Attention deficit hyperactivity disorder and sensory modulation disorder: a comparison of behavior and physiology

Automatic sensory change processing in adults with attention deficit and hyperactivity disorder: a visual mismatch negativity study

In addition to higher-order executive functions, underlying sensory processing ability is also thought to play an important role in Attention-Deficit/Hyperactivity Disorder (AD/HD). An event-related potential feature, the mismatch negativity, reflects the ability of automatic sensory change processing and may be correlated with AD/HD symptoms and executive functions. This study aims to investigate the characteristics of visual mismatch negativity (vMMN) in adults with AD/HD. Twenty eight adults with AD/HD and 31 healthy controls were included in this study. These two groups were matched in age, IQ and sex. In addition, both groups completed psychiatric evaluations, a visual ERP task used to elicit vMMN, and psychological measures about AD/HD symptoms and day-to-day executive functions. Compared to trols, the late vMMN (230-330 ms) was significantly reduced in the AD/HD group. Correlation analyses showed that late vMMN was correlated with executive functions but not AD/HD symptoms. However, further mediation analyses showed that different executive functions had mediated the relationships between late vMMN and AD/HD symptoms. Our findings indicate that the late vMMN, reflecting automatic sensory change processing ability, was impaired in adults with AD/HD. This impairment could have negative impact on AD/HD symptoms via affecting day-to-day executive functions.

Relationship between sensory processing skills and motor skills in 12-month-old infants

INTRODUCTION

Identifying sensory processing problems of 12-month-old preterm and term children and defining their relationship with motor skills are essential for appropriate interventions and optimal sensory-motor development. This study aimed to determine sensory processing difficulties in 12-month-old babies and examine their relationship with motor skills.

METHODS

This cross-sectional study included 61 infants (28 preterm and 33 full-term, ages 12 months). The infants' sensory processing skills were evaluated using the Test of Sensory Functions in Infants (TSFI), and their gross and fine motor skills were assessed with the Peabody Developmental Motor Scales-2 (PDMS-2).

RESULTS

Sensory processing difficulties were more common in preterm babies. Multiple linear regression models indicated a significant positive association between PDMS-2 gross/fine motor scores and TFSI total scores, reactivity to tactile deep pressure, and ocular-motor control in the total sample. Furthermore, there was a relationship between gross motor and adaptive motor function, and fine motor scores were found to be associated with visual-tactile integration sensory scores.

CONCLUSIONS

Preterm babies are more likely than their full-term peers to have sensory processing problems around the age of one, which can affect their motor skills. The results support the relationship between children's sensory and motor processing skills. Practitioners such as occupational and physical therapists should be alert to this relationship in infants with sensory processing and motor problems. Taking this relationship into consideration when planning intervention programs can be a guide for an effective intervention.

Atypical Sensory Processing in Neurodevelopmental Disorders: Clinical Phenotypes in Preschool-Aged Children

BACKGROUND

Sensory processing issues are frequent in neurodevelopmental disorders (NDDs), with very variable prevalence rates ranging from 20% to 95%. This study aimed to investigate sensory processing in preschool-aged children with NDDs, to clarify the epidemiology, and to identify associated or correlated clinical and psychometric variables.

METHODS

A total of 141 NDD children (age range 2-5 years old) were included and enrolled in two subgroups: 72 with ASD and 69 with other NDDs. A standardized neuropsychological evaluation was assessed (Griffiths III/WPPSI-III/Leiter-R, ADOS-2) and the parents completed the CBCL ½-5, the SPM-P, and the ADI-R.

RESULTS

Atypical sensory processing was reported in 39.7% of the total sample, more frequently in ASD (44.4%) than in other NDDs (34.8%). No statistically significant differences were found regarding gender and developmental level. A positive correlation was found between sensory processing abnormalities and behavioral problems (p < 0.01).

CONCLUSIONS

Compared to other NDDs, ASDs more frequently have atypical sensory processing and appear to present a specific vulnerability in the processing of proprioceptive and vestibular inputs. Our results suggest that sensory processing difficulties should be considered regardless of developmental level and in children with behavioral problems.

Audio-visual multisensory integration and haptic perception are altered in adults with developmental coordination disorder

Developmental Coordination Disorder (DCD) is a movement disorder in which atypical sensory processing may underly movement atypicality. However, whether altered sensory processing is domain-specific or global in nature, are unanswered questions. Here, we measured for the first time, different aspects of sensory processing and spatiotemporal integration in the same cohort of adult participants with DCD (N = 16), possible DCD (pDCD, N = 12) and neurotypical adults (NT, N = 28). Haptic perception was reduced in both DCD and the extended DCD + pDCD groups when compared to NT adults. Audio-visual integration, measured using the sound-induced double flash illusion, was reduced only in DCD participants, and not the DCD + pDCD extended group. While low-level sensory processing was altered in DCD, the more cognitive, higher-level ability to infer temporal dimensions from spatial information, and vice-versa, as assessed with Tau-Kappa effects, was intact in DCD (and extended DCD + pDCD) participants. Both audio-visual integration and haptic perception difficulties correlated with the degree of self-reported DCD symptoms and were most apparent when comparing DCD and NT groups directly, instead of the expanded DCD + pDCD group. The association of sensory difficulties with DCD symptoms suggests that perceptual differences play a role in motor difficulties in DCD via an underlying internal modelling mechanism.

[Sensory regulation disorders in child psychiatry]

INTRODUCTION

The processing of sensory information determines the development and growth of a child's abilities. Dysfunction in the processing of sensory stimuli can affect a child's behavior and can disrupt development. Sensory Regulation Disorders are frequently associated with Autism Spectrum Disorder (ASD), with the DSM-5 even including it as a diagnostic criterion. However, they are also observed in other neurodevelopmental disorders. At present, the frequency of Sensory Regulation Disorders in children consulting child psychiatry has never been evaluated, although it seems to be a population at risk.

OBJECTIVES

To evaluate the frequency of sensory regulation disorders in children between 3 and 6 years old who first consult a child psychiatrist in Marseille. To determine whether certain reasons for consultation are correlated with the presence of sensory regulation disorders.

METHODS

A multicenter cross-sectional study was conducted for four months in Marseille. Sensory regulation disorders were assessed by the second version of Dunn's short sensory profile.

RESULTS

Fifty-eight patients were included. A significant difference was found between the frequency of SRT in our primary child psychiatry population and the general population. Subgroup analyses according to the reason for consultation showed that there would be more SRT in the Motor Instability/Inattention, Conduct Disorder and Socialization Disorder subgroups.

CONCLUSION

We observed a higher frequency of SRT in the child psychiatry consultation population. SRT could explain, or at least partly participate in, the children's symptomatology. The results are in favor of an early detection of SRT in the population of children consulting child psychiatry. The evaluation of the sensory profiles of these children allows a better understanding of the child's functioning and an adjustment of the intervention and support strategies proposed to the family.

Neurite orientation dispersion and density imaging of white matter microstructure in sensory processing dysfunction with versus without comorbid ADHD

Introduction

Sensory Processing Dysfunction (SPD) is common yet understudied, affecting up to one in six children with 40% experiencing co-occurring challenges with attention. The neural architecture of SPD with Attention Deficit and Hyperactivity Disorder (ADHD) (SPD+ADHD) versus SPD without ADHD (SPD-ADHD) has yet to be explored in diffusion tensor imaging (DTI) and Neurite Orientation Dispersion and Density Imaging (NODDI) has yet to be examined.

Methods

The present study computed DTI and NODDI biophysical model parameter maps of one hundred children with SPD. Global, regional and voxel-level white matter tract measures were analyzed and compared between SPD+ADHD and SPD-ADHD groups.

Results

SPD+ADHD children had global WM Fractional Anisotropy (FA) and Neurite Density Index (NDI) that trended lower than SPD-ADHD children, primarily in boys only. Data-driven voxelwise and WM tract-based analysis revealed statistically significant decreases of NDI in boys with SPD+ADHD compared to those with SPD-ADHD, primarily in projection tracts of the internal capsule and commissural fibers of the splenium of the corpus callosum.

Conclusion

We conclude that WM microstructure is more delayed/disrupted in boys with SPD+ADHD compared to SPD-ADHD, with NODDI showing a larger effect than DTI. This may represent the combined WM pathology of SPD and ADHD, or it may result from a greater degree of SPD WM pathology causing the development of ADHD.

The Effect of Methylphenidate Treatment on Olfactory Function in Children and Adolescents With ADHD

OBJECTIVE

This study aimed to research whether there is an olfactory disorder in ADHD, and if so, what is the effect of methylphenidate on this condition.

METHOD

This is a cross-sectional study aiming to evaluate olfactory threshold, identification, discrimination and threshold, discrimination, and identification (TDI) scores in 109 children and adolescents, 33 of whom have ADHD without medication, 29 with ADHD with medication and 47 control groups.

RESULT

In the post hoc tests, the mean odor discrimination test, the mean odor identification test, and the mean TDI scores of the unmedicated ADHD group were significantly lower than those of the other two groups, and that the mean odor threshold test scores of the medicated ADHD group were significantly lower than those of the control and unmedicated groups.

CONCLUSION

Olfactory function could be a useful tool to monitor treatment effects and may be a promising candidate as a biomarker in ADHD.

Sensory processing and sleep characteristics in preterm infants in the early period of life

OBJECTIVE

The present study aimed to investigate the following: (i) differences in sensory processing and sleep characteristics between preterm infants born at < 32 weeks', vs. those born at ≥ 32 weeks' gestation; (ii) differences in sleep characteristics between preterm infants with typical vs. atypical sensory processing; and (iii) relationship between sensory processing and sleep characteristics in preterm infants at 3 months of age.

METHODS

A total of 189 preterm infants, 54 born at < 32 weeks' gestation (26 females; mean gestational age [standard deviation (SD)], 30.1 [1.7] weeks), and 135 born at ≥ 32 weeks' gestation (78 females; mean gestational age [SD], 34.9 [0.9] weeks) were included in the present study. Sleep characteristics were evaluated using the Brief Infant Sleep Questionnaire, and sensory processing was assessed using the Infant Sensory Profile-2.

RESULTS

There were no significant differences in sensory processing (P > 0.05) or sleep characteristics (P > 0.05) between the preterm groups; however, more infants snored in the <32 weeks' gestation group (P = 0.035). Preterm infants with atypical sensory processing showed lower nighttime (P = 0.027) and total sleep durations (P = 0.032), and higher rates of nocturnal wakefulness (P = 0.038) and snoring (P = 0.001) than preterm infants with typical sensory processing. A significant relationship, therefore, was observed between sensory processing and sleep characteristics (P < 0.05).

CONCLUSIONS

Sensory processing patterns may play an important role in understanding sleep problems in preterm infants. The early detection of sleep problems and sensory processing difficulties are necessary for early intervention.

Evaluation of Ayres Sensory Integration® Intervention on Sensory Processing and Motor Function in a Child with Rubinstein-Taybi Syndrome: A Case Report

The Rubinstein-Taybi Syndrome (RSTS) literature is limited about sensory integration, which is a foundational neurological function of the central nervous system that may affect the development of cognitive, social, and motor skills. The aim of this case report was to investigate the effects of Ayres Sensory Integration® (ASI) intervention on processing and integrating sensations, motor functions and parental goals of 3-year-old child with RSTS. Analysis of assessment data reviewed before and after treatment. Assessment collected by interview, Sensory Profile (SP), Sensory Processing Measure-Preschool (SPM-P) Home, Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measurement-88 (GMFM-88), and Gross Motor Function Classification System (GMFCS). Progress toward goals and objectives was measured with Goal Attainment Scale (GAS). ASI intervention was implemented 3 times per week for 8 weeks. At pre-intervention, SP and SPM-P Home revealed prominent sensory processing and integration difficulties in this case. PDMS-2 scores indicated the child was far behind his peers in fine and gross motor areas. In addition, systematic observations determined that the child's GMFCS level was III. After 8 weeks of ASI intervention significant improvements were found in parent reports of sensory processing in the areas of vestibular, tactile, and oral functioning on the Sensory Profile. Gains in functional motor skills were found on the GMFM-88 and the GMFCS. Consistent with these results, significant gains at or above expected levels of performance were found on GAS goals which reflected the family's main concerns for social participation, feeding, play, and movement. There are limited studies on sensory processing and integration in children with RSTS. This case report identified sensory processing and integration difficulties for the first time in a child with RSTS. Results also provide preliminary support for the positive effects of ASI intervention on sensory processing, functional motor skills, and parental goals of a child with RSTS.

Deficits of Sensory Integration and Balance as Well as Scoliotic Changes in Young Schoolgirls

The aim of this study was to assess the relationship between sensory integration and balance deficits as well as scoliotic changes in young schoolgirls. The study comprised 54 girls aged 11 years with scoliotic changes. The Clinical Test of Sensory Integration and Balance of the Biodex Balance System platform were used to analyze the deficits in sensory integration and balance. Scoliotic changes were assessed using the Diers Formetric III 4D optoelectronic method. In the present study, there was a significant relationship between sensory integration and balance deficits as well as spine curvature angle (°) (p = 0.01), vertebral surface rotation (°) (p = 0.03), pelvic tilt (°) (p = 0.02), and lateral deviation (mm) (p = 0.04). The integration of the sensory systems has a positive effect on the structure of the intended and controlled movement as well as body posture and the development of the spine. In the treatment of scoliotic changes, one should also consider exercises that improve sensory integration as well as position and balance reactions.

Sensory Processing in Children and Adolescents with Attention Deficit Hyperactivity Disorder

OBJECTIVE

The aim is to assess the sensory processing difficulties in children and adolescents with ADHD.

METHODS

In all, 38 ADHD children of the age group 6-14 years and 34 age- and gender-matched typically developing controls were included in the study. Sensory processing was assessed on Child Sensory Profile-2. The child behavior checklist and Weiss functional impairment rating scale were applied to assess behavioral problems and functional impairments, respectively.

RESULTS

A significantly higher sensory processing difficulties were seen in children with ADHD than typically developing controls. There were positive correlations between the scores of Child sensory profile 2 with internalizing (with Sensitivity p = .036, Avoiding p = .001, and Auditory p = .029) and externalizing T scores (with Seeking p = .031, Movement p = .025, and Visual p = .018) of CBCL and also with scores of Weiss functional impairment rating scale (with Seeking p = .001, Sensitivity p = .019, and Registration p = .045).

CONCLUSIONS

Sensory problems were common in children with ADHD and add to the functional impairments.

Reading performance in children with ADHD: an eye-tracking study

Reading disabilities have a profound impact on the academic performance and achievement of children. Although oculomotor pattern abnormalities during reading in children with dyslexia are well known, those in individuals with attention deficit and hyperactive disorders (ADHD) - who also frequently exhibit a reading impairment - remain largely undetermined. The objective of the present study was to evaluate the peculiarities of oculomotor pattern abnormalities during a reading task. An eye-tracker was used to record eye movements in four distinct groups of children with neurodevelopmental disorders: children with dyslexia, children with ADHD with and without comorbid dyslexia, and in a group of typically developing children (TD). Ninety-six children participated in the study (24 children per group, IQ- and age-matched groups). The duration of fixation, the total reading time, and the number of forward and backward saccades were similar in children with dyslexia and ADHD + dyslexia, but were significantly different from those observed in children with ADHD and with TD. Our findings suggest a link between dyslexia and oculomotor reading impairments in both children with dyslexia and children with ADHD + dyslexia, indicating that the oculomotor pattern in children with ADHD without comorbid dyslexia is similar to that observed in TD children. We suggest that an objective eye movement recording during a reading task could help clinicians to better evaluate the possible presence of comorbid dyslexia in children with ADHD. Furthermore, children with ADHD with and without comorbid dyslexia could also have working memory deficiencies. Further studies are needed to confirm this finding.

The Perceived Causal Relations Between Sensory Reactivity Differences and Anxiety Symptoms in Autistic Adults

Background

Rates of anxiety are inordinately high in autistic adults. Sensory reactivity differences, such as hyperreactivity (e.g., strong reactions to sound), hyporeactivity (e.g., no, or slower reactions to pain), and seeking (e.g., fascination with spinning objects), are a diagnostic criterion of autism and have been linked with anxiety. Understanding how individuals perceive these to be causally related can impact the assessment and treatment of anxiety. Therefore, we examined the perceived causal relations (PCR) between sensory reactivity differences and anxiety in autistic adults.

Method

Two hundred forty-six autistic adults aged 18-76 years took part in an online study. They completed self-report assessments of sensory reactivity differences, and anxiety, followed by the PCR scale, indicating whether they perceived their sensory reactivity differences to be more of a cause or an effect of their anxiety symptoms.

Results

We found sensory reactivity hyperreactivity, hyporeactivity, and seeking to be significantly correlated with anxiety. Further, we found total sensory hyperreactivity, and visual, auditory, and olfactory hyperreactivity, to be perceived as significantly more of a cause of anxiety than an effect, and total sensory seeking, and tactile and vestibular seeking, to be perceived as significantly more of an effect of anxiety than a cause.

Conclusion

Future individualized approaches to treating anxiety in autistic individuals may benefit from differentiating between potential sensory causes of anxiety (e.g. hypersensitivities) vs. potential sensory effects of anxiety (e.g. sensory seeking behaviors).

Sensory Modulation in Children with Developmental Coordination Disorder Compared to Autism Spectrum Disorder and Typically Developing Children

Developmental Coordination Disorder (DCD) is one of the least studied and understood developmental disorders. One area that has been minimally investigated in DCD is potential issues with sensory modulation. Further, in other neurodevelopmental disorders (e.g., autism spectrum disorder (ASD)) sensory modulation is related to many other challenges (e.g., social issues, repetitive behaviors, anxiety); however, such potential relationships in children with DCD have been largely unexplored. The purpose of this study is to explore sensory modulation differences in DCD and to understand the relationships between sensory modulation and social emotional measures, behavior, and motor skills in DCD in comparison to ASD and typically developing (TD) peers. Participants (aged 8-17) and their caregivers (DCD, N = 26; ASD, N = 57; and TD, N = 53) completed behavioral and clinical measures. The results indicated that 31% of the DCD group showed sensory modulation difficulties, with the DCD group falling between the ASD and TD groups. In the DCD group, sensory modulation was significantly associated with anxiety, empathic concern, repetitive behaviors, and motor skills. Data are compared to patterns seen in ASD and TD groups and implications for interventions are discussed.

Sensory over-responsivity and obsessive-compulsive disorder: Measuring habituation and sensitivity through self-report, physiological and behavioral indices

Individuals with obsessive-compulsive disorder (OCD) may report Sensory Over Responsivity (SOR), but evidence for specific shared mechanism is limited. This study investigated a habituation-sensitivity mechanism in individuals with OCD (n = 30). Sensory habituation and sensitivity were compared with a neurotypical sample, divided to high (n = 30) and low (n = 30) obsessive-compulsive symptoms (HOCS and LOCS). Participants completed self-report sensory questionnaires and a physiological protocol measuring Electro Dermal Activity (EDA) while presenting aversive and neutral sounds in two conditions: Aversive stimuli followed by neutral stimuli (AVfirst), or neutral stimuli followed by aversive stimuli (NEfirst). In addition, participants could shorten the stimulus duration by pressing a key. LOCS differed from HOCS and OCD in most sensory self-report scores, with no significant difference between OCD and HOCS. HOCS had no significant differences in habituation patterns across conditions, while OCD had no differences in habituation patterns in AVfirst (p = .08) but significantly slower habituation patterns to the NEfirst neutral stimuli (p < .001). Condition order determined sensitivity for LOCS (AVfirst p = .017; NEfirst p = .045) but not for OCD and HOCS. HOCS and OCD shortened aversive stimuli by key pressing more than LOCS, with no significant difference between OCD and HOCS. The habituation process of individuals with OCD and HOCS was more influenced by stimulus type than by condition order, which might be due to a cognitive bias of prediction. Individuals with elevated OCS have difficulty relying upon sensory input to respond adaptively to the environment. This process can explain the avoidant behavior and complains of individuals with OCD not being able to ignore and to habituate to the sensory environment. These evidence warrants design of psychoeducation and intervention methods for relying on prior sensory information to improve functioning in individuals with OCD and SOR.

Attention-Deficit/Hyperactivity Disorder Symptoms, Sensation-Seeking, and Sensory Modulation Dysfunction in Substance Use Disorder: A Cross Sectional Two-Group Comparative Study

Background: Attention-deficit/hyperactivity disorder (ADHD) and sensation-seeking, a trait characterized by risk-related behaviors, have been recognized as risk factors in substance use disorder (SUD). Though ADHD co-occurs with sensory modulation dysfunction (SMD), SMD has scarcely been explored in SUD. Thus, this study aimed to characterize ADHD symptomology, sensation-seeking, and SMD, as well as to explore their contribution to SUD likelihood. Methods: A cross sectional two-group comparative study including therapeutic community residents with SUD (n = 58; study group) and healthy individuals (n = 62; comparison group) applying the MOXO continuous performance test (MOXO-CPT) evaluating ADHD-related symptoms. In addition, participants completed the ADHD Self-Report Scale—Version 1.1 for ADHD screening; the Brief Sensation Seeking Scale quantifying risk-taking behaviors; and the Sensory Responsiveness Questionnaire-Intensity Scale for identifying SMD. Results: The study group demonstrated higher SMD incidence (53.57% vs. 14.52%) and lower performance in three MOXO-CPT indexes: Attention, Impulsivity, and Hyperactivity, but not in Timing, compared to the comparison group. Sensory over-responsiveness had the strongest relationship with SUD, indicating 27-times increased odds for SUD (95% CI = 5.965, 121.216; p ≤ 0.0001). A probability risk index is proposed. Conclusion: We found SMD with the strongest relation to SUD exceeding that of ADHD, thus contributing a new perspective for developing future therapeutic modalities. Our findings highlight the need to address SMD above and beyond ADHD symptomology throughout the SUD rehabilitation.

Subtyping of Internalizing and Externalizing Behaviors in Japanese Community-Based Children: A Latent Class Analysis and Association with Family Activities

Externalizing and internalizing behavioral problems occurs at a high rate among children. However, this has rarely been examined among Japanese children using a person-oriented method. Hence, this study aims to explore its subtypes and clarify their association with family-based group activities. We conducted a cross-sectional survey in a typical community-based suburban area for all families with primary school children in Japan. We investigated children's internalizing and externalizing behaviors based on the Japanese version of the Strengths and Difficulties Questionnaire (SDQ), and different types of activities that family members frequently engaged in. Data from 206 families were collected and used for the analysis. The subtypes were explored using latent class analysis (LCA). The relationship between family activities and latent class membership was analyzed using a logistic regression model. Moreover, three latent class models and their probabilities were identified, namely, risk group (31.3%), moderate group (44.9%), and normal group (23.8%). Frequent family activities including play sports, traveling or hiking, watching TV and communicating, cooking or making a dessert, and doing housework, which were significantly related to the normal group. These results would add evidence to potential types of children's behavioral problems and preventive childcare practices needed in the primary gate of families.

Reconceptualizing non-pharmacologic approaches to Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS): A theoretical and evidence-based approach. Part II: The clinical application of nonpharmacologic care for NAS/NOWS

There has been increasing emphasis on the importance of the development of self-regulatory capacities of the individual as the cornerstone of development. The caregivers' abilities to manage their own attention, emotions, physiology and behaviors influence the development of the child's self-regulatory and interactive capacities, and thereby their overall development. Newborns prenatally exposed to psychoactive substances and/or to other prenatal stressors such as maternal poor nutrition, increased maternal stress, trauma, difficult and/or impoverished environments, in tandem with genetic predispositions, can result in alterations to their neurodevelopment that predispose them to self-regulatory problems that can be expressed at any stage of life. The care of infants with Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS) and their mother/caregiver is a window of opportunity to assess the regulatory and co-regulatory capacities of both, and to provide holistic interventions with the goal of empowering the mother/caregiver in their own self-knowledge/self-regulation capacities and their crucial role in promoting the healthy development of their children. Non-pharmacologic care for the infant with NAS/NOWS is the first line of treatment and of paramount importance. Yet, current approaches are based on a limited scope of infant functioning, and the scoring systems in current use do not result in individualized and specific non-pharmacologic care of the infant, which can result in excessive or insufficient medication and a lack of caregiver appreciation for the infant's strengths, difficulties and early development. The interventions described here are based on the infant's signs of dysregulation in four neurobehavioral subsystems that can be dysregulated by NAS/NOWS, the infant's adaptive or maladaptive responses to return to a regulated functioning, and the co-regulatory behaviors of the infant and the mother/caregiver. In Part I of this two-part series on re-conceptualizing non-pharmacologic care for NAS/NOWS we laid the foundation for a new treatment approach, one grounded in developmental theory and evidence-based observations of infant and interpersonal neurobiology. Here, in Part II, we outline actionable, individually tailored evaluations and approaches to non-pharmacologic NAS/NOWS treatment based on strategies to support the regulatory capacities and development of 4 key domains: 1) autonomic; 2) motor/tone; 3) sleep/awake state control; and 4) sensory modulation subsystems.

Reconceptualizing non-pharmacologic approaches to Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS): A theoretical and evidence-based approach

Discussions about non-pharmacologic interventions for Neonatal Abstinence Syndrome and Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) have been minor compared with wider attention to pharmacologic treatments. Although historically under-recognized, non-pharmacologic interventions are of paramount importance for all substance-exposed infants and remain as a first line therapy for the care of infants affected by NAS. Here we examine the role of non-pharmacologic interventions for NAS/NOWS by incorporating theoretical perspectives from different disciplines that inform the importance of individualized assessment of the mother-caregiver/infant dyad and interventions that involve both individuals. NAS/NOWS is a complex, highly individualized constellation of signs/symptoms that vary widely in onset, duration, severity, expression, responses to treatment and influence on long-term outcomes. NAS/NOWS often occurs in infants with multiple prenatal/postnatal factors that can compromise neurobiological self-regulatory functioning. We propose to rethink some of the long-held assumptions, beliefs, and paradigms about non-pharmacologic care of the infant with NAS/NOWS, which is provided as non-specific or as "bundled" in current approaches. This paper is Part I of a two-part series on re-conceptualizing non-pharmacologic care for NAS/NOWS as individualized treatment of the dyad. Here, we set the foundation for a new treatment approach grounded in developmental theory and evidence-based observations of infant neurobiology and neurodevelopment. In Part II, we provide actionable, individually tailored evaluations and approaches to non-pharmacologic NAS/NOWS treatment based on measurable domains of infant neurobehavioral functioning.

Home participation, support and barriers among children with attention-deficit/hyperactivity disorder before and during the COVID-19 pandemic

Objectives

Few studies have focused on the participation of children with attention-deficit/hyperactivity disorder (ADHD) in daily routine and leisure activities. This study aimed to compare the participation, support and barriers for children with ADHD at home pre-COVID-19 and during the COVID-19 outbreak.

Methods

The study included 55 children with ADHD aged 6–11 years. Participation frequency, involvement, desire for change, supports and barriers at home were assessed using the Participation and Environment Measure for Children and Youth (PEM-CY).

Results

During the COVID-19 pandemic compared with the pre-COVID-19 period, the mean frequency of participation of children with ADHD in computer and video games (5.8% vs 5%, respectively), socialising with other people (7% vs 6.2%) and household chores (5.5% vs 4.6%) was shown to be significantly higher (p < 0.05). Mothers of children with ADHD reported higher levels of involvement during the COVID-19 pandemic compared with the pre-COVID-19 period across four areas of home participation, including computer and video games (4.1% vs 3.2%, respectively), arts, crafts, music and hobbies (3.7% vs 3%), household chores (3.6% vs 2.8%) and personal care management (4.2% vs 3.5%) p < 0.05). Mothers of children with ADHD reported that during the pandemic the following two features of the environment made participation easier than pre-COVID-19 (p < 0.05): cognitive demands (36.4% vs 60%, respectively) and social demands (5.5% vs 34.5%). More mothers reported that services (92.7%), supplies (87.3%) and information (85.5%) were available and/or adequate in the COVID-19 period than pre-COVID-19 (p < 0.05).

Conclusions

Mothers of children with ADHD reported that their children were participating more frequently in some of the home-related activities during the COVID-19 pandemic compared to pre-COVID-19. Reduced cognitive and social demands, and more readily available resources in the home environment during the COVID-19 period resulted in increased home participation compared to pre-COVID-19.

Clinical Conundrums When Integrating the QbTest into a Standard ADHD Assessment of Children and Young People

The uptake of the QbTest in clinical practice is increasing and has recently been supported by research evidence proposing its effectiveness in relation to clinical decision-making. However, the exact underlying process leading to this clinical benefit is currently not well established and requires further clarification. For the clinician, certain challenges arise when adding the QbTest as a novel method to standard clinical practice, such as having the skills required to interpret neuropsychological test information and assess for diagnostically relevant neurocognitive domains that are related to attention-deficit hyperactivity disorder (ADHD), or how neurocognitive domains express themselves within the behavioral classifications of ADHD and how the quantitative measurement of activity in a laboratory setting compares with real-life (ecological validity) situations as well as the impact of comorbidity on test results. This article aims to address these clinical conundrums in aid of developing a consistent approach and future guidelines in clinical practice.

Association between sensory modulation and sleep difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD)

BACKGROUND

Sleep difficulties have been reported in up to 85% of children with Attention Deficit hyperactivity disorder (ADHD). Children with ADHD exhibit commonly sensory modulation difficulties (SMD) and experience more significant functional difficulties. Sleep difficulties have also been associated with SMD. The aim of this study was to evaluate whether SMD are associated with sleep difficulties in children with ADHD.

METHODS

We assessed sleep difficulties using the Children's Sleep Habits Questionnaire, and SMD using the Short Sensory Profile (SSP) questionnaire. A total of 25 children with ADHD and atypical sensory profiles, 13 children with ADHD and typical sensory profiles and 38 children used as controls (all children aged 8-11 years) were included.

RESULTS

Sleep difficulties were detected in 86.4% of children with ADHD and atypical SSPs, as compared to 30.8% of children with ADHD and typical SSPs, and 16.7% of controls. A multivariate logistic regression revealed that children with ADHD and atypical SSPs had significantly increased odds for sleep difficulties as compared to controls (OR = 32.4; 95% CI 4.0-260.1, p = 0.001), while children with ADHD and typical SSPs were indistinguishable from controls. Suspected confounders (gender, age, mother's education, and stimulant therapy) did not contribute to sleep difficulties.

CONCLUSION

In this pilot study, SMD were associated with sleep difficulties in children with ADHD.

The relationship between sensory reactivity, intolerance of uncertainty and anxiety subtypes in preschool-age autistic children

LAY ABSTRACT

This study found links between greater sensory hyperreactivity (e.g., over-sensitive to sensory input), intolerance of uncertainty and anxiety, including separation anxiety, in autistic pre-schoolers. Sensory hyperreactivity may predict both anxiety and intolerance of uncertainty, and anxiety and intolerance of uncertainty may both be mutually important, mediating factors. These findings have implications for early anxiety interventions. But there is a pressing need for objective assessments that can be used with preschool-age autistic children.

Characteristics of Idiopathic Sensory Processing Disorder in Young Children

This study described the developmental and behavioral characteristics of children identified with idiopathic sensory processing disorder (SPD) as well as the relations among specific types of SPD as proposed by the nosology presented by Miller et al. (2007), adaptive behavior profiles, and behaviors associated with mental functioning. A retrospective, non-experimental design applying descriptive and correlational analyses was used. Data were obtained from clinic medical records of 78 children ages 2 to 7 years who were identified with sensory processing problems affecting daily life, but who did not meet criteria for any other neurodevelopmental or mental disorders following a comprehensive diagnostic evaluation. Results revealed that all SPD types as described by current typologies were well represented with the most common being the over-responsivity sensory modulation subtype. Within the sample, 53% of the children displayed more than one SPD type. Atypical externalizing and internalizing behavior scores associated with various mental disorders as measured by the child behavior checklist (CBCL) fell in the borderline dysfunctional range. Adaptive behavior for all developmental domains was below average, and the severity of SPD symptoms moderately and positively correlated with behaviors associated with mental disorders, and with lower adaptive behavior performance. It was concluded that symptoms characteristic of the various types of idiopathic SPD overlap substantially suggesting that current typologies may include more types/subtypes than are necessary or clinically useful. Children with SPD share similar, but often less severe pathological behaviors associated with other mental or related neurodevelopmental disorders. Psychometrically sound measures of SPD are needed, and further study of the neural mechanisms involved in sensory processing deficits is vital for validating idiopathic SPD as its own diagnostic entity.

Sensory Modulation Disorder and its Neural Circuitry in Adults with ADHD: A Pilot Study

Compared to healthy controls (HCs), individuals with attention-deficit/hyperactivity disorder (ADHD) exhibit more symptoms of sensory processing disorder (SPD), which is associated with difficulties in educational and social activities. Most studies examining comorbid SPD-ADHD have been conducted with children and have not explored relations to brain volumes. In this pilot study, we assessed a subtype of SPD, sensory modulation disorder (SMD), and its relation to select brain volumes in adults with ADHD. We administered part of the Sensory Processing 3-Dimensions Scale (SP3D) to assess subtypes of SMD and collected structural imaging scans from 25 adults with ADHD and 29 healthy controls (HCs). Relative to HCs, subjects with ADHD scored higher on sensory craving (SC) and sensory under-responsivity (SUR) subscales. Although sensory over-responsivity (SOR) was marginally higher, this was no longer true when accounting for co-occurring anxiety. In individuals with ADHD, both SC and SUR were positively associated with amygdalar volume, SUR was also positively associated with striatal volume, whereas SOR was negatively associated with posterior ventral diencephalon volume. These preliminary findings suggest that SC and SUR may be characteristic of ADHD while SOR may be driven by co-occurring anxiety. Because different modalities were associated with different brain volumes, our findings also suggest that the modalities may involve unique neural circuits, but with a partial overlap between SC and SUR. These pilot data provide support for conducting studies examining SMD in larger samples of adults with ADHD to determine reproducibility, applicability and implications of these findings.

Sensory profiles in adults with and without ADHD

BACKGROUND

Our previous work demonstrates that adults with ADHD produce more force at the fingertips compared to adults without ADHD. One possibility is that somatosensation is impaired in ADHD. However, ADHD is often comorbid with anxiety, and anxiety influences sensory responsivity.

AIMS

The goal of the current work was to evaluate differences in the self-report of sensory experiences in adults with and without ADHD, while controlling for internalizing behaviors.

METHODS AND PROCEDURES

Forty-five adults (23 with ADHD) completed a semi-structured interview for the diagnosis of ADHD, the Adolescent/Adult Sensory Profile (AASP), and the Achenbach Adult Self Report (ASR).

OUTCOMES AND RESULTS

Adults with ADHD reported more hyper- and hypo- sensitivity compared to adults without ADHD, even when controlling for internalizing behaviors. Specifically, between group differences were found for low registration, sensation seeking, and sensory sensitivity scores, but not for sensation avoiding, and for movement, visual, touch, activity, audition, or taste/smell.

CONCLUSIONS AND IMPLICATIONS

These findings demonstrate that sensory hyper- and hypo- sensitivity may be features of ADHD in adults. Further, they demonstrate that internalizing behaviors influence the perception of sensory experiences and thus should be accounted for in studies of sensory processing, integration, and modulation in adults with ADHD.

Reliability and Validity of the Chinese Version of the Infant/Toddler Sensory Profile

IMPORTANCE

In Chinese-speaking societies, a reliable and valid measure is needed to enable early identification of young children's challenges in sensory processing.

OBJECTIVE

To examine the psychometric properties of the Chinese version of the Infant/Toddler Sensory Profile (ITSP-C) when used with Taiwanese children.

DESIGN

Prospective study.

SETTING

Multiple settings.

PARTICIPANTS

Participants were 367 typically developing (TD) infants ages 0-6 mo (mean [M] age = 3.44 mo, standard deviation [SD] = 1.82) and 677 toddlers ages 7-36 mo (M age = 22.33 mo, SD = 8.15), along with 42 toddlers with developmental disabilities (DD; M age = 28.4 mo, SD = 6.7).

OUTCOMES AND MEASURES

The ITSP, a caregiver questionnaire that measures how children respond to sensory events in daily life, was translated and cross-culturally adapted into a Chinese version (ITSP-C).

RESULTS

Internal consistency was high for the 0-6 mo subscale (α = .80) and the 7-36 mo subscale (α = .82). Test-retest reliability was excellent for the 7-36 mo subscale (intraclass correlation coefficient = .94). Logistic regression analysis demonstrated that the ITSP-C discriminated between children with DD and TD children.

CONCLUSIONS AND RELEVANCE

The ITSP was successfully adapted to Chinese with similar reliability and validity to the original ITSP. The 7-36 mo subscale had a higher level of reliability than the 0-6 mo subscale, and quadrant scores were more reliable than section scores. Moreover, the ITSP-C discriminated children with DD from TD children on the basis of their sensory processing patterns.

WHAT THIS ARTICLE ADDS

The ITSP-C has sound psychometric properties and support for its use in early identification of sensory processing difficulties in young Chinese-speaking children.

Sensory Processing and Attention Profiles Among Children With Sensory Processing Disorders and Autism Spectrum Disorders

This study explores the differences in the profile of relationships between sensory processing and attention abilities among children with sensory processing disorder (SPD), autism spectrum disorder (ASD), and typically developing (TD) children. The Test of Everyday Attention for Children (TEA-Ch), a performance-based measure of attention, was administered to 69 children (TD: n = 24; SPD: n = 21; ASD: n = 24), ages 6-10 years. All participants' parents completed the Short Sensory Profile (SSP), a standardized parent-report measure of sensory-related behaviors. Discriminant analyses using the TEA-Ch and the SSP domains revealed two classification functions; the first revealed that both clinical groups significantly differed from the TD group with greater sensory processing challenges in the categories of auditory filtering, under-responsive/seeks sensation, low energy/weak, and taste/smell sensitivity subscales of the SSP. The second function discriminated between the two clinical groups, indicating that children with ASD had significantly greater control and sustained attention deficits and less sensory issues than did children with SPD. Together, the two functions correctly classified 76.8% of the participants as to their group membership. The different profiles of sensory processing and attention abilities in children with SPD and ASD may provide guidance in identifying appropriate individualized therapeutic strategies for these children.

Prevalence and patterns of sensory processing behaviors in a large clinical sample of children with prenatal alcohol exposure

BACKGROUND

Atypical behavioral responses to sensation are reported in a large proportion of children affected by prenatal alcohol exposure (PAE). Systematic examination of symptoms across the fetal alcohol spectrum in a large clinical sample is needed to inform diagnosis and intervention.

AIMS

To describe the prevalence and patterns of atypical sensory processing symptoms in a clinical sample of children with PAE.

METHODS

Retrospective analysis of diagnostic clinical data from the University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network (FASDPN). Participants were ages 3 through 11 years, had a diagnosis on the fetal alcohol spectrum, and Short Sensory Profile (SSP) assessment. The proportions of children categorized with definite differences on the SSP across selected clinical and demographic features were examined with chi-square analyses.

OUTCOMES

The sample consisted of 325 children; 73.2 % had SSP total scores in the definite difference range. Atypical sensory processing symptoms were significantly more prevalent among children with higher reported levels of PAE. The prevalence of atypical symptoms was comparably high across age, levels of diagnostic severity, and other prenatal/postnatal risks.

CONCLUSIONS

Results lend support for altered sensory processing as another domain of brain function affected by the teratogenic impact of PAE, guiding clinical work and research.

Sensory processing patterns in developmental coordination disorder, attention deficit hyperactivity disorder and typical development

BACKGROUND

Sensory processing difficulties (SPD) are present in children with Developmental Coordination Disorder (DCD) and Attention Deficit and Hyperactivity Disorder (ADHD). However, little is known about sensory processing variability in these disorders.

OBJECTIVE

The purpose of this study was to explore SPD among children with DCD, ADHD and co-occurring symptoms in comparison to children with typical development (TD) and to determine how potential social confounders may influence these associations.

METHODS

The study involved 452 children aged 6-12 years. The Short Sensory Profile-2 was used to assess sensory processing patterns. Multiple linear regressions were utilized to investigate the relationship between DCD, ADHD and co-occurring symptoms and sensory processing patterns, adjusting for social covariates.

RESULTS

Children with DCD and ADHD symptoms showed greater variability of atypical sensory processing patterns compared with TD children. Low registration and sensory sensibility issues were more prevalent in the DCD group. ADHD children showed higher rates of low registration, sensory sensibility and sensory seeking, and all children in the co-occurring symptoms group presented sensory sensibility.

CONCLUSION

This study reports significant variability in sensory processing among children with DCD, ADHD and co-occurring symptoms using a population-based sample. These differences can contribute to understand how neurological and social factors correlates across diagnoses.

Sensory Modulation in Children Exposed to Continuous Traumatic Stress

Preliminary evidence supports a possible association between post-traumatic stress disorder (PTSD) and sensory modulation disorder (SMD). Nevertheless, the research focusing on this relationship in children is notably limited. This study examined children with and without PTS symptoms, by comparing their mothers' perceptions of their responses to sensory events in daily life. Mothers of 134 non-referred children aged 5-11, exposed to continuous traumatic stress due to political violence, completed the UCLA-RI and the Short Sensory Profile questionnaires. Significant differences emerged between children with different levels of PTS symptoms in various sensory modalities. Furthermore, half of the symptomatic children had suspected clinically significant deficits in sensory processing. In addition, PTSD symptoms were significantly associated with most of the sensory processing scores. Logistic regression indicated that the overall sensory processing score was a significant predictor of group classification. The results indicate that children with PTS symptoms may be at increased risk for sensory processing deficits. Evaluation of sensory processing should be incorporated into the routine evaluation of this population in order to determine whether this is an additional factor contributing to a child's difficulties in participating in daily activities. Subsequent intervention programs should then address the multiple needs of these children.

Diverse Autonomic Nervous System Stress Response Patterns in Childhood Sensory Modulation

The specific role of the autonomic nervous system (ANS) in emotional and behavioral regulation—particularly in relation to automatic processes—has gained increased attention in the sensory modulation literature. This mini-review article summarizes current knowledge about the role of the ANS in sensory modulation, with a focus on the integrated functions of the ANS and the hypothalamic-pituitary-adrenal (HPA) axis and their measurement. Research from the past decade illustrates that sympathetic and parasympathetic interactions are more complex than previously assumed. Patterns of ANS activation vary across individuals, with distinct physiological response profiles influencing the reactivity underlying automatic behavioral responses. This review article advances a deeper understanding of stress and the complex stress patterns within the ANS and HPA axis that contribute to allostatic load (AL). We argue that using multiple physiological measurements to capture individual ANS response variation is critical for effectively treating children with sensory modulation disorder (SMD) and sensory differences. We consider the relative contributions of automatic vs. deliberately controlled processes across large-scale neural networks in the development of sensorimotor function and their associated links with arousal patterns and sensory over- and under-responsivity.

Assessment of Sensory Processing and Executive Functions at the School: Development, Reliability, and Validity of EPYFEI-Escolar

The aim of this study was to determine the psychometric properties of the Assessment of Sensory Processing and Executive Functions at the School (EPYFEI-Escolar), a questionnaire designed to assess the sensory processing and executive functions as underlying processes for school participation. The total sample consisted of 536 children aged between 3 and 11 years old who lived in Spain. A total of 103 teachers completed the questionnaire. An exploratory factor analysis was conducted, which showed five main factors: (1) initiation, organization, execution, and supervision of the action; (2) inhibitory control; (3) sensory processing; (4) emotional self-regulation and play; and (5) self-competence. Some of these factors were similar to those found in the EPYFEI for parents in the home context. The reliability of the analysis was high, both for the whole questionnaire and for the factors it is composed of. The results provide evidence of the potential usefulness of the EPYFEI-Escolar in school contexts for determining academic needs and difficulties of children; moreover, this tool can also be used to plan intervention programs in the school environment according to the needs of each child and school.

Sensory Gating Capacity and Attentional Function in Adults With ADHD: A Preliminary Neurophysiological and Neuropsychological Study

Objective: The inability to filter sensory input correctly may impair higher cognitive function in ADHD. However, this relationship remains largely elusive. The objectives of the present study is to investigate the relationship between sensory input processing and cognitive function in adult patients with ADHD. Method: This study investigated the relationship between deficit in sensory gating capacity (P50 amplitude changes in a double-click conditioning-testing paradigm and perceptual abnormalities related to sensory gating deficit with the Sensory Gating Inventory [SGI]) and attentional and executive function (P300 amplitude in an oddball paradigm and attentional and executive performances with a neuropsychological test) in 24 adult patients with ADHD. Results: The lower the sensory gating capacity of the brain and the higher the distractibility related to sensory gating inability that the patients reported, the lower the P300 amplitude. Conclusion: The capacity of the brain to gate the response to irrelevant incoming sensory input may be a fundamental protective mechanism that prevents the flooding of higher brain structures with irrelevant information in adult patients with ADHD.

An exploratory study of parent-child association in sensory modulation disorder involving ADHD-related symptoms

BACKGROUND

Sensory modulation disorder (SMD) and attention deficit hyperactivity disorder (ADHD) can co-occur and have overlapping symptoms, thus challenging practitioners. This study aimed to phenotypically explore parent-child associations in SMD, and the interplay between SMD- and ADHD-related symptoms in children with SMD and their parents.

METHODS

A cross-sectional study examined 70 parents (n = 35 mothers; n = 35 fathers) and their 35 children with and without SMD, aged 4-6 years. Parents completed care-giver reports: The Short Sensory Profile (SSP) and the ADHD Rating Scale, and self-reports: The Sensory Responsiveness Questionnaire (SRQ) and the ADHD Self-Report Scale (ASRS).

RESULTS

In the entire sample, we found a mother-offspring correlation between SSP and SRQ-Aversive scores (rs = -0.68; p < 0.001), but no such father-offspring correlation. However, when testing the ADHD Rating Scale and ASRS scores, we found correlations between mothers and offspring (rs = 0.54, p = 0.0008), and between fathers and offspring (rs = 0.34, p = 0.0494). In the entire sample a high correlation was found between SSP and ADHD Rating Scale scores (rs = -0.837, p < 0.001). We further found a high correlation in mothers (rs = 0.70, p < 0.001), and a moderate correlation in fathers (rs = 0.40, p = 0.019) between SRQ-Aversive and ASRS scores.

CONCLUSIONS

Novel findings reveal that parents-offspring heritability patterns differ in both these related conditions. These may contribute to familial practice and research.

PET Measures of D1, D2, and DAT Binding Are Associated With Heightened Tactile Responsivity in Rhesus Macaques: Implications for Sensory Processing Disorder

Sensory processing disorder (SPD), a developmental regulatory condition characterized by marked under- or over-responsivity to non-noxious sensory stimulation, is a common but poorly understood disorder that can profoundly affect mood, cognition, social behavior and adaptive life skills. Little is known about the etiology and neural underpinnings. Clinical research indicates that children with SPD show greater prevalence of difficulties in complex cognitive behavior including working memory, behavioral flexibility, and regulation of sensory and affective functions, which are related to prefrontal cortex (PFC), striatal, and midbrain regions. Neuroimaging may provide insight into mechanisms underlying SPD, and animal experiments provide important evidence that is not available in human studies. Rhesus monkeys (N = 73) were followed over a 20-year period from birth into old age. We focused on a single sensory modality, the tactile system, measured at 5-7 years, because of its critical importance for nourishment, attachment, and social reward in development. Positron emission tomography imaging was conducted at ages 12-18 years to quantify the availability of the D1 and D2 subtypes of the DA receptor (D1R and D2R), and the DA transporter (DAT). Heightened tactile responsivity was related to (a) elevated D1R in PFC overall, including lateral, ventrolateral, medial, anterior cingulate (aCg), frontopolar, and orbitofrontal (OFC) subregions, as well as nucleus accumbens (Acb), (b) reduced D2R in aCg, OFC, and substantia nigra/ventral tegmental area, and (c) elevated DAT in putamen. These findings suggest a mechanism by which DA pathways may be altered in SPD. These pathways are associated with reward processing and pain regulation, providing top-down regulation of sensory and affective processes. The balance between top-down cognitive control in the PFC-Acb pathway and bottom-up motivational function of the VTA-Acb-PFC pathway is critical for successful adaptive function. An imbalance in these two systems might explain DA-related symptoms in children with SPD, including reduced top-down regulatory function and exaggerated responsivity to stimuli. These results provide more direct evidence that SPD may involve altered DA receptor and transporter function in PFC, striatal, and midbrain regions. More work is needed to extend these results to humans.

A Path From Childhood Sensory Processing Disorder to Anxiety Disorders: The Mediating Role of Emotion Dysregulation and Adult Sensory Processing Disorder Symptoms

Although maladaptive sensory processing has been observed among individuals with persistent heightened anxiety, it is unclear if difficulties processing sensory input early in life lead to anxiety disorders in adulthood and what mechanisms would drive this progression. In a transdiagnostic clinical sample of 231 adults characterized by heightened difficulties with emotion regulation, the present study sought to examine whether: (a) childhood sensory processing disorder (SPD) symptoms predict an increased probability of an anxiety disorder diagnosis in adulthood; and (b) difficulties with emotion regulation and adult SPD symptoms mediate this relationship. Participants were administered the Structured Clinical Interview for Axis-I disorders and self-reported symptoms of SPD experienced in childhood and adulthood. Results suggested that childhood SPD symptoms were significantly associated with a higher likelihood of a lifetime anxiety disorder diagnosis. Difficulties with emotion regulation fully mediated the relationship between childhood SPD and (a) any anxiety disorder in adulthood and, specifically (b) current generalized anxiety disorder (GAD). Further, we found evidence for a candidate model accounting for the relationship among childhood SPD, adulthood SPD, difficulties with emotion regulation, and anxiety disorders in adulthood. Specifically, our data indicated that high symptoms of SPD in childhood may lead to high SPD symptoms in adulthood, which then lead to high emotion dysregulation, ultimately conferring vulnerability for an anxiety disorder diagnosis. Taken together, these findings provide preliminary evidence for how sensory processing impairments in childhood may relate to anxiety through difficulties regulating emotion regulation.

Parent-Offspring Transmission of Internalizing and Sensory over-Responsivity Symptoms in Adolescence

Reactions to sensory experiences are an overlooked correlate of affective regulation, despite the importance of bodily states on psychological processes. Children who display sensory over-responsivity (i.e., adverse reactions to typical sensations) are at greater risk for developing affective disorders. We extended this literature to adolescents and their middle-aged parents. Participants in a birth record-based study of families of adolescent twins (N = 506 families; 1012 adolescents; 53% female) completed a subset of items from the Adult Sensory Profile. We derived adolescent self-reported internalizing disorder symptoms and parent affective diagnoses from structured diagnostic interviews. Structural equation models tested the relationship between parent sensory over-responsivity symptoms and affective diagnoses and their adolescent offspring's sensory over-responsivity and internalizing symptoms. Adolescent sensory over-responsivity symptoms were correlated with internalizing disorder symptoms. Parents with a diagnosis of anxiety or depression (mothers only) reported more frequent SOR symptoms than parents without a diagnosis. Parent depression was significantly related to adolescent sensory over-responsivity symptoms, over and above parent sensory over-responsivity symptoms (β = 0.26, p < 0.001 for mothers; β = 0.13, p = 0.004 for fathers). Father alcohol abuse/dependency also predicted offspring sensory over-responsivity symptoms. Offspring of parents with affective disorders were at additional risk for sensory dysregulation via parents' influence on offspring internalizing problems.

Co-occurrence of Sensory Overresponsivity with Obsessive-Compulsive Symptoms in Childhood and Early Adolescence

OBJECTIVE

Sensory overresponsivity (SOR) is characterized by challenges in integrating and responding to everyday sensory experiences. Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts, ritualistic behaviors, and sensory phenomena. There is some evidence that individuals with co-occurring symptoms of SOR and OCD experience more severe anxiety than those with symptoms of OCD alone, but most studies employed small numbers of participants (typically with an OCD diagnosis) assessed at a single time point. Our 2-fold objective was to replicate previous research showing an association between OCD symptoms and SOR symptoms concurrently and to extend these analyses longitudinally in a large, birth-register-based sample.

METHOD

Twins (N = 1613) and their primary caregivers participated in a multimodal, multimethod, longitudinal study. Primary caregivers completed the SOR inventory for their offspring at the age of 8 years, and twins completed the adult sensory profile at the age of 13 years. Parents completed the OCD module of the Diagnostic Interview Schedule for Children-IV when twins were 8 years; twins completed the same module at 13 years. Linear regression models tested for the concurrent and longitudinal associations between SOR and OCD controlling for socioeconomic status.

RESULTS

Concurrently, participants' likelihood of exhibiting OCD symptoms increased with each symptom of tactile or auditory overresponsivity at 8 years and 13 years (odds ratio = 1.1-2.7). However, SOR measured at age 8 years was unrelated to adolescent OCD symptoms at 13 years and vice versa.

CONCLUSION

SOR symptoms, although significantly related to concurrent OCD symptoms, do not appear to precede OCD symptoms, suggesting that SOR symptoms may reflect another type of OCD sensory phenomenon rather than a comorbid condition.

Sustained attention in sensory modulation disorder and attention deficit/hyperactivity disorder

BACKGROUND

There are high comorbidity rates between sensory modulation disorder (SMD) and attention deficit hyperactivity disorder (ADHD). Knowledge regarding the objective neuropsychological differentiation between them is scarce.

AIM

This study examines the effects of SMD and ADHD on a sustained attention task with and without aversive auditory conditions.

METHOD

Sixty six young adult females were tested on the Conjunctive - Continuous Performance Task-Visual (CCPT-V) measuring sustained attention, under two conditions: 1) aversive condition (with the three most aversive sounds chosen by the participant), and 2) non-aversive condition (without sounds).

RESULTS

Both the SMD and ADHD factors exhibited performance deficits in the sustained attention task. All study participants performed worse on both sustained attention and speed of processing when aversive sounds were present.

CONCLUSION

We conclude that impaired sustained attention cannot differentiate between SMD and ADHD. Hence, these results should be taken under consideration in the assessment process of ADHD vs. SMD.

Initial Studies of Validity of the Sensory Processing 3-Dimensions Scale

AIMS

This study examined the validity of a new measure of sensory processing for children, the Sensory Processing 3-Dimensions Scale (SP-3D). The SP-3D is a performance-based measure for children ages three to thirteen years, designed to assess sensory processing abilities, and identify the three patterns of sensory processing disorder (SPD) and related subtypes, including sensory modulation, sensory discrimination, and sensory-based motor disorders.

METHODS

Age trends were explored using descriptive statistics and graphing techniques with a sample of children with and without SPD. SP-3D scores were correlated with scores from the Sensory Processing Measure (SPM) to examine criterion-related validity. Discriminant validity was assessed by comparing SP-3D scores from children with and without SPD.

RESULTS

Age trends of SP-3D scores supported sensory discrimination, praxis and postural functions as developmental constructs. Several mild to moderate correlations were found between the scores of the SP-3D and the SPM, indicating that the tools are measuring similar constructs, and supporting the SP-3D as a measure of sensory processing. Modulation and Motor Behavior Scores from the SP-3D discriminated typically developing children from those with SPD, while results from subtests measuring sensory discrimination, postural and praxis were mixed regarding capacity for discrimination suggesting revision to several items.

CONCLUSION

The study provides preliminary evidence of the SP-3D as a valid measure of sensory processing abilities and dysfunction. Further research regarding the reliability and validity of the SP-3D are needed.

Psychometric Evaluation of the Short Sensory Profile in Youth with Autism Spectrum Disorder

The Short Sensory Profile (SSP) is one of the most commonly used measures of sensory features in children with autism spectrum disorder (ASD), but psychometric studies in this population are limited. Using confirmatory factor analysis, we evaluated the structural validity of the SSP subscales in ASD children. Confirmatory factor models exhibited poor fit, and a follow-up exploratory factor analysis suggested a 9-factor structure that only replicated three of the seven original subscales. Secondary analyses suggest that while reliable, the SSP total score is substantially biased by individual differences on dimensions other than the general factor. Overall, our findings discourage the use of the SSP total score and most subscale scores in children with ASD. Implications for future research are discussed.

Association between sensory modulation and daily activity function of children with attention deficit/hyperactivity disorder and children with typical development

BACKGROUND

The severity of the functional difficulties of children with attention-deficit/hyperactivity disorder (ADHD) is heterogeneous and may be affected by measurable factors.

AIMS

To characterize subgroups of children with ADHD with or without sensory modulation difficulties (SMD) and the association between sensory modulation and daily activity function in children with ADHD and children with typical development.

METHODS

38 children with ADHD and 39 controls (ages 8-11) were recruited and assessed, using the Conner's Parent Rating Scale-Revised: Short Form, the Short Sensory Profile (SSP) and the Children Activity Scale for Parents (ChAS-P).

RESULTS

The total SSP score of the ADHD group was lower (142.13 vs. 180.08; t=-8.23, p < 0.001) with a higher proportion of SMD (65.8% vs. 2.6%, χ² = 34.46, p < 0.001). The daily function of children with ADHD was lower than controls (mean ChAS-P: 3.95 vs. 4.78, p < 0.001). The difference was significant for children with ADHD and SMD (3.70 versus 4.81, p < 0.001), but not significant for children with ADHD and typical SSP (4.42 versus 4.81, p=0.35).

CONCLUSION

In this pilot study, we found that SMD, in children with ADHD is correlated with daily activity consequences. Hence, it should be evaluated in children with ADHD and addressed in their treatment plan.

Migration Influences on the Allostatic Load of Children: Systematic Review Protocol

Background

Migration is a worldwide phenomenon in recent times. Recently, documented studies suggest that the change in environments involved in migration may have an influence on children’s allostatic load related to health and well-being.

Objective

The aim of this review is to systematically search the extant literature and critically examine the evidence on how migration affects allostatic load in children and describe the relevant methods in measuring allostatic load.

Methods

A systematic review will be conducted to recapitulate the evidence on the influence of migration on allostatic load and describe the methods employed in measuring allostatic load parameters among migrant children using the following search terms combinations: 1) allostasis OR allostatic OR allostatic load OR allosta*; 2) migration OR migrant OR immigration OR immigrant OR migra* OR *migra*; and 3) children OR child* OR adolescen*. We will search for peer-reviewed articles in English using a three-step process: title and abstract review, individual article review, and reference hand-searching among the following databases: Medline, CINAHL, ProQuest, PubMed, Science Direct and BioMed Central. Two independent review authors will analyze for data quality, level of evidence and risk of bias; a third review author will be consulted if consensus cannot be met. Data on study details, participant characteristics, allostatic load operationalization and description, methods, and results summary will be extracted. Evidence will be synthesized statistically when possible and narratively clustered into themes.

Results

At present, we have conducted only a preliminary search to test out our search terms. The systematic search, appraisal, synthesis and analysis will be finished by June 2018. It is projected that the manuscript that describes the systematic review will be available by the last quarter of 2018.

Conclusions

The results of this systematic review have implications on supporting the concept of allostasis as a mechanism underlying the adaptive processes related to migration. Furthermore, our findings can lead to the development of innovative evidence-informed evaluation and intervention programs aimed at migrant children's needs. Likewise, it is hoped that this review can be an impetus to inform health and sociopolitical policies responsive of migrant children's current contexts.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO): CRD42017068895; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68895 (Archived by WebCite at http://www.webcitation.org/6wprRkxvA)

The Role of Ethnicity and Environment in the Regulation of Response to Sensory Stimulus in Children: Protocol and Pilot Findings of a Neurophysiological Study

BACKGROUND

The ability to regulate the response to sensory stimuli has been associated with successful behavioral patterns necessary for daily activities. However, it is not known whether a child's ethnicity and environment can influence autonomic regulatory mechanisms.

OBJECTIVE

This study aims to explore the role of ethnicity and environment in the regulation of responses to sensory stimuli in children.

METHODS

In this study, we intend to recruit 128 children from different ethnic groups or environment contexts as follows: (1) 32 typically developing Chinese children living in Hong Kong; (2) 32 typically developing Filipino children living in Hong Kong; (3) 32 typically developing Filipino children who are living in urban areas; and (4) 32 typically developing Filipino children who are living in rural areas in Philippines. Autonomic activity (heart rate variability [HRV] and electrodermal activity [EDA]) will be measured and recorded using Polar H2 heart rate monitor and eSense GSR skin response sensor. Autonomic activity (HRV-low frequency, HRV-high frequency, and EDA) at different conditions between pairwise groupings will be tested using multivariate analysis of variance (MANOVA). All significant levels will be set at P ≤.05.

RESULTS

We present the research protocol of this study, as well as a short discussion of the preliminary findings from our pilot data, with consequent power and sample size analysis that informs the appropriate sample needed to test our hypothesis.

CONCLUSIONS

This study will increase the understanding on the role of individual differences related to a child's ethnicity and environment in the regulation of response to sensory stimuli. The findings of this research may further shed light on the evaluation and treatment planning for children across and within cultures.