ROTH, Alex: A Comparison of Four Rhythm-Based Treatments for Attention Deficit Hyperactivity Disorder (ADHD)

Wikis > Final Projects > ROTH, Alex: A Comparison of Four Rhythm-Based Treatments for Attention Deficit Hyperactivity Disorder (ADHD)

Project Proposal

Research Question: What is the most effective rhythm-based treatment
for Attention Deficit Hyperactivity Disorder (ADHD)?

Attention Deficit Hyperactivity Disorder (ADHD) represents one of the
most prevalent mental health problems of school-age children. NIMH
estimates that between three and five percent of children in the
United States are afflicted with this disorder. Such symptoms as
inattention, distractibility, and impulsivity contribute to both
academic underachievement and to behavioral problems for many of these
children. Treatment of children with ADHD using various psychotropic
medications demonstrates various degrees of effectiveness but often
produces untoward side effects such as appetite changes and agitation.
Behavioral treatments for ADHD offer the obvious advantage of
negligible side effects and the possibility of skills development and
increased sense of personal competency. There now exists evidence in
support of using rhythm-based behavioral treatment strategies for
alleviation of symptoms of ADHD. A number of studies suggest that
teaching children to enhance their rhythm skills and gain increased
control over their brain wave rhythms can improve their focusing
capabilities (Shaffer et al., 2001). In other words, improved rhythm
skills and brain wave patterns have the potential of reducing some of
the concentration impairments found in ADHD.

Research in the area of rhythm and attention deficit disorders
suggests the possibility of promising treatment interventions. In
particular, Gilden and colleagues (2009) show that those with ADHD
have rhythm perception cutoffs that are quicker in tempo than those
without the disorder. That is, individuals with ADHD need faster
tempos in order to recognize rhythm patterns. In a sense, the disorder
seems to recalibrate the internal clock that regulates the subjective
experience of such temporal events as rhythm. This observation leads
one to wonder if those with ADHD could be taught to lower their rhythm
threshold. If so, this might allow them to learn to “reset” aspects of
their internal clock and thereby improve focus over periods of time.
In a similar vein, London posits that metric skills rely on
entrainment, that is, the ability of an individual to synchronize
his/her internal clock to an external stimulus, namely a rhythm
pattern. One might speculate that developing such synchronization
skills might improve an individual’s capacity to focus on a changing
external stimulus and thereby enhance concentration and reduce
distractibility. In fact, studies by Shaffer and colleagues (2001)
demonstrate that those children with ADHD who improved their “mental
timing” skills through practiced sessions with a metronome had
improved scores on measures of ADHD symptoms.

In addition to strategies that rely on enhancing internal timing and
rhythm skills, another line of research that relies on operant
conditioning of brain waves also shows promise as a basis for
behavioral approaches to ADHD. Specifically, “Neurofeedback in
Psychological Practice” by Masterpasqua and colleagues (2003) reviews
controlled studies that support the effectiveness of biofeedback
training for the amelioration of ADHD symptoms. In these studies,
individuals are taught through feedback rewards (i.e., a Pac-man
figuring advancing in a biofeedback exercise) to synchronize their
brain waves, as measured by EEG, to particular frequencies that
correspond to relaxed and/or focused states. If children can learn to
modify such brain wave rhythms so as to increase relaxation and focus,
then symptoms of ADHD should diminish.

Works Cited

Gilden, D. L., & and Marusich L. R. (2009). Contraction of Time in
Attention-Deficit Hyperactivity Disorder. Neuropsychology, 23 (2),
265-69. Google Scholar. Web. 9 Apr. 2013.

Masterpasqua, F., & Healey, K. N. (2003). Neurofeedback in
Psychological Practice. Professional Psychology: Research and
Practice, 34 (6), 652-56. Google Scholar. Web. 9 Apr. 2013.

Shaffer, R. J., Jacokes, L.E., Cassily, J.F., Greenspan, S.I.,
Tuchman, R.F., & Stemmer, P.J. (2001). Effect of Interactive Metronome
Training on Children With ADHD. The American Journal of Occupational
Therapy, 55, 155-62. Google Scholar. Web. 9 Apr. 2013.

Literature Review

Research Question: What is the most effective rhythm-based treatment for Attention Deficit Hyperactivity Disorder (ADHD)?

Attention Deficit Hyperactivity Disorder (ADHD) represents one of the most prevalent mental health problems of school-age children. NIMH estimates that between three and five percent of children in the United States are afflicted with this disorder. Such symptoms as inattention, hyperactivity, and impulsivity contribute to both academic underachievement and to behavioral problems. Treatment of children with ADHD using various psychotropic medications demonstrates various degrees of effectiveness but often produces untoward side effects such as appetite changes and agitation. Behavioral treatments for ADHD offer the obvious advantage of negligible side effects and the possibility of skills development and an increased sense of personal competency. Wiebe’s review of the literature (2007) indicates that music has the capacity to improve self-control as well as attention and memorization skills. There now exists evidence in support of using rhythm-based behavioral treatment strategies for alleviation of symptoms of ADHD. A number of studies suggest that both the teaching of rhythmic skills as well as listening to music with varying rhythms may enhance concentration and reduce impulsivity, thereby improving the functioning of those with ADHD (Gilden & Marusich, 2009; Pratt, 2004; Shaffer et al., 2001; Wiebe, 2007). Although there is no consensus as to which rhythm-based approach is most effective in reducing ADHD symptoms, there exists support for the use of music therapy in treating ADHD with particular emphasis on the rhythm component. Such rhythm-associated approaches seem to fall into the broad categories of development of memory, timing, and rhythm skills, and the therapeutic effects of rhythm-connected background music (Pratt, 2004).

Methods that rely on improving competency in timing and rhythm offer particular promise for ADHD treatment. There is increasing evidence that attention impairments relate to such constructs as “motor planning,” “sequencing,” and “rhythmicity” (Shaffer et al., 2001). In fact, areas of the brain associated with temporal perception are affected in those suffering symptoms of inattention. Volkow and colleagues (2007) find that dopamine activity in limbic areas of the brain is depressed in those with ADHD. Wiebe (2007) explores the link between impairments in working memory, a subset of short-term memory that holds focus while other tasks are being processed, and attention deficits found in ADHD. In a similar vein, Richards (2003) examines strategies that rely on movement, rhythm, and repetition to enhance working memory. Information is more easily retained when placed in songs with rhymes and familiar rhythms. Regarding specific timing anomalies in those with attention disorders, Gilden and Marusich (2009) show that those with ADHD have rhythm perception cutoffs that are quicker in tempo than those without the disorder. That is, individuals with ADHD need faster tempos in order to recognize rhythm patterns. In a sense, the disorder seems to recalibrate the internal clock that regulates the subjective experience of such temporal events as rhythm. This observation leads one to wonder if those with ADHD could be taught to lower their rhythm threshold. If so, they might learn to “reset” aspects of their internal clock and thereby improve focus over periods of time. This line of research raises the possibility of other interventions that might beneficially affect internal timing mechanisms that are impaired in attention disorders.

Such timing interventions might be designed to directly enhance various kinds of rhythmic skills. In this regard, London (2012) posits that metric skills rely on entrainment, that is, the ability of individuals to synchronize their internal clocks to an external stimulus, namely a rhythm pattern. One might speculate that developing such entrainment skills might improve capacity to focus on a changing external stimulus and thereby enhance concentration and reduce distractibility. In fact, studies by Shaffer and colleagues (2001) demonstrate that those children with ADHD who improve their “mental timing” skills through practiced sessions with a metronome boast improved scores on measures of ADHD symptoms. In this study, rhythmicity scores from a metronome provide feedback to subjects as to how close their responses match a reference beat. The purpose of the metronome treatment is to assist subjects in improving their ability to selectively attend and improve concentration. Other studies find similar beneficial effects of using an interactive metronome to enhance cognitive skills in children. Improvements in reading fluency and comprehension, areas often affected by attention disorders, are shown in those children with language/reading impairments given interactive metronome treatment (Ritter et al., 2012). In addition to the interactive metronome, other methods of enhancing timing and rhythm skills have been employed. For example, Rickson (2004) examines the effects of “instructional” versus “improvisational” music therapy sessions on measured levels of motor impulsivity shown by adolescent boys with ADHD. The instructional intervention is based on behavioral theory and involves direct modeling of beat and rhythm tasks, whereas the improvisational approach is consistent with humanistic, client-centered models of psychotherapy. In this latter approach, the client develops relationships with others and engages in music-making with them. Results indicate that both types of interventions yield significant reduction in measured impulsivity.

Regarding strategies that focus on enhancing internal timing and rhythmic skills, another related line of research relies on brain wave entrainment and uses rhythmic stimuli to alter brain wave frequency to improve the attention deficits and distractibility in ADHD. Huang and Charyton (2008) as well as Masterpasqua and colleagues (2003) review studies that support the effectiveness of biofeedback training for the amelioration of ADHD symptoms. In these studies, individuals are taught through feedback rewards (e.g., a Pac-man figuring advancing in a biofeedback exercise) to synchronize their brain waves, as measured by EEG, to particular frequencies that correspond to states of enhanced relaxation and focus (Masterpasqua et al., 2003).

In addition to research focused on skills such as memory and rhythmic competency, other ADHD studies incorporate the hearing of selected background music. Pratt (2004) refers to a music/medicine study that shows that seventy percent of children with ADHD who receive neurofeedback training along with instrumental music by Mozart reduce deficits of inattention and impulsivity compared with those who get only the feedback. Wiebe (2007) notes that children and adolescents are active users of music media and that listening to music assists in the development of memory and attention skills. Furthermore, Wiebe suggests that certain rhythms produce curiosity and interest and so tend to enhance attention. In Wiebe’s single case study, she shows how an adolescent male diagnosed with ADHD increases his attention and concentration time after listening to music with varying rhythms through headphones during school and homework.

Although the majority of studies reviewed demonstrate promising results for rhythm-based treatments for ADHD, a few studies reveal minimal treatment effectiveness or mixed results. Cioca (2012) refers to Pratt’s study that shows no significant differences in symptoms between groups receiving neurofeedback training with or without the addition of classical music. Similarly, Mrazova and colleagues (2010) find no differences between the effectiveness of music therapy including rhythm-based tasks and controls on antisocial behavior with ADHD. In a review of controlled studies, Mrazova and colleagues also make reference to past work by Rickson that demonstrates no benefits for music therapy with improving motor impulsivity. While both effective, Rickson’s (2004) two groups, instructional and improvisational music, show no differential effects. A study on the efficacy of different rhythm-based treatments for ADHD might support previous positive findings in the field as well as clarify the potency of one approach over another. Such research might compare the relative effectiveness of various rhythm-based treatments including training in rhythm discrimination, entrainment, rhythm memory tasks, and listening to background music.

Works Cited

Cioca, I. (2012). Music therapy – An effective tool in treating various condition specific to children and adolescents. Romanian Journal of Child and Adolescent Psychiatry, 6(3-4), 28-34. Retrieved from Google Scholar, http://arpcapa.ro/wp-content/uploads/2013/04/sinteze-3.pdf

Gilden, D. L., & Marusich L. R. (2009). Contraction of time in attention-deficit hyperactivity disorder. Neuropsychology23(2), 265-69. doi: 10.1037/a0014553

Huang, T. L., & Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Altern Ther Health Med14(5), 38-50. Retrieved from Google Scholar, http://www.doctorspreferredprograms.com/research-articles/Comprehesive%20Review…Brain%20Entrainment%20Email.pdf

London, J. (2012). Hearing in time: Psychological aspects of musical meter (2nd ed). New York: Oxford University Press.

Masterpasqua, F., & Healey, K. N. (2003). Neurofeedback in psychological practice. Professional Psychology: Research and Practice34(6), 652-56. doi: 10.1037/0735-7028.34.6.652

Mrazova, M., Celec, P., & Ing, D. (2010). A systematic review of randomized controlled trials using music therapy for children. The Journal of Alternative and Complementary Medicine, 16(10), 1089-95. doi: 10.1089/acm.2009.0430

Pratt, R.R. (2004). Art, dance, and music therapy. Physical Medicine and Rehabilitation Clinics of North America, 15, 827-41. doi: 10.1016/j.pmr.2004.03.004

Richards, R.G. (2003). The source for learning & memory strategies. East Moline, IL: LinguiSystems.

Rickson, D.J. (2004). Instructional and improvisational models of music therapy with adolescents who have attention deficit hyperactivity disorder (ADHD): A comparison of the effects of motor impulsivity. (Doctoral dissertation.) Retrieved from Google Scholar,http://muir.massey.ac.nz/handle/10179/255

Ritter, M., Colson, K.A., & Park J. (2012). Reading intervention using interactive metronome in children with language and reading impairment. Communication Disorders Quarterly,34(2), 106-19. doi: 10.1177/1525740112456422

Shaffer, R. J., Jacokes, L.E., Cassily, J.F., Greenspan, S.I., Tuchman, R.F., & Stemmer, P.J. (2001). Effect of interactive metronome training on children with ADHD. The American Journal of Occupational Therapy55, 155-62. doi: 10.5014/ajot.55.2.155

Volkow, N.D., Wang, G., Newcorn, J., Telang, F., Solanto, M.V., Fowler, J.S., Logan, J., Ma, Y., Schulz, K., Pradhan, K., Wong, C., & Swanson, J.M. (2007). Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder. Archives of General Psychiatry64(8), 932-40. doi: 10.1001/archpsyc.64.8.932

Wiebe, J.E. (2007). ADHD, the classroom and music: A case study. (Master’s thesis.) Retrieved from Google Scholar,