The American Occupational Therapy Association [AOTA] (2014) defines social participation as, "the interweaving of occupation to support desired engagement in community and family activities as well as those involving peers and friends" (American Occupational Therapy Association [AOTA], 2014, p. S21).  

Social Participation, Music, and Drumming for Children with Disabilities

Social participation is an occupation that is often the focus of pediatric intervention. Increasing social participation in the lives of children can improve health, functional performance, and quality of life (Hilton, 2015). Children with disabilities often struggle with social participation. For example, children with Autism Spectrum Disorder (ASD) experience deficits in social skills as compared to their typically developing peers (Liu et al., 2019). Adolescents with ASD may also experience challenges in establishing and maintaining relationships (Audet, 2019). Children with learning disabilities also face social deficits related to their ability to solve interpersonal problems. These children are also more likely to use dysfunctional strategies to solve interpersonal problems, including aggression. This may lead to children with learning disabilities having fewer positive friendships (Pina et al., 2013). Similarly, individuals with an intellectual disability have lower levels of social skills competence. A positive correlation was found between the level of intellectual function and the acquisition of social skills (Dučić et al., 2018).   

History of Music and  Benefits with Social Participation

Music's value has been studied throughout many professions, including speech pathology, music education, and psychology. Few studies have examined the social benefit of group drumming interventions, but research has shown the benefits of other music interventions on social behavior. Kirschner and Tomasello (2010) examined the effect that singing and dancing together had on social behavior in four-year-old children. Children in groups of two were given a challenging task to complete. The task has a background story to motivate the children and to make the task a game. During the task, the experimenters manipulated the condition to have one of the children have a sudden accident. This gave the other partner a choice to help or continue playing on his or her own. They also created a game that allowed the pair to decide if they would solve a task individually or cooperatively. For the experimental group, children sang, dance, and played percussion instruments together with the experimenter. The control group completed the same task with spoken word, and no instruments (Kirschner & Tomasello, 2010).

The results demonstrated that children from both genders were more likely to help their partner after making music together. In situations when the child chose not to help, the music group was more likely to give a verbal excuse, suggesting a greater social commitment to their peers. Children from the music group also chose the cooperative solution to the problem, rather than the individual solution. The group that had previously made music together also was more likely to use positive communicative phrases, such as "let's try to pull together" (Kirschner & Tomasello, 2010). Results from this study provide statistically significant evidence that music can have a positive effect on children's social skills. Group drumming offers an opportunity for participants to make music together, which was the main focus of this study. Therefore, it is possible for group drumming to have similar pro-social effects for children. It is also difficult to determine from this study whether it was singing or dancing that provided the therapeutic benefits. Continued research in this topic would be beneficial to examine if this effect carries over to group drumming, specifically with children who have disabilities.

Sooful et al. (2010) studied the use of dance and music to enhance social integration for children with intellectual disabilities. Researchers investigated how educators perceive music and dance as interventions for the social integration of children with intellectual disabilities. Teachers were interviewed on topics such as how dance and music effect social integration, and what strategies can be used to facilitate integration through dance and music. Four themes were found, including attitude, self-realization, support, and interaction. Throughout all focus groups, educators agreed that music and dance changed the attitudes that mainstream children had towards children with an intellectual disability. The authors also found that dance and music helped to break down communication and attitude barriers, causing enhanced integration and socialization. They found that music and dance helped overcome barriers such as hearing impairments and speech deficits. Researchers also found that participation in dance and music programs promoted independence, emotional security, and discipline (Sooful et al., 2010). Similar to the study by Kirschner and Tomasello (2010), it cannot be determined whether music or dance created positive benefits found by teacher interviews in this study. Continued research may shed more light on this concept. These studies demonstrating the effectiveness of music as an intervention may be used to create a program using music and group drumming as an intervention.

How Drumming Affects the Brain

Kokal et al. (2011) found that drumming in sync with others increased activity in the same area of the brain involved in monetary reward. Participants in the study attended a training session to learn the rhythm, a fMRI scanning session to locate the region of the brain involved in processing rewards, and an fMRI session while drumming with the experimenters. They were then evaluated on a prosocial commitment test, involving number of pencils picked up that the experimenter dropped. During the fMRI drumming session, the participants were asked to play the rhythm they initially learned as correctly as possible. The experimenter would either play in sync with the participant (synchronous) or out of sync (asynchronous). The participants who drummed with the synchronous experimenter were more likely to show prosocial behavior. Meaning, the participant was more likely to help their partner if they had drummed together at the same time. Experimenters also found that the reward center of the brain was more active when the task came easier to the participants, and when they were able to drum in sync with others (Kokal et. Al, 2011). This suggests that the group should be a just-right challenge to the participants. Adapting the group to each member to ensure success and enjoyment will increase the building of social skills and enjoyment.

The Therapeutic Benefits of Drumming and  Percussion

Group drumming has been shown to be effective for reducing aggression for adolescent girls with conduct disorder (Van Rensburg et al., 2016). Using a randomized pre-test post-test control group design, they examined how a drumming group using African Djembe drums influenced the participants. The intervention included ten one-hour sessions, with an opportunity for each participant to reflect at the end. The study also featured a control group that participated in their normal day-to-day activities instead of the intervention. After the interventions, 76.9% of the participants in the experimental group had lower Aggression Scale scores, while only 30.8% of the control group had lower Aggression Scale scores. Van Rensburg et al. also found a statistically significant difference between the post-test scores of the control vs. experimental groups, suggesting that group drumming may be an effective intervention for reducing aggression for adolescents with conduct disorder (Van Rensburg et al., 2016). These results may indicate future research examining group drumming in other contexts. Although this study does not address social behavior explicitly, decreased aggression may allow adolescents and children to form social relationships and participate more effectively in groups.

Mungas and Silverman (2014) explored how a drumming group affected the affective states in university students. The study used a pre-test and post-test design to examine the immediate effects of a single-session of wellness drumming on students from the University of Minnesota. The results showed statistical significance for the domains of wide-awake/drowsy, relaxed/anxious, friendly/aggressive, and clear-head/confused. The participants experienced more positive affect after the intervention. Mungas and Silverman discuss that although there was a lack of randomization in this study, the results indicate a need for more research on the positive effects of group drumming (Mungas & Silverman, 2014). Although this study does not focus on children, the friendly/aggressive, and relaxed/anxious affective state changes in this study suggest possible effects on social participation. If participants show more friendly and less anxious behavior, this may improve their ability to participate socially, and be accepted by their peers.

In a study with social workers, Maschi et al. (2013), found that group drumming was beneficial to improving energy and feelings of empowerment and community. They also found that it relieved stress. The drum program that was utilized group drumming to empower individuals to cope with stressors and express feelings through recreational drumming. The program utilized various drums including congas, djembes, doumbeks, and hand-held instruments. The most important result of this study for social participation is their hypothesis stating that group drumming would increase connectedness. They found a statistically significant change in the level of connection between the group members, as well as increased calmness, energy, and empowerment (Maschi et al., 2013). This increased sense of community within the group may be beneficial to promote social participation among children.

A group drumming intervention led by a counselor was found to improve social-emotional behavior for children from low-income homes (Ho et al., 2010). Students in fifth-grade were part of a drumming group during the school day for 45 minutes weekly for 12 weeks. The weekly groups had a consistent theme of focus and listening, as well as session themes such as team building, expressing feelings, dealing with stress, and empathy. The group's theme of focus and listening was reinforced through the duration of the program using call and response, which is repeating an improvised rhythm played by another group member. The drums were also used to express feelings after a spoken "calm down" mantra. Participants would also speak positive affirmations along to the beat for the other weekly session themes. Each session would begin with the entire group playing a repeating rhythmic pattern in an attempt to relieve stress and establish the group community. The Teacher's Report Form was used to analyze various behaviors expressed by children considered at-risk. Students in the drumming program displayed significant improvements in social-emotional behavior. Students also displayed significant changes in attention problems, inattention, attention-deficit/hyperactivity programs, and oppositional defiant problems (Ho et al., 2010). This study demonstrates how group drumming can be an effective medium for intervention alongside a skilled professional. Although the children in this study did not necessarily have a diagnosed disability or developmental delay, benefits of this intervention medium may show effects for this population as well.

The Mungas & Silverman (2014) study and the Van Rensburg et al. (2016) study are both similar in that they show a direct correlation between group drumming and positive behavior. Although neither study worked with individuals with disabilities specifically, these positive behaviors and moods may help children to participate socially. Similarly, the Maschi et al. (2013) study used group drumming to improve mental health. The main differences between the studies are the ages of the participants and the discipline of the study. The van Rensburg et al. (2016) study was the most relevant to the proposed program because it was led by occupational therapists with an adolescent population. The Ho et al. (2010) study was with children but led by a mental health counselor. Mugas and Silverman (2016) based their study around music therapy with college-aged individuals and the Maschi et al. (2013) study was led by social workers and examined social workers. Although there is a gap in the literature regarding occupational therapy research, these non-occupational therapy studies can provide insight to the therapeutic benefit of group drumming throughout many populations, providing a rationale to create a group drumming program.