Consideration deficit/hyperactivity dysfunction (ADHD) is essentially the most extensively recognized neurodevelopmental situation, affecting as many as 5% of kids and adolescents (Cortese et al., 2023) and three% of the grownup inhabitants (Ayano et al., 2023).
Folks with ADHD usually tend to expertise bodily and psychological well being comorbidities (Arrondo et al., 2022; Faraone et al., 2015), and former research counsel that individuals with ADHD may expertise atypical sensory processing as effectively (Dunn et al, 2002).
The idea of sensory modulation was first described as “the interplay between the neurological threshold and self-regulation” by Winnie Dunn, in 2001. Underneath this framework (1997), individuals can fall into 4 totally different classes:
- Low Registration: they don’t detect all of the sensory info, however they don’t proactively search extra sensory enter.
- Sensory Looking for: they don’t detect all of the sensory info, and they proactively search extra sensory enter.
- Sensory Delicate: they detect a variety of sensory info, however they don’t proactively attempt to cease this when it’s overwhelming.
- Avoiding: they detect a variety of sensory info and they actively attempt to keep away from additional sensory stimuli if it’s overwhelming.
Everybody has their very own manner of processing sensory info, however when these patterns develop into too excessive or exhausting to handle, they will begin to intrude with each day life and influence cognitive capabilities and psychosocial growth (Dunn, 2001); depth and pleasure of social interplay (Cosbey et al., 2010); and regulation of feelings and a spotlight (DelCarmen-Wiggins et al., 2004).
This meta-analysis by Jurek et al. (2025) explores proof of variations in Sensory Modulation between individuals with ADHD and people with out; to tell the care and assist we offer for individuals with ADHD.
Sensory processing atypicalities could make unusual stimuli really feel like a fireplace alarm – and make life difficult in ADHD.
Strategies
This research was registered in PROSPERO, the worldwide systematic evaluation registry. The literature search lined 3 of essentially the most established databases for publications dated up till June 30 2024. Phrases associated to ADHD and SPPs had been appropriately refined to streamline the search.
The authors additionally assessed potential bias and general research high quality utilizing a modified Newcastle–Ottawa Scale (NOS),
This systematic evaluation targeted solely on research the place ADHD was formally recognized, excluding self-diagnosed or non-diagnosed contributors. Research during which contributors had greater than 20% of comorbid autism spectrum dysfunction, mental incapacity, or genetic problems had been additionally excluded (Juret et al,, 2025).
By way of the research design, unique cohort, case-control and cross-sectional research had been included, while case research had been excluded.
The research appeared on the following outcomes:
- Severity of sensory processing variations (measured constantly). Primarily based on Dunn’s 4 sensory modulation patterns (sensitivity, low registration, looking for, avoiding) and 6 sensory sorts (contact, sound, sight, style/scent, motion, physique consciousness).
- Threat of being hypersensitive or hyposensitive (measured as sure/no). Primarily based on how contributors had been rated within the research.
This systematic evaluation evaluated binary and steady variations in sensory processing difficulties, for individuals formally recognized with ADHD.
Outcomes
A complete of 30 research (32 publications) had been included, with 5,374 contributors (1,656 with ADHD, 3,718 controls). Most research had been cross-sectional and targeted on youngsters, although some included adolescents and adults.
Females had been underrepresented (common 30%) and ethnicity was poorly reported. Contributors usually had common IQ, with low IQ excluded in most research. ADHD prognosis was based mostly on DSM/ICD standards or scientific judgment, although diagnostic instruments diverse. Reporting of comorbidities and medicine standing was inconsistent.
Sensory processing was measured utilizing numerous instruments, mostly the Sensory Profile (SP), Brief Sensory Profile (SSP), and Adolescent/Grownup Sensory Profile (AASP). Threat of bias was unclear in most research.
The next outcomes had been recognized:
- Meta-analysis of sensory sensitivity (13 research) confirmed considerably elevated scores in people with ADHD.
- Sensory avoiding was greater in ADHD, however not important in low-risk research on account of restricted information and excessive heterogeneity.
- Low sensory registration was considerably greater in ADHD, with extra pronounced results in older contributors.
- Sensory looking for was elevated general in ADHD however not in adults, and solely important below sure research situations; no publication bias was discovered.
- ADHD contributors confirmed better issue processing tactile, visible, auditory, oral, and movement-related enter, however not physique place.
- Folks with ADHD had been 9 instances extra more likely to be hypersensitive, even after correcting for publication bias.
- Hyposensitivity was practically 10 instances extra seemingly in ADHD, seen solely in adults, although based mostly on a restricted variety of research.
Throughout research, quite a lot of instruments such because the Sensory Profile (SP), Brief Sensory Profile (SSP), and Adolescent/Grownup Sensory Profile (AASP), had been used to check sensory processing and responses.
Conclusion
This meta-analysis synthesises a medium to giant set of research into ADHD and sensory profiles and challenges, to spotlight the complexity of sensory processing patterns for individuals with ADHD.
Whereas there’s a heterogeneity throughout research’ designs and dangers of bias, rising outcomes counsel ADHD people’ sensory profiles can exhibit hypersensitivity and/or hyposensitivity, in numerous particular sensory modalities – which lends weight to theories of a number of coexistent and atypical sensory patterns throughout Dunn’s 4 sensory classes, for ADHD people, which will be strengths or challenges in distinctive situations.
Strengths and limitations
This research is the first large-scale meta-analysis specializing in sensory processing in ADHD. Strengths embrace the excessive variety of research and contributors included. The methodology was systematic, following PRISMA pointers with clear inclusion and exclusion standards. Most research used validated sensory processing questionnaires (SP, SSP, AASP), enhancing comparability. Subgroup analyses had been performed based mostly on research inhabitants (youngsters, adults), threat of bias, evaluation software, and exclusion of autism and IQ.
The principle limitation is the excessive heterogeneity throughout research, making it exhausting to inform if variations replicate true results or inconsistent strategies. One other limitation is how “sensory processing” was outlined. Completely different instruments had been used throughout research, so the authors created their very own system to group outcomes. Whereas mandatory to mix information, this will likely have launched bias since these classes weren’t all the time utilized constantly within the unique research, doubtlessly influencing findings in methods the authors couldn’t absolutely management.
Generalisability is proscribed: feminine contributors had been underrepresented (common 30%) throughout research, and ethnicity was largely unreported and predominantly White the place accessible. Though not formal exclusion standards, this will likely point out {that a} “hyperactive White boys” archetype nonetheless dominates scientific and analysis cohorts in ADHD research. Additional, remedy standing was usually lacking, so it’s unclear if the target or subjective impacts of this variable on SPPs must be managed for in future analysis.
Reporting on contributors with autism was inconsistent. 20 research excluded ASD, one included a couple of, and 9 gave no particulars. Due to this, it’s unclear how having each ADHD and ASD may influence the findings. Folks with ASD are identified to usually expertise extra pronounced sensory variations (Ben-Sasson et al., 2009), so not absolutely accounting for co-occurring ASD may restrict how effectively the conclusions replicate sensory processing on this group.
Lastly, indicators of publication bias had been detected for outcomes like sensory avoiding, low registration, and hypersensitivity. Statistical changes had been made, however this bias suggests reported results is perhaps considerably overestimated.
The underrepresentation of girls and ethnic minorities with ADHD in research included on this evaluation, makes it obscure what sensory processing ‘fireplace alarms’ seem like for these communities.
Implications for follow
Interested by SPPs (sensory processing patterns) in layman’s phrases, we are able to consider the mind working like a fireplace alarm:
- The alarm’s sensitivity is the neurological threshold, and our response is the self-regulation.
- Completely different individuals’s fireplace alarms could also be kind of delicate to smoke, earlier than they ring.
- One particular person’s alarm may solely go off when the complete constructing is on fireplace (excessive neurological threshold), another person’s may go off on the puff of a vape (low neurological threshold).
- Some individuals may not reply to the alarm being triggered and simply look forward to it to cease (passive responders), some may open the home windows to let the smoke out or disable the alarm all collectively (energetic responders), and others may get overwhelmed.
Whereas common characterisations of individuals with ADHD generally is a hyperactivity related to perpetual stimulus looking for, this evaluation identifies that there will be quite a lot of sensory processing patterns in ADHD people, which seem like extensively distributed throughout Dunn’s sensory domains.
Folks with ADHD will be often hypersensitive to quite a lot of bodily stimuli, however a cohort of people who find themselves hyposensitive relative to undiagnosed populations shouldn’t be excluded from therapeutic design issues.
Though not explicitly acknowledged on this research’s evaluation – given the heterogeneity of obtainable information for evaluation, the variations recognized between ‘low registration’ SPP prevalence in older individuals and ‘sensory looking for’ SPP earlier than maturity may additionally open an avenue for additional analysis on ADHD and any developments in sensory processing patterns throughout the lifespan.
Studying about sensory processing profiles, can affect extra inclusive therapies and assist design, for individuals with ADHD throughout the lifespan — leaving nobody behind when their alarm bells ring.
Assertion of pursuits
None to declare
Hyperlinks
Major paper
Jurek L, Duchier A, Gauld C, Hénault L, Giroudon C, Fourneret P, Cortese S, Nourredine M. Sensory Processing in People With Consideration-Deficit/Hyperactivity Dysfunction In contrast With Management Populations: A Systematic Evaluation and Meta-analysis. J Am Acad Baby Adolesc Psychiatry. 2025 Apr 16:S0890-8567(25)00209-6. doi: 10.1016/j.jaac.2025.02.019. Epub forward of print. PMID: 40250555.
Different references
S. Cortese, M. Track, L.C. Farhat, et al. Incidence, prevalence, and international burden of ADHD from 1990 to 2019 throughout 204 nations: information, with important re-analysis, from the World Burden of Illness research. Mol Psychiatry, 28 (11) (2023), pp. 4823-4830, 10.1038/s41380-023-02228-3
G. Ayano, L. Tsegay, Y. Gizachew, et al. Prevalence of consideration deficit hyperactivity dysfunction in adults: umbrella evaluation of proof generated throughout the globe. Psychiatry Res, 328 (2023), Article 115449, 10.1016/j.psychres.2023.115449
Gonzalo Arrondo, Marco Solmi, Elena Dragioti, Luis Eudave, Maite Ruiz-Goikoetxea, Amaia M. Ciaurriz-Larraz, Sara Magallon, Andre F. Carvalho, Andrea Cipriani, Paolo Fusar-Poli, Henrik Larsson, Christoph U. Correll, Samuele Cortese, Associations between psychological and bodily situations in youngsters and adolescents: An umbrella evaluation. Neuroscience & Biobehavioral Opinions Quantity 137, June 2022, 104662 https://doi.org/10.1016/j.neubiorev.2022.104662
S.V. Faraone, P. Asherson, T. Banaschewski, et al. Consideration-deficit/hyperactivity dysfunction. Nat Rev Dis Primers, 1 (1) (2015), Article 15020, 10.1038/nrdp.2015.20
Dunn, W. (2001) The sensations of on a regular basis life: empirical, theoretical, and pragmatic issues, American Journal of Occupational Remedy, 55(6), pp. 608–620.
Dunn W, Bennett D. Patterns of sensory processing in youngsters with consideration deficit hyperactivity dysfunction. Occupational Remedy Journal of Analysis. 2002;22(1):4-15. https://doi.org/10.1177/153944920202200102
Dunn, W. (1997). The influence of sensory processing skills on the each day lives of younger youngsters and their households: A conceptual mannequin. Infants & Younger Kids, 9(4), pp.23–35. https://doi.org/10.1097/00001163-199704000-00005
J. Cosbey, S.S. Johnston, M.L. Dunn Sensory processing problems and social participation. Am J Occup Ther, 64 (3) (2010), pp. 462-473, 10.5014/ajot.2010.09076
R. DelCarmen-Wiggins, A. Carter Handbook of Toddler, Toddler, and Preschool Psychological Well being Evaluation Oxford College Press, New York, NY (2004)
Ben‑Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel‑Yeger, B. & Gal, E. (2009) A meta‑evaluation of sensory modulation signs in people with autism spectrum problems. Journal of Autism and Developmental Issues, 39(1), pp. 1–11.
