2 [38, 39]. Positive youth development interventions facili- tate positive outcomes through developmentally appropri- ate achievements intended to address the “whole child” [39]. 1.2. Group Drumming for Positive Development, Cultural Relevance and Stress Reduction. Group drumming is a recreational music making activity that builds social- emotional assets consistent with a positive youth develop- ment approach. It is conducted in a circle and often led by a facilitator whose role is to maximize a sense of community through rhythmic dialogue. Group drumming is inclusive; it is non-verbal, universal, and does not require previous experience for participation. Furthermore, group drumming is culturally relevant; it is an integral part of diverse cultures, and supports the value of collectivism, shared by non- European-based cultures [40]. Previous studies of adults [41–43] and adolescents [44] have shown the biopsychosocial eﬃcacy of group drumming, using protocols involving reﬂection and self-disclosure to reduce stress. These studies found neuroendocrine and immune changes that were indicative of reduced stress in normal adults with no previous experience in drumming [41], reduced burnout and improved mood in long-term care workers and nurses [42, 43], and improved social- emotional functioning in adolescents from a court-referred residential treatment center [44]. Other art forms used in therapeutic contexts with adults and children have also been linked with improvement in biopsychosocial indicators of stress [45–62]. The unique eﬀectiveness of group drumming with reﬂec- tion and self-disclosure [41], versus group drumming with- out these components, suggests the possible added beneﬁt of integrating counseling activities with group drumming to reduce social and emotional manifestations of stress in low- income youth. Social–emotional skill building delivered in a framework of drumming may also confer beneﬁts without the stigma of therapy. 1.3. Theoretical Rationale. According to Social Cognitive Theory, group drumming combined with group coun- seling activities would foster individual self-eﬃcacy and positive outcome expectations through enactive attainment, vicarious experience, verbal persuasion and reduction of physiological arousal [63]. Furthermore, collective eﬃcacy may grow through a shared sense of purpose [63]. In support of this notion, Paulo Freire’s Empowerment Education Theory of Dialogue and Praxis asserts that the development of empathy through common experience enables more meaningful reﬂection and dialogue, which in turn sets the stage for action, or empowerment [64, 65]. 1.4. Research Objective. In summary, low-income youth are in need of interventions to address social and emotional behavior linked to chronic stress. Therefore, could a school- based group drumming program, integrated with activities from group counseling, improve social and emotional behav- ior in low-income children? Evidence-Based Complementary and Alternative Medicine 2. Methods 2.1. Design and Population. Upon written approval by the Institutional Review Board of the University of California, Los Angeles, as well as the Program Evaluation and Research Branch of the Los Angeles Uniﬁed School District (LAUSD), we utilized a pretest-post-test non-equivalent control group design to assess the eﬀects of 12 weeks of school-counselor- led drumming, aimed at social and emotional skill building, on problem behavior in low-income ﬁfth graders. Fifth graders were targeted for early intervention because they would be old enough to beneﬁt from rhythm-based thera- peutic activities involving reﬂection, and their peer-centric developmental stage would lend itself well to group activities [66]. The study was conducted in spring of 2007 at Napa Street Elementary School in the LAUSD. Students at the school were 89% Latino [67], of which ∼90% were US born [68], 75% were of Mexican ethnicity [68] and 66% were English learners [67]. Ninety-seven percent of the students in the school participated in the reduced-price lunch program, a statewide index of socioeconomic disadvantage [67]. 2.2. Recruitment. Students from all four ﬁfth-grade classes in the school were recruited for the study. Since there were two classes in each of two diﬀerent academic scheduling tracks, one class from each track was assigned to the experimental condition, and the other class from each track was assigned to the standard education control condition. Assignment to treatment conditions was not randomized, due to school administrative constraints. The students were told that the study was being conducted to see how drumming might aﬀect their experience in school. They were also told that one group would get weekly drumming for 12 weeks, while the other group would get two sessions after the end of the study. Of 106 students, 101 obtained parental consent for participation (95%). In one case, non-participation was due to parent refusal. In four cases, consent forms were not returned, and parents could not be contacted. Students that did not have consent to participate went into the control classrooms during the intervention. 2.3. Demographics of Participants. Demographic character- istics of the four classes can be found in Table 1. Of 101 participants in the study, 47 (46.5%) were male and 54 (53.5%) were female. Ninety-one (90%) were Latino, ﬁve (5%) were African American, two (2%) were Filipino, two (2%) were European American and one (1%) was Asian; these percentages reﬂected the racial/ethnic demographics of the school [67]. The mean student age was 10.5 years (range 10–12 years). The 10 non-Latino students were spread across all four classrooms. In total, 54 students received the intervention and 47 students were in the standard education control group. There were no signiﬁcant diﬀerences in the proportion of boys versus girls across the four classes. The two experimental group teachers were a European American male, age 43 years, and a Latina, age 33 years; the two control group teachers were European American females, ages 30 and 32 years. There was no loss of student or teacher participation in either the experimental or control groups.