A few days ago, I had the opportunity to meet an individual who shared his struggles with ADHD, comorbid with Autism. He revealed that he only received his diagnosis after his son
was diagnosed, realizing that “we have the same behaviours.” In an attempt to understand his condition better, he even tried his son’s Ritalin medication, a stimulant used to treat ADHD. He recounted how it took him years to learn social cues; for instance, during his time at university, his friends had to guide him on how to navigate social situations, such as how to behave at parties and how to avoid correcting intoxicated individuals, which could make interactions awkward. I would have never guessed, he appeared so easy-going and open speaking to myself. He simply replied “I’m still learning” although admitted he acquired the ability to observe human behaviour in intricate detail and learn behavioural patterns to predict what will happen in social interactions. I was fascinated. The man was very successful, I could not help but appreciate all the challenges he’s overcome, and lessons learned to get where he is. I asked him “so what really helped you?”, “aha” he responded, “I listen to 528Hz sounds, it’s the only thing that puts me to sleep, but if I am dreaming, and I wake up, I can’t hear these sounds”. I went on to listen to this fascinating story. He showed me a study he read about that prompted him to try these sounds in the first place and I went on to further do my research. Presented in this blog and inspired by this intriguing individual I had the luck to meet, are promising findings exploring additional strategies and techniques to coping with ADHD and/or ASD symptoms.
Background & Comorbidity
Clinically, Attention Deficit Hyperactivity Disorder (ADHD) is primarily characterised by symptoms of inattention, hyperactivity, and impulsivity, whereas Autism Spectrum Disorder (ASD) is defined by challenges in social interaction, communication difficulties, and repetitive behaviours. Children with ADHD tend to be talkative and active, often eager to interact, while children with ASD may exhibit more motor stereotypies, idiosyncratic communication, and a preference for predictable behaviours to avoid unpredictability. These disorders also differ epidemiologically; ASD is typically diagnosed before the age of three, whereas ADHD diagnoses often occur later. However, both are neurodevelopmental disorders with frequent comorbidities. Literature evidence suggests estimates of ADHD in ASD range from 50% to 70%, although there is considerable variability across studies, which can be attributed to differing methodologies and sample populations (Hours et al., 2022). Individuals with ADHD and autism often share common experiences, including sensory differences, intense focus on specific interests, rejection sensitivity, executive dysfunction, sleep disturbances, and emotional dysregulation (Petti et al., 2023).
Attention plays a crucial role in understanding the cognitive profiles of both ASD and ADHD. Attention refers to the process of selecting and focusing on specific stimuli, which can be influenced by working memory, executive functions, and sensory perception. In ASD, sustained and focused attention can be stronger than in neurotypical individuals, particularly in non-social settings. However, deficits in reflexive disengagement and voluntary orienting of attention are noted. While ADHD primarily involves deficits in attention span and distractibility, ASD-related attentional issues are more closely tied to social deficits and perceptual processing. This highlights that attention impairments in ASD and ADHD differ, with ASD’s attentional difficulties often linked to heightened perception and difficulty shifting focus, rather than short attention spans.
The DSM-5 now allows for the diagnosis of both ADHD and ASD in the same individual, which was not the case in earlier diagnostic manuals such as the DSM-IV and ICD-10. However, the issue of comorbidity between ASD and ADHD remains complex. Studies suggest that children with ASD and comorbid ADHD exhibit more severe symptoms, especially in areas of social interaction and impulsivity. This raises the question of whether such symptoms are truly indicative of ADHD, or whether they stem from the severity of the ASD itself. Structural differences in attentional processes between ASD and ADHD have been found in some studies, while others highlight shared deficiencies. Researchers such as Barnard-Brak (2015) note differences in cognitive tasks, such as sustained attention, with individuals with ASD showing better performance in tasks like rapid letter naming compared to those with ADHD. Such findings call for caution in interpreting attentional task results, as environmental factors can influence outcomes.
Physiopathological studies, including imaging and EEG data, further illuminate the distinctions between ASD and ADHD. ASD is associated with anomalies in regions such as the orbitofrontal cortex, fusiform gyrus, and cerebellum, which are tied to learning, memory, and executive functioning. ADHD, on the other hand, is primarily linked to deficits in the prefrontal cortex, which affects inhibition and executive control. Neuroimaging studies by Chantiluke et al. (2014) have shown that comorbid ASD-ADHD presents unique impairments, distinct from either disorder alone. While both disorders involve atypical attention processing, the underlying causes differ. ADHD’s attention deficits are often due to impaired inhibitory control, whereas ASD involves sensory processing challenges that impact attention.
Cognitive and behavioural studies reinforce the complexity of distinguishing ASD from ADHD. For instance, children with ASD can focus intensely on tasks that interest them, such as puzzles or drawing, while children with ADHD often struggle to maintain attention even during engaging activities. This selective attention capacity in ASD contrasts with the more global attentional deficits seen in ADHD. Studies by Mayes et al. (2012) and Van der Meer (2015) suggest that ADHD and ASD may be manifestations of an overarching neurobiological disorder, with emotional regulation as a shared factor. This overlap includes genetic components, as Ghirardi et al. (2018) point out that there may be a genetic link between ADHD and ASD, which genomic studies have likely underestimated.
Sleep, Stress & Anxiety Relief
Sleep disturbances are more prevalent among individuals with both ASD and ADHD compared to the general population. These disruptions often include specific sleep disorders such as sleep onset insomnia (SOI), obstructive sleep apnea (OSA), sleep-disordered breathing, restless leg syndrome (RLS), and periodic limb movement disorder (PLMD), (Gupta, 2023). Children with ASD and ADHD often experience heightened levels of stress due to their difficulties in social interactions, communication challenges, and sensory sensitivities. This increased stress can lead to elevated physiological arousal, which can interfere with the ability to fall asleep and stay asleep (López et al., 2020). Moreover, chronic stress can lead to the release of cortisol, a hormone that, when chronically elevated, has been linked to disrupted sleep patterns and poorer sleep quality (Gupta et al., 2018). Sleep disturbances, in turn, can increase anxiety and irritability, further exacerbating behavioural symptoms associated with ADHD, such as impulsivity and inattention (Glick et al., 2020).
Research indicates that neurobiological factors, including dysregulation of circadian rhythms and alterations in melatonin production, play significant roles in sleep disturbances
among these children (Glick et al., 2020). Impairments in the melatonin pathway may lead to a decreased ability to initiate and maintain sleep, which is crucial for optimal functioning and behaviour regulation (Glick et al., 2020). Moreover, the presence of sensory sensitivities, common in both ASD and ADHD, can exacerbate sleep difficulties. Children may struggle to create a conducive sleep environment due to sensitivities to light, noise, and other sensory inputs, leading to increased nighttime awakenings and difficulties settling down to sleep (Dewald-Kaufmann et al., 2019). These factors, coupled with the behavioural manifestations of ADHD, such as impulsivity and hyperactivity, create a compounding effect on sleep quality, thereby impacting cognitive, emotional, and social functioning.
Additionally, the impact of sleep difficulties on behavioural and cognitive outcomes in children with ASD and ADHD cannot be overstated. Poor sleep quality has been associated with increased severity of ADHD symptoms, including inattention and hyperactivity, and can lead to heightened anxiety and irritability in children with ASD (Dewald-Kaufmann et al., 2019). The reciprocal relationship between sleep problems and behavioural symptoms suggests that interventions targeting sleep may result in improvements in core symptoms of both disorders (Becker et al., 2021). For instance, behavioural interventions focusing on establishing regular sleep routines and improving sleep hygiene have shown promise in reducing sleep problems, which in turn may enhance daytime functioning and behavioural regulation (Cortese et al., 2021).
By addressing the complex interplay between sleep and the neurodevelopmental profiles of children with ASD and ADHD, clinicians can develop targeted interventions that optimise treatment outcomes and improve the overall well-being of affected children. More specifically, interconnectedness of stress, sleep problems, and behavioural challenges suggests that interventions aimed at reducing stress may be beneficial in improving sleep quality and behavioural outcomes.
528 Hz – The Miracle Sound
Akimoto and colleagues conducted a study exploring how music at a frequency of 528 Hz affects our body and mind, specifically focusing on stress levels. Nine healthy participants listened to 528 Hz music for five minutes and the results were significant. After listening, their levels of cortisol, a hormone related to stress, dropped from 0.43 ± 0.04 to 0.25 ± 0.02 μg/dl (p < 0.011). This indicates that the 528 Hz music helped reduce stress. In contrast, listening to 440 Hz music did not show a significant change in cortisol levels, highlighting the unique calming effect of the 528 Hz frequency. Additionally, the participants’ levels of oxytocin, often called the “feel-good hormone,” significantly increased from 37.57 ± 1.53 to 73.58 ± 5.04 (p < 0.038) after listening to the 528 Hz music. This suggests that this frequency might enhance feelings of happiness and relaxation. While there was a trend for another stress-related substance, chromogranin A, to decrease after listening to 528 Hz music, this change wasn’t statistically significant.
Looking at how music impacts the nervous system, both music types led to a decrease in the ratio of low frequency to high frequency (LF/HF), which suggests that the body shifted towards a more relaxed state. However, a specific measure of heart rate variability (CVRR) significantly decreased only after listening to 528 Hz music (p < 0.025), indicating a more noticeable calming effect with this frequency. Participants also reported feeling less tense and anxious (p < 0.0091) and experienced a decrease in overall mood disturbance (p < 0.0487) after listening to the 528 Hz music, pointing to a positive effect on their emotional well-being. On the other hand, the 440 Hz music did not lead to significant improvements in mood, and there was even a slight increase in feelings of anger, suggesting some discomfort associated with this frequency.
The study demonstrates that music at a frequency of 528 Hz can significantly lower stress levels and improve mood. The reduction in cortisol levels and increase in oxytocin after listening to 528 Hz music suggest it has a calming influence on the body. Given that these benefits were observed after only a short listening period, this frequency may be a valuable tool for helping people manage stress and improve their emotional health (Akimoto et al., 2018).
The use of music, particularly with a frequency of 528 Hz and characteristics of internal repetition, presents significant benefits for children with ADHD and autism, who often face challenges related to sensory sensitivities and anxiety. Children on the autism spectrum frequently engage in repetitive behaviours, such as rocking or flapping, as a means of self-regulation to alleviate anxiety. However, societal stigma around these behaviours can lead to social isolation and hinder their emotional and social development. Traditional concert environments, which typically require children to sit quietly and remain still, can be overwhelming for those with sensory sensitivities, preventing them from enjoying the full benefits of live music experiences. Kim’s (2022) research indicates that predictable patterns within music can enhance engagement and interest for these children, allowing them to connect with the performance while managing their sensory overload. For instance, the study highlights that music featuring strong internal repetition not only calms but also captivates the attention of children aged 5-14, facilitating a more positive experience in settings like live concerts. Such findings suggest that integrating music with these characteristics into therapeutic interventions could support emotional regulation and social engagement for children with ADHD and autism, offering them a joyful avenue for self-expression and connection with others.
Further support examining the effectiveness of music-listening interventions for managing pain and stress, focusing on how frequency modulation and participant selection influence outcomes aimed to identify the most effective method for alleviating pain and stress. While the study has limitations, such as the lack of a non-musical control group and challenges in generalisability, it serves as an important first step toward understanding the relationship between music, pain perception, and stress, particularly for children with ADHD and autism who may benefit from tailored music interventions. The potential of music—especially when designed to meet the specific needs of children with sensory sensitivities—highlights its therapeutic value. The research suggests that predictable musical patterns can enhance engagement and emotional regulation, fostering a more inclusive environment for children with ADHD and autism during live music experiences (Feneberg et al., 2020).
Conclusions, Key Takeaways and Future Implications
The story of the individual with ADHD and comorbid ASD highlights the unique challenges faced by many navigating these neurodevelopmental conditions. His use of 528 Hz music as a coping mechanism demonstrates the potential of sound frequencies to enhance emotional well-being and sleep quality, both of which are often compromised in children with ADHD and autism. Given the promising evidence supporting music therapy, integrating sound-based interventions into treatment plans could significantly benefit affected individuals. Future research should focus on long-term effects of music exposure on stress reduction, sleep improvement, and emotional regulation through randomized controlled trials. Personalizing music interventions based on individual preferences can enhance their effectiveness.
As we delve deeper into the therapeutic potential of music for ADHD and autism, we pave the way for holistic approaches that address the multifaceted challenges these children face, ultimately promoting greater inclusion and well-being in their lives.
Written by Weronika, Smart TMS Edinburgh practitioner
References
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