Music and ADHD

 by Madison Michel, MM, MT-BC

Before we dive in to how individuals with ADHD can benefit from music, we need to discuss the definition and diagnostic criteria. 

In order to be diagnosed with attention-deficit/hyperactivity disorder (ADHD), 6 or more inattention symptoms must have persisted for at least 6 months; be inconsistent with developmental level; and negatively impact social, academic, and leisure activities (American Psychiatric Association, 2013). Examples of inattention symptoms include difficulty following through with tasks, difficulty managing sequential tasks, disorganization of task materials, difficulty focusing on selective stimuli, and more. 

According to the DSM-5, when compared with typical peers, children diagnosed with ADHD show:

  • Reduced total brain volume
  • Slower neural network communication
  • Delays in posterior and anterior cortical maturation (American Psychiatric Association, 2013). 

A Shifting Treatment Approach

In 2014, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders was published, housing the ADHD diagnosis under Neurodevelopmental Disorders rather than classification in the previous editions as a Disruptive Behavior Disorder (Doernberg, 2016). Continually emerging evidence explaining ADHD in terms of neurologic function shifts clinical treatment paradigms from strictly behavioral to a neurological basis for understanding and facilitating change in behavior. 

As neurodiversity becomes more widely studied, the ADHD diagnosis has come to be more widely accepted as a type of neurodiversity. ADHD has long been treated within the context of a behavior/conduct disorder; however, knowing that the root cause is neurodiversity, therapy treatment approaches can and should shift. 

 

Brain illustration

Neurological Differences in ADHD

  • Visual Cortex: Differences in visual processing cortex and disruption in connectivity with frontal processing networks give neurologic evidence for difficulties integrating visual information (de Celis Alonso, 2014). Why does this matter? Recruitment of frontal lobe executive control over visual and other sensory integration information in important for tasks related to attention.

  • Cerebellum: The cerebellum, which plans, organizes, and executes movement and learning interference was reduced in volume and showed differences in activation in ADHD groups compared to typically functioning peers. Networking between the cerebellum and bilateral prefrontal cortex, implicated in executive control, was also less active (de Celis Alonso, 2014). Why does this matter? Communication between the cerebellum and bilateral frontal cortex is important for error detection and control over correction and memory networking, crucial to actively attending to one’s own learning processes. 

  • Prefrontal Cortex: Implicated in regulating networks of attention, emotion, and action, the prefrontal cortex has been shown to mature slower and in smaller volume in ADHD as compared to typical development. Networking activity between the prefrontal cortex and cerebellum has been shown to be extra sensitive to environment (Sharma, 2013). Why does this matter? Since prefrontal cortex regulates multiple networks implicated in attentional and cognitive control, disrupted or sensitive connectivity between the PFC and other areas of the brain can result in dysregulated or dysfunctional attentional regulatory behavior. 

 

Girl Dj'ing

 

Neurological Music Evidence in ADHD: Why Music Makes a Difference

  • Insight: Music provides a rewarding neurological experience which can help maintain motivation. Evidence: Musical rhythm can activate dopaminergic neural reward networks which increase the strength of neural firing through aesthetic pleasure from beat predictability, neural entrainment, and emotional motivation (Slater & Tate, 2018). 

  • Insight: Musical experiences strengthen neural communication between brain networks affected in ADHD. Evidence: Engaging in musical experiences has the potential to increase and strengthen neural network communication between frontal and parietal cognitive control regions and the cerebellum, implicated in body regulation and output (Slater & Tate, 2018). 

  • Insight: The synchronicity music provides for sensory systems maintains neural attention highly effectively.  Evidence: Music can provide synchronized multisensory information that can increase neural and motor entrainment and synchronicity through activation of multisensory feedback loops, thereby coordinating synchronized arousal and attention (Goldstein & Brockmole, 2017). 

  • Insight: Rhythm has the potential to isolate and target motor and timing deficits in ADHD. Evidence: Motor and timing deficits increasingly have begun to be isolated as common symptoms in ADHD. Fronto-cerebellar pathways play a distinct role in rhythmic processing, and since these pathways are interrupted in ADHD, the use of rhythm with ADHD could be key to identifying how neural systems are disrupted (Slater & Tate, 2018). 

  • Insight: Musical rhythm has the potential to increase dopamine production in ADHD and enhance neural coordination and reward. Evidence: Genetic risk factors for ADHD implicate dopaminergic transmission which coordinates neural reward timing systems. In the context of musical rhythm, dopamine production increases with temporal expectation (Slater & Tate, 2018).  

  • Insight: Many of the neural regions and networks enhanced in musicians are proven to be areas of deficit in ADHD. Since music experience has the potential to shape these regions, music experience has the potential to drive neurologic change in ADHD. Evidence: Musicians overall perform better than controls on rhythm perception, temporal discrimination tasks, sensorimotor timing tasks, and inhibitory control tasks. They also have larger brain volume in the motor control areas like the cerebellum and basal ganglia and cognitive control regions in the frontal and parietal lobes (Slater & Tate, 2018). The enhancement of these neural regions and networks suggests that there is potential for experience (musical training) to shape neural systems.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., pp 59-65). Neurodevelopmental disorders. American Psychiatric Publishing. 

 Carrer, L. (2015). Music and Sound in Time Processing of Children with ADHD. Frontiers in Psychiatry, 6, 127–127. https://doi.org/10.3389/fpsyt.2015.00127

De Celis Alonso, H. (2014). A Multi-Methodological MR Resting State Network Analysis to Assess the Changes in Brain Physiology of Children with ADHD. PloS One, 9(6), e99119–e99119. https://doi.org/10.1371/journal.pone.0099119

Doernberg, H. (2016). Neurodevelopmental disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11. CNS Spectrums, 21(4), 295–299. https://doi.org/10.1017/S1092852916000262

Goldstein, E. B., & Brockmole, J. R. (2017). Sensation and perception. Cengage Learning.

 Jackson, N. (2003). A survey of music therapy methods and their role in the treatment of early elementary school children with ADHD. The Journal of Music Therapy, 40(4), 302–323. https://doi.org/10.1093/jmt/40.4.302

Rickson, D. (2006). Instructional and Improvisational Models of Music Therapy with Adolescents Who Have Attention Deficit Hyperactivity Disorder (ADHD): A Comparison of the Effects on Motor Impulsivity. The Journal of Music Therapy, 43(1), 39–62. https://doi.org/10.1093/jmt/43.1.39

Sharma, C. (2013). A review of the pathophysiology, etiology, and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). The Annals of Pharmacotherapy, 48(2), 209–225. https://doi.org/10.1177/1060028013510699

Slater, T., & Tate, MC. (2018). Timing Deficits in ADHD: Insights From the Neuroscience of Musical Rhythm. Frontiers in Computational Neuroscience, 12, 51–51. https://doi.org/10.3389/fncom.2018.00051

Thaut, Michael H., & Gardiner, James, C. (2014). Musical attention control training. In Thaut, Michael H., & Hoemberg, Volker (Eds.), Handbook of neurologic music therapy. (1st ed., pp. 257-269). Oxford University Press. 

 Tiffin-Richards, H. (2004). Time reproduction in finger tapping tasks by children with attention-deficit hyperactivity disorder and/or dyslexia. Dyslexia, 10(4), 299–315. https://doi.org/10.1002/dys.281

Madison Michel, MM, MT-BC

madison@heartandharmony.com