Consideration deficit/hyperactivity dysfunction (ADHD) is probably the most broadly 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 folks with ADHD may expertise atypical sensory processing as properly (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), folks can fall into 4 totally 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 numerous sensory data, however they don’t proactively try to cease this when it’s overwhelming.
- Avoiding: they detect numerous sensory data and they actively attempt to keep away from additional sensory stimuli if it’s overwhelming.
Everybody has their very own manner of processing sensory data, however when these patterns turn out to be too excessive or laborious to handle, they’ll begin to intrude with each day life and affect cognitive features and psychosocial growth (Dunn, 2001); depth and pleasure of social interplay (Cosbey et al., 2010); and regulation of feelings and a focus (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 help we offer for folks with ADHD.
Sensory processing atypicalities could make odd stimuli really feel like a hearth alarm – and make life difficult in ADHD.
Strategies
This examine was registered in PROSPERO, the worldwide systematic overview 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 total examine high quality utilizing a modified Newcastle–Ottawa Scale (NOS),
This systematic overview targeted solely on research the place ADHD was formally recognized, excluding self-diagnosed or non-diagnosed individuals. Research during which individuals 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 examine design, authentic cohort, case-control and cross-sectional research have been included, while case research have been excluded.
The examine seemed on the following outcomes:
- Severity of sensory processing variations (measured repeatedly). Primarily based on Dunn’s 4 sensory modulation patterns (sensitivity, low registration, in search of, avoiding) and 6 sensory varieties (contact, sound, sight, style/scent, motion, physique consciousness).
- Danger of being hypersensitive or hyposensitive (measured as sure/no). Primarily based on how individuals have been rated within the research.
This systematic overview evaluated binary and steady variations in sensory processing difficulties, for folks formally recognized with ADHD.
Outcomes
A complete of 30 research (32 publications) have been included, with 5,374 individuals (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. Individuals typically 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 various. Reporting of comorbidities and medicine standing was inconsistent.
Sensory processing was measured utilizing varied instruments, mostly the Sensory Profile (SP), Brief 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 resulting from restricted information and excessive heterogeneity.
- Low sensory registration was considerably greater in ADHD, with extra pronounced results in older individuals.
- Sensory in search of was elevated total in ADHD however not in adults, and solely important underneath sure examine situations; no publication bias was discovered.
- ADHD individuals confirmed higher issue processing tactile, visible, auditory, oral, and movement-related enter, however not physique place.
- Folks with ADHD have been 9 instances extra prone 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), 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 reveal hypersensitivity and/or hyposensitivity, in several 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 situations.
Strengths and limitations
This examine is the first large-scale meta-analysis specializing in sensory processing in ADHD. Strengths embrace the excessive variety of research and individuals 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 have been performed based mostly on examine inhabitants (youngsters, adults), danger of bias, evaluation instrument, and exclusion of autism and IQ.
The principle limitation is the excessive heterogeneity throughout research, making it laborious to inform if variations replicate true results or inconsistent strategies. One other limitation is how “sensory processing” was outlined. Totally different instruments have been used throughout research, so the authors created their very own system to group outcomes. Whereas vital to mix information, this may occasionally have launched bias since these classes weren’t all the time utilized constantly within the authentic research, doubtlessly influencing findings in methods the authors couldn’t absolutely management.
Generalisability is proscribed: feminine individuals have been underrepresented (common 30%) throughout research, and ethnicity was largely unreported and predominantly White the place obtainable. Though not formal exclusion standards, this may occasionally point out {that a} “hyperactive White boys” archetype nonetheless dominates scientific and analysis cohorts in ADHD research. Additional, medicine 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 individuals 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 affect the findings. Folks with ASD are identified to typically expertise extra pronounced sensory variations (Ben-Sasson et al., 2009), so not absolutely accounting for co-occurring ASD may restrict how properly the conclusions replicate 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 girls and ethnic minorities with ADHD in research included on this overview, makes it obscure what sensory processing ‘hearth alarms’ seem like for these communities.
Implications for apply
Enthusiastic about SPPs (sensory processing patterns) in layman’s phrases, we will consider the mind working like a hearth alarm:
- The alarm’s sensitivity is the neurological threshold, and our response is the self-regulation.
- Totally 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 entire 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 watch for it to cease (passive responders), some may open the home windows to let the smoke out or disable the alarm all collectively (lively responders), and others may get overwhelmed.
Whereas common characterisations of individuals with ADHD could be a hyperactivity related to perpetual stimulus in search of, this overview identifies that there may be quite a lot of sensory processing patterns in ADHD people, which seem like broadly distributed throughout Dunn’s sensory domains.
Folks with ADHD may 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 concerns.
Though not explicitly said on this examine’s evaluation – given the heterogeneity of obtainable information for overview, 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 developments in sensory processing patterns throughout the lifespan.
Studying about sensory processing profiles, can affect extra inclusive therapies and help 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 Evaluation and Meta-analysis. J Am Acad Little one 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: information, with important re-analysis, from the International Burden of Illness examine. 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 overview 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 overview. 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 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 affect of sensory processing talents 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.
