Interactive metronome treatment for ADHD/ADD; swing your arms about, cure your brain

Ian Dury. Because… any excuse.

One of the best things about starting this blog was several e-mails I got from like-minded people saying nice things, and often, pointing me towards interesting bits of neurobollocks that I wasn’t aware of. Such was a series of e-mails from Deborah Budding and Michael Thaut (who must be one of only a few people in the world who holds posts as Professor of Music, and Professor of Neuroscience – cool) about the ‘interactive metronome’ technique. Michael’s research (unsurprisingly) focuses on the interplay between the brain and music, and in particular, the processing of temporal information as it relates to rhythmicity, so it’s probably fair to say he certainly knows his way around a metronome.

But what’s this interactive metronome business? Well, as you can see in this video on the hypochondriac’s website of choice (WebMD), it’s basically waving your arms about and moving your feet in time to a regular beat. So, it’s basically dancing then, but much more boring.

Surprisingly, given it appears to be such a simple technique, some people are claiming that it can have profound effects, and assist with various disorders such as ADHD, Parkinson’s, MS and even post-brain injury and stroke. The usual bunch of jokers with slickly-designed websites have sprung up offering treatment for all these things and more. The ‘How it works’ section of that website claims that the underlying deficit in a variety of disorders, claiming that the underlying dysfunction in ADHD, autism, dyslexia, Parkinson’s and others is just a ‘neural timing deficit’. The exercises used in IM correct the timing deficit, and therefore (supposedly) treat the disorder.

To say this is startlingly simplistic would be a massive understatement; it’s just plain wrong. The precise neurological issues in many of these disorders are difficult to pin down and are the subject of active investigation but, to take a simple example, we know exactly what the problem is in Parkinson’s; neuronal depletion in the substantia nigra. To claim that it’s some vague neural ‘timing’ issue goes well beyond disingenuousness and into the realm of outright deception.

There’s even a home-based version of IM therapy, that can be run on any computer – however the basic equipment (wiresless button boxes, tap mats for the feet etc.) and the software licence cost $800.

A PubMed search for ‘interactive metronome adhd’ actually produces five hits! However, on closer inspection, all five articles are seriously compromised in some way – studies with no control group, or with very low numbers. Interestingly, one of the papers that pops up is one I’ve discussed before in reference to Brain Balance Centers. So, IM appears to form a cornerstone of what the Brain Balance guys (chiropractic, with a thin layer of neuro-woo laid on top) are pushing too. The IM guys have gone to a lot of trouble to make their approach appear scientific – there’s a well-populated ‘Science’ section on the website, that contains links to lots of articles, however, many of them are ‘white papers’ of uncertain provenance, and the rest are articles from obscure journals, or on barely relevant topics.

Another problem with IM is that it gets conflated with serious interventions. There’s a large field of study focussed on the use and effectiveness of musical-type interventions for a variety of neurological disorders (broadly, called Neurologic Music Therapy, or NMT) that has some solid research behind it. The slick marketing of IM seeks to conflate their approach with much more high-standard music-based therapy approaches.

In Prof. Thaut’s words (my emphases added):

First, where is the research? Studies that back up the clinical effect of IM directly, are very rare or nonexistent. A small study from 2001 is one that comes up repeatedly. One small study does not build clinical evidence. IM seems in general a well marketed but unresearched application. From a research point I see no evidence for the therapeutic benefit of IM.

Second, brain mechanisms in therapy work differently. Possibly to fill the research void IM generously includes ‘borrowed’ research that has nothing to do with their device. Since I am one of the authors they use I have to clearly  state that my brain research in music and rhythm does not address IM and our results do not support IM applications, neither with patients nor physiologically in explanatory brain mechanisms. The only forms of therapy in brain rehabilitation that work are active and specific exercises based on functional learning and training paradigms, not machine tapping. 

Last, rhythm has its own life. The claim that tapping to a metronome improves timing in patients which in turn transfers to all kinds of cognitive and motor improvements is not only unsupported by research but seems based on a misunderstanding. Rhythmic synchronization is a very complex process that fluctuates continuously on a millisecond level and is inherently unstable and variable. This time flexibility is the actual hallmark of functional entrainment. Therefore the IM definitions and measurements of what constitutes rhythmic improvement seem physiologically and functionally meaningless.

So, there you have it. If you’re concerned about your child’s sense of rhythm (for some reason?) you’d probably be much better off signing them up for dance classes, or piano lessons. It’ll almost certainly be cheaper, and they’ll likely have a lot more fun too.

17 responses to “Interactive metronome treatment for ADHD/ADD; swing your arms about, cure your brain


    Besides WEBMD for hypochondriacs, where do you suggest patients, who wish current medical research, obtain it online.

  2. Hi. You quote professor Thaut. What is the source or forum in which it was stated. I’ve searched and can’t find it published anywhere else but your blog.

    • That was from an email exchange I had with Prof. Thaut. I believe he’s also posted something similar on a developmental psychology email list, but I’m afraid I don’t know which one – may not be publicly search-able. Prof. Thaut is aware of the blog piece and gave me permission to use the quote, so you can treat it as ‘official’ if you like.

  3. As with many neurotechnologies, Interactive Metronome Programs offer the platform for neuoplastic changes, the impact of which is dependent on a case by case basis – variables include the engagement of the individual and also the clinical insight and application of IM by the provider. IM is changing lives but it is not a ‘one size fits all’ instant fix, it is hard work not only for the participant but also for the provider. I have heard of negative feedback about this treatment tool, but in fairness the same could be said for neurotechnologies across the board – every brain is different. I do concur with your reference to the bad press related to Brain Balance Centers, which is unfortunate. However, as an individual provider working in environments as divergent as elite private schools to schools specializing in profound autism; adult ABI to professional athletes. Simply put, individuals that benefit from IM training present with difficulties in comprehending the expression and passage of time which translates into a disruption of the temporal order of everyday events. Clapping your hands together on a beat is not the cornerstone to this program. It is in enabling an individual to learn how to associate to a rhythmic beat that is key. Merzenich, Ratey and Zull all teach of the power of learning through engagement, of the power of movement and the influence of reflecting on performance through experience. The IM program is able to offer all of these elements. I am sad that you had such a poor experience – I am a strong believer in the negative effects of unforgiving memories generated through bad experience. Perhaps you may never be able to recover sufficiently to see the help that this program is offering to infants, children in early learning, children through higher learning, adults recovering from strokes, migraines, dyslexia, veterans recovering from blast related injuries. I encourage you to open your opinion to the timing capabilities within these domains.

    • I’ve never had any bad experiences with IM. My problem with it is that there is no evidence that it is effective. And by evidence I don’t mean anecdotes, I mean published, peer-reviewed empirical data. It may well be highly variable, but as long as those variables can be quantified in a meaningful way it should still be possible to show that it’s effective (or not).

  4. So one doctor states he has not found any gains from IM, and you claim its useless? How about you interviewing people that actually has had the therapy? Instead of just interviewing a critic with a degree?

    • Well, no, one very highly qualified professor of music and neuroscience says it’s useless, actually. But that’s not the point – the point is that there is no evidence that it’s effective. And by ‘evidence’ I mean well-conducted empirical studies that are reported in peer-reviewed publications. Anecdotal statements from IM clients do not fit this criteria I’m afraid.

  5. Thank you for ur post. It’s interesting that I found this while I was searching for IM home service in Seoul, Korea for my 5-year-old kid with autism. Yes, I understand your point, and I can’t deny that you sound very persuasive. But I will still try IM, coz I hear so many successful stories with it that it is hard to ignore the hope as a mother. Let me thank you for this article. Very helpful indeed.

  6. Have you tried ABA? Much more success stories that can be proven.

  7. ABA? No comparison with IM! We use both in our school for children on the spectrum and both are valued. As far as empirical studies go, I would urge you to look at the science behind the program – there are numerous published, peer reviewed studies across multiple functional domains. Once again, if you are going to give an opinion, please make sure it is balanced and not merely massaging what appears to be a bruised ego!

  8. I found it very to finish this article! You left no hope for the parents! So what if there is not much papers published on MI for us to use it! I am a doctor and a mother of a disabled kid and I would try anything to help her as long as it is not invasive and safe! I can not waste her golden years waiting for a supporting paper to emerge! I have tried for my daughter the oxygen therapy despite the weak evidence and the disincourgment of neurologist and I was impressed with the great improvement in her cognition and speech to the extent that her teachers called me to discuss it!

    • I’m very glad to hear you’re getting good results with your daughter with whatever ‘oxygen therapy’ is, but you tried an unproven treatment on her, against the advice of her neurologist? Do you really think that’s a sensible approach, and one which, as a doctor, you should be promoting?

  9. Hi NeuroBollocks (love your name) – I’m wondering if you’ve heard of Timocco? I’d appreciate your opinion. Seems similar to IM – they say they make therapeutic computer games for kids with disabilities.

  10. Hey NeuroBollocks like your angle, but your response to the Doctor Mum alarms me. Did you ever study History and Philosophy of Science. Paradigms are constantly being broken in the scientific field, that’s how we move ahead. You may be right on this issue, but you may be wrong as well. Just becuase science’s little measuring stick is not able to measure the greater reality, doesn’t mean that the greater reality is not true. Would you think that Edison was not a sensible person for trying to push the boundaries of reality beyond how we know them to be. Maybe it won’t be IM. But some of these Neuro Therapies in about 50 years will finally be measured by science and found out to be true. And while these people are using them, and saying I could have told you that. You will be reading about it on the 25th page of the daily news paper, at the bottom of the page, in some 150 word article on interesting facts.

  11. I consider myself an “out-of -the-box” speech therapist. I have used IM, when I felt it was appropriate, since I began with it in 2006. I remember a 55 year old developmentally delayed woman whose mother was better able to understand her within 3 weeks, and we were simply using a digital metronome. I remember a bus driver who had suffered brain injury in an accident, whose case worker nurse called me to ask how I had managed to do so much for him in such a short time. For him, we did use the IM.
    i do not need studies to give me permission to try modalities, especially those that can do no harm. I practice other modalities as well, perhaps much more controversial, but I use them because they work! Lighten up, guys!

  12. I just checked my university’s databases for research about this therapy, and it appears there’s actually quite a lot of support for its effectiveness in peer-reviewed medical and OT journals. There are studies supporting its effectiveness using control groups and all other manner of respectable methods. I realize that you wrote this article in 2013. Maybe it’s time to make an amendment to your previous comments?

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