Music and Rhythm as Promising Tools to Assess and Improve Cognitive Development in Children: A Scoping Review

ABSTRACT

Aim

Cost‐effective methods are needed to monitor and support cognitive development in children at risk of deficits. The aim of this review was to explore the diagnostic and therapeutic use of music and rhythm for cognition in children, either typically developing or with acquired brain injuries.

Method

A systematic literature search was performed on 2 September 2024, using PubMed, Embase and PsycINFO. We included studies involving music and rhythm‐based interventions aimed at assessing or improving cognitive functions in children with typical development or acquired brain injuries.

Results

We included 27 studies: 26 on typically developing children and one on children with acquired brain injuries. The cognitive domains addressed included executive functioning (16 studies), attention (nine studies), intelligence and learning (seven studies), sensory processing (five studies), mathematical skills (three studies) and self‐regulation (two studies). In total, 23 studies reported a positive effect of music and rhythm on at least one cognitive domain, most commonly executive functioning, attention and intelligence. For children with acquired brain injuries, one study reported improved attention.

Conclusion

Music and rhythm‐based interventions show promise to assess and improve cognitive development in typically developing children. Further research is required to determine their value in children with acquired brain injuries.

Abbreviations

ABI

acquired brain injury

ANT

Attention Network Test

BASC

Behaviour Assessment System for Children

BDS

backward digit span

BRIEF

Behaviour Rating Inventory of Executive Function

BRSA

Bracken School Readiness Assessment

CBRS

Child Behaviour Rating Scale

CF

cognitive flexibility

CSBQ

Child Self‐Regulation and Behaviour Questionnaire

D2

D2 test of Attention

DCCS

dimensional change card sort

EF

executive functioning

FDS

forward digit span

h

hours

IC

inhibitory control

IMT

instrumental music training

IQ

intelligence

IVA‐CPT

Integrated Visual and Auditory Continuous Performance Task

KSTWMT

Klingberg Short Term and Working Memory Task

K‐TEA

Kaufman Test of Educational Achievement

MFFT

Matching Familiar Figures Test

min

minutes

MTT

music theory training

ND

neurodevelopmental disorder

pw

per week

RT

reaction time

SL

statistical learning

SMS

sensorimotor synchronisation

SR

self‐regulation

SWAN

Strengths and Weaknesses of ADHD‐symptoms and Normal behaviour

TD

typically developing

TEA‐Ch

Test of Everyday Attention for Children

TEMA‐3

Test of Early Mathematics Ability‐3

ToL

Tower of London

TONI‐4

Test of Non‐verbal Intelligence

TOVA

Test of Variables of Attention

TSB

Tehran‐Stanford‐Binet Intelligence Scale

WISC‐IV

Wechsler Intelligence Scale for Children, Fourth Edition

WJ4

Woodcock‐Johnson IV Tests of Achievement

WM

working memory

WPPSI‐III

Wechsler Preschool and Primary Scale of Intelligence, Third Edition

y

years

Summary.

• Standardised, cost‐effective methods are needed to monitor and improve cognitive development in children who are at risk of deficits.

• Music and rhythm‐based interventions have diagnostic and therapeutic value for cognition in typically developing children, particularly for executive functioning, attention, and intelligence.

• Further research is required to determine the value of music and rhythm‐based interventions to assess or improve cognitive functioning in children with acquired brain injuries.

1. Introduction

Over the last 20 years, research has emerged on the health effects of music in general and musical rhythm in particular [1]. The diagnostic and therapeutic use of music and rhythm has been demonstrated in several paediatric populations [2, 3, 4, 5, 6, 7, 8, 9]. This includes preterm infants admitted to the Neonatal Intensive Care Unit and children with autism spectrum disorder or attention deficit hyperactivity disorder. Health effects have also been demonstrated in adults with an acquired brain injury such as stroke or traumatic brain injury [10, 11, 12, 13, 14, 15].

Music and rhythm‐based interventions can be broadly categorised into instrumental music training, music theory training, and rhythm and movement‐based interventions [16, 17, 18]. Instrumental music training involves learning to play a specific musical instrument, while music theory training focuses on training in rhythm, pitch, melodies, and basic musical concepts. Rhythm and movement‐based interventions refer to activities that combine coordinated rhythmic movement with music. The exact underlying mechanisms behind the beneficial effects of music and rhythm on cognitive functions are not fully clear [19]. However, it can most likely be attributed to two principles: rhythmic entrainment on the neural level and sensorimotor synchronisation on the behavioural level [20]. Rhythmic entrainment refers to the synchronisation of neural activity with external rhythms, such as music, by recognising patterns and making predictions [20, 21, 22]. Predictive processes and pattern recognition also play a key role in cognitive development, because many cognitive processes are associated with remembering and managing information sequences [19]. Therefore, it is argued that rhythmic entrainment, which improves timing skills, can also be used as a technique to improve cognitive function [23, 24]. Sensorimotor synchronisation refers to the synchronisation of body movements with an external beat, which involves rhythmic entrainment and the coordination of motor and cognitive systems [4, 23].

In this context, sensory processing also plays a vital role. Sensory processing is defined as the unconscious reaction to incoming sensory information, which includes touch, vision, and hearing. This multi‐sensory information is perceived and integrated to organise an appropriate response [3, 25, 26, 27]. It is argued that higher‐order cognitive processes and behavioural responses, including motor action, rely on sensory processing. Directly measuring sensory processing is challenging. However, its output in terms of sensorimotor synchronisation can be measured using a tapping task, in which the participant has to tap along to an external rhythm [4].

There is growing understanding of the diagnostic and therapeutic role of music and rhythm among various populations. However, a systematic exploration of its value in monitoring and improving cognitive neurodevelopment in children is lacking. Children with acquired brain injuries, who are at risk of cognitive deficits, may particularly benefit from cost‐effective methods to assess and enhance their cognitive development [28]. Therefore, the aim of this scoping review was to explore the diagnostic and therapeutic use of music and rhythm for cognition in children. We focused on children with typical neurodevelopment and those at risk of impaired neurodevelopment due to an acquired brain injury.

2. Methods

2.1. Study Selection and Screening

The following electronic bibliographic databases were searched: PubMed, Embase, and PsycINFO. The search strategies are shown in Table S1. Studies published from 2003 onwards were sought, and the last update of the search was on 2 September 2024. Following the search, duplicates were removed using the Rayyan application [29]. Title and abstract screening was performed using the artificial machine learning tool ASReview v1.5 (Utrecht University, Utrecht, the Netherlands), which uses active learning to influence the order of papers based on relevance for inclusion [30, 31]. One reviewer (J.G.J.V.) provided the initial training data to ASReview, which consisted of five relevant papers selected during the pilot search [19, 23, 32, 33, 34]. Subsequently, the classifier created a progressive ranking of the unseen records. The same reviewer then screened the relevant papers using predefined eligibility criteria. Since the papers are ranked based on textual similarity, the likelihood that ASReview will present a relevant paper decreases with each consecutive excluded paper. Therefore, our cut‐off for stopping title and abstract screening was as follows: when ASReview provided 50 consecutive non‐relevant papers to the first reviewer (J.G.J.V.), a second reviewer (C.E.J.P.) independently assessed the subsequent 50. When the second reviewer agreed that there were no more relevant papers based on the eligibility criteria, title and abstract screening was finished. Subsequently, the papers selected through title and abstract screening were fully assessed by two independent reviewers (J.G.J.V. and C.E.J.P.).

2.2. Eligibility Criteria

The inclusion criteria encompassed studies involving children with typical development or acquired brain injuries who received music or rhythm‐based interventions aiming to assess or improve cognitive functioning. Eligible cognitive outcomes included executive functioning, attention, self‐regulation, intelligence and learning, mathematical skills, and sensory processing. Only papers in English and published in a peer‐reviewed journal were included. Studies involving neonates, adolescents, and children with comorbidities other than acquired brain injuries, such as attention deficit hyperactivity disorder, intellectual disabilities, or audiovisual impairments, were excluded. Studies that focused on motor, language, or social skills as primary outcomes were also excluded. In addition, review articles, feasibility studies, study protocols, case reports, and dissertations were not considered for inclusion.

2.3. Data Extraction and Synthesis

Data extraction was performed by one reviewer (J.G.J.V.) and cross‐checked by a second reviewer (C.E.J.P.). Studies were categorised by population, either children with typical development or those with acquired brain injuries, and by cognitive outcome domain. ChatGPT (San Francisco, California, USA) was used for language editing and grammar checks.

2.4. Protocol and Registration

The scoping review was conducted in accordance with the JBI methodology for scoping reviews [35]. The study was preregistered on Open Science Framework on 24 June 2024, prior to data collection.

3. Results

3.1. Study Selection

Figure 1 presents the PRISMA flowchart of the inclusion process [36]. A total of 1547 records were collected from PubMed, Embase, and PsycINFO. After the removal of duplicates, 1311 unique records were screened by title and abstract. A total of 50 papers met the inclusion and exclusion criteria. Following full‐text screening, 22 papers were included. In addition, five papers were included through snowballing, resulting in a total of 27 papers.

FIGURE 1.

Flow diagram of the study selection [36].

3.2. Study Characteristics

The characteristics of the included studies are presented in Table 1. Of the 27 included studies, 26 involved typically developing children and one involved children with acquired brain injuries. The duration of the interventions ranged from a single 30‐min session to weekly sessions spanning two and a half years. In total, 24 papers examined the therapeutic use of music and rhythm in children aged 3–12 years. The remaining three papers described the use of music and rhythm as a diagnostic tool in children aged 7–12 years. A total of 24 studies included control groups: 12 were inactive, 8 were active, and four had both. Three studies adapted a longitudinal design [16, 32, 39]. Executive functioning was featured in 16 papers, attention in nine, intelligence and learning in seven, sensory processing in five, mathematical skills in three, and self‐regulation in two.

TABLE 1.

Characteristics of the included studies and outcome.

Study	Age, size, TD or ABI	Design; control a (size)	Domain (test)	Intervention (duration), provider	Outcome
Lesiuk (2015) [33]	9–11 years, n = 71, TD (n = 42) and EF‐deficits (n = 29)	Retrospective; no control group	EF (BRIEF)	Music perception testing (duration unknown), by music therapist	Better duration discrimination (p = 0.007, d = 0.60) and rhythm discrimination (p = 0.024, d = 0.51) in children without EF‐deficits compared to those with EF‐deficits
Jaschke et al. (2018) [32]	± 6.5 years, n = 176, not specified	Prospective; inactive (n = 37) and active (n = 29)	IC, WM + planning (ToL, KSTWMT, Go/No‐Go), IQ (WPPSI‐III)	IMT/MTT (1–2 h pw for 2.5 years), by music teacher	Positive effect of music training on IC (p < 0.05), planning (p = 0.05) and verbal IQ (p < 0.05). The effects are long term (> 2.5 years)
Schibli et al. (2023) [37]	9–12 years, n = 20, not specified	Prospective; inactive b (n = 9)	IC, WM + executive attention (Go/No‐Go)	IMT (9 h pw), by music teacher	Faster response times on the Go‐trials in the IMT group (p < 0.05), compared to the controls
Paquet et al. (2022) [38]	7–11 years, n = 26, not specified	Retrospective; inactive (n = 13)	WM (FDS/BDS), auditory retrieval (auditory retrieval task)	IMT (≥ 80 min pw for ≥ 14 months), by music teacher	Better frequency retrieval (p = 0.007, η 2 = 0.26) and comparable duration retrieval (p = 0.09, η 2 = 0.11) after IMT, compared to the controls. No difference between groups on FDS (p = 0.24) and BDS (p = 0.11)
Habibi et al. (2018) [39]	6–7 years, n = 68, TD	Prospective; inactive (n = 24) and active (n = 23)	IC (Stroop)	IMT (6–7 h pw for 2 years), by music teacher	No significant difference between groups on IC accuracy (p = 0.21) and RT (p = 0.31)
Bugos et al. (2017) [40]	4–5 years, n = 34, not specified	Prospective; active (n = 17)	IC (MFFT, Stroop)	IMT (90 min pw for 6 weeks), by music teacher	Significant less errors on MFFT after IMT (p = 0.035). RT did not differ between groups
Bowmer et al. (2018) [41]	3–4 years, n = 41, not specified	Prospective; inactive (n = 25) and active (n = 12)	IC, WM, CF + planning (Stroop, Peg Tapping, DCCS, Trucks, ToL, Spin the Pots)	MTT (40 min pw for 8–16 weeks), by music teacher	Better performance on Peg Tapping, DCCS, ToL and Spin the Pots in all groups. Significant better performance on ToL and Peg Tapping (p < 0.05, η 2 = 0.099) in the MTT group compared to the inactive control
Moreno et al. (2011) [42]	4–6 years, n = 48, not specified	Prospective; active (n = 24)	EF (Go/No‐Go), IQ (WPPSI‐III)	Computerised MTT (2 h for 20 days), by music teacher	Better Go/No‐Go task accuracy (p < 0.05, η 2 = 0.12) and verbal IQ (p < 0.001, η 2 = 0.33) after MTT, not in the control
Frischen et al. (2019) [34]	5–6 years, n = 76, not specified	Prospective; active (n not reported)	IC (NEPSY‐II), WM (Matrix Span, Corsi Block), CF (DCCS)	MTT (1 h pw for 20 weeks), by trained research assistant	Positive effect on IC in the rhythm training group (p = 0.004, d = 0.56), not in the pitch training (p = 0.062) or control group (p = 0.734). All groups improved in WM (d = 0.35) and CF (d = 0.55), with no significant difference between groups
Zanto et al. (2024) [43]	8–9 years, n = 53, not specified	Prospective; inactive (n = 21)	IC (Flanker, Stroop), WM (Corsi Block), sustained attention (TOVA), math fluency (WJ4), SMS (rhythmic game)	Computerised MTT (1 h pw for 6 weeks), using an iPad	No significant effect of MTT on IC (p = 0.376), sustained attention (p = 0.413), WM (p = 0.103) and math fluency (p = 0.608). Improvement in performance variability (measure of SMS) after MTT (p = 0.008, d = 0.648)
Bentley et al. (2023) [23]	3–4 years, n = 213, TD	Prospective; inactive (n = 101)	IC, WM + CF (iPad games from the Early Years Toolbox), SR (CSBQ, CBRS), school readiness (BRSR)	Rhythm and movement program (16 sessions of 20 min over 8 weeks), by preschool teacher	Positive effect on IC (p = 0.002, η 2 = 0.23), SR (p < 0.001, η 2 = 0.08) and school readiness (p = 0.038, η 2 = 0.09) in the movement group. No significant effect on WM (p = 0.687) and a deleterious effect on CF (p = 0.005)
Williams et al. (2019) [18]	4–5 years, n = 113, not specified	Prospective; inactive (n = 54)	IC (Go/No‐Go), WM (Mr. Ant), CF (Card Sorting), SR (CSBQ)	Rhythm and movement program (1 h pw for 8 weeks), by music therapist	Positive effect on CF in boys in the movement group (p = 0.01, d = 0.60). Improved behavioural (d = 0.99), emotional (d = 0.98) and cognitive (d = 0.21) SR in 1/3 intervention groups. No significant effect on WM (p = 0.72) and IC (p = 0.97)
Shen et al. (2020) [44]	±4 years, n = 60, TD	Prospective; inactive (n = 30)	IC (Go/No‐Go), WM (BDS), CF (DCCS), executive attention (ANT)	Rhythm and movement program (1–2 h pw for 8 weeks), by street‐dance teacher	Better WM (p < 0.05, η 2 p = 0.074), IC (p < 0.05, η 2 p = 0.108), CF (p < 0.05, η 2 p = 0.087) and executive attention (p < 0.05, η 2 p = 0.085) in the movement group, compared to the control
Vazou et al. (2020) [45]	6–11 years, n = 39, not specified	Prospective; active (n = 17)	IC, WM + CF (Flanker), attention and behavioural control (SWAN), rhythmic performance (tapping)	Rhythm and movement program (1 h pw for 7 weeks), by researcher not further specified	Better performance on Flanker (p < 0.001 c ) in all groups, no significant difference between groups. No significant effect on attention and behavioural control. Significant improved rhythmic abilities in the rhythm group (d = 0.42)
Maróti et al. (2019) [20]	6–7 years, n = 40, not specified	Prospective; active (n = 13)	WM (WISC‐IV), attention (ANT), sensorimotor entrainment (tapping)	Music and movement intervention (3 h pw for 8 months), by music teacher	All groups showed better ANT RT (p < 0.001, η 2 = 0.834), with no significant difference between groups; ANT accuracy (p = 0.041, η 2 = 0.108), with better performance in the control (p = 0.026); and WM (p < 0.001, η 2 = 0.472), with better performance in rule‐based group (p = 0.003) and the free movement group (p = 0.006). No significant group differences for entrainment
Lukacs et al. (2024) [46]	6–7 years, n = 40, not specified	Prospective; active d (n = 15)	EF (Digit/Counting Span), IQ, (WISC‐IV), entrainment (tapping)	Music and movement intervention (≥ 90 min pw for 1.5 years), by music teacher	Various movement programs (teacher‐directed, improvised or no movement) did not have a differential impact on EF, IQ and sensorimotor entrainment
Khalil et al. (2013) [22]	7–12 years, n = 102, not specified	Prospective; no control group	Attention (SWAN, Flanker)	Rhythmic synchronisation testing, by music teacher	Rhythmic synchrony significantly correlated with attention (p < 0.001)
Birkett et al. (2012) [47]	8–11 years, n = 21, not specified	Prospective; no control group	Attention (TEA‐Ch, ADHD Behaviour Rating Scale)	Rhythmic synchronisation testing, by researcher not further specified	Sustained attention significantly associated with auditory implementation variance (p < 0.05)
Kasuya‐Ueba et al. (2020) [48]	6–9 years, n = 29, TD	Prospective; active e (n = 29)	Attention (TEA‐Ch)	IMT (30 min), by researcher not further specified	IMT significantly improved the response speed of attention control/switching even when controlling for IQ (p = 0.003), but not when controlling for ADHD traits
Roden et al. (2014) [16]	7–8 years, n = 345, not specified	Prospective; active (n = 153)	Visual attention (D2), processing speed (Zahlen‐Verbindungs‐Test)	IMT (45 min pw for 18 months), by music teacher	Both groups increased in visual attention and processing speed, the former with a benefit for the control group (p < 0.05, d = 0.44) and the latter with a benefit for the IMT group (p < 0.001, d = 0.30)
Ribeiro et al. (2017) [17]	8 years, n = 46, not specified	Prospective; inactive f (n not reported)	Numerical cognition (Zareki‐R)	MTT (1 h pw for 14 weeks), by music teacher	Significant improvement in multiple subtests for numerical cognition following MTT in both children with low achievements in math and those with expected achievements in math
Raja et al. (2021) [49]	5–8 years, n = 156, not specified	Prospective; inactive (n = 75)	Mathematical skills (TEMA‐3)	IMT (3 h pw for 20 weeks), provider unspecified	Improved mathematical ability after IMT in all 3 intervention groups (p = 0.009 and d = 0.32, p = 0.004 and d = 0.11, p < 0.001 and d = 0.41)
Schellenberg (2004) [50]	6 years, n = 132, not specified	Prospective; active (n = 34) and inactive (n = 36)	IQ (WISC‐III, K‐TEA, BASC)	IMT (36 weeks), by music teacher	Positive effect on IQ in the IMT group (p < 0.05, d = 0.35), seen in all four index scores (p < 0.01, d = 0.46) and 10 of 12 subtests (p < 0.05) of the WISC‐III
Kaviani et al. (2014) [51]	5–6 years, n = 60, not specified	Prospective; inactive (n = 30)	IQ (TSB)	IMT/MTT (75 min pw for 12 weeks), by music teacher	Positive effect of music training on IQ (p < 0.001, η 2 = 0.46). Positive effect for visual/abstract reasoning (p < 0.05), verbal reasoning (p < 0.01) and short‐term memory (p < 0.01) in both groups, with larger effect sizes in the music group (η 2 = 0.50, 0.75 and 0.46, respectively)
Vasuki et al. (2017) [52]	9–11 years, n = 50, TD	Retrospective; inactive (n = 25)	WM (FDS/BDS), sustained attention (IVA‐CPT), IQ (TONI‐4), SL (2‐AFC)	IMT (± 3.9 years), by music teacher	Both groups improved in auditory SL (p < 0.001), with better performance in the IMT group (p < 0.005, d = 0.96), and visual SL (p < 0.005), with no significant difference between groups. No group differences in WM, non‐verbal IQ, and sustained attention tasks (p > 0.05)
Braun Janzen et al. (2014) [53]	10–14 y, n = 57, not specified	Retrospective; inactive (n = 26)	Timed movement (tapping, circle drawing)	IMT (≥ 2 h pw for 2–6 years), by music teacher	Better timing performance after IMT (p = 0.01). Better tapping precision in children with average training of 4 and 6 years (p = 0.03 and p = 0.004, respectively), not 2 years
Bringas et al. (2015) [54]	3–12 years, n = 34, severe NDs (perinatal n = 24)	Prospective; inactive (n = 17)	Cognition (unvalidated questionnaire)	Music training (1.5 h pw for 4–8 weeks), by music therapist	The addition of music training to standard rehabilitation improved attention and communication (p < 0.001)

^a Active control groups received another form of training (e.g., visual arts or sports training). Inactive control groups received no additional training (e.g., usual preschool program).

^b One‐third of the children in the control group received limited music training, ranging between 1 and 2 h per week (lessons and practice combined). Additionally, both the intervention group and the control group participated in basic music instruction as part of their school curriculum.

^c Effect sizes were η ² = 0.59 (Standard Flanker RT), η ² = 0.63 (Reverse Flanker RT), η ² = 0.27 (Reverse Flanker accuracy), η ² = 0.29 (Mixed Flanker RT), and η ² = 0.46 (Mixed Flanker accuracy).

^d In study 1, directed movement was compared to no movement. In study 2, directed movement was compared to improvised movement.

^e All children participated in the experimental task (i.e., music intervention) and the control task (i.e., video game training).

^f The normative data of another, similar study functioned as a (untrained) control group. The sample included typically developing children from the same region and cultural background.

3.3. Outcomes for Typically Developing Children

One paper described the use of music as a diagnostic tool to assess executive functioning. Lesiuk et al. tested music perception in 29 children with executive function deficits and 42 typically developing children, referring to their ability to discriminate and process auditory stimuli [33]. Music perception was assessed through various music listening tasks. Typically developing children performed significantly better in the discrimination of tone and rhythm duration, referring to the ability to distinguish between different tone lengths and rhythmic sequences. No significant differences were found in the discrimination of pitch and tone.

Five papers described the therapeutic use of instrumental music training on executive functioning. Four studies demonstrated a significant improvement in executive functions: three reported effects on inhibition, two on working memory, one on planning, one on cognitive flexibility, one on executive attention, and one on auditory memory [32, 37, 38, 40]. One study compared the effect of ensemble music training with sports training and an inactive control group in 6–7‐year olds [39]. The authors did not find a significant difference in inhibition between groups, as measured using a behavioural version of the colour–word Stroop task. However, the music group showed stronger neural activation during the cognitive inhibition task in regions associated with response inhibition, as measured using functional MRI.

Four papers explored the use of music theory training to enhance executive functions. Three studies found a significant improvement in executive functions, with three reporting effects on inhibitory control, one on planning, one on working memory and one on cognitive flexibility [34, 41, 42]. One study investigated the effects of a 6‐week computerised music training programme, which consisted of a gamified rhythmic tapping task on an iPad, and found no significant effect on executive functions [43].

Six papers reported on the relation between rhythm and movement‐based interventions and executive functions. Three studies reported that rhythm and movement‐based interventions significantly improve executive functioning, with three reporting effects on working memory, two on inhibition and two on cognitive flexibility [20, 44, 45]. One of these studies found no significant difference comparing a movement programme to a standard physical activity programme, suggesting that both interventions were equally effective [45]. In addition, two studies explored the Rhythm and Movement for Self‐Regulation programme (Queensland University of Technology, Queensland, Australia) in preschoolers. One of these studies found a significant effect on cognitive flexibility specifically in boys [18]. The other study demonstrated significant improvement in inhibitory control and school readiness as measured by the Bracken School Readiness Assessment, and an unexpected adverse effect on cognitive flexibility [23]. Finally, one study investigated the effects of three different movement programmes: teacher‐directed movement, improvised movement, or no movement [46]. The authors found no differential impact on intelligence measures.

Two papers explored whether rhythm can be used to measure attention abilities in primary school children. Khalil et al. reported that rhythm synchronisation ability in a group setting can predict children's attentional behaviour [22]. Birkett et al. conducted a study on 21 children aged 8–10 years to evaluate the relation between attention skills and timing abilities [47]. They used a tapping task with either auditory or visual signals. The motor timing task, using auditory signals, showed a significant association between sustained attention and implementation variance, referring to less consistent movement execution to the tapping task.

Three studies analysed the therapeutic use of instrumental music training on attention. One study compared music lessons to natural science training, finding that visual attention significantly improved in both groups, with a larger effect in the science group [16]. One study found an effect on executive attention [37]. Finally, one study found a positive effect on attention control and switching [48].

One paper reported on the use of music theory training to enhance attention [43]. The study examined the effect of computerised music training in preschool children, which involved a gamified rhythmic tapping task using an iPad. No significant effects on sustained attention were found.

Three papers reported on the relation between rhythm and movement‐based interventions and attention. Two studies demonstrated that a rhythm and movement‐based intervention significantly improved executive attention [20, 44]. However, one of these studies found a greater effect in the music group without additional movement [20]. One study did not demonstrate any effect of a rhythm and movement‐based programme on attention [45].

The results yielded no papers on music or rhythm as a tool to assess self‐regulation in children. Two papers described the use of the Rhythm and Movement for Self‐Regulation programme (Queensland University of Technology, Queensland, Australia), a rhythm and movement‐based intervention, to enhance self‐regulation in preschoolers. Both studies found a significant positive effect on self‐regulation, measured using the Child Self‐Regulation and Behaviour Questionnaire [18, 23]. One of these studies found that this effect remained consistent until 6 months post‐intervention [23].

The results yielded no papers on rhythm or music as a tool to assess intelligence or learning in children. Five papers explored the use of instrumental music training to enhance intelligence or learning in primary school children: three studies reported a significant positive effect on intelligence, one on statistical learning, and one on processing speed [16, 32, 50, 51, 52].

One study investigated the effect of computerised music theory training on intelligence measured using the Wechsler Preschool and Primary Scale of Intelligence [42]. The music theory training consisted of a combination of cognitive tasks and training in basic musical concepts, projected onto a classroom wall. The results demonstrated a significant positive effect on the verbal scale, but no effect on the visuo‐spatial scale. In addition, one study investigated the effect of three different movement programmes on intelligence, using the Wechsler Intelligence Scale for Children [46]. No difference in intelligence was found between the teacher‐directed, improvised, and no movement groups.

The results yielded no papers on rhythm or music as a tool to assess mathematical skills in children. Two papers described the use of music theory training to enhance mathematical abilities. One study reported that rhythmic and melodic activities improved multiple subtests for numerical cognition [17]. The other study examined the effect of computerised music training, using gamified rhythmic tapping tasks on an iPad, demonstrating no significant improvement in math fluency [43].

One study explored the effect of Carnatic music training on mathematical skills [49]. Carnatic music training, a melodic form of music from South India that includes singing lessons, rhythmic exercises, and instrumental playing, significantly improved mathematical skills.

The search did not identify any papers on the use of rhythm or music to assess sensory processing. However, multiple papers discussed music and rhythm‐based interventions to improve sensorimotor synchronisation [20, 43, 45, 46, 53]. One paper described the use of instrumental music training to improve sensorimotor synchronisation [53]. Children with 4 or 6 years of music training were found to perform significantly better on a tapping task compared to those with 2 years of music training. Another study investigated the effect of music theory training on sensorimotor synchronisation [43]. They reported that computerised music training, which involved a gamified rhythmic tapping task on an iPad, significantly improved sensorimotor synchronisation abilities but not measures of executive functioning.

Three papers reported on the relation between rhythm and movement‐based interventions and sensorimotor synchronisation. One study reported significantly better rhythmic performance after a rhythmic movement intervention, which was not reflected in cognitive measures [45]. Two studies compared three different movement programmes, with both finding no difference in tapping task performance between the teacher‐directed, improvised, and no movement groups [20, 46].

3.4. Outcomes for Children With Acquired Brain Injuries

No papers on rhythm or music as a tool to assess cognition in children with acquired brain injuries were found. The search yielded one paper on music and rhythm‐based interventions to enhance cognition in this population. Bringas et al. investigated the value of music therapy in 34 children with severe neurological impairments, mainly of perinatal origin [54]. Music therapy was added to a standard neurological rehabilitation programme targeting motor, social, emotional, and cognitive outcomes. The music therapy programme aimed to improve sustained and selective attention, as well as communication skills, through music‐based games. Activities included throwing a ball in response to musical cues and focusing on a single instrument while ignoring the rest. The training consisted of weekly 1.5‐h sessions for a duration of 4–8 weeks, conducted in groups of four children. Outcomes were assessed using a newly designed questionnaire. The results demonstrated that the addition of music therapy to standard rehabilitation programmes significantly improved attention and communication.

4. Discussion

4.1. Summary

This scoping review explored the use of music and rhythm‐based interventions to assess and enhance cognitive functioning in children, either typically developing or with acquired brain injuries. Overall, the results suggested that music and rhythm‐based interventions have a clear diagnostic and therapeutic value for cognitive functioning in typically developing children, particularly with regard to executive functioning, attention, and intelligence and learning. Effect sizes were reported by 17 studies, ranging from small to large, with the largest effects demonstrated for executive functioning and intelligence and learning. However, most studies were limited by small sample sizes, short duration of the intervention, non‐randomised designs, or lack of a control group. Considering the latter, it has been suggested that any cognitive training might be more beneficial for cognitive growth compared to an inactive control group. Therefore, the effects of music training may appear larger when a study lacks an active control group [55]. Literature on the value of rhythm and music to assess or enhance cognition in children with acquired brain injuries was found to be scarce.

Multiple studies described the value of music and rhythm in relation to cognition in typically developing children, in particular to improve executive functioning, attention, and intelligence and learning. This aligned with previous studies using music and rhythm to increase these abilities in children with autism spectrum disorder or attention deficit hyperactivity disorder, and adults with acquired brain injuries [6, 11, 12, 13, 14, 15]. However, considering the limited data and study designs, further research should confirm this. Some papers also reported improvements in self‐regulation, mathematical skills, and sensorimotor synchronisation abilities following music and rhythm‐based interventions [17, 18, 20, 23, 43, 45, 46, 49, 53]. However, the evidence was limited due to constraints in the study designs. Furthermore, since sensorimotor synchronisation integrates both cognitive and motor systems, performance likely reflected a combination of both systems rather than cognitive abilities alone. To evaluate cognitive abilities specifically, additional targeted tasks are necessary.

Only one paper focused on children with acquired brain injuries. Bringas et al. demonstrated that music therapy enhances attention and changes brain plasticity in children with severe neurological impairments, including impairments of perinatal origin [54]. To assess these effects, the study used a newly designed questionnaire. Their results aligned with previous studies in adults with acquired brain injuries [11, 12, 13, 56]. While these results are promising, further research is needed to confirm the value of music therapy in children with acquired brain injuries.

The studies mentioned above investigated the therapeutic potential of music and rhythm for children aged 3–12 years. However, its diagnostic potential was only studied in children aged 9–11 years, leaving its value for younger children uncertain. Both brief and prolonged interventions, ranging from 30 min to two and a half years, improved cognitive function in the short term [32, 48]. However, in all studies except the one by Bowmer et al., it was unclear whether these cognitive benefits persisted due to the lack of follow‐up assessments [41]. While repeated practice with increasing difficulty is thought to produce more lasting effects, there was no consensus on the ideal duration of the intervention [57, 58]. Therefore, further studies with follow‐up assessments are needed to determine the optimal duration and frequency of music and rhythm‐based interventions. Finally, some studies reported no significant difference in cognition between music training and active control groups [16, 34, 39]. Similar to music training, group‐based arts or sports training require self‐discipline and repeated practice, attention, sensorimotor integration, and social interaction [39, 58]. It has been proposed that the most effective interventions to improve executive functions involve repeated practice, engagement, joy, and social belonging through peer‐to‐peer interaction [58]. This suggests that the interactive and motivational aspects of training may be more influential than its musical components.

4.2. Future Implications

There is a need for more standardised and cost‐effective methods to assess and improve cognitive neurodevelopmental outcome in children at risk of cognitive deficits. Procedures using music and rhythm as a diagnostic or therapeutic tool need further study, but do show potential for use in paediatric follow‐up care. Since music training delivered by a trained professional is not always feasible, the key elements of music training could be incorporated into a computerised intervention. An example is a serious game, designed with a primary purpose other than entertainment, such as education or training. In healthcare, serious games have been used in multiple areas, including physical rehabilitation and pain management. These games offer several advantages: they are widely accessible via digital devices, child‐friendly and engaging, and suitable for at‐home training [59]. A recently published systematic review demonstrated that gamified interventions hold promise for cognitive training in children with acquired brain injuries [60]. However, before music and rhythm‐based serious games can be implemented in paediatric follow‐up care, further research is needed to confirm their effectiveness and to identify which cognitive domains can be targeted. In addition, it is important to further conceptualise theoretical models regarding the key aspects of musical or rhythmic assessments and training. These models should also consider the developmental phase of the target group.

4.3. Limitations

This review had several limitations. There was substantial variation in the music and rhythm‐based interventions that were studied, particularly regarding their content and duration. Multiple studies suggested that different music training content targets different musical skills, potentially leading to different outcomes [17, 41, 48]. In addition, while some studies described a progression in difficulty during the intervention [41, 43, 44], this was not specified in most studies [32, 34, 42]. Progression in task difficulty has been described as important for the training of executive functions [58]. Furthermore, most trainings were conducted in group settings, while others were conducted individually [43, 48]. It has been suggested that interventions which provide a sense of relatedness to others may lead to better outcomes [45, 57]. In addition, the duration of the interventions varied from 30 min to two and a half years [39, 48], and only one study incorporated follow‐up data collection points [41]. Therefore, it was uncertain whether the positive effects of music and rhythm‐based interventions sustain over time.

5. Conclusion

Music and rhythm‐based interventions show promise as tools for assessing and enhancing cognitive development in children. However, considering the substantial variation in these interventions, small sample sizes and the limited number of robust studies, further research is needed to confirm their value, particularly for children with acquired brain injuries.

Author Contributions

J. G. J. Visee: writing – original draft; conceptualisation; visualisation; data collection and extraction. C. E. J. Parmentier: supervision; writing – original draft; writing – review and editing; data collection and extraction; conceptualisation. J. Dudink: supervision; writing – review and editing; conceptualisation. A. L. van Baar: supervision; writing – review and editing; conceptualisation. A. Volk: supervision; writing – review and editing; conceptualisation. M. L. Tataranno: supervision; writing – review and editing.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1.

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.