1 ADHD and Sensory Processing: Theory, Research, and Clinical Implications" C. Joe Egli, M.A., Ph.D., L.P.! Minnesota Association for Children s Mental Health Sunday, April 27 th, 2014
2 ADHD & Sensory Processing An Introduction" l Recognition of a need for multidisciplinary treatment approaches! l Disconnect between disciplines! l ADHD and comorbidity! l ADHD and sensory processing difficulties!
3 DSM-5 ADHD Criteria
4 Sensory Processing (Sensory Integration) Disorder/Difficulties l Ability to register, screen, organize and interpret information from our senses and environment to enable adaptive responses to changing circumstances and contexts. l Part of our foundation for sense of security, competence, social-emotional, cognitive, motor, communication and other life functions.
5 Sensory Systems Considered" l Vision! l Hearing! l Touch light touch, pressure, pain, temperature! l Taste! l Smell! l Vestibular! l Proprioception! l Interoceptive!
7 Over-Responsivity" Under-Responsivity" Sensory Craving Sensory Based Motor Disorder
8 Risk Factors for SPD" Genetics! Preterm birth! Prenatal risk factors! Birth trauma, complication during labor or delivery, jaundice, infant health issues, hospitalizations and medical procedures! Exposure to toxins! Adoption orphanage, sensory deprivation! Exposure to trauma, neglect/abuse!
9 Prevalence of SPD and Co-Occurring Disorders T.M.Benson, SPD Summary" Estimated 5-13% children have SPD, 73% male! Estimated Frequency Common Co-morbidities:! 40-60% ADHD & SPD! 70-90% Autism Spectrum Disorder & SPD!
11 Review: ADHD-Sensory Research" l Methodological issues!! Who is conducting the research?! How are ADHD and sensory processing measured?! How aware/sensitive are parents to challenges with sensory processing?!
13 Differences between ADHD and SPD: Research" l ADHD = more impulsive (Ognibene, 2002; Miller, 2006)! l SPD = more difficulties habituating to sensory stimuli (Ognibene, 2002)! l ADHD = anxiety specific to social concern (Lane, Reynolds, and Thacker, 2010)!
14 Combined ADHD + SPD: Research (when both are present)" l Greater anxiety (Reynolds and Lane, 2009; Lane, Reynolds, and Thacker, 2010)! l Problems with aggression, delinquency, academic achievement, and cognitive processing (Ghanizadeh, 2011)! l Greater sensory-related behaviors than ADHD alone and greater attention difficulties than SPD alone. (Miller, Nielsen, and Schoen, 2012)!
15 ADHD/Executive Functions Theory" l Barkley s model of ADHD and executive functions (Barkley, 1997)! Executive functions are higher order cognitive skills! Inhibition most important! l ADHD reflects deficits in executive functioning! l Evaluate with checklists, normed questionnaires, and cognitive skill measurement!
16 ADHD Testing and Research" l Less inhibitory motor control in children and adults with ADHD (Lijffijt, 2005)! l In adults, inhibition may be the strongest predictor of ADHD compared to measurement of other executive functions (Boonstra, et al., 2010)! l Working memory deficits persist into adulthood, increasing the difficulty of working memory measures will improve identification (Alderson, et al., 2013)!
17 Differentiating ADHD vs. Sensory" Helpful Hints ADHD! SPD! Consistently disruptive behavior! Yes! No! Anxiety and irritability! No! Yes! Measured executive deficits! Yes! No! ADHD medication is effective! Yes! No! Negative effects of ADHD meds! No! Yes! More organized/regulated after OT! No! Yes! Still impulsive with OT! Yes! No! Seeks new, nonspecific stimulation! Yes! No!
18 Best Clinical Practices" Client with ADHD symptoms! Refer for psychological testing of executive functions! Include sensory and motor questions in intake! If sensory/motor differences suspected, refer for occupational therapy evaluation! Mental health and O.T.s coordinate interventions! If no psych testing consider outcome of occupational therapy/evaluation!
20 References" Ahn, R.R., Miller, L.J., Milberger, S., McIntosh, D.N., (2004). Prevalence of parents' perceptions of sensory processing disorders among kindergarten children. American Journal of Occupational Therapy 58 (3): ! Alderson, R.M., Kasper,L.J., Hudec, K.L., and Patros, C.H.G. (2013). Attention-deficit/hyperactivity disorder (ADHD) and working memory in adults: A meta-analytic review. Neuropsychology (27): ! Ayres, A.J. (1979). Sensory integration and the child. Los Angeles: Western Psychological Services.!! Barkley, R.A.(1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying!theory of ADHD. Psychological Bulletin, 121: ! Barkley, R. A., Issues in the diagnosis of attention-deficit/hyperactivity disorder in children. Brain and Development 25(2), ! Bar-Shalita, T., Vatine, J., Parush, S., Sensory modulation disorder: a risk factor for participation in daily life activities. Developmental Medicine and Child Neurology 50(12): ! Ben-Sasson, A., Carter A. S., Briggs-Gowan, M. J., 2009a. Sensory over-responsivity in elementary school: Prevalence and social-emotional correlates. Journal of Abnormal Child Psychology 37(5): ! Biel, L., Peske, N Raising a sensory smart child, The definitive handbook for helping your child with sensory processing issues. Updated, rev.ed. Penguin Books, New York, N.Y.! Biel, L Sensory processing challenges: Effective clinical work with kids and teens. W.W.Norton Co. New York, N.Y.!
21 References cont. Boonstra, A.M., Kooij, J.J.S., Oosterlaan, J., Sergeant, J.A., and Buitelaar,J.K. (2010). To act or not to act, that s the problem: Primarily inhibition difficulties in adult ADHD. Neuropsychology, 24: ! Bundy,A.C., Lane, S.J, and Murray, E.A. (Eds). (2002). Sensory integration:theory and practice. (2 nd ed). Philadelphia: F.A.Davis.! Cermak, S. A.,1991. Somatodyspraxia. In: Fisher, A. G., Murray, E. A., Bundy A. C. (Eds.), Sensory integration: Theory and practice. F.A. Davis Company, Philadelphia, PA, ! Cosby, J. Johnson, SS., Dunn, ML. (2010). Sensory processing disorders and social participation. American Journal of Occupational Therapy. 64: ! DeGangi, G Pediatric disorders of regulation in affect and behavior: A therapist s guide to assessment and treatment. Elsevier Science (USA), Academic Press, San Diego, Ca.! Dunn, W., The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children 9(4): ! Dunn, W., The sensory profile: Examiner's manual. The Psychological Corporation,SanAntonio,TX.! Ghanizadeh,A Sensory processing problems in children with ADHD, a systematic review,!!! Psychiatry Investigations.June 8(2): 89-94! Gouze, K.R., Hopkins, J., Lebailly, S.A., Lavigne, J. V., Re-examining the epidemiology of sensory regulation dysfunction and comorbid psychopathology. Journal of Abnormal Child Psychology 37(8): !
22 References cont.! Interdisciplinary Council on Developmental and Learning Disorders (ICDL), Diagnostic manual for infancy!and early childhood: Mental health, developmental, regulatory-sensory processing, language and learning disorders ICDL-DMIC. Interdisciplinary Council on Developmental and Learning Disorders, Bethesda, MD.! James,K., Miller, LJ, Schaaf, R., Nielsen, D., Schoen, S. (2011). Phenotypes within sensory modulation dysfunction. Comprehensive Psychiatry, 52: ! Koomar, J. A., Bundy, A. C., Creating direct intervention from theory. In: Bundy, A. C., Lane, S. J., Murray, E. A. (Eds.), Sensory Integration Theory and Practice. F. A. Davis Company, Philadelphia, ! Lane SJ. Structure and function of the sensory systems. In: Bundy A,Lane SJ, Murray E, editors. Sensory integration: theory and practice, 2nd Ed Philadelphia: F.A. Davis; ! Lane,SJ, Reynolds,S. Dumenci,L. (2012). Sensory over-responsivity and anxiety in typically developing children and children with autism and attention deficit hyperactivity disorder: Cause or coexistence? American Journal of Occupational Therapy, 66: ! Lane, SJ, Reynolds,S., Thacker, L Sensory over-responsivity and ADHD: Differentiating using electrodermal responses, cortisol and anxiety. Frontiers in Integrative Neuroscience! Lijffijt, M., Kenemans, J.L., Verbaten,M.N., and Van Engeland, H. (2005). A meta-analytic review of stopping performance in attention-deficit/hyperactivity disorder: Deficient inhibitory motor control? Journal of Abnormal Psychology, 114: !
23 References, cont. Mangeot, S. D., Miller, L. J., McIntosh, D. N., McGrath-Clarke, J., Simon, J., Hagerman, RJ., Goldson, E., Sensory modulation dysfunction in children with attention-deficit-hyperactivity disorder. Developmental Medicine and Child Neurology 43(6): ! May-Benson, T.A., Koomar, J.A., Teasdale, A. (2009). Incidence of pre-, peri-, and post-natal birth and developmental problems of children with sensory processing disorder and children with autism spectrum disorder., Frontiers in Integrative Neuroscience, 3: 31: published online Nov.11, 2009! Miller, L.J. (2006) Sensational kids: Hope and help for children with sensory processing disorder. New York: G.P. Putnam s Sons.! Miller, L. J., Reisman, J. E., McIntosh, D. N., Simon, J., An ecological model of sensory modulation: Performance of children with Fragile X Syndrome, Autistic Disorder, Attention-Deficit/Hyperactivity Disorder, and Sensory Modulation Dysfunction. In: Fisher, A. G., Murray, E. A., Bundy A. C. (Eds.), Sensory integration: Theory and practice. F.A. Davis Company, Philadelphia, PA ! Miller, L., Anzalone, M., Lane, S., Cermak, S., Osten, E., 2007a. Concept evolution in sensory integration: A proposed nosology for diagnosis. The American Journal of Occupational Therapy 61(2): ! Miller, L. J., Coll, J. R., Schoen, S. A., 2007b. A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy 61(2): ! Miller, L.,Nielsen,D.,Schoen,S Attention deficit hyperactivity disorder and sensory modulation disorder: A comparison of behavior and physiology. Research in Developmental Disabilities 33: !
24 References, cont.! Mulligan,S.,1996. An analysis of score patterns of children with attention disorders on the Sensory Integration and Praxis Tests. American Journal of Occupational Therapy 50(8): Journal of Autism Developmental Disorders 38(3): ! Ognibene, T. (2002). Distinguishing sensory modulation dysfunction from attention-deficit-hyperactivity disorder: Sensory habituation and response inhibition processes. PhD Dissertation, University of Denver.! Parham,L.D.,Johnson-Ecker,C.,2000. Evaluation of Sensory Processing. In Bundy, A., Lane, S., Murray, E. (Eds.),Sensory Integration Theory and Practice. F.A. Davis Company,Philadelphia, ! Parush, S., Sohmer, H., Steinberg, A., Kaitz, M. (2007). Somatosensory functions in boys with ADHD and tactile defensiveness. Physiology & Behavior 90(4): ! Reynolds, S., Lane, S. J., Diagnostic validity of sensory over-responsivity: A review of the literature and case reports.! Reynolds, S., Lane, S. J., Sensory over-responsivity and anxiety in children with ADHD. American Journal of Occupational Therapy 63(4): ! Roley, S., Blanche, E., Schaaf, R. (Eds.) (2001). Understanding the nature of sensory integration with diverse populations. Therapy Skill Builders, San Antonio, Tx: Therapy Skill Builders.! Royeen CB, Lane SJ. Tactile processing and sensory defensiveness. In:Fisher AG, Murray EA, Bundy AC, editors. Sensory Integration: Theory and Practice. Philadelphia: FA Davis; ! Shochat, T., Tzischinsky, O., Engel-Yeger, B., Sensory hypersensitivity as a contributing factor in the relation between sleep and behavioral disorders in normal schoolchildren. Behavioral Sleep Medicine 7(1): !
25 References, cont. Van Hulle, C.A., Schmidt, N.L., Goldsmith, H.H. (2012). Is sensory over-responsivity distinguishable from childhood behaviors problems? A phenotypic and genetic analysis. Journal Child Psychol Psychiatry. 53(1): ! Willeamson, G.G., and Anzalone, M.E. (2001). Sensory integration and self-regulation in infants and young toddlers: Helping very young children interact with their environment. Washington, DC: Zero to Three, National Center for Clinical Infant Programs.! Yochman, A., Alon-Beery, O., Sribman,A, Parush, S. (2013). Differential diagnosis of sensory modulation disorder (SMD)and attention deficit hyperactivity disorder (ADHD):Participation, sensation, and attention. Frontiers in Human Neuroscience, 7/862: 1-10.! Yochman, A., Parush, S., Ornoy, A., Responses of preschool children with and without ADHD to sensory events in daily live. American Journal of Occupational Therapy 58(3): ! Zero to Three, Diagnostic classification: 0-3R: Diagnostic classification of mental health and developmental disorders in infancy and early childhood. Rev.ed. Zero to Three Press, Washington, DC.!
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