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Children Australia
Page1of9 CThe Author(s) 2017 doi:10.1017/cha.2017.40
Drumming to a New Beat: A Group Therapeutic
Drumming and Talking Intervention to Improve
Mental Health and Behaviour of Disadvantaged
Adolescent Boys
Karen Emma Martin and Lisa Jane Wood
School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
Background: This research examined the impact of a programme integrating therapeutic music and
group discussions (Holyoake’s DRUMBEAT programme) on disadvantaged adolescents’ mental wellbeing,
psychological distress, post-traumatic stress symptoms and antisocial behaviour. Method: Students
displaying antisocial behaviours in grades eight to ten at three socio-economically disadvantaged
secondary schools in Perth, Western Australia were invited to participate in a 10-week DRUMBEAT
programme (incorporating drumming with djembes, therapeutic discussions and a final performance).
Eight DRUMBEAT programmes were held in 2014. Pre- and post-intervention questionnaires measured
mental wellbeing (Warwick–Edinburgh Mental Wellbeing Scale), psychological distress (Kessler-5), post-
traumatic stress symptoms (Abbreviated Post-Traumatic Stress Disorder Checklist- Civilian Version) and
antisocial behaviours (Adapted Self-Reported Delinquency Scale). Results: Of the 62 students completing
DRUMBEAT, 41 completed pre- and post-questionnaires. Post-programme boys scored an average 7.6%
higher mental wellbeing (WEMWBS) (
p
=.05), 19.3% lower post-traumatic stress symptoms (A PCL-C)
(
p
=.05) and 23.9% lower antisocial behaviour (ARSDC) (
p
=.02). These changes were not evident for
girls. No significant differences were detected for differences in psychological distress for either gender.
Conclusion: This research highlights the potential of the DRUMBEAT programme as an effective, targeted
strategy to reduce post-traumatic stress symptoms and antisocial behaviour and increase mental wellbeing
in socio-economically disadvantaged adolescent boys.
Keywords: mental wellbeing, adolescent boys, music therapy, post-traumatic stress, psychological
distress, antisocial behaviour
Background
Thementalhealthofchildrenandadolescentsisanes-
calating international concern. World-wide up to 20% of
children and adolescents experience a mental illness and
in many countries suicide is the leading cause of death
for young people (World Health Organization, 2001). The
large impact of youth mental illness is costly to individu-
als and society. Mental disorders are an antecedent to self-
harm, suicidal thoughts and suicide (Prince et al., 2007)
and a precursor to adulthood major depression, anxiety
disorder, illicit substance abuse/dependence, and intimate
partner violence victimisation (Kessler, Angermeyer, & An-
thony, 2007; McLeod, Horwood, & Fergusson, 2016). Fur-
thermore, a constellation of other health risk factors is asso-
ciated with poor mental health in youth including antisocial
behaviour (i.e., aggression, rule-breaking and oppositional
behaviours) (Rasche et al., 2016), lower physical activity,
smoking and alcohol consumption (Patel, Flisher, Hetrick,
& McGorry, 2007). These behaviours have a distinct impact
on an individual’s long-term health, academic prospects and
future employment (Jacka et al., 2011; Siegel & Welsh, 2011).
Thus, although in Australia mental illness is already the
largest contributor to burden of disease (disability-adjusted
life years lost) for those aged 15–24 (Australian Institute of
ADDRESS FOR CORRESPONDENCE: Dr Karen Martin, Asst Professor,
School of Population and Global Health, The University of
Western Australia (M431) 35 Stirling Hwy, Crawley, Western
Australia 6009, Australia. E-mail: karen.martin@uwa.edu.au
1
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Karen Emma Martin and Lisa Jane Wood
Health and Welfare, 2011), it is likely that the costs to society
extend well beyond the health domain.
Increasingly, evidence is starting to ‘unpick’ the complex
web of disordered mental health and behavioural function-
ing in adolescents. For instance, research indicates that ag-
gression may be facilitated by post-traumatic stress disorder
and psychological distress (Rasche et al., 2016). There are
vast immediate and long-term social and economic impacts
of problematic behaviour (Siegel & Welsh, 2011) stemming
from childhood. Longitudinal data indicates that persistent
antisocial behaviour is associated with mental health prob-
lems, substance dependence, financial problems and crimi-
nal behaviour in adulthood (Moffitt, Caspi, Harrington, &
Milne, 2002).
There is also burgeoning understanding about the rela-
tionships between mental health and physiology (Cacioppo
et al., 2000; Klimecki, Leiberg, Lamm, & Singer, 2013;
Walters & Kiehl, 2015). For instance, an examination of just
over 2600 college students in Ohio identified that chron-
ically lonely individuals recorded elevated mean salivary
cortisol levels across the day (Cacioppo et al., 2000). Like-
wise, behaviour has been noted to be associated with neu-
rophysiology. Magnetic resonance imaging was used in a
study of 191 incarcerated youth in the United States to ex-
plore grey matter volumes of the amygdala (associated with
fear conditioning) and hippocampus (associated with be-
havioural control and memory problems) (Walters& Kiehl,
2015). Their results noted that higher reported ‘fearless-
ness’ was associated with lower amygdala grey matter vol-
ume and higher reported ‘disinhibition’ was associated with
lower hippocampal grey matter volume. Promisingly, there
is the building evidence around brain plasticity with new
information that activities can actually change functioning
areas of the brain. Neuroimaging research has discovered
that a mindfulness-based intervention resulted in increases
in brainstem grey matter concentration concurrently with
improvement in psychological wellbeing (Singleton et al.,
2014). Klimecki et al. (2013) investigated the impact of
compassion training on functional neuronal responses us-
ing functional magnetic resonance imaging (fMRI). They
noted that, compared to their control group, compassion
training elicited increased neuronal activity in a brain re-
gion associated with positive affect and affiliation (Klimecki
et al., 2013). Music interventions are likewise postulated
to impact brain regions and thus emotions and behaviour.
Onestudynotedthatactivationofthebrainacousticsensory
streams (as measured using electrophysiological and auto-
nomic instrumentation) led to changes in mental health
and dysfunctional behaviours in youth diagnosed with gen-
eralised anxiety disorder or adjustment disorder (Kazymov,
Mamedov, Alieva, & Chobanova, 2014). Music therapy has
also been seen to improve behavioural and developmental
outcomes in children and adolescents with psychopathology
(Gold, Voracek, & Wigram, 2004).
DRUMBEAT is a multicomponent programme incor-
porating therapeutic use of music (i.e. drumming on a
djembe), group therapeutic discussions and relationship
building to assist people experiencing, or at risk of prob-
lematic health and social outcomes. DRUMBEAT was de-
signed initially for Australian Aboriginal youth in the West-
ern Australian Wheatbelt region by an Aboriginal elder and
Holyoake staff. The aim of the DRUMBEAT programme is
to promote social understanding, compassion and connec-
tion through a team drumming experience. Facilitators gain
accreditation after attending a 3-day training course. The
DRUMBEAT programme is facilitated by at least one accred-
ited facilitator who leads group discussions and rhythms
and harmonies with djembes. The programme incorporates
teaching drumming and sound making skills to participants
(who sit in a circle) via analogies, role play, games and group
activities. The programme includes goal setting (with a focus
on generating competence and confidence) and culminates
in a group performance to an audience. After an initial ses-
sion, incorporating learning base rhythms and developing
group guidelines, six learning modules are covered includ-
ing (1) rhythm of life, (2) relationships, (3) harmony, (4)
individuality and self-expression, (5) emotions and feelings
and (6) teamwork. Sessions eight and nine focus on develop-
ing and practicing harmonies to deliver at the performance
scheduled for session ten.
Despite some difficulties with evaluating music interven-
tions in the school setting (Crooke, 2014), there is evidence
that group music programmes delivered at school may have
a positive impact on adolescent socio-emotional outcomes
(Jackways, 2014; Uhlig, Jansen, & Scherder, 2017). For in-
stance, evaluation results of the Rap and Sing Music Therapy
programme held in a school in the Netherlands identified
that psychological wellbeing, self-description, self-esteem
and emotion regulation of 190 grade eight students im-
proved significantly post-programme when compared to a
control group (Uhlig et al., 2017). The DRUMBEAT pro-
gramme has been implemented in schools widely in Aus-
tralia and more recently in North America, the United
Kingdom, New Zealand, Canada and Anguilla. Previously,
DRUMBEAT has been shown to increase self-esteem and
reduce reported behaviour incidents in primary and sec-
ondary school students (Wood, Ivery, Donovan, & Lam-
bin, 2013). The value of implementing programmes such
as DRUMBEAT in school settings includes high reach
and extended contact which assists with programme up-
take, accessibility and completion (Clarke, Morreale, Field,
Hussein, & Barry, 2015). A plethora of mental and be-
havioural programmes suitable for school implementa-
tion exist (for a comprehensive list of Australian program-
mes, see https://www.mindmatters.edu.au/tools-resources/
programs-guide), however schools can struggle to identify
which intervention is likely to be the most suitable and suc-
cessful for their students. This is particularly problematic as
many therapeutic programmes have not been evaluated by
external researchers and there are few rigorous school pro-
gramme evaluations published. In addition to being effec-
tive, a programme needs to fit into school setting limitations
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Drumming to a new beat
such as budgets and timetabling, term length and teacher
expectations. Additional issues with running programmes
in disadvantaged schools, such as low attendance and dif-
ficulties gaining parental consent, also need to be consid-
ered. With its combination of therapeutic components and
structured programme, a study exploring the potential im-
pact of DRUMBEAT on students’ mental and behavioural
outcomes in disadvantaged schools was warranted.
Aim and Hypothesis
The aim of this study was to identify if mental wellbeing,
psychological distress, post-traumatic stress symptoms and
antisocial behaviour changed for adolescents following their
attendance at a 10-week DRUMBEAT programme. It was
hypothesised that the DRUMBEAT programme, delivered
in the school setting, would be associated with increased
mental wellbeing, and reduced psychological distress, post-
traumatic stress symptoms and antisocial behaviour in boys
and girls.
Methods
Design
A single group pre-test/post-test research design was im-
plemented. Initially, a control group (using a wait-list) was
proposed, however due to low student consent responses,
and a limited data collection time-frame, this was not
possible.
Sample selection
This study sought to recruit schools within areas of low
socio-economic status (SES) due to the association between
socio-economic disadvantage and higher rates of mental
health disorders (Sawyer et al., 2000) and antisocial and
delinquent behaviours (Losel, Carson, & Bull, 2003). Thus,
three schools were purposely selected from three of the low-
est socio-economic areas within the Perth metropolitan re-
gion, with one school each located in the northern, eastern
and southern corridors.
Initial contact regarding the research was made with each
school’s psychologist. Once formal written approval was
provided by the Principal, potential student participants
were identified and agreed upon by school psychologists,
student services coordinators and/or grade coordinators.
Selection criteria included students within grades eight to
ten (grade mix of groups decided by each school) who dis-
played antisocial behaviour. The uptake of the programme
and research was approximately 50% of those invited – this
was mainly due to the failure of students to return a signed
consent form from their parent/guardian.
Ethical Considerations
Approval for the study was gained from the institutional
ethics committee and the state education department. Stu-
dents were told that their participation in the DRUMBEAT
programme and the research was completely voluntary and
that they could withdraw from either the programme and/or
theresearchatanytime.Theywerealsoinformedthatthey
could still participate in the DRUMBEAT programme if they
declined or withdrew their involvement in the research. In-
formed written consent to participate in the research was
gained from both the student and their parent/guardian.
This project involved minimal risk to participants. As the
research involved measurement of mental health constructs,
the students and parents were informed (via the information
and consent forms) that the school psychologist would be
notified about students who exceeded normal thresholds for
psychological distress and post-traumatic stress scores. Stu-
dents who exceeded these thresholds could continue with
the DRUMBEAT programme and the research. Participa-
tion in the DRUMBEAT programme did mean that students
would miss one class per week for 10 weeks. This however,
was considered by the school staff to be appropriate consid-
ering the social, learning and behavioural difficulties being
faced by the students and the potential benefit of their par-
ticipation in the DRUMBEAT programme.
Instruments and Measurement
The pre- and post-programme questionnaires included
four instruments: (1) Warwick Edinburgh Mental Wellbe-
ing Scale (WEMWBS) (Tennant et al., 2007), (2) Kessler
5 (K5) (Australian Institute of Health and Welfare, 2009),
(3) Abbreviated Post-traumatic stress disorder (PTSD)
Checklist – Civilian version (A PCL-C) (Lang et al., 2012)
and (4) Adapted Self-Reported Delinquency Scale (ASRDS)
(Carroll, Durkin, Houghton, & Hattie, 1996; Mak, 1993).
These instruments were chosen due to their brevity,
readability and constructs (as below).
(1) Mental Wellbeing was assessed using the 14 item War-
wick Edinburgh Mental Wellbeing Scale (WEMWBS) (Ten-
nant et al., 2007). This is a validated measure of positive
mental wellbeing (content validity .89, internal reliability
.87, test–retest .83). This instrument asks respondents to sig-
nify which response best describes their experience over the
last 2 weeks;1=none of the time, 2 =rarely, 3 =some of the
time, 4 =often, 5 =all of the time, for feelings and thoughts
such as ‘I’ve been feeling cheerful’. All feelings and thoughts
are positive thus a higher score indicates higher mental well-
being (resultant score between 14 and 120). This instrument
wasrecentlytestedinanAustraliansampleandperformed
well in adolescents aged 13–16 (Hunter, Houghton, & Wood,
2015).
(2) Psychological distress was measured using the Kessler
5(K5).TheK5isanadaptedversionoftheKessler6
(K6) (Australian Institute of Health and Welfare, 2009).
Recent testing of the K6 in adolescents demonstrated the
scale to have .79 sensitivity and .83 specificity (Furukawa,
Kessler, Slade, & Andrews, 2003). The K5 was adapted for
use with Australian Aboriginal populations. This adaptation
involved the removal of the statement ‘I feel worthless’ as it
is considered potentially offensive to Aboriginal and Torres
Strait Islanders (Australian Institute of Health and Welfare,
2009). This K5 instrument asks respondents – During the
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Karen Emma Martin and Lisa Jane Wood
past 30 days, about how often did you feel a) nervous, b) hope-
less, c) restless or fidgety, d) so depressed that nothing could
cheer you up, e) that everything was an effort.Responseop-
tions include; 1=none of the time, 2 =a little of the time,
3=some of the time, 4 =most of the time, and 5 =all of the
time. Responses were summed to generate a total K5 score
(resultant score between 5 and 25).
(3) Post-traumatic stress symptoms were measured us-
ing the Abbreviated PTSD Checklist – Civilian version (A
PCL-C) (sensitivity .92, specificity .72, efficiency .75) (Lang
et al., 2012). This instrument includes six questions ask-
ing respondents to indicate, how much, in the last month
(1 =not at all; 2 =a little bit; 3 =moderately; 4 =quite a
bit; 5 =extremely), they had been bothered by; a) repeated,
disturbing memories, thoughts, or images of a stressful experi-
ence; b) feeling very upset when something reminded you of a
stressful experience; c) avoiding activities or situations because
they reminded you of a stressful experience; d) feeling distant
or cut off from other people; e) feeling irritable or having angry
outbursts; and f) having difficulty concentrating. Responses
were summed to generate a total A PCL-C score (resultant
score between 6 and 30).
(4) Antisocial behaviours were measured using the
Adapted Self-Reported Delinquency Scale (ASRDC) (good-
ness of fit >.85, internal consistency .67 to .91) (Carroll
et al., 1996). The ASRDC is a Western Australian adaptation
of the Australian Self-reported Delinquency Scale (Mak,
1993). The ASRDC asks respondents to indicate how often
they have behaved in a particular way in the past month. This
questionnaire incorporates 11 questions asking respondents
In the past 1 month how often (Never, 1–3 times, 4–6 times,
once a month, more than once a month, more than once a
week they have; a) deliberately damaged your own property
or that of others, b) disrupted other people’s games or activities
(e.g., classwork) c) sworn at others or called them names, d)
not done your classwork or homework, e) hit, pushed, punched
or slapped someone else, f) been unable to concentrate in the
classroom, h) disrupted the class by calling out or by being
out of your seat, i) teased or made fun of someone else, j)
been sent out of the classroom, k) been suspended from school,
l) skipped class or wagged school? Responses were summed
to generate a total antisocial score (resultant score between
11 and 66).
Procedure
A series of eight DRUMBEAT programmes were delivered
within the three schools over a seven-month period (be-
tween May 2014 and November 2014). Six programmes
were single sex (three male, three female) and two pro-
grammes incorporated mixed genders. Each DRUMBEAT
programme was facilitated by an accredited DRUMBEAT
facilitator assigned to deliver the programmes within the
schools. Each facilitator also had either a certificate or de-
gree in youth work and had facilitated DRUMBEAT to disad-
vantaged youth previously. A school liaison staff member or
school psychologist at each school assisted the DRUMBEAT
facilitators with organising the DRUMBEAT programmes,
co-facilitated the programme, and assisted the researchers
with data collection.
Each research participant was assigned a unique confi-
dential code to identify the school, DRUMBEAT group and
student. A risk management plan was created by the research
team and school staff whereby the research team alerted the
school when a student scored equal to or higher than 12 on
the K5, or 14 on the A PCL-C.
Ahardcopyofthequestionnairewascompletedat
the first session (or second session for first-week absent
members). The questionnaires were designed to be self-
completed, however the DRUMBEAT facilitators and/or
UWA researchers were available to assist students with ques-
tionnaire completion. Questions were read aloud (quietly
to avoid student discomfort) to any students experienc-
ing literacy issues. The post-programme questionnaire was
completed at the final DRUMBEAT session after the perfor-
mance. Students who did not attend the last DRUMBEAT
session were asked by the school liaison or DRUMBEAT fa-
cilitator to complete the questionnaire as soon as possible
after programme completion.
Of the eight DRUMBEAT programmes, four were held
within a northern corridor school, three at the eastern cor-
ridor school and one at the southern corridor school. One
programme at the eastern corridor school finished early
(after only seven sessions) due to the co-facilitator being
unwell and a late start. This programme did not include a
performance and these data were excluded from analysis.
The final dataset included three ‘girl only’ groups (grades
8–9, 9–10, 8–10), three ‘boy only’ groups (all grades 8–9)
and the one ‘mixed gender’ group (grades 8–9). Group sizes
ranged from 8–10 participants, however one grade 8–9 boy
only group had only five participants.
Data Treatment and Analysis
Analyses of questionnaire data were completed by the first
author using SPSS V21. Total scores for each student were
calculated for the WEMWBS, K5, A PCL-C and ASRDC
scales from the pre- and post-programme questionnaires.
If one response was missing within an individual measure
construct (e.g. A PCL-C), the individual’s mean for that
construct was imputed. Data were excluded from analysis if
two or more responses were missing within a construct.
Previously published thresholds were used to categorise
mental stress for each student into binomial categories. For
the K5 (Commonwealth of Australia, 2005), scores less than
or equal to 11 were classified as none to mild psychological
distress (consistent with a diagnosis of no or mild depression
and/or anxiety disorder), scores 12 or greater were classified
as moderate to severe psychological distress (consistent with
a diagnosis of moderate to severe depression and/or anxiety
disorder). For the post-traumatic stress symptoms variable
(Lang & Stein, 2005), scores less than 14 were classified
as PTSD unlikely, scores 14 or a greater were classified as
possible PTSD (i.e., showing signs of PTSD thus should be
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Drumming to a new beat
TABLE 1
Participant mental wellbeing, psychological distress, post-traumatic stress symptoms and antisocial behaviour scores pre- and
post-DRUMBEAT; all participants and by gender.
Boys (
n
=17) Girls (
n
=24)
Time All mean (sd) mean (sd) mean (sd)
Mental wellbeing (WEMWBS) Range 14–70. Pre 51.2 (8.8)ˆb52.4 (7.6)∗b50.4 (9.7)
Higher score =higher mental wellbeing Post 53.5 (8.8)ˆb56.4 (9.0)∗b51.5 (8.2)
Psychological distress (K-5) Pre 11.9 (3.6) 10.8 (3.7) 12.7 (3.4)
Range 5–25. Higher score =higher psychological stress Post 11.6 (4.2) 10.9 (4.3) 12.0 (4.1)
Post-traumatic stress symptoms (A PCL-C) Pre 13.9 (5.5) 14.2 (5.0) 13.7 (5.9)
Range 5–30. Higher score =higher post-traumatic stress symptoms Post 13.1 (5.4) 11.9 (5.1)∗13.9 (5.5)
Antisocial behaviour (ASRDC) Pre 25.1 (11.3)∗b31.1 (13.7)∗a,b 20.9 (6.8)∗a
Range 11–66. Higher score =more antisocial behaviour Post 22.4 (10.3)∗b25.1 (13.0)∗b20.5 (7.6)
ˆ
p
<.08, ∗
p
<.05, a =difference between boys and girls mean scores, b =differences between pre- and post-DRUMBEAT means scores, sd =standard
deviation, WEMWBS =Warwick Edinburgh Mental Wellbeing Scale, K-5 =Kessler 5, A PCL-C =Abbreviated Post-traumatic Stress Disorder (PTSD)
Checklist – Civilian version, ASRDC =Adapted Self-Reported Delinquency Scale. pre =pre-DRUMBEAT, post =post-DRUMBEAT programme.
referred for clinical assessment). These categories were used
to provide names of students exceeding thresholds to the
school psychologist.
Descriptive statistics were also generated for each out-
come continuous variables (see Ta ble 1) and age. Repeated
measures tests for differences between means were used to
examine for differences between pre- and post-programme
for WEMWBS, K5, A PCL-C and ASRDC scores (see
Table 1 ). Analysis by gender was then undertaken (see
Table 1 ). Due to the small sample size, further analysis by
subgroup was not appropriate.
Results
Baseline data were available for 63 adolescents. These re-
sults indicated that 57.1% (n=36) of participants were
experiencing moderate to severe psychological distress (i.e.,
exceeded normal threshold scorefor the K5), 49.2% (n=31)
high PTSS (exceeded normal threshold score for A PCL-C)
and 34.9% (n=22) both moderate to severe psychological
distress and high post-traumatic stress symptoms. Antiso-
cial behaviour (ASRDC scores) were strongly positively as-
sociated with both psychological distress (K5 scores) (Spear-
man’s r=.36, p=.009) and post-traumatic stress symptoms
(A PCL-C scores) (Spearman’s r=.42, p=.002).
Of the 84 students who enrolled in a DRUMBEAT pro-
gramme, 62 (73.8%) students completed the whole pro-
gramme (due to incomplete programme at one school
and students withdrawing from the programme or leav-
ing school). Of these, 41 (66.1%, 24 girls and 17 boys)
completed the programme and both the pre- and post-
programme questionnaires (mainly due to school absences).
Themeanageofthefinal41samplewas13.8years(SD =.7)
with 17.0% (n=7) identifying themselves as an Abo-
riginal and/or Torres Strait Islander. Country of origin
was not asked due to perceived sensitivities relating to
tensions at two of the schools between different cultural
groups.
At baseline, boys were more likely to report higher an-
tisocial behaviour than girls (p=.003). No significant dif-
ferences were detected between boys’ and girls’ baseline
mental wellbeing, psychological distress or post-traumatic
stress symptoms. Bivariate analysis of all participants sug-
gested reduced antisocial behaviour (p=.05) and improved
mental wellbeing post-DRUMBEAT (p=.07); no changes
were observed for psychological distress or post-traumatic
stress symptoms scores. Gender split results however, in-
dicated that there were significant improvements in boys’
mental wellbeing (p=.05), post-traumatic stress symptoms
(p=.05) and antisocial behaviour (p=.02) after DRUM-
BEAT when compared to programme start. These changes
were not evident for girls. Following participation in the
DRUMBEAT programme, on average boys’ recorded 7.6%
higher WEMWBS scores (mental wellbeing), 19.3% lower A
PCL-C scores (post-traumatic stress symptoms) and 23.9%
lower ARSDC (antisocial behaviours). No significant dif-
ferences were detected for psychological distress changes
between pre- and post-DRUMBEAT programme for either
gender.
Discussion
With youth mental health and suicide being such a catas-
trophic issue in Australia and internationally (World Health
Organization, 2001), ascertaining which group programmes
are most effective in reducing psychological distress and
improving mental wellbeing in children and adolescents is
essential. In this study, boys reported significantly higher
mental wellbeing, reduced post-traumatic stress symptoms
and lower antisocial behaviour after participating in the
DRUMBEAT programme. This therapeutic drumming and
talking programme holds promise in being able to assist
large numbers of disadvantaged boys experiencing mental
and behavioural issues.
In this study, sample baseline post-traumatic symptom
scores indicated that 34.9% of the participants were likely
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Karen Emma Martin and Lisa Jane Wood
to be experiencing PTSD. This proportion highlights the
importance of addressing this mental health problem. Par-
ticipation in the DRUMBEAT programme led to a near 20%
average decrease in boys’ post-traumatic stress symptoms.
Programme content within DRUMBEAT does not specifi-
cally address traumatic experiences or symptoms, however
it is likely that some programme components assist with
trauma recovery. Research exploring drumming and its im-
pact on PTSD is rare, however one published study noted
that returned soldiers experiencing PTSD experienced re-
duced post-traumatic stress symptoms after participating
in a group drumming programme (Bensimon, Amir, &
Wolf , 2008). Further research exploring the potential im-
pact of DRUMBEAT on post-traumatic stress symptoms
within children and young people is warranted.
Our study also signified that higher average mental well-
being was evident for boys after DRUMBEAT participation.
Mental wellbeing is increasingly being recognised as an im-
portant protective factor against mental illness (Gargiulo &
Stokes, 2009). Maximising mental wellbeing in adolescent
populationsisconsideredapriorityinattemptstoreduce
the burden of mental illness in populations, and as a preven-
tive strategy for future physical and mental health (Clarke
et al., 2011). Prior research with adolescents also indicated
that DRUMBEAT increases self-esteem (Wood et al., 2013),
and it is likely that DRUMBEAT contributes to supportive
bi-directional relationships between self-esteem and mental
wellbeing.
These study results also demonstrate that boys partici-
pated in significantly less antisocial behaviour after partic-
ipating in DRUMBEAT. This aligns closely with previous
research (Wood et al., 2013) in which objective measures
of antisocial behaviours in school (behavioural incident
reports ) reduced for 29% of DRUMBEAT partici pants. Ado-
lescent antisocial behaviour leads to high social, interper-
sonal and financial costs to individuals, families and com-
munities (Piotrowska, Stride, Croft, & Rowe, 2015), and is
an ongoing stress and burden for teachers and school admin-
istrators (Sullivan, Johnson, Owens, & Conway, 2014). The
time taken by school staff to address antisocial behaviour
is significant, with 90% of school teachers and leaders
reporting that behaviour management accounts for at least
10% of their time (Australian Government Department of
Education and Training, 2014). Bringing together groups of
boys exhibiting antisocial behaviours is certainly a challenge
for DRUMBEAT facilitators, however the potential positive
impact on behaviour is likely to have far-reaching benefits
for the boys as they mature, and school staff and peers
alike.
The findings that psychological distress was not lower
after being involved in DRUMBEAT were contrary to expec-
tation. It is possible that changes to psychological distress
take time and that DRUMBEAT may reduce psychological
stress in the longer term. Longer term follow-up would as-
sist with examining the potential of DRUMBEAT to impact
psychological distress.
It is important to identify mechanisms underpinning
the impact of interventions; however, the observed bene-
fits from DRUMBEAT participation can only be speculated
at this stage. The multiple components integrated within
DRUMBEAT such as education, music, motor activity and
behavioural mimicry likely contribute to improved men-
tal wellbeing and reduced post-traumatic stress and an-
tisocial behaviour. The DRUMBEAT programme includes
educational strategies evidenced as being characteristic of
effective social and emotional interventions in schools such
as teaching cognitive and affective skills, competence en-
hancement and empowering, interactive teaching methods
(Clarke et al., 2011). Music has been noted previously to
provide a calming effect for those listening to or ‘making’
music, and this is increasingly demonstrated through ob-
jective measurement. For example, prior research in a psy-
choneurology clinic in Azerbaijan identified that a music
therapy intervention led to normalising of emotional status
and reduction of heart rate and blood pressure for ado-
lescents diagnosed with anxiety and/or adjustment disorder
(Kazymov et al., 2014). Due to a strong neuronal connection
between motor experience and empathic processes, coordi-
nated movement (used in drumming) is also theorised to be
a contributor to empathy and pro-social behaviour devel-
opment (Behrends, M¨
uller, & Dziobek, 2012). Behavioural
mirroring is also suggested to play a role in creating affil-
iation, rapport and social cohesion (Lakin & Chartrand,
2003), and another component within DRUMBEAT that
could contribute to emotional and social changes. Thus, the
mirroring of movement and eye contact, combined with
the sensorimotor activities associated with the drumming
itself may improve mood (Shuman, Kennedy, DeWitt, Edel-
blute, & Wamboldt, 2016) and strengthen group cohesion.
Another potential factor generating positive changes is the
link between post-traumatic stress and antisocial behaviour
as noted in the baseline data analyses and prior research
(Vermeiren, 2003). Participation in DRUMBEAT may di-
rectly reduce post-traumatic stress and antisocial behaviour;
however, it is also possible that there are some bi-directional
changes that are generated. For example, a reduction in post-
traumatic stress symptoms resulting from DRUMBEAT par-
ticipation may also lead to lower antisocial behaviour – this
change in behaviour may then further reduce stress. Further
exploration of mechanisms underpinning changes to men-
tal health and antisocial behaviours via multicomponent
programmes such as DRUMBEAT would be valuable.
It is important to consider alternative explanations for
our study findings. Another change in the participants’ en-
vironments unrelated to DRUMBEAT could have led to the
changes in outcomes. Although a waitlist group had been
proposed to generate a comparison group, due to the dif-
ficulty in retrieving signed consent forms and programme
timing, this was not achievable. Another factor impacting
the mental health and antisocial behaviour of participants
mayhavebeenchangestobehaviourorextrasupportof-
fered by school staff after being informed about students
6CHILDREN AUSTRALIA
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Drumming to a new beat
exceeding normal K5 and/or post-traumatic stress symp-
toms thresholds, although staff reported they were already
alerted to the mental health states of these students hence
their referral to DRUMBEAT. Unfortunately, the uptake of
the DRUMBEAT programme was only approximately 50%
of children within the invited sample. The school liaison
staff did note this as being related to students forgetting
to return consent forms (and a common dilemma faced in
school-based programmes at these low SES schools). How-
ever, this does indicate potential selection bias within this
study; for example, the participants in our sample may be
more receptive to new programmes or have increased con-
nectedness to the school. Not being able to compare differ-
encesforstudentswhodidnotreturnconsentformsisalsoa
limitation of the study. Without consent we were not able to
collect any data for those students who did not return their
consent forms. Social acceptability bias may have impacted
the self-reporting of participants with the adolescents be-
ing aware of expected changes following DRUMBEAT par-
ticipation. Due to higher than expected absences, student
withdrawal from the programme or school and the one in-
complete programme, the sample size was lower than antic-
ipated thus reducing the power to detect changes. This study
did not follow-up participants after they had participated in
DRUMBEAT thus it is unclear if self-reported mental health
states and behaviour returned to pre-programme states.
The strengths of this study include the pre- and post-
design using population validated measures of psychologi-
cal distress, mental wellbeing and antisocial behaviour (al-
though note the A PCL-C has only been used in adolescents
in a Chinese adapted version (Hou et al., 2011)). Further, the
DRUMBEAT programme was held at multiple sites increas-
ing external generalisability. Despite the challenges involved,
the evaluation of a programme within a real-world setting
enhances the relevance of the results.
Additional research with larger samples and a con-
trol/comparison group will assist with building evidence
about the impact of DRUMBEAT. A larger sample size will
also enable exploration of outcomes related to participant
characteristics (e.g., higher antisocial behaviours, cultural
background) and/or programme components (e.g., facil-
itator, number of sessions attended). Sex differentials are
also important to further explore, and this is particularly
relevant with evidence that adolescent girls report higher
stressors in specific domains (e.g., interpersonal), and re-
spond more strongly to stressors (Hankin, Mermelstein, &
Roesch, 2007). For girls, DRUMBEAT may have impacted
‘internalising’ behaviours, such as self-harm and thus fur-
ther research is needed to establish the possible impact of
DRUMBEAT on girls in other outcomes.
Conclusion
The DRUMBEAT programme shows promise as a poten-
tially effective targeted strategy to significantly improve
mental wellbeing and reduce post-traumatic stress symp-
toms and antisocial behaviour in socioeconomically disad-
vantaged adolescent boys. Further research incorporating
larger samples and a control group will assist with verify-
ing these findings and exploring potential moderators or
confounders impacting programme success.
Acknowledgements
The authors would like to thank all those who assisted
with facilitating this work including; the participating stu-
dents, school staff, DRUMBEAT facilitators and manage-
ment and our Research Assistants; Shannen Vallesi, Char-
lotte Schiefler, Nick Wood, Julian Ming and Madeleine Ford.
Financial Support
Dr Karen Martin was supported by the Western Australian
Health Promotion Foundation (Healthway) through a Post-
doctoral Research Fellowship (#23347) during this research.
Competing Interest Statement
The authors have declared that they have no competing or
potential conflicts of interest.
Original Work Statement
This original research has not been previously published
and is not under consideration in the same or substantially
similar form in any other peer-reviewed journal. All au-
thors listed have contributed sufficiently to the project to be
included as authors and are listed on the manuscript title
page. To the best of our knowledge, no conflict of interest,
financial or other, exists.
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