4 contemporary drum circles and in group counseling with school-age pupils, to maximize development of social and emotional skills through guided interaction, reﬂection, and self-disclosure. Drums and rhythms were chosen to reﬂect cultural diversity; drumming activities emphasized process and not performance. Session themes included various combinations of positive behavior, team building, positive risk taking, self-esteem, awareness of others, leadership, sense of self, expressing feelings, managing anger, managing stress, empathy and gratitude. “Focus and listening” was a constant theme. Each session began with the whole group playing an ongoing rhythm pattern to release stress, energize and establish a sense of community. Focus and listening was encouraged throughout the program via the use of non- verbal cues and “call and response”-type activities, which required the echoing back of an improvised rhythm played by a member of the group. Rhythmic activities were also used as the basis for lessons corresponding with session themes. For example, in the session on positive behavior, participants would simultaneously speak and beat the aﬃrmation, “I am responsible, I do the right thing”; this was followed by a group discussion of the meaning of the aﬃrmation for inte- gration and internalization. In the session on sense of self and awareness of others, children shared their favorite color, food and animal while drumming to the syllables of the words. In the session on expressing feelings and managing anger, the group brainstormed ways to manage anger, learned a spoken “calm down mantra”, and then expressed feelings on the drums. In the session on team building and positive risk taking, hand shakers were systematically passed around the circle in increasingly rapid succession until many dropped; this was followed by a discussion of the acceptability of making mistakes in the learning process and how it feels to give and receive. In the session on leadership, empathy and gratitude, when students were given an opportunity to lead a call and response from the center of the circle, other students were asked how the leader may have felt, which segued into a discussion of empathy and gratitude. Session activities promoted the following constructs found in eﬀective positive youth development programs: social-emotional-cognitive-behavioral-moral competence, self-eﬃcacy, clear standards for behavior, healthy bonding, opportunities for prosocial involvement and recognition, structure and consistency in program delivery [38]. A more complete description of the group drumming protocol and its development will be published in a separate article. 2.8. Statistical Analysis. To examine group diﬀerences in the current sample, based on changes in scores from baseline to post-intervention/control, diﬀerence scores for the TRF scales were calculated by subtracting post- intervention/control scores from baseline scores for all scales. Preliminary analyses to examine the potential eﬀect of the sex of the child on baseline TRF scores did not reveal any diﬀerences across the four classes. As the current investigation used a quasi-experimental design and did not randomly assign classrooms to study conditions, the drum- ming and control classes were not combined. Therefore, a 25 20 s e r o c lse 15 a c s O T10 n a e M 5 0 TE 1 (D) Baseline Post TE 2 (CN) TE 3 (D) Classroom TE 4 (CN) Evidence-Based Complementary and Alternative Medicine Figure 1: Total problems—mean intervention/control scores by classroom. baseline and post- series of ANOVAs were conducted to examine the eﬀect of teacher (TE1 versus TE2 versus TE3 versus TE4) on each of the TRF scales separately. In the event of a signiﬁcant omnibus F, Fisher’s least signiﬁcant diﬀerence (LSD) post- hoc tests were conducted to specify which groups diﬀered. The distributions of the TRF diﬀerence scores were examined to ensure that assumptions for parametric analyses were met. To normalize the distributions, outliers were identiﬁed and excluded for individual scales as detailed below. As recommended by Tabachnick and Fidell [73], distributions of scores were examined within each classroom; values >2 SD from the mean were considered outliers. Eﬀect sizes are reported in the form of partial eta squared (η2p). 3. Results 3.1. TRF Broad-Band Scales. Baseline, post-intervention/ control, and diﬀerence scores for TRF broad-band scales that were statistically signiﬁcant are displayed in Table 2. Total Problems (TO—an aggregate of all items on the rating form). For TO diﬀerence scores, there was an overall signiﬁcant group diﬀerence (F(3,97) = 5.27, P < .01; η2p = 0.14). Post-hoc tests showed that drumming teacher TE1 rated students as improving more on TO scores than the two control teachers (TE2 and TE4) (Figure 1). Also, drumming teacher TE3 rated students as improving more on TO scores than control teacher TE4. Internalizing Problems (IP—a composite of scores from three narrow-band syndrome scales: Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints). For IP diﬀer- ence scores, the ANOVA showed a signiﬁcant diﬀerence among groups (F(3,97) = 3.73, P < .02; η2p = 0.10). Post-hoc tests indicated that drumming teacher TE3 rated students as improving more on IP scores compared to control teacher TE2 (Figure 2). Externalizing Problems (a composite of scores from two narrow-band syndrome scales: Rule-Breaking Behavior,