Press the instruments to add their noise to the beat. Press space to go into Play Mode, the down arrow will delete the last sound that you added, and the up arrow will reset the sound list and bring the game back to Create Mode if you hold your finger down on it.
The black stop sign's sound is a rest. Also, the first sound will play twice. I don't know why. Also, the question mark generates a random beat and adds it to your beat.