ADHD in Children: Music Therapy

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopment conditions affecting children. While much has been studied about the condition, its pathogenesis is not clearly leading to gaps in developing effective clinical management guidelines to minimize the symptoms. Generally, ADHD is manifested as a behavioral syndrome that is characterized by three core symptoms: hyperactivity, impulsivity, and inattention. However, some patients may not have all the three chief symptoms with some predominantly having only hyperactivity and impulsivity while a certain faction may only present with inattention (Tarver, Daley, & Sayal, 2014). The advances in the medical management of conditions make the focus to be placed on the incorporation of pharmacological and non-pharmacological interventions. The focus has been on the management of children with ADHD. Therefore, Music therapy has been thought of as an effective approach in the management of ADHD among children. Some scholars even suggesting music use to delay or decrease the use of pharmacologic drugs.

This paper explores the influence that music therapy may have in the management of ADHD in young children. A literature review will be conducted through different databases to investigate previous researches on the topic as well as their results. Several studies have documented the beneficial effects of music therapy in other psychiatric and neurodevelopmental disorders such as autism, depression, dementia, and cancer. The purpose of this work is to estimate if music therapy is an effective method to early control the symptoms of ADHD in young children and improve their level of attention without the necessity of the use of pharmacologic drugs.

Music therapy has been identified as a potential approach through which to handle, control and provide a very effective treatment to ADHD and several other disorders coexisting with the condition (CDC, 2018). Anecdotal evidence suggests that there is very minimal evidence of sound studies to have been conducted to carry on systemic trials of music therapy in regards to ADHD. As such, the plan to carry out a properly designed systemic research study to assess the effect of MT in the management of ADHD among children aged between 4 to 10 years of age will act as a critical guide for clinical practice and highlight areas for further research in the area.

This study would also be important in updating clinical knowledge regarding the application of music therapy in the management of ADHD in children of 4 to 10 years. The study is a form of a continuous education enhancement process that has been linked to better outcomes in the care of patients in all clinical settings for nurses (Garafalo, 2016). This literature review will help determine the sufficiency of the evidence to prove music therapy as an alternative method to conventional drugs in ADHD treatment. In that case, the research would help health care providers, especially the advanced registered nurses working in primary care levels, to either recommend or not recommend music therapy to caregivers as an intervention to improve the attentiveness and impulsivity of children with ADHD.

The focus of this literature review is to gain insight regarding what other researchers have explored regarding the effect of music therapy (MT) in the management of children with ADHD, especially those aged between 4 to 10 years. Additionally, the literature review will also focus on understanding how other researchers have compared MT with pharmacologic interventions. Previous scholarly literature findings published in the last 5 years (2013 to 2018) will get used in fulfilling these objectives.

Relevant Nursing Theory 

Concerning the topic of ADHD, Callista Roy’s Adaptation model will act as the conceptual framework for this research paper. The Adaptation Model asserts that nurses have a core objective of improving the ability of individuals to respond and adapt positively to environmental stimuli (Alligood, 2017). Additionally, the model illustrates that by nurses promoting adaptation during ill health, they help enhance a person’s ability to interact appropriately with the environment, thereby improving their overall health (Ursavaş, Karayurt, & İşeri, 2014). Generally, patients with ADHD have maladaptive issues that are often manifested in their behavior like aggression, poor impulse control, and behavioral disinhibition amongst other maladaptive manifestations (Forner, 2017). As such, Roy’s model provides a perfect framework through which the MT can get implemented to improve the cognitive functioning of children with ADHD.

Roy’s model describes important stimuli and subsystems that can be manipulated to promote positive adaptation. These stimuli include; focal stimuli which are seen as a confrontation between an individual’s internal and external environments which they try to resist; the contextual stimuli that are seen to contribute to the focal stimuli and the residual stimuli which include individual beliefs and behaviors (Alligood, 2017). In the case of ADHD, the use of MT is meant to reach a balance in the internal and external environment, thereby helping promote positive adaptation. Additionally, Roy’s model also describes the cognate subsystem that is responsible for high cognitive functions, which are often impaired in ADHD (Ursavaş, Karayurt, & İşeri, 2014). The utilization of the MT in ADHD is meant to help enhance the functioning of the cognate subsystem through music, thereby promoting positive response and adaptation to environmental stimuli. Therefore, just like it is described in Roy’s theory, the major objective in the management of children with ADHD is to try and meet their needs. The children's needs are met by regulating the environmental stimuli they are exposed to including ptenntial therapies such as music therapy.

Music Therapy Vs. Pharmacologic Interventions 

While there is a lot of existing literature linking MT and ADHD, there seem to be few studies directly comparing MT and pharmacological interventions. However, there exists research evidence pointing out the negative consequences of pharmacological interventions with scholars recommending and prioritizing non-pharmacological interventions (Wang et al., 2013). The study by Wang et al. (2013) reveals discrepancies among scholars on the exact effects of ADHD drugs on dopamine stores. Such open discrepancies give room for trying out non-pharmacological interventions such as MT till concrete evidence is available to support the pharmacological interventions, especially in mild cases.

Additionally, while pharmacological interventions may be considered as effective, they may be ineffective at times. In their paper, Shier, Reichenbacher, Ghuman, and Ghuman (2013) note that not all children with ADHD are bound to benefit from pharmacological interventions. Additionally, the scholars also noted that some of the children’s parents were opposed to stimulant medications, thereby the need for alternatives (Shier et al., 2013). Therefore, this creates room for non-pharmacological interventions such as MT to be implemented. However, while this paper by Shier et al. (2013) highlights majorly on pharmacological interventions, it does not address the issue of comparisons with MT. As such, there is grey literature evidence to suggest or make a firm conclusion regarding MT in comparison with pharmacologic interventions.

Conclusions 

There are obvious knowledge gaps with minimal evidence available to enable any meaningful comparison between MT and pharmacological interventions. However, evidence from these studies indicates that MT can help improve the classical symptom of inattentiveness and impulsivity (Carrer, 2015; Rothmann et al., 2014; Porter et al., 2017). Besides, evidence from earlier research studies suggests that music therapy is an effect effective therapeutic technique for enhancing social skills for children suffering from psychiatric conditions such as autism (Ghasemtabar et al., 2015). Therefore, there is hope that MT can also help improve ADHD symptoms.

Although several studies conducted concerning adopting music therapies in treating children who have ADHD, the results obtained from some of these studies show a grave weakness in methodological approaches. For example, the mentioned studies like that by Acebes-de Pablo and Carabias-Galindo, 2014 include only two subjects, and of the other studies have no control groups. Besides, the lack of use of evidence-based approaches, standardized methods, follow-ups, and randomized controlled trials are some of the evident weaknesses in the studies. Based on these selected earlier research studies and findings, the researcher looks forward to researching the same area and to specifically examine the impact of music therapy in children with ADHD. The research looks to discover whether music therapy also works for children aged 6 to 10 years with ADHD.

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