Music Therapy as a Complementary Approach for Attention Deficit and Hyperactivity Disorder: A Perspective

Abstract

Attention deficit and hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity that is present across at least two settings. ADHD treatment includes pharmacological and nonpharmacological interventions; among the latter, music therapy (MT) has gained interest for its potential cognitive and emotional benefits. Music evokes and modulates mood and emotion, and music-based interventions (active production and receptive listening) are used to support attention, inhibitory control, emotional regulation, hyperactivity reduction, self-esteem, and social functioning. In this perspective, we describe the role of MT in ADHD and propose a conceptual framework for its clinical use and future research directions.

Introduction

Attention deficit and hyperactivity disorder (ADHD) affects children and adults and is defined by pervasive patterns of inattention and/or hyperactivity-impulsivity that impair function across settings. ¹ It commonly occurs in childhood and frequently persists into adulthood. ² Diagnostic criteria described in DSM-5 require symptoms to begin before age 12, persist for ≥6 months, and be present in two or more settings. ³ ADHD is classified into three presentations: predominantly inattentive presentation, predominantly hyperactive-impulsive presentation, and combined presentation. The predominantly inattentive presentation is characterized by persistent difficulties in sustaining attention, increased distractibility, and impairments in organization and task completion. The predominantly hyperactive-impulsive presentation involves excessive motor activity, restlessness, and difficulties remaining still or quiet. The combined presentation, which is the most common, includes symptom criteria from both inattentive and hyperactive-impulsive domains. ⁴ Typical symptoms of ADHD include: poor sustained attention, distractibility, difficulty organizing tasks, frequent careless mistakes, fidgeting, inability to remain seated, and impulsive actions. Comorbidities frequently include mood disorders, anxiety disorders, learning disorders, and conduct problems. ⁵

This manuscript synthesizes the conceptual rationale and clinical evidence for music therapy (MT) as a complementary approach in ADHD, clarifies methods and intended outcomes, identifies limitations of the current evidence, and suggests directions for future research.

ADHD: Neurophysiology and Core Symptoms

ADHD is associated with functional and structural alterations in neural systems involved in attention and executive function, particularly within frontostriatal circuits, the anterior cingulate cortex (ACC), and the dorsolateral prefrontal cortex (DLPFC). Neuroimaging studies have reported reduced volume and altered activation in these regions in individuals with ADHD, which are associated with impairments in inhibitory control and attentional regulation. The ACC plays an important role in selective attention and conflict monitoring, whereas the DLPFC is critically involved in sustained attention and executive control processes. Functional MRI studies also demonstrate reduced frontostriatal activity in individuals with ADHD, reflecting inefficient neural processing during attention-demanding tasks. Attention is a fundamental cognitive function that supports learning, social interaction, and communication development.^5,6

Music Therapy

MT is a therapeutic approach that uses music to address various physiological and neurological conditions. Active MT involves direct patient participation, such as playing or creating music with a therapist, whereas passive MT focuses on listening to music without active involvement. However, the literature often does not clearly distinguish between these two types of interventions. ⁷ Music therapists are expected to be skilled and experienced musicians, capable of singing, playing multiple instruments, and composing music or songs. They must also be proficient in various therapeutic methods, including improvisation, and be able to establish effective interaction with clients. ⁸

There are two broad approaches often used (and commonly combined) in clinical practice:

Active MT (production): Participant engages in music-making—playing instruments, improvisation, song composition, or vocalization. Techniques include improvisation, re-creative (reproducing musical pieces), and composition. Active methods can support motor planning, rhythmic entrainment, social interaction, and self-expression. ⁹

Receptive MT (listening): Involves participants engaging with music selected or structured by a therapist, often accompanied by guided imagery, relaxation strategies, or reflective discussion. This approach is designed to regulate arousal levels, promote relaxation, and deliver targeted auditory stimulation to enhance attentional processes. ⁹

Longitudinal studies suggest that children participating in extended music training programs (e.g., 2 years) demonstrate increased activation in brain regions associated with cognitive control, including the ACC, inferior frontal gyrus, motor cortex, and insula. In addition, shorter music-based interventions have also shown potential benefits. ¹⁰ Music engages auditory processing systems and distributed brain networks, including cortical attentional regions and subcortical reward circuits involved in motivation and emotion. Neuroimaging studies demonstrate that rhythm and musical structure can influence timing, attention, and emotional processing through interactions between auditory, motor, and limbic systems. However, the neurophysiological mechanisms underlying therapeutic effects remain incompletely understood, and longitudinal neuroimaging studies of music-based interventions represent an important direction for future research.^11,12

Evidence for Music-based Interventions in ADHD

Attention

Attention is a fundamental skill for optimal cognitive function and plays an important role in cognitive, social, and communication development. There are several types of attention, namely sustained attention, selective attention, and divided attention. ¹³ When a person listens to a melody, the right temporal hemisphere (auditory) is activated and connected to the left hemisphere (language). Listening only to tones engages short-term memory and activates specific regions of the right auditory cortical system. When individuals listen to music, auditory information is transmitted through the thalamus to the auditory cortex, where higher-order processing occurs. The thalamus plays an important role in sensory gating and attentional modulation by prioritizing relevant stimuli. Musical elements such as rhythm and melody may therefore facilitate attentional engagement through multisensory neural activation.^14,15

Mood and Emotional Regulation

MT may contribute to emotional regulation through neurophysiological and psychological mechanisms. Individuals with ADHD are at increased risk of depressive symptoms, which may involve dysregulation of serotonergic and dopaminergic systems. Some experimental studies have reported that structured MT programs can reduce depressive symptoms and physiological stress markers. For example, one intervention protocol combined resonance frequency breathing with receptive and active MT components. Resonance frequency breathing refers to a slow, paced breathing technique (typically around 4.5–6.5 breaths/min) designed to optimize autonomic balance and heart rate variability through cardiorespiratory synchronization. In this protocol, participants first engaged in paced breathing while listening to music with a steady tempo, followed by receptive listening and active musical improvisation. This structured intervention was associated with reductions in depression scores and cortisol levels. ¹⁶

Hyperactivity

Hyperactivity in children with ADHD is characterized by excessive motor activity, difficulties with self-regulation, and impaired impulse control, which can lead to challenges in maintaining appropriate behavior, particularly in structured settings. ⁵ Music is a complex sensory stimulus that engages multiple neural networks and influences various aspects of human functioning through brain neuroplasticity. By modulating distinct brain states and neuromodulatory systems, music affects emotional processing, self-referential cognition, and social behavior, partly through the release of hormones such as endorphins and oxytocin. MT utilizes these neurobiological effects to address patients’ physical, cognitive, and emotional needs. ¹⁷

Inhibitory Control

Inhibitory control is a core component of behavioral self-regulation and refers to the ability to suppress inappropriate responses and guide goal-directed behavior according to contextual demands. Music-based interventions may support inhibitory control through engagement of neural networks involved in cognitive and motor regulation. For example, an orchestral music training program consisting of ten sessions over 3 months was associated with improvements in inhibitory control in school-aged children. These findings suggest that both sustained and shorter-duration music interventions may contribute to the development of executive control processes, although further controlled studies are needed to confirm causal effects. ¹⁸

Self-esteem

Self-esteem is defined as a personal evaluation of one’s worth, reflected in an individual’s attitude toward themselves. Individuals with high self-esteem tend to be more confident in social situations, more self-assured in completing tasks, able to maintain curiosity in learning, and enthusiastic when facing new challenges. The MT approach can foster self-esteem among children with ADHD who experience academic failure, carelessness, irritability, forgetfulness, and difficulties in completing tasks. MT serves as an intervention that enhances self-esteem across several dimensions, including competence, significance, virtue, and strength. ¹⁹

Limitations of the Evidence

Current research on MT for ADHD reflects substantial variability in intervention approaches, intensity, outcome measures, and participant characteristics. Much of the existing work consists of small-scale studies, often using pilot or quasi-experimental designs rather than large randomized controlled trials. While reported outcomes are largely encouraging, the overall evidence base remains at an early stage, highlighting the need for more methodologically robust and well-powered studies to clarify the therapeutic potential of music-based interventions for ADHD. ²⁰

Practical Considerations for Clinicians

• Integration with standard care: MT is a complementary strategy and should not replace first-line pharmacotherapy or evidence-based behavioral interventions when indicated.

• Intervention selection: For attention/inhibitory control targets, interventions that emphasize rhythmic entrainment and active participation may be prioritized. For mood regulation, receptive interventions with relaxation components may be useful.

• Therapist qualifications: Prefer credentialed music therapists.

• Outcome measurement: Use standardized attention and behavior rating scales, objective neurocognitive tests where possible, and monitor for transfer to real-world functioning. ²⁰

Perspective and Recommendations for Future Research

Future research should prioritize well-powered randomized controlled trials with standardized interventions and outcomes, dose–response analyses, mechanistic studies (e.g., neuroimaging), and longitudinal designs to assess the durability and real-world functional impact of interventions, including social, academic, and adaptive functioning beyond symptom reduction. ²⁰

Conclusion

Based on current evidence, MT shows promise as a complementary intervention to support attention, inhibitory control, mood regulation, and social functioning in individuals with ADHD. However, the evidence remains limited by small samples, heterogeneous methods, and inconsistent outcome measures. We therefore propose that MT be considered as an adjunctive, individualized option integrated with other evidence-based treatments while more rigorous trials are undertaken. Future research should define standardized intervention protocols, clarify mechanisms of action, and evaluate real-world functional outcomes.