Sensory Processing in Individuals With Attention-Deficit/Hyperactivity Disorder Compared With Control Populations: A Systematic Review and Meta-Analysis

Objective To evaluate the association between attention-deficit/hyperactivity disorder (ADHD) and atypical sensory processing patterns. Method For this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from their inception until June 30, 2024. Studies examining sensory processing patterns using questionnaires in participants with a diagnosis of ADHD compared with healthy controls were included. The study risk of bias was assessed using a modified Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted using R Version 4.3.1 software, considering sensory modulation severity atypicities as the primary outcome. The risk of publication bias was explored, and sensitivity analyses were conducted to test the robustness of findings. Results After screening 10,750 references, 30 studies (reported in 32 publications) encompassing 5,374 participants were included, with 23 studies focusing on children and 7 focusing on adults. Patients with ADHD presented with significantly more severe sensory atypicities than the control group in multiple domains: sensory sensitivity (k = 13, SMD=1.17, 5% CI [0.75, 1.59], I 2 = 87%), sensory avoiding (k = 11, SMD=1.15, 95% CI [0.66, 1.64], I 2 = 92%), low sensory registration (k = 23, SMD=1.22, 95% CI [0.89, 1.56], I 2 = 92%), and sensory seeking (k = 15, SMD=1.23, 95% CI [0.48, 1.97], I 2 = 97%). Heterogeneity was high in all analyses. Only 9 studies were deemed at overall low risk of bias. Conclusion Even though available ADHD clinical guidelines do not specifically mention the need to assess sensory processing in ADHD, this meta-analysis suggests that this should be systematically explored in the evaluation of children and adults referred for ADHD. Plain language summary This systematic review and meta-analysis examined 30 studies including over 5,000 participants to assess the link between attention-deficit/hyperactivity disorder (ADHD) and atypical sensory processing. Findings show that individuals with ADHD experience significantly higher sensory sensitivity, sensory avoidance, sensory seeking, and low sensory registration compared to controls. Given their impact on daily functioning, assessing sensory processing could improve clinical evaluations for both children and adults with ADHD. Study registration information Association between ADHD and sensory processing disorder: A systematic review and meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022325271. Diversity & Inclusion Statement We actively worked to promote sex and gender balance in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science.