum, and then they were sung a final song. Children were given the opportunity for individual expression, and each child was encouraged to participate. Children from the intervention group showed significant improvements in the domains of violent and destructive behavior and misbehaving with others, while children from the control group did not show a significant difference in these domains. Researchers concluded that adding a music intervention to the daily routines and curriculum for children with intellectual disability can have a positive impact (Kalgotra & Warwal, 2017). 

Percussion as a Means of Occupational Engagement and Social Participation

Although there is limited research exploring group drumming's effect on social participation for children with disabilities, some studies have shown the positive relationship between drumming and occupational engagement. Most of these studies take place outside of the U.S. A study by Plastow, et al. (2018) explored the effect of African drumming on the mental well-being of adults with mood disorders. In this quasi-experimental study that took place in South Africa, group African drumming was shown to have a positive effect on psychiatric inpatients experiencing mood disorders such as depression, anxiety, and bipolar disorder. The group was led by an OT and used Cole's seven-step formal for 45-minute sessions. There was a statistically significant difference between pretest and posttest scores on all six domains of mental well-being, which was measured by the Stellenbosch Mood Scale. Participants who were initially more anxious or depressed showed even more improvement than participants who were less anxious or depressed. They concluded that OT-led drumming groups may help immediately improve mood and increase feelings of enjoyment for participants (Plastow et al., 2018).

Although Plastow et al. (2018) did not have pediatric participants or a focus on social participation, their research may indicate a potential social benefit for an OT based group drumming intervention (2018). Children with disabilities such as ASD, ADHD, and intellectual disability often suffer from mood disorders such as anxiety and depression (Gordon-Lipkin et al., 2018). Reducing these feelings may allow children to be more comfortable to participate socially. More research needs to be done to determine if the effects on adults carry over to the pediatric population and if this has an effect on social participation.

A program entitled Drumtastic has demonstrated beneficial results for children with ASD in the social realm (Willemin et al., 2018). The program applied concepts of fitness, drumming, and music into a therapeutic activity. The drums were large stability balls held in place by large buckets. The sessions focused on fine motor dexterity exercises, drumming and singing, rhymical clapping games, and drum and dance choreography. There were 14 participants who were diagnosed with ASD, and 19 graduate student mentors to help implement the group and assess the participants. The Social and Personal Relationship Scale (SPRS) was used to measure how the participants responded and adapted pro-socially. They also used a rating system for the children based on emojis to describe their feelings, called the smiley-o-meter. The scales had five to eight faces which corresponded to a Likert scale number. Results showed statistically significant results in the domains of enjoyment and fun. Results were not statistically significant for developing improved social relationships but showed a positive trend. These results indicate a possible benefit of group drumming interventions (Willemin et al., 2018). Further research on this topic may show similar positive trends for pro-social behavior and lead to improved social skills for children with disabilities.

A group drumming intervention has also been shown to help Korean middle school students decrease aggression and to develop pro-social behavior and emotional management skills (Suh, 2019). Participants of the study attended a 10-week group drumming program each school day led by a music therapist, while the control group was involved in the general violence prevention program. There was an additional experimental group that was led by a music teacher, with a music education approach rather than a therapy approach. Individuals in the therapeutic drumming group demonstrated the largest reduction in aggression. Although the therapist in the case of this study was a music therapist, it may demonstrate that collaborating with a therapy profession can provide a greater effect for group drumming's benefits. Authors of the study also noted that the therapeutic drumming group improved participants prosocial behavior and relational skills (Suh, 2019).

Drumming has been shown to promote the emotional and social function of children aged 7-12 living in a youth care center. In a qualitative study by Flores et al. (2016), children living in residential care were selected to be part of a group drumming intervention. The purposeful selection included children with the highest levels of depression, anxiety, and social interaction difficulties. They also had minimal experience with music and no experience with drumming. The intervention took place for four-months, with weekly, 45-minute African drumming workshops. The groups gradually became more and more challenging each week, allowing the participants to feel successful. The earlier sessions taught the participants the basics of music and drumming skills, and the later groups allowed them to be more creative and prepare a song for the center's annual concert. Overall, the authors found that social function was enhanced during and immediately following each session. They found emerging emotional function themes of increased emotional regulation and playfulness. The drumming workshops helped the children with emotional regulation and allowed them more positive affective states (Flores et al., 2016).

Flores et al. also found emerging themes for increased social functioning. During the sessions, participants played rhythms in groups and pairs. Having the opportunity to listen to each other and participate in call and response interaction. They also took turns being the pulse keeper and the soloist. These activities increased the children's ability to take turns, listen, and share. The group also allowed the children to collaborate and gave them increased ability to adapt to different social roles. The children also played drumming games that facilitated teamwork and collaboration. Researchers noted that group activities increased the group's impulse control, listening skills, and attentiveness. Flores et al. noted that the drumming group was able to transcend differences in age and learning styles (2016). Drumming itself offered flexibility and allowed participants to express themselves at their ability levels. Rhythms and call response activities were able to be graded up or down based on the child's comfort level (Flores et al., 2016).

The Drumtastic group and the African drumming group for residential care both indicate the need for future research in this topic (Flores et al., 2016; Willemin et al., 2018). Both studies showed positive social responses to group drumming intervention. Although neither study was run by an occupational therapist, benefits of increased social participation indicate the need for occupational therapy-based perspective and programs. The African drumming group in the Flores et al. study also incorporates principles often found in occupational therapy such as grading up and grading down activities and being included in all abilities and comfort levels (Flores, van Niekerk & le Roux, 2016). The Drumtastic study showed possible prosocial benefits for a group drumming intervention (Willemin et al., 2018). The group used stability balls instead of instruments, but the focus on fine motor dexterity and social participation shows relevance within the domain of occupational therapy. 

Fleming Cottrell and Gallant (2003) used a single-case study design to show the effectiveness of a group drumming intervention called the Elder Drum Project with older adults. Although this is not a high level of evidence it provides precedence for further research on the topic. The drumming group took place in a skilled nursing facility and was led by the OT department once per week. The researchers performed semi-structured interviews and then coded the interviews for themes. They found that the Elder drum project contributes to overall quality of life. Participants noted greater life satisfaction, including social support, and a sense of accomplishment and control. Participants even noted increased health status, including decreased pain, increased strength, and psychological outlook (Fleming Cottrell & Gallant, 2003).