What is Attention Deficit Disorder?

Attention-deficit/ hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder that involves a pattern of inattention, impulsiveness, or hyperactivity. These traits may prevent those affected from functioning or developing properly throughout life. Individuals with ADHD often just have one of these traits though it is possible to have more than one. In the younger population the most common symptom is hyperactivity including behaviors like difficulty concentrating and being unfocused. Inattention symptoms include problems with finishing assignments, getting distracted easily, or bad time management skills. Impulsiveness and hyperactivity symptoms include fidgeting, constantly talking, being impatient, or interrupting in certain situations. There is no single test for diagnosis of this disorder though the patient must have a chronic history of inattention, hyperactivity, or impulsiveness.

The symptoms must interfere with the patient's quality of life and be behind with development (NIH, 2016). ADHD can be complicated and difficult to assess because there is no real definition of this disorder due to many symptoms that can overlap with other mental disorders. These symptoms including inattention, hyperactivity, impulsivity, poor behavioral control, learning difficulties, anxiety, and disrupted social interactions that can also be symptoms of mood disorders, learning disorders, or even conditions such as allergies, stress, or poor diet (Jackson, 2003). In a journal article published by Burcham & DeMers (1995) researchers go into detail about the information needed in order to complete a comprehensive assessment of ADHD which includes information from multiple sources, the extent of the ADHD symptoms that are present, the extent of the symptoms that can be related to another mood or learning disorder, and the extent that these characteristics are interfering in the child's overall functioning. Comprehensive assessment is not done with a specific test for ADHD but rather with questionnaires, screenings or tasks to measure and distractibility. There is an issue with the assessment of ADHD because it generally occurs in the offices of pediatricians and general family practitioners, is not standardized, and can lead to misdiagnoses including over diagnosis and under-diagnosis (Jackson, 2003; Carey, 1999).

Typically these symptoms are seen as early as the age of 3 and continue into adulthood. This mental disorder is one of the most common affecting 8.4 percent of children and 2.5 percent of adults in the United States. It is common for teachers and school staff to provide parents and medical professionals with information to help assess and even assist with behavior and learning problems. Students who have significant symptoms of ADHD that impairs their learning may qualify for special education which can include person-centered services like study skills instruction, changes to the classroom structure, alternative teaching techniques or a modified curriculum. In adults with ADHD, many do not realize they have the disorder and are treated with medication, psychotherapy, and helpful strategies like behavior management (APA, 2017). Although there are many treatments for ADHD, none of them are entirely satisfactory and people are still exploring new methods and looking for ways to help better manage this disorder. The ability of music and its power to improve sensory integration as an element of music therapy is important in the treatment of individuals with ADHD. Music therapy can be primary or multidisciplinary and ranges between different individuals.

The type of music including low-tempo and high-tempo songs also plays a role by preference. This treatment may be case-specific for those with ADHD and can be described depending upon the setting, the referral source, and the needs of the child. Different types of music therapy methods including music and movement, instrumental improvisation, musical play, and group singing can be combined in the treatment of ADHD. Previous studies suggests several elements of music that can help in the treatment of ADHD including the element of movement and its effect on dual hemispheric activation inside the brain, ability of music to increase memory functions and auditory perception for improved learning, and the ability of specific sounds or tones to affect the production of brain waves (Jackson, 2003). Music & rhythm therapy methods often address multiple types of goals, and still include other forms of treatment, with a majority receiving medication. Researchers have found music to improve auditory perception and language skills in learning disabled children and have taken an interest in the effects of music and sound on neurological functioning. Since studies have found that music has an impact upon brain function, attention, activity level, social behavior, and learning, there is good reason to support further investigation into the different ways that music might be used to effectively treat children with ADHD.

Though in the past there is little research within music therapy about its treatment on ADHD, studies on the effectiveness of this treatment have been on the rise. A random sample of 500 music therapists surveyed through questionnaires about the treatment of early elementary school children with ADHD and many provided additional commentary about the effectiveness of music therapy. Music therapists included that this treatment encourages on-task behavior, increases attention span, positive behaviors, and self-esteem, decreases frustration and resistance, contributes to improved sensory integration, and is especially effective with medication. Participants added that music therapy is the one group they sit through and stay focused, provides structure that helps children get organized, and provides opportunity for energy release within a structure mentioning that consistency and structure are key elements (Jackson, 2003). Imaging studies have shown key parts of the brain that are involved when processing musical rhythm including activation in the auditory, frontal, parietal and motor regions. Other parts of the brain that play a role in sensory-motor integration include the supplementary motor area, basal ganglia and cerebellum (Slater & Tate, 2018).

An important observation that explains how unique it is for humans to process musical rhythm can specifically be seen in nonhuman vocal learning species including parrots or songbirds. The sensory-motor coupling that is needed for synchronization of movement to music in these species is a necessary basis for learning and producing complex communication signals (Patel and Iversen, 2014). Evidence that these systems play a large role in temporal processing and cognition is due to the activation of motor areas during rhythm perception. Music is so influential for healing and stimulating emotions that specific populations like the Greeks at Asclepius would place an ill individual in the center of the amphitheater and used specific voices to heal that person (Jausovec et al., 2006). Music has also been found to help in the learning of foreign languages, reading and mathematics, retention of terminology, and creative ability (Lozanov, 1978; Panksepp, 1998; Jausovec, 1994; Adaman and Blaney, 1995). These combinations of sound are proposed to be a 'prelanguage' that is available early in life and act as an exercise for activating and exciting the flow of cortical firing patterns responsible for higher brain functions.

The firing patterns enhance the cortex's ability to accomplish pattern development and is explained through a concept called the 'Mozart effect'. The effect is defined by an enhancement of performance or change in neurophysiological activity associated with listening to Mozart's music and can be found in the improved performance on spatial IQ tests (Jausovec et al., 2006; Rauscher et al., 1993 & 1995). This study led by Rauscher included a control group of college students that had spent 10 minutes listening to Mozart and ended scoring 8-9 points higher than the students who had listened to a relaxation tape or listened to nothing. The explanations and research have been criticized because there was no prior evidence of cross-modal priming between unrelated stimuli. Though this hypothesis is supported by a study done by Jausovec and Habe (2005) in which they show that Mozart's music had a beneficial influence on performance of spatial rotation tasks and a slightly negative influence on the performance of numerical tasks.

The etiology of attention-deficit/ hyperactivity disorder is still being researched due to no direct cause. However, there are some important factors that affect the risk of developing ADHD including genetics, prenatal care/environment, and environmental exposure to toxins. This disorder is heritable meaning that it can be passed down to offspring. Unhealthy prenatal behaviors including smoking, alcohol consumption, or drug use can affect the risk of developing ADHD. Environmental factors include being exposed to toxins during pregnancy or high levels of lead (NIH, 2016). Though there is insufficient evidence, an article by Dr. Emma Sciberras describes how several studies have found that prematurity, low birth weight, and stress during pregnancy are also associated with ADHD development in offspring (Sciberras, 2017). Attention-deficit/ hyperactivity disorder is a chronic condition that is not yet curable and most individuals affected are prescribed stimulant or non-stimulant medications. Stimulants work to increase the levels of neurotransmitters in the brain like dopamine and norepinephrine (NIH, 2016). Most individuals with ADHD find that medications for this disorder improve their quality of life by being able to focus on daily tasks. To find the right medication a patient might have to try several different ones. Stimulants can also play a role with increasing anxiety, which is a problem for young adults with ADHD that were found to have significant psychiatric comorbidities (Hauck, 2017).

Researchers Volkmar, Hoder, and Cohen (1985) analyzed the inappropriate use of stimulant therapy including the lack of careful consideration of the risks associated with stimulant medications, the lack of careful comprehensive assessment, and poor monitoring of patient response to medication. Many of these studies suggest that medication treatment is not the final answer for treating individuals with ADHD (Jackson, 2003). Most of these young adults are also diagnosed with anxiety and/or depression or another type of psychological condition. Having another type of psychological condition can lead to more medications like antidepressants in addition to the stimulants or other treatment used for ADHD. Psychotherapy is another form of treatment for this disorder and that includes behavioral therapy in which the patient learns how to control certain behaviors and think with a clear mind. Another type of treatment is cognitive behavioral therapy that patients can use to learn about mindfulness or meditation (NIH, 2016). Behavioral therapy is a type of treatment for ADHD that appears often in literature and science journals even though many studies have shown that these interventions and self-management strategies have been largely ineffective with the ADHD population (Abikoff, 1985).

Other ways to improve the organization and well-being of an individual with ADHD is keeping a routine, giving positive reinforcement to positive behavior, and using organizers like a homework folder (CDC, 2016). Case Study Patient X is identified as a 24-year-old male who has been having difficulty in school due to severe difficulty concentrating, constantly losing things, and being easily distracted. Medical history includes drug use of the mother of Patient X while pregnant and an initial presentation of these symptoms as a child. Environmental risks include early life exposure to toxins like lead in running water while living in an urban/city area. There was a concern of attention-deficit/ hyperactivity disorder at the age of six. However, treatment was decided to be behavioral therapy until the age of 12 when the hyperactive behavior was controlled. Due to the severity of these symptoms in adulthood, Patient X reached out to professionals and was tested for more symptoms of ADHD. This started with a questionnaire and compressive assessment that is compared to the criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders. Patient X engaged in tasks including intellectual screenings, and measures of sustained attention and distractibility.

Attention and distractibility are measured with continuous performance tests, word memory tasks, and puzzles. Patient X was prescribed a stimulant by a psychiatrist to control focus and functioning. After a couple weeks on the stimulant Patient X started to feel more in control and concentration improved significantly. Patient X continued to explore different methods of treatment and though music therapy was not an initial option when he was younger, Patient X explains how the effects music has benefited his well-being and treatment of ADHD. Patient X described his experience with this disorder as having several thoughts going at once and not being able to grasp any and constantly needing something to do. Music helps me zone-in on the tasks I have at hand. I can't just do this with any pop culture music, it has to be continuous and have a steady beat. I find this with lo-fi slow tempo music and if I want some thing more energetic I'll listen to electronic dance music that has a faster pace or high tempo. says Patient X. Lo-Fi music is also known as Low Fidelity music in which songs are lower quality of sound recordings than the regular modern audio that would be played on the radio. Electronic dance music ranges within different sub-genres and some are specifically known to have a high tempo; though it is known to be as continuous and steady as low tempo music.

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