Evidence-Based Complementary and Alternative Medicine Table 5: Mean (standard deviation) TRF other scale scores by classroom. TE1 (n = 24) D TE2 (n = 22) CN TE3 (n = 30) D TE4 (n = 25) CN 0.8 (1.3) 1.3 (1.2) 1.8 (2.1) 2.9 (2.4) 0.3 (0.9) 2.2 (1.6) 0.6 (1.1) 2.5 (1.5) 0.5 (1.6) −0.9 (1.8) 1.2 (1.6) 0.4 (1.8) 1.2 (1.5) 2.3 (1.7) 0.3 (0.7) 2.1 (2.8) 0.3 (0.5) 3.3 (2.1) 0.2 (0.5) 2.2 (2.6) 0.9 (1.4) −1.0 (1.4) 0.1 (0.3) −0.1 (1.6) TE: teacher; D: drumming; CN: control; TRF: Teacher’s Report Form; Diﬀerence: diﬀerence score (post-intervention/control minus baseline); PT: post- traumatic stress problems; ST: sluggish cognitive tempo. A positive value for diﬀerence scores indicates improvement whereas a negative value indicates worsening of symptoms. Neuroendocrine indicators ↓Plasma and salivary cortisol ↓DHEA to cortisol ratios ↑Oxytocin Pain indicators ↓Sedative/analgesic use ↓Pain appraisal ↑Pain tolerance 10 Condition TRF Scale Baseline PT Post- PT Diﬀerence PT Baseline ST Post-ST Diﬀerence ST Figure 12: Stress reduction as the proposed mediator between the drumming intervention and reduced internalizing and externalizing behavior. repeated intervention could mitigate behavior problems— such as substance abuse, gang involvement, and school dropout—that are not typically seen at the elementary school level. Additionally, while this study has demonstrated the eﬀectiveness of group drumming for improving social- emotional behavior in a normative sample, future studies should assess its potential utility in a clinical population. The participants in this study were a non-referred population that showed baseline scores at or below the norm in all behavior scales; therefore, clinical signiﬁcance cannot be inferred despite the statistically signiﬁcant reductions in problem behaviors reﬂected in these scales [4, 9, 18, 69]. Future research should also investigate the eﬀects of the group drumming intervention on academic performance [105, 106], particularly given a meta-analysis of 300+ studies that found academic achievement and behavior signiﬁcantly improved by social-emotional learning [107]. The study reported here did not utilize the academic performance portion of the TRF, in an eﬀort to reduce the burden on teacher respondents. Additionally, family participation may Drumming intervention for social and emotional skill buliding STRESS REDUCTION Reduced internalizing and externalizing behavior Neuroimmune indicators ↑Plasma and salivary IgA ↑Plasma IgG ↑NK cell activity and numbers ↑LAK cell activity ↑CD4+ Cells ↓HIV viral load Autonomic nervous system indicators ↓Heart rate ↓Blood pressure ↓Respiratory rate ↑PO2 in arterial blood ↑O2 saturation of hemoglobin