Auditory stimulation and its effects on ADHD students

Auditory Stimulation: Its effect on the ADHD student

The presence of students with ADHD in the classroom is an increasingly common occurrence. Teachers must be aware of possible methods to improve the behavior and performance of students with this disability. One commonly occurring characteristic of ADHD is defective processing of auditory information. Methods using or minimizing auditory stimuli are explored, with an emphasis on how teachers can either implement certain techniques or refer students to practitioners for necessary treatment. The physiology involved in the processing of auditory information is discussed, as well as research into how sound can help or hinder the performance of children with ADHD

The typical classroom environment is encompassed by several stimuli. General activity, talking, and background noise may all serve as distractions to students that need to pay attention in order to learn. Disruptive stimuli may especially pose a challenge for students with attention deficit hyperactivity disorder (ADHD), a debilitating learning disability characterized by distractibility, impulsiveness, and an inability to pay attention in a sufficient manner. ADHD has become an increasingly common problem among American children, and some would argue that the occurrence of this disorder in the general population is growing consistently (Jackson, 2003). Therefore, teachers need to have a heightened awareness of this disorder and how the classroom environment may be contributing to the difficulties experienced by children with ADHD, as well as how the atmosphere provided within the classroom may help to facilitate learning for these learning disabled students.

Noise in the classroom is unavoidable. The sound of the teacher's voice echoing through the room, pencils grinding in pencil sharpeners, the murmur of students' chatting, and even the sound of pages of a book turning are all familiar auditory stimuli found in the classroom. How does noise affect the concentration and learning performance of students with ADHD? Why do students with ADHD react in certain ways to auditory stimuli? Is there a way that auditory stimuli may be helpful to these students? What can teachers do to improve the classroom in order to facilitate learning for students with ADHD?

Auditory processing and ADHD

The way children with ADHD process auditory stimuli fundamentally differs from normal children. Understanding these differences helps to elucidate the nature of ADHD and may indicate possible options for improving the learning conditions for students with the disorder. Often measures using auditory stimuli, such as the stop-signal task (Quay, 1997) and indications of electrodermal activity during listening tasks are used in the diagnosed ADHD. For instance, Shibaki et al. (1993) found that lower arousal and shorter attention spans among individuals with ADHD is demonstrated by decreased amplitude of skin conductance response with both passive and active listening tasks. In another study using auditory stimuli, Pearson et al. (1991) revealed that hyperactive children have difficulty reorienting to a switch in dichotically presented auditory stimuli. In other words, ADHD subjects could not switch their attention from one ear to the other. This indicates that the auditory reorientation skills of hyperactive children may be underdeveloped. Recognizing how sounds in the classroom contribute to the distraction and impulsiveness will only serve to improve conditions for students with ADHD.

Why do certain children experience ADHD and others do not? Quay (1997) believes that the answer to this question lies with the behavioral inhibition system (BIS). This is the system that conditionally responds to stimuli for punishment, non-reward, novelty and stimuli of innate fear in order to bring about passive avoidance and extinction. The output of this system causes the stopping of ongoing behavior, an increase in arousal, and the focusing of attention on environmental cues that are relevant to the present situation. The BIS controls the inhibition of responding learned under the threat of non-reward and punishment. ADHD is essentially a disorder characterized by the inability to inhibit responses even when faced with imminent punishment, such as a student who continually exhibits disruptive behavior in the classroom even though the child is aware that this behavior leads to punishment. Therefore, it makes sense to Quay (1997) that the roots of ADHD are grounded in the BIS.

One way of examining dis-inhibition involving auditory stimuli among children with ADHD is to us the stop-signal task. Subjects are instructed to perform a motor response to a target in a continuous performance task. They are also instructed not to respond to the target when an auditory signal is presented. The results indicated that the children with ADHD inhibited fewer responses than the controls. Therefore, the ADHD group was unable to stop a motor response when given an auditory signal, and shows the impulsiveness that is so prevalent in this disorder. If an auditory signal is ineffective in stopping a current, ongoing behavior exhibited by students with ADHD, teachers may have to adapt their communication and disciplining techniques in order to improve the behavior and performance of these students.

On the physiological level, researchers have found that distractible children, including children with ADHD, exhibit abnormal processing of auditory information. Kilpelainen et al. (1999) looked at the P300 event-related potential (ERP) at different points during an auditory stimulus discrimination task in a group of children who were either easily distractible or non-distractible. The easily distractible children showed a short-latency P300 response throughout the entire task, whereas the non-distractible group displayed a smaller corresponding response and the response got decreasingly smaller throughout the task. The short-latency P300 response indicates that the brain is utilizing its orienting networks, and this response decreases in size when stimuli become familiar and lose their novelty. Therefore, the persistent P300 response exhibited by the distractible children suggests that they are continually trying to orient to stimuli that should already be familiar and processed. This may indicate that instruction through auditory stimuli may not be as effective for students with ADHD because they can not properly encode and categorize the information due to their distractibility. Furthermore, if auditory instruction is used in the classroom, consistent repetition or maybe pairing of auditory information with visual stimuli may be necessary.

Impulsivity is common among children with ADHD. The extent to which this characteristic is affected by auditory stimuli was examined in a study by Gray et al. (2002). The researchers looked at how normal children and children with ADHD responded to auditory stimuli that was presented in a predictable, semi-predictable, or unpredictable manner. The findings indicated that in conditions where the background sounds were unpredictable, all children, both normal and ADHD, exhibited impulsiveness. However, the two groups of children diverged in the conditions of semi-predictable and predictable sounds. It appeared that children with ADHD became impulsive at lower levels of uncertainty in comparison to the normal children. Therefore, the researchers concluded that increasing the predictability of background sounds might reduce impulsivity among students with ADHD. Teachers may incorporate these findings into the classroom by finding ways to eliminate or at least reduce the occurrence of unpredictable, random and spontaneous background sounds in the classroom. Doing so may result in a marked improvement in the performance of students with ADHD.

Another characteristic commonly found among children with ADHD is impairment in psychological sense of time. Studies using auditory stimuli have also been used in the study of this phenomenon. West et al. (2000) obtained data from both children with ADHD and children in a control group using the Time Perception Application, in which the subjects performed both visual and auditory time reproduction tasks. The results indicated that ADHD subjects showed larger errors on visual reproduction tasks than the control subjects, but no difference between the groups were observed for the auditory time reproduction task. With the auditory reproduction task both the ADHD group and the control group consistently underestimated the time durations to be reproduced. How can these findings translate into the classroom setting? Teachers may find it valuable to incorporate a balanced amount of visual and auditory stimuli into their instructional methods.

Can sound help students with ADHD?

According to the research discussed, children with ADHD process auditory information differently than normal students. This inevitably has an effect on their performance due to the wide range of auditory stimuli that occur continually in the classroom environment. Teachers can integrate these research findings into their practice in order to reduce distraction experienced by students with ADHD and facilitate their learning.

Since children with ADHD process auditory stimuli different, is there a way that sound may be helpful to them in the classroom? The following research indicates that certain auditory stimuli may help to alleviate distraction and impulsivity among students with ADHD. Uno et al. (2006) sought to establish the continuous performance test (CPT), which measures sustained attention, as a tool for diagnosis by examining the effect that noise has on children with ADHD with they performed this test. Results indicated that certain error on the CPT decreased among the children with ADHD in the noise condition. This implies that noise may in a certain way induce improved attention in students with ADHD. These findings may be used in the classroom to improve the learning environment for students with ADHD, possibly through the use of background noise during times when sustained attention is required of students.

Further evidence for the possible value of noise for children with ADHD is presented by Abikoff et al. (1996). These researchers evaluated the effect that extra-task auditory stimulation had on academic task performance of children with ADHD. This was executed by studying both children with ADHD and normal students during the performance of arithmetic tasks during three different auditory stimulus conditions: high stimulation (music), low stimulation (speech) and no stimulation (silence). The findings indicated that the normal subjects performed similarly under all three conditions, while the ADHD subjects performance was significantly better under the music condition that the silence or speech conditions. This information could prove to be valuable for teachers in the classroom environment. The presence of music in the classroom during tasks such as arithmetic might facilitate the performance of students with ADHD. Since normal students performed equally well under all auditory conditions, the presence of music would not impede their performance at all.

Although the use of stimulant medications is generally used for the treatment of ADHD, other alternative, complementary treatments may be used to further improve the performance of children with this disability. There are several reasons why parents of children with ADHD may seek therapies other than drugs for treatment of the disorder. The pursuit of alternative treatments reflects the heterogeneity and complexity of ADHD (Baumgaertel, 1999). Music therapy has received attention from researchers as an effective therapy for children with ADHD. For instance, the use of auditory stimulation with individualized music has been shown to improve situational performance of children with ADHD during cognitive tasks (Baumgaertel, 1999). Could music therapy prove to be a valuable tool for teachers in the classroom with students that have ADHD?

Rickson (2006) examined the effects that instructional and improvisational models of music therapy have on the motor impulsivity of adolescents who have ADHD. The results of the study indicated that the instructional model of music therapy contributed to a reduction of restless and impulsive behaviors displayed by students with ADHD in the classroom. Therefore, based on these findings, teachers may find it valuable to include forms of music therapy through instructional models to improve performance of students with ADHD in several developmental areas including motor responses and cognitive tasks.

Jackson (2003) also investigated the use of music therapy with children who have ADHD. This researcher conducted a survey with the purpose of ascertaining exactly what music therapy methods are being used with children diagnosed with ADHD, how effective this treatment is, and the role that music therapy has in relation to other types of therapy.

Findings indicated that several different types of music therapy are used in the treatment of ADHD, and multiple types of goals are addressed through this type of treatment. Furthermore, the outcome of treatment using music therapy is generally perceived to be favorable for children with ADHD. Music therapy is an accessible option as well, and most referrals for treatment come from parents and teachers. Jackson (2003) does acknowledge that the vast majority of children with ADHD who receive music therapy are also on medication, and that his is in most cases necessary for successful treatment of this disorder.

Incorporating music into the classroom has been shown to be one possible way that teachers can improve the performance of students with ADHD through the use of auditory stimulation. Another auditory modality that may be an option is auditory integration training, or AIT. According to Schonbeck (2000), AIT is a specific type of auditory or music therapy rooted in the work of two French otolaryngologists Dr. Alfred Tomatis and Dr. Guy Berard. The premise on which this therapeutic method is based is that distortion in how auditory stimuli are heard contributes greatly to behavioral and learning disorders in children, such as ADHD. Essentially, training individuals with ADHD to listen in a particular way can stimulate cortical and central organization.

Central auditory processing (CAP) is the domain in which auditory integration is merely a facet. Schonbeck (2000) describes CAP how we process and integrate the auditory stimuli that we hear. Essentially, it may be understood as how we listen to what we hear, or how we form information from raw sensory data. Furthermore, CAP is the actual perception of sound and everything we do with sound stimuli, including attending to sound, remembering auditory stimuli, retaining the information in the long and short terms, the ability to selectively listen to sound, and to identify the location of sounds.

The treatments proposed by these two French therapies have similarities in their basis, but differ somewhat in their execution. The auditory integration training put forth by Berard consists of twenty half-hour sessions in which individuals listen to musical sounds through a stereophonic system using earphones. The music is random and contains filtered frequencies. The sound waves that travel through the earphones and into the individuals' ears exercise structures in the middle ear through vibration. Sessions are generally performed twice a day for 10 days.

The method employed by Tomatis utilizes an invention of his called the Electronic Ear. Through the operation of a series of filters, this device acts to re-establish right ear dominance in hearing. Schonbeck (2000) states that Tomatis' work is based in the following principles:

The most important purpose of the ear is to adapt sound wave into signals that charge the brain.

Sound is conducted via both air and bone. It can be considered something that nourishes the nervous system, either stimulating or destimulating it.

Just as seeing is not the same as looking, hearing is not the same as listening. Hearing is passive. Listening is active.

A person's ability to listen affects all language development for that person. This process influences every aspect of self-image and social development.

The capacity to listen can be changed or improved through auditory stimulation using musical and vocal sounds at high frequencies.

Communication begins in the womb. As early as the beginning of the second trimester, fetuses can hear sounds. These sounds literally cause the brain and nervous system of the baby to develop.

According to Schonbeck (2000), there are certain defects in central auditory processing are associated with the development of learning disorders in children, including ADHD. These defects include phonetic decoding, Tolerance-fading memory, response delays and difficulties with phonics, and problems with auditory organization. Auditory integration training addresses these problems through the implementation of the therapies mentioned above. One key factor in the success of these treatments is the universal presence of plasticity, or the ability that the brain has to physically change its connections and structuring through the learning process. This means that auditory integration training actually changes the physiological structures responsible for the development of learning structures in the brains of children with ADHD. As knowledge of the brain and its functions increases, this type of training will most likely only develop further and will become more accessible in the future. Practitioners of AIT may prove to be a valuable resource for teachers who must instruct students with ADHD.