Journal of Music Therapy, XL (4), 2003,302-323

© 2003 by the American Music Therapy Association

A Survey of Music Therapy Methods and

Their Role in the Treatment of Early
Elementary School Children with ADHD
Nancy A. Jackson
Temple University

Attention-Deficit Hyperactivity Disorder (ADHD) has recently

been receiving more frequent attention in professional cir­
cles and in the press, and some sources would assert that its
occurrence in the general population is consistently growing.
Because music therapists often work with preschool and
school-age children, it is likely that they will increasingly be
treating children with a diagnosis of ADHD. However, there is
little in the music therapy literature about music therapy
treatment for ADHD. The purpose of this survey was to as­
certain what music therapy methods are being used for chil­
dren with an ADHD diagnosis, how effective this treatment is
perceived to be, and the role that music therapy treatment
plays in relation to other forms of treatment. Results of the
survey indicated that music therapists often utilize a number
of music therapy methods in the treatment of children with
ADHD. They often address multiple types of goals, and treat­
ment outcome is generally perceived to be favorable. Refer­
rals for music therapy services are received from a number of
different sources, although parents and teachers were indi­
cated to be the most frequent referral sources. Most children
with ADHD receiving music therapy services also receive
other forms of treatment, with an overwhelming majority re­
ceiving medication. The implications of these results are dis­
cussed, and areas for continuing research into the use of
music therapy with ADHD are identified.

The author wishes to express sincere gratitude to Cheryl Dileo, PhD, for guid­
ance and encouragement throughout the completion of this project.

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 Vol. XL, No. 4, Winter 2003 303

Attention-Deficit Hyperactivity Disorder (ADHD) is a diagnosis

which creates controversy regarding every aspect of the disorder
from definition to treatment. Most sources agree on its basic de­
scription: a disorder characterized by a pattern of inattentiveness,
often with hyperactivity, and sometimes with concurrent impulsiv­
ity, which is of a persistent nature, is more severe than is typically
seen in other individuals of the same developmental level, and
which causes subsequent difficulties in learning, behavior manage­
ment, interpersonal relationships, and socialization (American Acad­
emy of Pediatrics, 2000; American Psychiatric Association, 2000). Be­
yond this description, there is very little agreement on a specific
definition of the disorder, with different sources identifying any­
where from two to seven sub-types, each of which suggests differing
etiologies (Amen, 2001; American Psychiatric Association, 2000; Au­
gust & Garfinkle, 1989; Marshall, Hynd, Handwerk, & Hall, 1997).
Assessment of ADHD is complicated not only because of the lack
of agreement in how to define the disorder, but also because many
of the symptoms of ADHD, such as inattention, hyperactivity, im­
pulsivity, poor behavioral control, learning difficulties, anxiety, and
disrupted social interactions, are also symptoms of other disorders,
such as learning disorders (Hannaford, 1995), mood disorders
(American Academy of Pediatrics, 2000), or conditions such as al­
lergies, stress, or malnutrition (Tobias, 1995). To further compli­
cate the matter, these other disorders are commonly co-morbid
with ADHD (American Academy of Pediatrics, 2000). Burcham
and DeMers (1995) indicated that a comprehensive assessment of
ADHD requires information from multiple sources, and must de­
termine the extent to which ADHD characteristics are actually
present, the extent to which these characteristics can be attributed
to some cause other than the disorder, and the extent to which the
characteristics are interfering in the child's global functioning.
However, assessment for ADHD, which generally occurs in the
offices of pediatricians and general family practitioners, is not
standardized, leading to misdiagnoses, which include both over­
diagnosis and under-diagnosis (Carey, 1999).
In light of the difficulties present in defining and assessing
ADHD in children, it comes as no surprise that proper treatment of
the disorder is also a matter of controversy. In reviewing the litera­
ture on ADHD, it is clear that clinicians generally feel that treatment
with stimulant medication, usually methylphenidate, is by far the

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 304 Journal of Music Therapy

most efficacious treatment (Johnson, 1988), and historically, it has

been the primary intervention for this population (Dupaul, Barkley,
& McMurray, 1991). However, Volkmar, Hoder, and Cohen (1985)
discuss how the lack of careful and comprehensive assessment, the
poor monitoring of patient response to medication, and the lack of
careful consideration of the risks associated with stimulant medica­
tions can lead to the inappropriate use of stimulant therapy. Addi­
tionally, improved academic performance and long-term behavioral
change have not been convincingly demonstrated in follow-up stud­
ies on stimulant treatment for ADHD (Barkley & Cunningham,
1978; Johnson, 1988). This suggests that medication treatment is
not the single or ultimate answer for treating children with ADHD.
Behavioral therapy frequently appears in literature on ADHD
even though numerous studies have shown that behavior therapy
interventions, and self-management strategies in particular, have
been largely ineffective with the ADHD population (Abikoff,
1985). The Multimodal Treatment Study of Children with Atten­
tion Deficit/Hyperactivity Disorder (MTA) overseen by the Na­
tional Institute for Mental Health (NIMH) demonstrated that mul­
timodal treatment for ADHD was more effective than behavioral
therapy treatment alone, but also found that multimodal treatment
was not significantly more effective than stimulant treatment alone
for the core symptoms of ADHD (MTA Cooperative Group, 1997).
A notable lack of literature is to be found on other forms of
treatment for ADHD. Some studies have addressed nutritional con­
cerns related to ADHD (Haslam, Dalby, & Rademaker, 1984; Wen­
der & Solanto, 1991). More recently, neurotherapeutics, the use of
specific tones embedded in white noise to modulate brainwave
function, has been espoused as a hopeful new treatment (Abar­
banel, 1995; Plude, 1995; Swingle, 1995). Art therapy has also ad­
dressed ADHD including the use of art therapy to assess the effec­
tiveness of medication treatment (Epperson & Valum, 1992), to
encourage creative growth (Smitheman-Brown & Church, 1996),
and as part of a multimodal approach to address interpersonal and
social problems associated with ADHD (Henley, 1998).
Likewise, literature on the use of music therapy to treat ADHD is
sparse at best. Background music has been shown to reduce hyper­
activity and other unwanted behaviors for those with attention
deficits (Gripe, 1986; Pratt, Abel, & Skidmore, 1995). Rock music
was used in conjunction with a time-out procedure as negative re­

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 Vol. XL, No. 4, Winter 2003 305

inforcement for effectively decreasing inappropriate or disruptive

behavior (Wilson, 1976). Montello and Coons (1996) studied the
effects of active versus passive music interventions, and found that
those with severe attentional deficits might benefit most from lis­
tening interventions that do not require the internal structure that
active interventions require.
The use of music to assist in learning has also received some at­
tention in the literature, including the use of music paired with vi­
sual cues to increase information retention (Shehan, 1981), and
the use of music to improve auditory perception and language
skills in learning disabled children (Roskam, 1979). Gfeller's
(1984) exploration of three theories of learning disability and the
different music therapy approaches that best fit these differing
theories has numerous implications for treatment of children with
ADHD since learning disabilities seem to be either part of, or co­
morbid with, ADHD. Also of interest are studies of the effect of mu­
sic and sound on neurological functioning, such as Furman (1978),
who studied the effect of music on alpha brain wave production in
children, and Morton, Kershner, and Siegel (1990) who demon­
strated that music enhances the effect of dichotic listening, which
may result in increased short-term memory, decreased distractibil­
ity and an enhancement of information processing.
Considering the potential of music to impact upon brain func­
tion, attention, activity level, social behavior, and learning, there
appears to be good reason to support further investigation into the
ways that music might be used to effectively treat children with
ADHD. More information is needed about how music therapy is
being used clinically for the treatment of ADHD, however, and
those currently working with these children can best provide that
information. Therefore, it was the purpose of this survey to ascer­
tain what music therapy methods are being used for children with
an ADHD diagnosis, how effective this treatment is perceived to be,
and the role that music therapy treatment plays in relation to other
forms of treatment.

Method
Subjects
A sample of board-certified music therapists was randomly se­
lected from members of the American Music Therapy Association

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 306 Journal of Music Therapy

(AMTA) who had identified themselves in the AMTA 2001 annual

survey as working with populations likely to include early elemen­
tary school children. Only practicing, board-certified clinicians
were selected from these categories, with students and others being
excluded. Using these filters, AMTA identified 1116 music thera­
pists who matched the criteria for the study, from which 500 were
randomly selected by the researcher to receive the questionnaire.
Design and Procedure
An experimenter-designed questionnaire, which was first sub­
mitted to a group of professional music therapists for feedback, was
used to survey subjects. The questionnaire, along with a cover let­
ter that indicated the purpose of the study, elicited informed con­
sent, and provided necessary information for the completion and
return of the questionnaire, was submitted to the Institutional Re­
view Board of Temple University for approval prior to administra­
tion. Those subjects who did not work with the identified popula­
tion were requested to indicate so and return the questionnaire to
determine if the number of responses received was sufficient to be
considered a representative sample. The responses from the re­
turned questionnaires were then compiled into aggregate form for
analysis using SPSS Systat 6.0 statistical software.
Results
Of the 500 questionnaires sent, a total of 268 responses were re­
ceived from music therapists residing in 43 states, constituting an
overall return rate of 54%. Of those responses, 98, or 37% of the
responses received, were from music therapists in 36 states who in­
dicated that they currently work with early elementary school chil­
dren diagnosed with ADHD. The data from these 98 survey re­
sponses was compiled utilizing the Systat program, and the results
were derived from basic statistical computations and from compar­
isons of various groupings and sortings of this data.
Music Therapy Methods Used with ADHD Children
Subjects were asked to identify the method or methods that they
use to treat children diagnosed with ADHD. These results are
shown in Table 1. Music and movement was the method that most
respondents indicated they use with this population, followed by
instrumental improvisation, musical play, and group singing, re­

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 Vol. XL, No. 4, Winter 2003 307

TABLE i
Music Therapy Methods Used for Treating ADHD Children

Method Number of respondents Percentage

Music and movement 73 74%

Instrumental improvisation 66 67%
Musical play 62 63%
Group singing 54 55%
Instrumental instruction 46 47%
Other creative arts 35 36%
Music assisted relaxation 31 32%
Vocal improvisation 22 22%
Mainstreamed music education 17 17%
Orff-Schulwerk 16 16%
Nordoff-Robbins 5 5%
Vocal instruction 5 5%
Other 22 22%
Note. Subjects were asked to indicate all the methods they use to address this popu­
lation. Biofeedback was a method offered on the questionnaire, but which no re­
spondent selected. Therefore, it has been deleted from this and subsequent tables.
"Percentage" is the percentage of all respondents. Methods identified as "Other" by
respondents included song writing, recreational music, educational music activities
for speech and skill development, music and sensory integration, music attention
training, hand bell choir, and music and equine-assisted therapy.

spectively. Most respondents indicated that they use two or more

methods, with only 2% indicating only one method.
Goals Addressed by Music Therapy Methods
Subjects were asked to indicate the types of goals they address in
music therapy for children with ADHD. Behavioral goals were iden­
tified by 92 respondents (94%), psychosocial goals were identified
by 87 respondents (89%), and cognitive goals were identified by 68
respondents (69%). Most respondents indicated that they address
two or more types of goals, and 81 (83%) ranked the types of goals
according to the frequency with which they address them. Again,
behavioral goals were identified as being addressed most fre­
quently, followed by psychosocial goals and then cognitive goals.
The types of goals addressed were also examined in relation to the
music therapy methods identified by respondents. Regardless of
method employed, behavioral goals were indicated as the type most
addressed, followed by psychosocial goals, then cognitive goals.

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 308 Journal of Music Therapy

TABLE 2
Perceived Effectiveness of Music Therapy Treatment for ADHD

Treatment outcomes Other professionals Teachers Parents Children

Number 98 93 82 81 94
Percentage 100% 95% 84% 83% 96%
Range 3 3 3 2 3
Mean 4.1 4.1 4.1 4.1 4.3
Note. Effectiveness ratings represent the respondents' perceptions, and were based
on a scale of 1-5; 1 = not effective. 3 = somewhat effective. 5 = very effective. "Num­
ber" is the number of respondents. "Percentage" is the percentage of all respon­
dents. "Range" is the difference between the minimum and the maximum reported
ratings. "Mean" is the average rating in each category.

Music Therapy Treatment Formats for ADHD Children

Subjects were asked to identify the format of their treatment of
ADHD children. Forty respondents (41%) indicated that they see
these children in both group and individual formats, followed
closely by 38 respondents (39%) who see children only in a group
format. Twenty respondents (20%) indicated that they treat ADHD
children individually. The questionnaire did not ask the subjects to
specify the type of setting in which they treat these children, but
many respondents added this information. These settings included
educational, residential, community-based, acute hospital, and psy­
chiatric treatment settings.
Perceived Effectiveness of Music Therapy Treatment for ADHD
Subjects were asked to rate the effectiveness of music therapy
treatment for children with ADHD based on their treatment out­
comes, and on their perception of the responses of other profes­
sionals, the responses of teachers, the responses of parents, and the
responses of the children receiving music therapy (Table 2). In
general, respondents' indicated that music therapy treatment is ef­
fective according to their treatment outcomes, and they perceived
that others also feel music therapy is an effective treatment.
To ascertain if the perceived effectiveness of music therapy treat­
ment varied according to the type of music therapy method em­
ployed or to the type of goal(s) addressed, responses were sorted
according to method and to type of goal, and the effectiveness ac­
cording to respondents' treatment outcomes was examined for each.
Regardless of the methods employed or the types of goals addressed,

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 Vol. XL, No. 4, Winter 2003 309

TABLE 3
Treatments Used in Conjunction with Music Therapy for ADHD
Type Number Percentage Percentage of total

Medication 85 91% 87%

Psychological services 52 56% 53%
Occupational therapy 51 55% 52%
Nutrition 27 29% 28%
Other creative arts 25 27% 26%
Physical therapy 25 27% 26%
Speech therapy 5 5% 5%
Therapeutic recreation 5 5% 5%
Massage 3 3% 3%
Chiropractic 1 1% 1%
Other 18 19% 18%
Note. Subjects were asked to identify all other treatments being used in conjunction
with music therapy for ADHD. "Percentage" is the percentage of respondents who
indicated that conjunctive treatments are used. "Percentage of Total" is the per­
centage of all respondents. Treatments identified as "Other" by respondents in­
cluded speech therapy, therapeutic recreation, rehabilitation services, anger man­
agement training, residential milieu programs, hippotherapy, cranio-sacral therapy,
and weighted vests.

the vast majority of respondents rated effectiveness as "effective" or

better (4 or 5 on the rating scale, with 5 being very effective).
Other Treatments Used in Conjunction with Music Therapy for ADHD
Subjects were asked to indicate if music therapy is provided in
conjunction with other forms of treatment for ADHD, and if so, to
specify what other treatments are used. Of the 98 respondents, 93
or 95%, indicated that other treatments were used (Table 3). Most
of these respondents indicated that medication was the most fre­
quently used conjunctive treatment, followed by psychological ser­
vices and occupational therapy, respectively.
Referral Sources for Music Therapy Treatment of ADHD
Referral sources from which respondents receive music therapy
referrals for children with ADHD are shown in Table 4. Respon­
dents indicated that parents and teachers are the most frequent
sources of referrals to music therapy for ADHD children, followed
closely by treatment teams. Subjects were also asked if their facility
uses an Individualized Education Plan (IEP), and, if so, if music
therapy is mandated on that form. Twenty-nine respondents (29%)

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 310 Journal of Music Therapy

TABLE 4
Music Therapy Referral Sources for ADHD Children

Source Number Percentage

Parents 43 44%
Teachers 31 32%
Treatment team 29 30%
IEP 14 14%
Physician 13 13%
School guidance counselor 13 13%
Psychologist or therapist 10 10%
Other 36 37%
Note. Subjects were asked to identify all sources from which they receive music ther­
apy referrals for children with ADHD. "Number" is the number of respondents
identifying each referral source. "Percentage" is the percentage of all respondents.
Referral sources identified as "Other" by respondents included social workers, pri­
vate music teachers, special education directors, Department of Developmental Dis­
abilities case managers, nurses, DSS workers, other creative arts therapists, occupa­
tional therapists, and speech therapists.

indicated that music therapy was mandated on the IEP in their fa­
cility. Their responses indicated that referrals for lEP-mandated
music therapy also come from numerous sources, and not solely
from the IEP process. These referral sources are shown in Table 5.
The Role of Music Therapy in Treatment of ADHD Children
Subjects were asked to describe the role that music therapy plays
in the treatment of ADHD as primary, multidisciplinary, or adjunc­
tive. A notable majority of the respondents (71 or 73%) described
music therapy's role with this population as multidisciplinary. A few
respondents also indicated that the role music therapy plays in
treatment for these children is case-specific, and may be described
in any of these three ways, dependent upon the setting, the referral
source and the needs of the child.
Additional Comments
A space was provided at the end of the questionnaire for addi­
tional information or comments for those subjects who felt these
would be helpful to the study and who chose to include them.
These additional comments, which are grouped in categories, are
presented in Table 6. Of all the respondents, 19 or 19%, chose to
add comments to the questionnaire.

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 Vol. XL, No. 4, Winter 2003 311

TABLE 5
Referral Sourcesfor lEP-mandated Music Therapy

Source Number Percentage

Parents 15 52%
IEP 11 38%
Teachers 10 34%
Treatment team 9 31%
Psychologist 3 10%
Physician 3 10%
Guidance counselor 2 7%
Other 12 41%
Note. This table presents the referral sources for those respondents who indicated
that music therapy is specifically mandated on the IEP in their facility. Subjects were
asked to identify all sources from which they receive referrals. The total number of
respondents represented in this table is 29. "Number" is the number of respondents
identifying each referral source. "Percentage" is the percentage of the 29 respon­
dents represented herein.

Discussion
A random sample of 500 music therapists were surveyed about
the treatment of early elementary school children with ADHD, re­
sulting in the receipt of 98 questionnaires completed by music
therapists working with this population. Because of the 54% over­
all return rate for the questionnaire, and because responses were
received from all regions of the country, it is not unreasonable to
assume that the results provide a generally accurate picture of how
music therapists are working with this population.
Music Therapy Methods Used with ADHD Children
Respondents identified many different types of music therapy
methods they use with ADHD children, and they combined these
methods in many different groupings, none of which showed any
particular trends. One would wonder, then, why music and move­
ment, instrumental improvisation, musical play, and group
singing were each identified by more than 50% of the respon­
dents. Perhaps there is a shared element or elements that lead to
their more frequent use. Or, perhaps further investigation would
show that the frequent use of these methods has more to do with
the age of the child than with the diagnosis. Or again, perhaps
the choice of method has some correspondence with the type of
setting. For instance, is group singing identified more often be­

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 312 Journal of Music Therapy

TABLE 6
Respondents'Additional Comments About Music Therapy and ADHD

Category Comments

Methods use methods that are multi-sensory (2)

use iso-principle-based activities (2)
improvisation allows the children to lead and create within
a structure
after a structured group music activity, give music choice
time for children to pick an instrument to play, or pick a
selection to listen to
sensory integration is important for younger and lower level
children
use group music activities that require attention, turn-taking,
and responding to cues
Effectiveness encourages on-task behavior (3)
interventions are effective during sessions, but little or no
generalized response is noted outside of sessions (2)
increases attention span, positive behaviors, and self­
esteem (2)
decreases frustration and resistance
improves healthy emotional expression
is related to the "chemistry between the therapist's aproach
and each child," and their ability to "observe/discern
together"
"some [children] are overly stimulated by certain types of
music and do better with verbal instruction in a quiet
environment"
especially effective with medication
"music therapy is the one group they sit through and stay
focused"
group music is effective because of its demands and its
ability to motivate
a multidisciplinary approach seems to work best
Elements of music provides structure that helps children "get organized"
therapy provides opportunity for energy release within a structure
"consistency and structure are key elements"
contributes to improved sensory integration
Recommendations parents should be involved in sessions so that results can
better generalize to other settings (2)
assist the child in finding what works best for him/her
a qualitative research approach might give more pertinent
information
a theoretical model is needed for formulating and testing
treatment strategies
Miscellaneous success in one setting may lead to referrals from other settings
more formalized training in this area might help music
therapists but none seems to be available
misdiagnosis is common
multiple diagnoses are common
Note, This table represents additional comments added to the questionnaire by re­
spondents. Some comments are paraphrased to fit into the chart format. Those com­
ments that are not paraphrased are in quotation marks.A number in parentheses after
a comment indicates that more than one respondent added this comment to the ques­
tionnaire, and identifies the specific number of respondents who made that comment.

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 Vol. XL, No. 4, Winter 2003 313

cause many of these children may be seen in an educational type

of group setting?
The previously cited literature on ADHD suggests several ele­
ments of music itself that may play a part in the choice of method
for treating ADHD. Among these are the element of movement and
its impact on dual hemispheric activation in the brain (Hannaford,
1995; Morton et al., 1990), the ability of music to increase memory
functions and auditory perception for improved learning (Roskam,
1979; Shehan, 1981; Wolfe & Horn, 1993), and the ability of specific
sounds or tones to affect brain wave production (Abarbanel, 1995;
Furman, 1978; Morton et al., 1990; Plude, 1995; Swingle, 1995). In
comparing the most often identified music therapy methods and
the elements just mentioned, one can see that at least some of these
elements are part of each of the methods. Music and movement, in­
strumental improvisation, musical play, and group singing all in­
volve some sort of physical movement, and all except group singing
are likely to often involve movement on both sides of the body and
across midline (dual activation of both hemispheres in the brain).
Musical play and group singing are likely to involve the pairing of
music and information, while music and movement may pair music
with an increased awareness of emotion or increased spatial aware­
ness (auditory perception and memory). And, of course, all involve
the use of sound and tones (potential brainwave modulation).
Clearly, further investigation is needed in each of these areas to bet­
ter understand how music can be effective for these children.
Goals Addressed by Music Therapy Methods for ADHD
A majority of the respondents indicated that they address more
than one type of goal with the methods that they use to treat chil­
dren with ADHD. Perhaps multiple goals are addressed by music
therapy because, regardless of the type of method used, music is
experienced on multiple levels simultaneously. As a parenthetical
example, a music intervention can have the ability to create an
experience of structure, both through the music itself, and through
the directives given to the participant. That same intervention may
involve learning a music skill that includes the movement of both
sides of the body across midline. It may also provide opportunity for
a fulfilling experience of appropriate interaction between the mu­
sic, the participant, and all other participants, while anchoring the
learning from that experience in the participant's memory
through the very movements required by participation. This one

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 314 Journal of Music Therapy

intervention could address behavioral, psychosocial, and cognitive

goals within a short span of time. It may be that there are few
modalities that are able to address multiple areas simultaneously.
Referring again to the cited literature, much of the evidence that
supports the use of music with this population is related to brain
function and its impact on processing of information and learning.
It is interesting, then, that cognitive goals are identified as being
addressed less often than behavioral or psychosocial goals. There
are a number of factors that might explain this. First, behavioral
and psychosocial improvements are much easier to track and doc­
ument in an "objective and measurable" manner than are cognitive
improvements, since cognitive improvements are likely to develop
and generalize over a period of time, and often require specific test­
ing in order to obtain a measurement. For example, it is easy to ob­
serve and measure on-task behavior or appropriate self-expression,
while observing and measuring brain activity, such as dual hemi­
spheric activation and its long-term results, is quite difficult.
Another reason that cognitive goals were not identified as being
addressed as often may be that music therapists, in general, do not
have extensive education in neurobiological functioning. This is a
specialized area of knowledge, and perhaps only those therapists
who have a particular interest in this area actually take the time to
learn more about it. This is also an area of science that we know
little about in comparison to other areas of physiology. Since evi­
dence does show that music encourages cognitive gains, it may be
that many music therapists address cognitive concerns with these
children without realizing that they are doing so. Further explo­
ration of music's effect on cognitive functioning could potentially
provide important information for the treatment of this population.
The current multidisciplinary nature of treatment may also play
a role in the types of goals that music therapists are addressing.
Multidisciplinary teams certainly have their advantages: better as­
sessment, more complete evaluation of treatment based on func­
tioning in multiple areas, better continuity of care, and so on. Mul­
tidisciplinary teams also have their disadvantages, however, and
chief among these is the tendency for the specificity that each dis­
cipline brings to the treatment process to be "watered down" or di­
luted through the process of developing a general plan. Also, be­
cause the current standard in healthcare is to provide objective and
measurable results for the treatment provided, it would not be sur­

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 Vol. XL, No. 4, Winter 2003 315

prising to find that multidisciplinary teams may tend to address

easily observable and measurable goals. As a result, it may be that
music therapists follow the more generalized plan of the multidis­
ciplinary team. Or, it may be that they are addressing cognitive ar­
eas in their treatment, but they adjust the way they describe what
they do to fit into the generalized plan. Regardless of the reasons
that cognitive goals are addressed less often, it may be time for mu­
sic therapists to pay closer attention to the cognitive benefits of the
interventions that they provide for these children.
Music Therapy Treatment Formats for ADHD Children
Subjects were not asked to specify the settings in which they treat
ADHD children; this was a flaw in the questionnaire design. The in­
formation on group or individual treatment does not give much
insight into treatment of these children without corresponding in­
formation about the setting in which the treatment takes place.
The format could be a function, of the setting, or it could give in­
formation independent of the setting.
Some respondents chose to offer information on the setting in
which they see these children, mentioning both educational and
health care settings. This is reflective of the prevalence of this di­
agnosis in the general population, and suggests that music thera­
pists need to be aware of the specific needs of these children and of
how music therapy can most benefit them.
Perceived Effectiveness of Music Therapy Treatment for ADHD
In general, it appears that music therapists feel that music ther­
apy treatment for children with ADHD is effective, and that they
also perceive others to feel that it is effective, based on feedback
that they receive from these others. Interestingly, the perception of
effectiveness was relatively the same regardless of methods used, or
the types of goals being addressed, or the other types of treatment
used in conjunction with music therapy. This consistent perception
of music therapy's effectiveness in treating ADHD children regard­
less of the variables revisits the question posed earlier: Is there
some element or elements of music itself which lead to the effec­
tiveness of music therapy treatment for these children?
Another interesting result is that the respondents' perceptions of
how the children in treatment feel about the effectiveness of music
therapy was consistently higher than any other group, even their

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 316 Journal of Music Therapy

own treatment outcomes. The amount of difference in the ratings

was not remarkable, just the consistency of the ratings regardless of
the variables being examined. A study that described and explored
the ADHD child's experience of music therapy might be an invalu­
able source of information for further defining and developing
music therapy's approach to treating these children. For example,
does the ADHD child feel that music therapy is effective because it
helps him to perform better academically, or because it helps him
to feel better and more confident about himself, or because it pro­
vides him an opportunity to release excess energy through creativ­
ity and self-expression? Each scenario suggests the use of a differ­
ent music therapy approach. Again, these questions provide fertile
ground for further research.
Other Treatments Used in Conjunction with Music Therapy for ADHD
It is no surprise that medication was indicated as being used in
conjunction with music therapy for a large majority of the children
with ADHD that respondents treat. The existing literature clearly
identifies medication as the most widely used form of treatment for
ADHD despite some controversy over whether it is the best or most
appropriate treatment in all cases. Those respondents who indi­
cated that medication was not used conjunctively with music ther­
apy for the children they treat, however, rated the perceived effec­
tiveness of music therapy treatment about the same as the overall
perceived effectiveness including those children who do receive
conjunctive medication treatment. The number of respondents in
this group was small, so no firm conclusions can be drawn from this
study, but further investigation in this area is warranted. Perhaps
there is something that music therapy can address with these chil­
dren upon which medication has no impact. Or perhaps the effec­
tiveness of music therapy may have to do with the actual music
therapy environment, in which case it might be enlightening to
explore how the positive effects of music therapy generalize to
other settings as compared with how the positive effects of medica­
tion generalize. Also of interest would be to closely study the dif­
ferences between children being treated with medication and chil­
dren not being treated with medication within the same music
therapy setting.
In looking at the respondents' perceptions of effectiveness for
music therapy treatment of children not receiving medication, it

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 Vol. XL, No. 4, Winter 2003 317

seems that the respondents perceived that they and the children
feel music therapy is somewhat more effective than do others. Fur­
ther studies that,would survey other professionals, teachers, and
parents about how they perceive the effectiveness of music therapy
might be quite helpful, since this study only reflects the respon­
dents' perceptions. This might also indicate that generalization to
other settings is a topic for careful study. If music therapy interven­
tions are effective within the confines of the session, but those ef­
fects are not generalized to other settings, then is music therapy ac­
tually effective? The answer might be yes if a cumulative effect was
found that could lead to generalization later in time. Further foun­
dational research in the effect of music upon brain functioning
might be extremely important in this case.
Referral Sources for Music Therapy Treatment of ADHD
There is certainly some meaning in the fact that most referrals
for music therapy for children diagnosed with ADHD come from
the parents of these children, even when music therapy is mandated
on the child's IEP. Perhaps this suggests that parents really do feel
that music therapy is effective for treating their ADHD children. Or
it might suggest that the standard treatments for ADHD are not fully
meeting their children's needs, or that the side effects from medica­
tion are unacceptable and parents are seeking alternate treatment
that will be effective. Again, a survey of the parents of these chil­
dren would provide needed information about why they seek mu­
sic therapy as a treatment, and how effective they find it to be.
Teachers, who make the second most referrals to music therapy
for ADHD children, could also provide important information if
asked the same questions. Additionally, teachers could provide in­
formation about the effects of music therapy on the scholastic per­
formance of these children, as well as providing feedback about
the generalization of skills or behaviors that are being developed in
music therapy.
The Role of Music Therapy in the Treatment of ADHD Children
Most respondents indicated that the role music therapy plays in
the treatment of ADHD children is multidisciplinary. It seems that
a multidisciplinary approach may be the best for this particular
population since, by definition, children with ADHD will present
problems in multiple functional domains and in multiple settings.

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 318 Journal of Music Therapy

As previously mentioned, when the music therapist works with oth­

ers in the treatment of these children, not only will the children
have the benefit of multiple approaches in treatment, but the ther­
apist will have the opportunity to receive feedback from others
about how the children are functioning in other settings, such as in
the classroom. The MTA study conducted by the NIMH, which was
cited earlier, was an attempt to determine if multiple forms of treat­
ment were most effective for children diagnosed with ADHD, but
the sheer size of the project may have hindered the success of its
outcome as no firm conclusions could be drawn from the results. A
more controlled study involving the comparison of similar facilities
treating similar populations might provide better results from
which conclusions could be drawn. This kind of study would bene­
fit all of the professions involved, and could make a real difference
in the kinds of treatment children with ADHD receive.
Additional Comments
Respondents made a number of comments related to music
therapy methods used for children with ADHD. Some commented
on the use of multi-sensory interventions or sensory integration.
Others commented on various ways of providing structure, or pro­
viding freedom within a structure. And, importantly, some men­
tioned the iso-principle, or the necessity of matching what feels
right to the child. These comments help in clarifying what thera­
pists consider when choosing an approach or method to employ in
treatment of these children, and also begin to define some of the
elements contained in these methods.
The idea of "freedom within a structure" has not been examined
in the existing music therapy literature as it relates specifically to
ADHD children, but which might be deserving of more attention.
Comments made by respondents implied that they combine the el­
ement of freedom with the element of structure to successfully
treat ADHD children. It would be interesting to see if there is some
connection between exposure to this type of experience and de­
velopment of the child's ability to internally structure himself. If so,
this might impact heavily upon the ADHD symptom of impulsivity,
a symptom that not only is disruptive to the child and his environ­
ment, but that also can be potentially dangerous.
Numerous comments related to the effectiveness of music ther­
apy treatment for ADHD children were made by respondents.

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 Vol. XL, No. 4, Winter 2003 319

These included comments pertaining to attention, on-task behav­

ior, increased self-esteem, increased self-expression, and increased
frustration tolerance, all of which the respondents felt were en­
couraged and supported by music therapy. Some respondents in­
dicated, however, that these improved behaviors do not seem to
generalize to settings outside the sessions. One respondent com­
mented that a multidisciplinary approach is most effective, and this
comment may be related to the question of generalization in that
professionals working together on a treatment or educational plan
for a child should create some continuity of care that should in­
crease the likelihood that improvement will be seen in more than
one setting. It also raises the question of who should be involved in
the music therapy session. If parents, teachers, or other people who
work with the child are involved in the music therapy sessions, will
there be better carry-over from one setting into another?
One respondent noted that the relationship between therapist
and child is an important element in the effectiveness of music
therapy treatment, stating that it is the ability to "observe/discern
together" that makes treatment successful. This is somewhat re­
lated to those who commented on the iso-principle in terms of
meeting the child where he is at the moment, but also implies that
the child himself has some inner wisdom about what he needs and
the therapist who is sensitive to that wisdom may have more success
with treatment. Studies examining the relationship between music
therapist and the ADHD child might not only bring insight into the
process of the therapy, but also might be informative in terms of
identifying those elements of music therapy that most contribute to
successful treatment.
Comments from respondents that were directly related to ele­
ments of music therapy treatment for ADHD children follow in suit
with the previous comments. Structure and how it is used in the
music therapy session seems to be an important element that can
be approached in different ways. Some comments mention struc­
ture in a manner that seems to suggest that it is the therapist's role
to create the structure needed for the child to organize himself,
while others seem to suggest that the therapist provides structure as
a container in which the child can decipher how he needs to be or­
ganized. This is a subtle difference that would have large impact on
the choice of method used in the therapy session. A closer exami­
nation of how structure is created and used within the music ther­

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 320 Journal of Music Therapy

apy session with ADHD children might yield some interesting and
revelatory findings.
Music's ability to improve sensory integration was mentioned by
a respondent as an element of music therapy important in the
treatment of children with ADHD. This is an area that merits fur­
ther investigation as it is very closely related to the cognitive pro­
cessing problems that some like Hannaford (1995) theorize is the
most likely culprit in ADHD symptomatology. Multi-sensory input
is easily created with music since it is experienced through hearing,
through touch by means of vibrations, through spatial awareness by
means of rhythm and movement, and through sense memory,
which can easily be activated with music. The manner in which mu­
sic as sensory input is used, however, may be extremely important.
One respondent noted that some ADHD children can become over­
stimulated by music, and do best when in a quiet environment.
A recommendation was made that a theory of music therapy be
developed for the formulation and testing of treatment strategies
for children with ADHD. The many questions raised by this survey
give credence to the need for such a model, and indeed, that idea
was intrinsic to the development of this study. It also mirrors the
state of treatment for ADHD in general, which seems to be contin­
ually searching for the theory that will bring forth better results in
the treatment of these children.
A final recommendation made by a respondent was to use quali­
tative research methods in order to better understand how music
therapists are treating children with ADHD. Hopefully, this recom­
mendation will not go unheeded. Some of the questions arising
from this study would benefit from a qualitative research approach,
such as: what is the ADHD child's experience of music therapy
treatment, and, what is the importance of the therapist/client rela­
tionship in the treatment of children with ADHD?
A last miscellaneous category of comments by respondents in­
cluded comments about misdiagnosis and multiple diagnoses.
These comments are reflective of what the cited related literature
reports about the lack of standard assessment for diagnosing
ADHD, and about co-morbid diagnoses that make assessment and
treatment more difficult. Music therapy may have a role to play in
assessment of children with ADHD if better understanding of the
effects of music on these children can be developed. In line with
this was a comment regarding training for music therapists. This re­

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 Vol. XL, No. 4, Winter 2003 321

spondent indicated that ADHD is an area in which specialized

training should be given for music therapists, and noted that very
little was available, even at national conferences. This may be,
again, reflective of the overall controversy surrounding ADHD, its
assessment and treatment. Until some consensus can be reached
about what ADHD is and how it should be diagnosed and treated,
training in this area will probably be sparse at best.
Conclusion
The purpose of this study was to develop a general picture of
how music therapists are treating early elementary school children
with a diagnosis of ADHD, and of the role music therapy plays in
the overall treatment of these children. It was hoped that this pic­
ture would provide music therapists with the information needed
to make more purposeful and effective choices for successful treat­
ment. It was also hoped that this picture might highlight patterns
upon which a theory of music therapy for the treatment of ADHD
might begin to be formed. As is usual with most research, the final
results raise many new questions. Among these are questions about
what element/s of music therapy is/are most responsible for bring­
ing about effective results, about how success in music therapy
treatment for ADHD can be generalized to other settings, and
about how music therapy treatment for ADHD compares to treat­
ment with medication. Ultimately, it is hoped that these and other
questions to which this study has given rise will provide impetus for
music therapists to further investigate the influence of music on
children with ADHD.
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