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Meta-Analysis
. 2024 Aug;63(8):778-788.
doi: 10.1016/j.jaac.2023.12.014. Epub 2024 Feb 28.

Systematic Review and Meta-Analysis: Do White Noise or Pink Noise Help With Task Performance in Youth With Attention-Deficit/Hyperactivity Disorder or With Elevated Attention Problems?

Joel T Nigg  1 , Alisha Bruton  2 , Michael B Kozlowski  2 , Jeanette M Johnstone  2 , Sarah L Karalunas  3
Affiliations
Meta-Analysis

Systematic Review and Meta-Analysis: Do White Noise or Pink Noise Help With Task Performance in Youth With Attention-Deficit/Hyperactivity Disorder or With Elevated Attention Problems?

Joel T Nigg et al. J Am Acad Child Adolesc Psychiatry. 2024 Aug.

Abstract

Objective: Public interest in the potential benefits of white, pink, and brown noise for attention-deficit/hyperactivity disorder (ADHD) has recently mushroomed. White noise contains all frequencies of noise and sounds like static; pink or brown noise has more power in the lower frequencies and may sound, respectively, like rain or a waterfall. This meta-analysis evaluated effects on laboratory tasks in individuals with ADHD or elevated ADHD symptoms.

Method: Eligible studies reported on participants with diagnosis of ADHD or elevated symptoms of ADHD who were assessed in a randomized trial using laboratory tasks intended to measure aspects of attention or academic work involving attention or executive function while exposed to white, pink, and brown noise and compared with a low/no noise condition. Two authors independently reviewed and screened studies for eligibility. A random-effects meta-analysis was conducted with preplanned moderator analyses of age, diagnostic status, and task type. Publication bias was evaluated. The GRADE tool was used to assess certainty of the evidence. Sensitivity analyses were conducted to evaluate robustness.

Results: Studies of children and college-age young adults with ADHD or ADHD symptoms (k = 13, N = 335) yielded a small but statistically significant benefit of white and pink noise on task performance (g = 0.249, 95% CI [0.135, 0.363], p < .0001). No studies of brown noise were identified. Heterogeneity was minimal, and moderators were nonsignificant; results survived sensitivity tests, and no publication bias was identified. In non-ADHD comparison groups (k = 11, N = 335), white and pink noise had a negative effect (g = -0.212, 95% CI [-0.355, -0.069], p = .0036).

Conclusion: White and pink noise provide a small benefit on laboratory attention tasks for individuals with ADHD or high ADHD symptoms, but not for non-ADHD individuals. This article addresses theoretical implications, cautions, risks, and limitations.

Plain language summary: Public interest in the potential benefits of white, pink, and brown noise exposure for enhancing task performance for individuals with attention-deficit/hyperactivity disorder (ADHD) has increased substantially. This systematic review and meta-analysis included 13 studies with 335 participants and found that white/pink noise improved cognitive performance for children and young adults with ADHD or significant ADHD symptoms. In contrast, white/pink noise impaired cognitive performance for individuals without ADHD. Positive effects of noise were small, but these results point to a possible low-cost, low-risk intervention that may benefit youth with ADHD. Additional studies are needed to confirm effects and identify safe and appropriate decibel levels. The potential detrimental effects for individuals without ADHD also requires further study.

Study preregistration information: White Noise for ADHD: A Systematic Review And Meta-analysis; https://www.crd.york.ac.uk/prospero; CRD42023393992.

Keywords: arousal theory; attention-deficit/hyperactivity disorder; meta-analysis; white noise.

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Conflict of interest statement

Disclosure: Drs. Nigg, Bruton, Kozlowski, Johnstone, and Karalunas have reported no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1:
Figure 1:. Time Series Plots of 60 Seconds of White, Pink, and Brown Noise, Respectively
Note: To hear an example of each type of noise, see: https://sciencenotes.org/colors-of-noise-white-pink-brown-and-more/ Note: Panels represent temporal plots of one minute of white, pink, and brown noise, respectively, as generated using the tuneR package in R. The y-axis is the amplitude limit of each wave, rescaled from −1 to 1. The plots illustrate that white noise has equal intensity at all sound frequencies. Pink and brown noise have greater intensity at different (lower) frequencies. White noise is sometimes described as sounding like radio static, pink noise like heavy rain, and brown noise like ocean waves or rolling thunder.
Figure 2:
Figure 2:. PRISMA) Diagram
Figure 3:
Figure 3:. Forest Plot of Primary Model Results for Individuals With Attention-Deficit/Hyperactivity Disorder (ADHD) or Elevated Attention Problems
Note: Size of square proportional to study N/weight; lines represent 95% CI. Final row diamond encompasses 95% CI.
See this image and copyright information in PMC

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