A preadolescent girl in Thailand began hearing instrumental music that no one else could hear. It arrived during specific hours of the day, had no lyrics, and upset her. Her hearing was normal, a brain-wave recording made during the episodes showed no seizure activity, and she had no psychotic illness.
The case, published in the January/February 2026 issue of the Journal of Developmental & Behavioral Pediatrics, adds to a thin medical record. Fewer than 50 pediatric cases of musical hallucinations have been reported, the authors wrote, and they are particularly uncommon in children without hearing impairment or psychosis.
Songs Without Lyrics, on a Schedule
The girl had been diagnosed with ADHD at age 5 and was taking methylphenidate, the stimulant sold in the United States under brand names including Ritalin and Concerta. She arrived with a one-week history of music heard in both ears. It was instrumental, did not pulse in time with her heartbeat, and came predictably during specific hours.
Hearing tests were normal in both ears. An EEG recorded during hallucination episodes showed normal background activity with no epileptic discharges. Clinicians also noticed frequent eye blinking consistent with simple motor tics.
Developmental testing found some delays, with a composite IQ of 87 and a gap between her verbal score of 79 and nonverbal score of 98. The authors said that gap could reflect both neurodevelopmental vulnerabilities and sociolinguistic factors.
Low-Dose Treatment and a Full Recovery
Limiting her media exposure and trying behavioral techniques did not stop the music. Clinicians then prescribed risperidone, an antipsychotic, at a low dose of 0.25 milligrams a day. Within three weeks, the hallucinations, the tics, and the distress had resolved completely, and she remained symptom-free at a three-month follow-up.
The published summary does not say whether her methylphenidate was adjusted, and it does not attribute the music to the stimulant. The authors' central message was that musical hallucinations can occur in children with ADHD even without hearing loss, epilepsy or psychosis. Recognizing the structured, nonpsychotic nature of these experiences, they wrote, may help clinicians avoid misdiagnosis.
A Symptom Usually Seen in Older Adults
Musical hallucinations more often affect older people, especially women with hearing loss. Estimates cited in a case report and literature review in Frontiers in Neurology put their prevalence at 0.16 percent in a general hospital setting and 2.5 percent among older adults with hearing complaints. One study cited there found musical hallucinations reported by 26.8 percent of psychiatric outpatients and 41 percent of those with obsessive-compulsive disorder. The music is often a familiar tune from the patient's own culture, the review noted, and most people who hear it understand it is not real. Hearing impairment is the most commonly identified predisposing factor, the review added, though only a minority of people with hearing loss ever develop the phenomenon. Brain lesions and epilepsy are other recognized contributors, which is why the girl's normal EEG mattered.
Medications can also trigger them. A review of drug-induced cases in Frontiers in Pharmacology identified 27 patients with an average age of about 58, with antidepressants, opioids, and anti-Parkinson drugs among the common triggers. Symptoms began anywhere from 75 minutes to 240 days after exposure, and treatment usually meant stopping or reducing the suspected drug, switching to a similar one, or adding another medication. The music disappeared completely in 24 of those 27 patients.
Stimulant labels do warn about new psychotic symptoms. The FDA prescribing information for Concerta says hallucinations and other psychotic or manic symptoms can occur at usual doses in people with no prior history. In pooled short-term trials, such symptoms occurred in about 0.1 percent of stimulant-treated patients and none on placebo. If they appear, the label advises considering a causal role for the stimulant and says stopping treatment may be appropriate. A Hong Kong study of more than 20,000 young people prescribed methylphenidate, however, found no increased risk of psychotic events during treatment periods compared with periods off the drug. The researchers compared each patient with themselves across time, a design that helps control for differences between young people who do and do not take the medication.
One Case Cannot Answer the Bigger Questions
ADHD is common. The CDC estimates that about 7 million U.S. children aged 3 to 17, or 11.7 percent, had a current ADHD diagnosis in 2024 survey data, and that about 32 percent of children with ADHD received both medication and behavior treatment in 2022. Against that backdrop, a single case cannot show how often children with ADHD hear music that is not there, what causes it, or whether any medication plays a role.
It also cannot establish that risperidone is the right treatment for other children, or whether her tics, which cleared at the same time as the music, were connected to it. Her reported follow-up lasted three months, so it is not known whether the music ever returned.
The authors stressed early recognition, a thorough evaluation, and care from multiple specialists. Parents whose child describes music, voices or other sounds without a source should raise it with the child's pediatrician or prescriber and should not stop or change ADHD medication without medical guidance.
Key Questions Answered
What are musical hallucinations?
They are experiences of hearing music, songs or instrumental sounds when none is playing. They are rare and most often reported in older adults with hearing loss.
What happened in this case?
A preadolescent Thai girl with ADHD heard instrumental music at predictable hours for about a week. Her hearing tests and EEG were normal.
Did her ADHD medication cause the music?
That was not established. Stimulant labels list hallucinations as a rare risk, but the case report did not attribute her symptoms to methylphenidate.
How was she treated?
After media limits and behavioral steps failed, low-dose risperidone resolved her hallucinations and tics within three weeks. She stayed symptom-free for three months.
Can medications trigger musical hallucinations?
Yes. A review of 27 drug-related cases, mostly in older adults, linked them to antidepressants, opioids, and anti-Parkinson drugs, among others.
What should parents do if a child hears sounds that are not there?
Tell the child's pediatrician or prescriber, who can arrange hearing and neurological evaluation. Do not change medication without medical advice.
