Did you know that ADHD is one of the most common neurodevelopmental disorders in Canada? According to the Centre for ADHD Awareness, it affects 4-6% of adults and 5-7% of children or approximately 1.8 million Canadians. This means 1 in every 21 Canadians has the disorder. So what is ADHD? ADHD stands for Attention-Deficit/Hyperactivity Disorder. The DSM-V defines symptoms of ADHD as inattention, hyperactivity and impulsivity. Inattention might include failure to pay attention to detail and difficulty focusing and following through tasks. Hyperactivity might include excessive fidgeting and movement not appropriate to the situation, while impulsivity may include difficulty with turn taking or blurting something out. ADHD can be defined as a predominantly inattentive, hyperactive/impulsive or combined presentation, and often persists into adulthood. However sometimes the diagnosis is missed in childhood leading to a diagnosis later in life. Persons with ADHD have lower levels of the neurotransmitter dopamine. Dopamine is involved in attention and memory, movement, reward and motivation. A study from Lyon University found that listening to the music you like will increase the release of dopamine from your brain. Curious to know more about how music can support persons with ADHD? Well, music is often used to practice attention skills. Attention can be broken down into four types: sustained, selective/focused, alternating and divided. Did you know that learning to play an instrument can help develop different memory and attention skills? For example, while playing piano you have to sustain your attention on the task, alternate your attention between the music and your hands, as well as divide your attention between the treble and bass clef. If you catch yourself playing a wrong note, you might also pause to practice the passage. Other examples of attention exercises might include responding to different musical cues with music and movement. For example, to practice selective/focused attention a music therapist might have the client drum along to a beat with distractions in the background and a distinct musical cue that indicates stop and start. Another example of an alternating attention exercise might look like clapping if you hear the drum and swaying if you hear the guitar - this requires you to switch your focus between two different sources! Overall, attention exercises are important for improving focus on tasks, filtering out distractions and multitasking. Persons with ADHD often struggle with executive function. Executive function is our ability to plan, organize and make decisions etc. Research suggests that music therapy can improve executive functioning. Improvisational music playing and musical composition can help a client work on these skills in a pleasurable and motivating environment! In order to create a musical composition you have to plan and organize the structure, making decisions about your creation along the way. Finally music can also help with stress management and emotion regulation. Music and progressive muscle relaxation or movement can help calm the body and mind, as well as get rid of excess fidgeting. Improvisational music playing, listening and creating can also provide a means of self-expression in order to regulate one’s emotions. No matter your age - music can help improve attention, reduce hyperactivity and create pleasurable experiences for persons with ADHD. 

“Good morning everyone! My name is Kaitlyn and I am so excited to be here with you all on this fine Tuesday...I’m going to sing you a song. If you know the words, feel free to sing along or just move to the music. It’s by an artist who most you probably know named Elvis Presley...and it has a little something to do with love.” Now in the second year of my music therapy internship at the University of Toronto , that introduction is one I’ve given many times at a practicum placement in long-term care. I can still remember that first morning last September like it was yesterday. After the temperature checks and the Covid tests we made our way through the winding halls to a back room. Residents were gathered in a circle playing games, patiently waiting for their next activity to start. Now I’ve been in long-term care homes before, probably more times than I can count. But never on this side. Never like this. A new music therapy intern, here to help and learn. I have two grandmothers with Alzheimer’s Disease so it probably wasn’t a surprise to anyone that I ended up here. As I witnessed the deterioration of my loved ones firsthand, I also experienced the profound influence that music continued to have in their lives. On the most difficult days, music continues to be our sole form of communication. When I play songs that remind them of their loved ones, their favorite Italian opera singer or the nursery rhymes they used to sing to me as a child, it sparks a connection between us, even if just for a moment. At that time in my life, I was completing a Bachelor of Music at the University of Toronto, and if I’m being honest, I struggled. I was in a constant state of stress, anxiety and fear, worried that I would never be enough as a musician. All the stress and pressure I had put on myself to succeed as a musician had tainted my relationship with music and my ability to share it with others. The thing that I had once loved, was no longer a source of joy, but a source of pain. Towards the end of my degree I discovered music therapy. Bev Foster even came to one of my classes to talk about Room 217 and her story. New to the world of music and health, I decided to jump in headfirst and apply for a masters in neurologic music therapy. From that first day of school I was in love, but I was also terrified. Terrified of making a mistake, terrified of making the wrong decision. The stakes seemed higher now. The music seemed to matter more now. All those insecurities that had become second nature during my undergraduate degree started to build up again, until one day I noticed they weren’t there anymore. Each time I worked with a client, that fear, anxiety and uncertainty started to chip away. As I learned about their families, their careers and their passions I began to share in their successes and they shared in mine. I developed relationships with others like I’d never known. Relationships that made saying goodbye at the end of the year oh so difficult. After months of working with others, I still hadn’t played for my own grandmothers. And if I’m being honest, it’s because I was scared. While I often sang along to recorded music with them, I had never accompanied myself on an instrument. This year I played music for all sorts of people. Why couldn’t I just play music for the people in my life? For the ones in my life who needed it the most? A couple of months ago I played for one of my grandmother’s in long-term care. Just us and my guitar. Finding music therapy not only allowed me to help others, but it helped me find myself again. To find my voice, my passion and the love I have for sharing my musical gifts with others. It reminded me why I even chose to pursue music in the first place. My grandmother doesn’t care if I play a wrong note or if I sound a little flat. She just cares that I’m there. She cares that I’m with her and for a moment, it’s just us. And even though she has lost the ability to use her words and she hasn’t remembered who I am in a very long time, I know that she loves and cherishes this time together. I watch her foot tap to the music, I feel her hands squeeze mine, and I know she is with me. At the end of every visit I always ask her for a kiss. I bring my cheek to her face and say “Dammi un bacio?” She kisses me every time. All I ever wanted to do was to make people happy with music. I wanted them to experience the same love and joy that music brought to my life. So as I enter my final year of study to become a neurologic music therapist, these are the things that I will keep with me. When those fears and insecurities try to creep in, I will remind myself of where I came from and where I’m going. I will remind myself of the people I am doing this for. Myself. My loved ones. The people I haven’t had the pleasure of meeting yet. There’s a lot of things to be scared of, but helping others with music like it has helped me, isn’t one of them. At least not anymore. Room 217 was part of my journey to becoming a music therapist. To this day I still have the pamphlet Bev handed out in that class. Her story inspired me . It reminded me why I wanted to use music to help others. It can be difficult to help our loved ones, to know where to start, especially when it comes to using music. The beauty of Room 217 is that it gives us that starting place, guides and supports us as we gain confidence with music in care. So wherever you are in your journey, know that it’s never too late to start to incorporate music into your life, your care visits. While you may or may not become a music therapist, all of us can access music as a means of care for ourselves and others. For more information on becoming a music therapist, visit the Canadian Association of Music Therapists www.musictherapy.ca .

Have you ever listened to a song and felt like you were transported back in time? I know I have. For individuals living with dementia, this can be harnessed as a powerful tool to help them remember important times in their lives with friends and family. In neurologic music therapy, we use a technique called Associative Mood and Memory Training or AMMT for short. Thaut (2014) describes AMMT as a musical mood induction technique to induce a mood congruent state for memory recall or to access associative mood and memory networks by inducing a positive emotional state in learning and recall. A mood congruent state occurs when information we are encoding or recalling matches our current mood. For example, remembering positive memories while in a positive mood. State dependent memories occur when information encoded in a particular state is better remembered if the same state is experienced at the time of recall. For example, remembering details of your own wedding while attending another wedding. Associative mood and memory networks refer to the fact that our memories are encoded in connection with concepts that describe the event, such as the people, weather or location. For these reasons, when I implement AMMT with older adults I play a combination of live and recorded music with different props and images related to songs they would have enjoyed in their young adult years and ask them questions about the music and their experiences to help facilitate memory recall. Did you know that our most significant memories are created between the ages of 15 and 25? This phenomenon is called a “reminiscence bump”. Studies have found that this applies to music as well. In the reminiscence bump, music and memories from these years will be more readily recalled. What's interesting about this is that we also have these cascading mini reminiscence bumps. The first mini bump occurs for the music our parents listened to, and the second mini bump occurs for the music our grandparents listened to! The next time you want to help someone reflect on the positive memories in their life, or even in your own life, put on some music related to these special memories and see what happens.

The impact of COVID in care settings, specifically Long-Term Care, has been monumental with social programming being set aside for safety protocols and PPE. Although the movement to a more medical model of care makes sense from a safety lens, we are now realizing the devastating effect this has had on residents as they express helplessness, loneliness, isolation, and boredom. In December 2021, Patient Ombudsman, Craig Thompson, was interviewed about the recent report entitled “Honouring Voices and Experiences, Long-Term Care Home Survey” where he suggests hiring more Recreation Therapists to offset the impact of restrictions. Elaine, an 85-year-old woman with dementia was quoted as saying ‘I just wish someone would dance with me.’ She acknowledges that her physical needs were taken care of as she was clothed and fed, but her greatest desire was for someone to stop and dance with her. The music care approach has been taught for over 16 years by Room 217. Our Level 2 Music Care Training talks about the 5 human domains being spiritual, cognitive, emotional, physical, and biological and how music works to meet needs in all areas. Recreation Therapists are trained to understand mental, physical, psychological, social, and spiritual domains of residents and develop programs providing care based on the needs of residents. When music is used by Recreation Therapists, the outcome is better quality of life for all, staff included. Our upcoming Masterclass is open to anyone with Level 2 or 3 Music Care Training, and all LEARN and CERTIFY members. On August 18th, we will be hosting a Dance Therapist and Teacher, Katherine Mandolidis of Ballet Edmonton who will walk us through a series of music and movement that can be added as an everyday wellness routine or break. Join us for music, movement and conversation and let’s bring some light back into the lives of those that need the music most. In the meantime, let’s all seek inspiration from the viral video of Marta Cinta Gonzalez, a former ballet dancer living with Alzheimer’s, come to life when she hears the music of Swan Lake. Watch video Link to report noted in blog: https://www.trontario.org/files/Advocacy/TRO-LTC-Commission-Submission-Nov-2020.pdf

This article was written by Julia Cara, and is part of a series provided by upper year Health Sciences students at McMaster University.