Consideration deficit/hyperactivity dysfunction (ADHD) is probably the most broadly identified neurodevelopmental situation, affecting as many as 5% of youngsters and adolescents (Cortese et al., 2023) and three% of the grownup inhabitants (Ayano et al., 2023).
Individuals 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 folks 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. Beneath this framework (1997), folks can fall into 4 completely different classes:
- Low Registration: they don’t detect all of the sensory data, however they don’t proactively search extra sensory enter.
- Sensory Looking for: they don’t detect all of the sensory data, and they proactively search extra sensory enter.
- Sensory Delicate: they detect a variety of sensory data, however they don’t proactively try to cease this when it’s overwhelming.
- Avoiding: they detect a variety of sensory data and they actively attempt to keep away from additional sensory stimuli if it’s overwhelming.
Everybody has their very own approach of processing sensory data, however when these patterns turn into too excessive or onerous to handle, they’ll begin to intervene with every day life and impression cognitive features and psychosocial growth (Dunn, 2001); depth and delight 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 folks with ADHD and people with out; to tell the care and assist we offer for folks with ADHD.
Sensory processing atypicalities could make abnormal stimuli really feel like a fireplace alarm – and make life difficult in ADHD.
Strategies
This research was registered in PROSPERO, the worldwide systematic evaluate registry. The literature search lined 3 of probably the most established databases for publications dated up till June 30 2024. Phrases associated to ADHD and SPPs have 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 evaluate targeted solely on research the place ADHD was formally identified, excluding self-diagnosed or non-diagnosed members. Research during which members had greater than 20% of comorbid autism spectrum dysfunction, mental incapacity, or genetic problems have been additionally excluded (Juret et al,, 2025).
By way of the research design, authentic cohort, case-control and cross-sectional research have been included, while case research have been excluded.
The research seemed on the following outcomes:
- Severity of sensory processing variations (measured constantly). Based mostly on Dunn’s 4 sensory modulation patterns (sensitivity, low registration, in search of, avoiding) and 6 sensory sorts (contact, sound, sight, style/odor, motion, physique consciousness).
- Danger of being hypersensitive or hyposensitive (measured as sure/no). Based mostly on how members have been rated within the research.
This systematic evaluate evaluated binary and steady variations in sensory processing difficulties, for folks formally identified with ADHD.
Outcomes
A complete of 30 research (32 publications) have been included, with 5,374 members (1,656 with ADHD, 3,718 controls). Most research have been cross-sectional and targeted on youngsters, although some included adolescents and adults.
Females have been underrepresented (common 30%) and ethnicity was poorly reported. Members typically had common IQ, with low IQ excluded in most research. ADHD prognosis was primarily based on DSM/ICD standards or medical judgment, although diagnostic instruments assorted. Reporting of comorbidities and drugs standing was inconsistent.
Sensory processing was measured utilizing numerous instruments, mostly the Sensory Profile (SP), Quick Sensory Profile (SSP), and Adolescent/Grownup Sensory Profile (AASP). Danger of bias was unclear in most research.
The next outcomes have 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 as a result of restricted knowledge and excessive heterogeneity.
- Low sensory registration was considerably greater in ADHD, with extra pronounced results in older members.
- Sensory in search of was elevated general in ADHD however not in adults, and solely important beneath sure research circumstances; no publication bias was discovered.
- ADHD members confirmed larger problem processing tactile, visible, auditory, oral, and movement-related enter, however not physique place.
- Individuals with ADHD have been 9 instances extra more likely to be hypersensitive, even after correcting for publication bias.
- Hyposensitivity was almost 10 instances extra possible in ADHD, seen solely in adults, although primarily based on a restricted variety of research.
Throughout research, a wide range of instruments such because the Sensory Profile (SP), Quick Sensory Profile (SSP), and Adolescent/Grownup Sensory Profile (AASP), have been used to check sensory processing and responses.
Conclusion
This meta-analysis synthesises a medium to massive set of research into ADHD and sensory profiles and challenges, to spotlight the complexity of sensory processing patterns for folks with ADHD.
Whereas there’s a heterogeneity throughout research’ designs and dangers of bias, rising outcomes counsel ADHD people’ sensory profiles can display 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 may be strengths or challenges in distinctive circumstances.
Strengths and limitations
This research is the first large-scale meta-analysis specializing in sensory processing in ADHD. Strengths embody the excessive variety of research and members included. The methodology was systematic, following PRISMA tips with clear inclusion and exclusion standards. Most research used validated sensory processing questionnaires (SP, SSP, AASP), enhancing comparability. Subgroup analyses have been performed primarily based on research inhabitants (youngsters, adults), threat of bias, evaluation software, and exclusion of autism and IQ.
The primary limitation is the excessive heterogeneity throughout research, making it onerous to inform if variations mirror true results or inconsistent strategies. One other limitation is how “sensory processing” was outlined. Completely different instruments have been used throughout research, so the authors created their very own system to group outcomes. Whereas essential to mix knowledge, this will likely have launched bias since these classes weren’t at all times utilized persistently within the authentic research, doubtlessly influencing findings in methods the authors couldn’t totally management.
Generalisability is restricted: feminine members have been underrepresented (common 30%) throughout research, and ethnicity was largely unreported and predominantly White the place out there. Though not formal exclusion standards, this will likely point out {that a} “hyperactive White boys” archetype nonetheless dominates medical and analysis cohorts in ADHD research. Additional, remedy standing was typically 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 members with autism was inconsistent. 20 research excluded ASD, one included a number of, and 9 gave no particulars. Due to this, it’s unclear how having each ADHD and ASD may impression the findings. Individuals with ASD are recognized to typically expertise extra pronounced sensory variations (Ben-Sasson et al., 2009), so not totally accounting for co-occurring ASD may restrict how effectively the conclusions mirror sensory processing on this group.
Lastly, indicators of publication bias have been detected for outcomes like sensory avoiding, low registration, and hypersensitivity. Statistical changes have been made, however this bias suggests reported results is perhaps considerably overestimated.
The underrepresentation of ladies and ethnic minorities with ADHD in research included on this evaluate, makes it obscure what sensory processing ‘hearth alarms’ appear to be for these communities.
Implications for apply
Eager about 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 folks’s hearth alarms could also be kind of delicate to smoke, earlier than they ring.
- One individual’s alarm may solely go off when your complete constructing is on hearth (excessive neurological threshold), another person’s may go off on the puff of a vape (low neurological threshold).
- Some folks won’t reply to the alarm being triggered and simply anticipate 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 widespread characterisations of individuals with ADHD is usually a hyperactivity related to perpetual stimulus in search of, this evaluate identifies that there may be a wide range of sensory processing patterns in ADHD people, which look like broadly distributed throughout Dunn’s sensory domains.
Individuals with ADHD may be normally hypersensitive to a wide range of bodily stimuli, however a cohort of people who find themselves hyposensitive relative to undiagnosed populations shouldn’t be excluded from therapeutic design concerns.
Though not explicitly acknowledged on this research’s evaluation – given the heterogeneity of accessible knowledge for evaluate, the variations recognized between ‘low registration’ SPP prevalence in older individuals and ‘sensory in search of’ SPP earlier than maturity might additionally open an avenue for additional analysis on ADHD and any traits in sensory processing patterns throughout the lifespan.
Studying about sensory processing profiles, can affect extra inclusive therapies and assist design, for folks with ADHD throughout the lifespan — leaving nobody behind when their alarm bells ring.
Assertion of pursuits
None to declare
Hyperlinks
Main 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 Evaluate 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. Tune, L.C. Farhat, et al. Incidence, prevalence, and world burden of ADHD from 1990 to 2019 throughout 204 nations: knowledge, with important re-analysis, from the International 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 evaluate 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 circumstances in youngsters and adolescents: An umbrella evaluate. Neuroscience & Biobehavioral Critiques 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 concerns, 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 impression of sensory processing skills on the every day lives of younger youngsters and their households: A conceptual mannequin. Infants & Younger Youngsters, 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.
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