Interactive Metronome

if you do a search on IM and Interactive Metronome you’ll find dozens of posts about this. There are several of us that have had our children do IM.

David Rabiner’s Attention Research Update reviewed a recent study of the effects of Interactive
Metronome training on boys with ADHD. His review is posted below:

EFFECTS OF INTERACTIVE METRONOME RHTYMICITY
TRAINING ON CHILDREN WITH ADHD

Could learning to keep the beat with a metronome be a helpful adjunctive treatment
for children with ADHD? This question addressed in a study published last year in
the American Journal of Occupational Therapy (Shaffer, R.J. et al., (2001). Effect
of interactive metronome rhythmicity training on children with ADHD. American
Journal of Occupational Therapy, 55, 155-162).

As you are probably aware, a metronome is a simple device that emits a sound at
regular and adjustable intervals. It is used to help developing musicians learn to “keep
the beat”. The Interactive Metronome (IM)is a variant of this device that uses a
computer to produces a rhythmic beat that individuals listen to through headphones.
As the participant listens, he/she must anticipate the beat and perform various hand
and foot exercises for a high number of repetitions. Regular auditory feedback is
provided through headphones indicating whether one’s response was on time, early,
or late. The difference between the participants’ response and the actual beat is
measured in milliseconds and indicates the size of the discrepancy between the beat
of the metronome and the person’s response. Over repeated practice sessions, many
individuals who initially have trouble coordinating their behavior with the beat of the
metronome gradually become more successful at “keeping the beat”. This
improvement in IM performance is thought to reflect meaningful gains in motor
planning and sequencing ability. For additional information about the Interactive
Metronome, visit http://www.interactivemetronome.com.

What does this have to do with helping children with ADHD? The rational for using
the interactive metronome as an adjunctive treatment for ADHD is evidence that
motor planning and sequencing, rhythmicity, and timing are all relevant to attention
problems. Difficulty regulating the sequence and timing of motor patterns are related
to problems with behavioral inhibition (i.e. being able to stop or inhibit oneself from
executing a behavioral response) and executive functioning (i.e. higher level cognitive
abilities such as goal setting and planning), that some experts believe are critical to the
understanding of ADHD. In addition, there is evidence of considerable overlap
between attention deficits and motor clumsiness and between the severity of
inattentive symptoms and motor clumsiness in boys with ADHD. Finally, substantial
overlap in brain areas thought to be involved in ADHD and those involved in the
regulation of timing and motor planning have also been reported. Collectively, these
findings suggest that technologies aimed at strengthening motor planning, sequencing,
timing, and rythmicity may have an important role in improving the capacity to learn
and attend.

In the study reference above, 56 6 to 12 year old boys with a confirmed diagnosis of
ADHD were recruited to participate in an investigation of the Interactive
Metronome. Boys were matched on ADHD severity, age, and medication dosage,
and then randomly assigned to one of three different experimental conditions: IM
Training, Video game training, and a no training control group.

IM training consisted of 15 one-hour training sessions administered over a 3-week
period. The goal was to help participants selectively attend - without interruption by
internal thoughts or external distraction - for extended periods of time. This was
done as explained above - i.e. by having participants execute various patterns of
hand and foot motions in keeping with the beat of the Interactive Metronome for
increasingly longer periods. The IM training device provided boys with immediate
feedback about how accurately they were “keeping the beat”, and all boys showed
improvement over the 15 training sessions.

Boys in the video game training group received instruction in 5 commonly available
PC-based non-violent video using an identical training schedule - i.e. 15 one-hour
sessions over a 3-week period. The games involved hand-eye coordination skills,
advanced mental planning, and multiple task sequencing. In each game, the difficulty
increased as boys became more skillful. Video game training was included so the
researchers could determine whether benefits of IM training exceeded those that may
result from concentrated video game play, an activity that also provides practice in
focus and concentration skills).

Boys in the IM and video game training groups received the same level of adult
supervision, encouragement, and support. The adults supervising both types of
training were college students without advanced degrees, who had no formal therapy
or teaching experience. Administrators were trained in IM and video game training
protocols, and supervised the training for boys in both groups. This assured that
there were no systematic differences between adults working with boys in each
group.

Boys in the control group received neither IM training nor video game training during
the 3-week period.

Before any training began, extensive information was collected on the functioning of
all boys. This included assessments of: 1) attention and concentration using a
computerized test of sustained attention; 2) intellectual ability using a standardized IQ
test; 3) clinical functioning using parent and teacher standardized behavior rating
scales; 4) academic and cognitive skills using standardized academic achievement
and language processing tests. These measures were administered a second time
after training ended - approximately 4-5 weeks after the pretest. When available, a
different version of the test was administered at pre- and post-test, and boys were
pre-and post-tested at the same time of day to control for medication schedules.
Examiners who administered the tests did not know which boys had received IM
training, which had received video game training, and which were in the control
group.

RESULTS

From these measures noted above, 58 separate scale scores were computed for
each boy based on pre and post-test results. Preliminary analysis of pre-test data
indicated that boys in each group were essentially equal prior to training.

To examine the impact of IM and video game training, post-test scores were
subtracted from pre-test scores on all measures. A positive result was obtained
when post-test scores exceeded pre-test scores, thus indicating improved
performance.

Boys in the control group had 28 scores improve and 30 scores decline. This is
consistent with what would be expected by chance, and indicates that neither prior
experience with the test, nor simply the passage of 4-5 weeks time, was sufficient to
produce consistent improvement in the different measures.

Boys in the video game training group showed improvement in 40 of the 58 variables
assessed. This pattern of improved scores is unlikely to have occurred by chance,
and demonstrates that video game training under adult supervision was associated
with better outcomes on many variables.

Boys who received IM training showed even greater gains - i.e. they improved on 53
of the 58 different scales. The number of scales on which higher post test scores
were found significantly exceeded results for the video game training, suggesting that
IM training produced significant additional benefits above and beyond those resulting
from video game training.

The authors next compared outcomes for the 3 groups of boys to determine where
IM training had yielded significantly better results. Compared to boys in the other 2
groups, boys who received IM training showed greater declines in parent rated
aggression, and greater improvements on reading achievement, motor control, and
computerized tests of attention. Because the pre and post-treatment means on these
variables was not provided in the article, the actual magnitude of these differences is
not known.

SUMMARY AND IMPLICATIONS

Results from this study provide initial evidence that IM training directed towards
improving rhythmcity, motor planning, and sequencing may be a beneficial adjunctive
treatment for boys with ADHD. As predicted, boys with ADHD who received IM
training showed improvement in a wide range of areas, and their gains exceeded
those associated with supervised training in a task that also requires sustained
concentration and focus in order to improve (i.e. boys who received video game
training). These results are consistent with the theory behind IM training - namely
that motor planning and sequencing ability influence a broad array of adaptive
functions, including attention.

While this was a carefully conducted study in which necessary experimental controls
were incorporated and promising results were obtained, it is important to recognize
the limitations of this research. First, all boys were already receiving medication
treatment for ADHD, so the effectiveness of IM training for ADHD in the absence of
medication treatment is not known. One cannot assume that IM training alone would
result in effective symptom management and/or functional improvement for children
with ADHD who were not taking medication. This would be an important question
to pursue in future research. It is worth noting, however, that because children were
presumably already benefiting from medication treatment, the fact that IM training
resulted in additional gains to those provided by medication is certainly encouraging.

Second, outcomes in this study were assessed immediately following treatment and
no additional follow up was conducted. Whether the benefits found for IM training
would persist over a sustained period is thus unknown. Because this study was
limited to boys with ADHD, the potential benefits of this treatment for girls with
ADHD is also unclear. Finally, because actual pre- and post-treatment scores were
not included with the results, the actual magnitude of the gains found for IM training
could not be examined.

In conclusion, results of this study provide promising indications that IM training may
play a useful role in the treatment of ADHD. Additional research in which the
limitations noted above are addressed will provide important information about the
utility of IM training as an adjunctive or perhaps even a primary treatment for
ADHD, and allow better informed decisions about the use of this treatment to be
made. Research conducted with the IM in related areas can be found at
www.interactivemetronome.com/research

Reprint requests to:

James Cassily
Director, Neural Technology Research Center
3090 Dawes Se
Grand Rapids, MI 49508

I hope you enjoyed the above review. The next issue of Attention Research Update
will be sent to you in approximately 2-3 weeks. Take care.

Sincerely,

David Rabiner, Ph.D.
Senior Research Scientist
Duke University

I can attest to the sequencing gains and the rest. I actually saw the biggest gains after IM was done. They should do follow up because I believe the results would be even better if you tested a few months after IM was finished.

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