Musical Hallucinations in a Preadolescent With ADHD: A Case Report

Musical hallucinations are a rare auditory phenomenon, with fewer than 50 pediatric cases reported in the literature. They are particularly uncommon in children without hearing impairment or psychosis.

A Thai girl with ADHD, diagnosed at age 5 years and treated with methylphenidate, presented with a 1-week history of bilateral musical hallucinations. The hallucinations consisted of instrumental music without lyrics, were nonpulsatile, occurred predictably during specific hours, and were emotionally distressing. Audiologic evaluation showed normal hearing bilaterally, and EEG showed normal background activity with no epileptiform changes during hallucination episodes. She also exhibited frequent eye blinking consistent with simple motor tics. Developmental assessment revealed some developmental delays, with a KBIT-2 composite IQ of 87, showing a moderate discrepancy between verbal (79) and nonverbal (98) domains, potentially reflecting both neurodevelopmental vulnerabilities and sociolinguistic factors. Initial nonpharmacological interventions including media restriction and behavioral techniques were unsuccessful. Low-dose risperidone (0.25 mg/day) led to complete resolution of hallucinations, tics, and associated emotional distress within 3 weeks. She remained symptom-free at the 3-month follow-up.

Musical hallucinations can occur in children with ADHD even in the absence of hearing impairment, epilepsy, or psychosis. Early recognition, comprehensive evaluation, and multidisciplinary management are essential. When symptoms cause significant distress, low-dose risperidone may be an effective treatment. Recognizing the structured and nonpsychotic nature of musical hallucination in neurodevelopmental contexts may help avoid misdiagnosis and guide appropriate intervention.