Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2020 Oct 7.
Published in final edited form as: Evid Based Pract Child Adolesc Ment Health. 2019 Aug 2;4(4):319–327. doi: 10.1080/23794925.2019.1647122

The Contribution of Sensory Sensitivity to Emotional Lability in Children with ADHD Symptoms

Mariah DeSerisy 1, Emily Hirsch 1, Amy Krain Roy 1,2
PMCID: PMC7540722  NIHMSID: NIHMS1535442  PMID: 33033744

Abstract

Emotional lability and sensory sensitivity have been shown to contribute to the overall clinical picture in children with attention deficit hyperactivity disorder (ADHD; Dunn & Bennett, 2002; Sobanski et al., 2010). Further, both of these characteristics have been individually demonstrated to contribute to poorer quality of life, increased functional impairment, and poorer treatment response (Anastopoulos et al., 2010; Boterberg & Warreyn, 2016). However, to date, no study has evaluated the relationship among all three of these factors. The current study hypothesized that increased sensory sensitivity would moderate the relationship between hyperactive/impulsive symptoms of ADHD and emotional lability in youth. Results indicate that heightened sensory sensitivity strengthens the relationship between hyperactive/impulsive symptoms of ADHD and emotional lability in children with three or more clinically impairing ADHD symptoms. This dimensional approach was taken in accordance with growing evidence that even children with sub-threshold ADHD experience significant functional impairment and high rates of sensory sensitivity (Hong et al., 2014). These findings suggest that clinicians treating children with ADHD symptoms and emotional lability should consider assessing for sensory sensitivity as integration of multi-sensory techniques or referral to concurrent occupational therapy may significantly improve treatment outcomes and quality of life for these children and their families.

While attention deficit hyperactivity disorder (ADHD) is a psychiatric condition primarily characterized by symptoms of hyperactivity, impulsivity, and inattention (American Psychiatric Association, 2013), recent evidence highlights the role of certain associated features that are important to the overall clinical picture. One of these features, emotional lability, or a tendency toward quick mood changes and over reactions in the face of provocation (Barkley, 2010; Sobanski et al., 2010), has garnered attention because it significantly contributes to greater functional impairment (Anastopoulos et al., 2010; Bunford, Evans, & Wymbs, 2015; Shaw, Stringaris, Nigg, & Leibenluft, 2014; Sobanski et al., 2010; Spencer et al., 2011) and poorer clinical outcomes (Barkley & Fischer, 2010; Biederman et al., 2012; Bunford et al., 2015; Graziano & Garcia, 2016; Shaw et al., 2014; Wehmeier, Schacht, & Barkley, 2010). Another associated feature of ADHD is sensory sensitivity, characterized by exaggerated behavioral responses to sensory experiences (Miller, Anzalone, Lane, Cermak, & Osten, 2007). Sensory sensitivities have been linked to emotional and behavioral dysregulation in both typically developing populations and children with developmental delays (Ben-Sasson, Soto, Martínez-Pedraza, & Carter, 2013; Ben-Sasson, Carter, & Briggs-Gowan, 2009; Tseng, Fu, Cermak, Lu, & Shieh, 2011). However, while there is evidence to suggest that children with ADHD exhibit higher levels of emotional lability and sensory sensitivity than their non-ADHD peers, there is no work evaluating the relationship across all three of these factors. Such an investigation can have important clinical and treatment implications. Thus, the present study aimed to examine the contribution of sensory sensitivities to emotional lability in children with elevated ADHD symptoms.

Although operational definitions of emotional lability vary, the term generally refers to emotional reactions that are out of proportion to the situation, sudden and unpredictable changes in mood, and increased attention to emotional stimuli (Sobanski et al., 2010). Within the literature specific to ADHD, emotional lability has also been referred to as emotional impulsivity (Barkley, 2010) and emotion dysregulation (Shaw et al., 2014). While emotional lability tends to cut across diagnoses (Stringaris & Goodman, 2009), many studies have shown that those with ADHD are especially prone to experiencing it (e.g. Graziano & Garcia, 2016; Sobanski et al., 2010). In fact, because emotional lability plays such a prominent role in ADHD, researchers have argued that it should be incorporated into the theoretical conceptualization of ADHD or should be added to its diagnostic criteria (Barkley, 2010; Shaw et al., 2014). Emotional lability in ADHD is associated with a greater severity of core symptoms of ADHD, increased co-occurring psychopathology, greater functional impairment (Sobanski et al., 2010; Spencer et al., 2011), and increased service utilization (Anastopoulos et al., 2010) compared to those with ADHD who do not experience emotional lability. Moreover, emotional lability in children with ADHD is predictive of subsequent psychopathology, including more psychiatric comorbidities, greater social impairment, and higher rates of persistence of ADHD (Barkley & Fischer, 2010; Biederman et al., 2012).

Sensory sensitivity is another co-occurring feature frequently observed in adults and children with ADHD (Dunn & Bennett, 2002; Parush, Sohmer, Steinberg, & Kaitz, 2007; Reynolds, Lane, & Gennings, 2010; Yochman, Parush, & Ornoy, 2004). According to Dunn (1997), children with greater sensory sensitivity exhibit negative or intense reactions to sensory stimuli that they experience as overwhelming. These responses mimic the description of emotional lability as a heightened reactivity to stimuli. Indeed, case study evidence suggests that sensory processing disorders, including sensory sensitivity, play a role in youth’s difficulties regulating their emotions (Cheng & Boggett-Carsjens, 2005). In non-clinical samples, sensory sensitivity is positively associated with emotional lability and difficult behaviors (Ben-Sasson et al., 2009; Boterberg & Warreyn, 2016). Moreover, the same positive association has been observed in children with autism spectrum disorder (ASD; Tseng et al., 2011). This relationship between sensory sensitivity and emotional lability has received limited attention in other pediatric clinical populations, although adult studies have found similar associations in adults with borderline personality disorder (Rosenthal, Ahn, & Geiger, 2011) and anorexia nervosa (Merwin et al., 2013). To date, studies examining sensory sensitivity in children with ADHD have found that it is related to behavioral and emotional outcomes, such as aggressive behaviors (Mangeot et al., 2001), anxiety (Reynolds & Lane, 2009) and a lower preference to engage in social or recreational activities (Engel-Yeger & Ziv-On, 2011), but have not focused specifically on emotional lability.

The aim of the current study was to investigate how the presence of sensory sensitivity may increase the likelihood that a child with ADHD would also exhibit emotional lability. The current study used a broader classification approach to ADHD due to increasing scientific evidence suggesting that ADHD should be considered on a continuum (Kalff et al., 2005; Larsson, Anckarsater, Råstam, Chang, & Lichtenstein, 2012; Marcus & Barry, 2011). Children with ADHD symptoms who do not meet criteria for a diagnosis of ADHD experience functional impairment (Hong et al., 2014) and have been shown to exhibit rates of sensory sensitivity similar to children with diagnoses of ADHD (Ben-Sasson, Soto, Heberle, Carter, & Briggs-Gowan, 2017). Given evidence that emotional lability in children with ADHD is most related to hyperactive-impulsive symptoms (Anastopoulos et al., 2010; Sobanski et al., 2010), it was hypothesized that sensory sensitivity would moderate the relationship between hyperactive-impulsive symptoms of ADHD and emotional lability in these youth. Support for such hypotheses would have significant implications for improving treatments for ADHD children exhibiting emotional lability.

Method

Participants

Study participants were recruited for two larger studies of disruptive behavior disorders. Children with a history of Autism Spectrum Disorder, psychosis, or post- traumatic stress disorder, or an IQ score of less than 75 as determined by the Kaufman Brief Intelligence Test (KBIT-2; Kaufman & Kaufman, 2004) were excluded. Additionally, one of the two studies included an MRI component; thus, children in that study were excluded for neurological disorders (e.g. epilepsy), psychoactive medication, and other MRI contraindications including metal of any kind in the body, previous surgeries, previous head injury, injury involving metal, and medical devices containing metal such as braces. For the present study, children were included if their parent endorsed three or more clinical symptoms of ADHD on a semi-structured diagnostic interview. Eighty-two children had complete data including the diagnostic interview, Short Sensory Profile and the Emotion Regulation Checklist. Of those youth, two were excluded due to IQ scores lower than 75. Nine additional children were excluded because they did not exhibit at least 3 clinical symptoms of ADHD. Thus, the final sample for the current study was 71 children (mean age age= 7.77 years, SD = 1.14; 55 [77.5%] boys).

Measures

Diagnostic Interview.

Parents completed a Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-PL; Kaufman, Birmaher, Brent, & Rao, 1997) diagnostic interview with a clinical psychology doctoral student or post-doctoral clinician. All clinicians received extensive training in using the KSADS-PL and were supervised by a licensed clinical psychologist. The current study used symptom counts for clinically impairing hyperactivity/impulsivity ADHD symptoms from the KSADS-PL as the primary measure of ADHD symptom severity.

Short Sensory Profile.

The Short Sensory Profile (SSP; Dunn, 2014) is 34 item parent-reported measure of children’s sensory experiences that demonstrates good reliability and validity in both community and clinical samples (Dunn & Bennett, 2002; Dunn & Brown, 1997; Dunn, 2014; Dunn, Little, Dean, Robertson, & Evans, 2016). Four primary subscales and 2 summary subscales can be derived. The present study used the Sensory Sensitivity subscale, which describes children’s ability to detect sensory input. This subscale was chosen because this construct has the strongest empirical support connecting it with both symptoms of ADHD and emotional lability (e.g. Ben-Sasson et al., 2017; Ben-Sasson et al., 2009; Dunn & Bennett, 2002). Within our sample, the Sensory Sensitivity subscale demonstrated good internal consistency with Cronbach’s alpha =.83. This subscale is normed to derive 5 categorical bands: one reflecting typical sensory development, two bands reflecting more sensory sensitivity than is typical, and two bands reflecting less sensory sensitivity than is typical. For the purposes of the current study, bands were collapsed to reflect two categories: Low and Typical Sensory Sensitivity and More than Typical Sensory Sensitivity.

Emotion Regulation Checklist.

The ERC is a 24-item, parent-reported measure of children’s emotion regulation ability and emotional lability with strong psychometric properties including good internal consistency and validity (Shields & Cicchetti, 1997). Two primary subscales can be derived: the Lability/Negativity Index (ERC-L/N) and the Emotion Regulation Index. The ERC-L/N describes a child’s tendency toward negative affectivity, emotionality, and reactivity and was selected for use in the current study as a measure of children’s mood lability and tendency toward negative mood states. Within our sample, the ERC-L/N subscale demonstrated good internal consistency with Cronbach’s alpha =.85.

Procedure

Participants were recruited through school referrals, mental health clinics, flyers, and newspaper and Internet advertisements. Parents interested in participating first completed a phone screen to determine eligibility. Families enrolled into either of the studies were then invited to the clinic to complete these study measures. After parental consent and child assent (verbal for children of 6 years of age and younger and written for children 7 years and older) were obtained, parents completed the K-SADS and a number of questionnaires, including the ERC and SSP, while the children completed several cognitive and behavioral tasks. Studies were approved by the Institutional Review Boards of all affiliated universities.

Statistical Analyses

Moderation analysis was performed using PROCESS version 3.1 for SPSS version 25 (IBM Corp.). The moderation analysis tested the effect of SSP sensory sensitivity on the relationship between hyperactivity/impulsivity symptoms as determined by clinician rating on the KSADS-PL and ERC-L/N scores. Moderation results were then probed using two broad categorical bands derived during the norming process of the SSP measure, described above: Low and Typical Sensory Sensitivity and More than Typical Sensory Sensitivity.

Results

Descriptives

Table 1 shows the age, sex, race, ethnicity, ERC-L/N, SSP sensitivity subscale scores, and number of clinically impairing hyperactive/impulsive symptoms for the full sample and across each of the two sensory groups. Children in the two sensory groups did not differ in age, sex, race, or ethnicity. Compared to the low sensitivity group, children with high sensory sensitivity demonstrated higher ERC-L/N subscale scores (t(68) =−3.13, p<0.01) and a greater number of clinically impairing hyperactive/impulsive symptoms(t(68) =−2.3, p<0.05).

Table 1.

Sample Characteristics

Full Sample Low and Typical Sensory Sensitivity High Sensory Sensitivity
(n = 71) (n = 24) (n = 47)
Mean Age (years±sd) 7.8 ± 1.12 7.96 ± 1.35 7.67 ± 1.02
Sex (% male) 55 (77.5%) 18 (75.0%) 37 (78.7%)
Race
 Caucasian 31 (43.7%) 7 (29.2%) 24 (51.1%)
 African American 16 (22.5%) 7 (29.2%) 9 (19.1%)
 Asian 6 (8.5%) 3 (12.5%) 3 (6.4%)
 Other/Mixed 18 (25.4%) 7 7 (29.2%) 11 (23.4%)
Ethnicity-Hispanic 20 (28.2%) 9 (37.5%) 11 (23.4%)
ERC-L/N 36.09 ± 7.0 32.65 ± 6.63 37.85 ± 6.58
SSP Sensitivity 26.53 ± 8.2 17.63 ± 5.65 31.08 ± 4.80
Hyperactive/Impulsive Symptoms 4.52 ± 2.48 3.75 ± 2.38 4.91 ± 2.47
Open in a new tab

Note. ERC-L/N: Lability/ Negativity subscale of the Emotion Regulation Checklist, SSP: Short Sensory Profile

As seen in Table 2, 48 (67.6%) children met criteria for a DSM-5 ADHD diagnosis (Combined, Predominantly Inattentive, Predominantly Hyperactive/Impulsive, or Other Specified) and two additional child met criteria for a rule out ADHD diagnosis (2.8%). Twenty-one children did not meet DSM-V criteria for ADHD but exhibited at least 3 clinically significant symptoms of ADHD as well as several other disorders.

Table 2.

Clinical Diagnoses

Full Sample n=71
Diagnosis n (%)
Attention-Deficit/ Hyperactivity Disorder (ADHD)
    Combined Type 25 (35.2%)
    Predominantly Inattentive Type 12 (16.9%)
    Predominantly Hyperactive-Impulsive Type 8 (11.3%)
    ADHD Unspecified 3 (4.2%)
    ADHD Rule Out 2 (2.8%)
Oppositional Defiant Disorder 30 (42.3%)
Mood Disorder 7 (9.9%)
Anxiety Disorder 27 (38.0%)
Other Disorders
    Conduct Disorder 6 (8.5%)
    Enuresis 9 (12.7%)
    Encopresis 1 (1.4%)
    Obsessive Compulsive Disorder 2 (2.8%)
No Disorders 4 (5.6%)
Open in a new tab

Moderation Analyses

The model of hyperactivity/impulsivity symptoms predicting ERC-L/N scores was significant (F[67,3] = 11.17, p< .01). Child SSP sensory sensitivity significantly moderated this association (β=.08, t=2.32, p=.024). See Figure 1. Simple regressions of ERC-L/N scores on clinically impairing hyperactivity/impulsivity symptoms were probed according to classifications specified by the SSP, as described above. The positive association between hyperactivity/impulsivity symptoms and ERC-L/N scores was only significant for those children with SSP scores higher than seen in typical children (F(1, 45)=16.83, p<0.001; unstandardized β= 1.39, t(46)=4.102, p<0.001). For children with SSP scores within or below the typical range, the association between hyperactivity/impulsivity symptoms and ERC-L/N scores was non-significant (F(1, 21)=0.01, p>0.05; unstandardized β = .07, t(22)=.10, p>0.05).

Figure 1.

Figure 1.

Open in a new tab

Association between lability/negativity and symptoms of hyperactivity/ impulsivity is moderated by sensory sensitivity. White squares (and dashed line) represent children in the high sensory sensitivity group. Dark circles (and solid line) represent children in the low to normal sensory sensitivity group. ERC-L/N: Lability/ Negativity subscale of the Emotion Regulation Checklist.

Discussion

The aim of the present study was to evaluate how sensory sensitivity may impact the association between hyperactivity/impulsivity symptoms and emotional lability in children. Children with the highest levels of sensory sensitivity were found to exhibit a significant relationship between clinically impairing hyperactivity/impulsivity symptoms and emotional lability/negativity. Children at lower levels of sensory sensitivity did not display such a relationship. Such findings have implications for the assessment and treatment of children with ADHD and co-occurring emotional lability.

The relationship between ADHD and emotional lability has been long established (Anastopoulos et al., 2010; Barkley & Fischer, 2010; Sobanski et al., 2010; van Stralen, 2016). In fact, Barkley and colleagues (2010) have demonstrated that emotional impulsiveness is a core feature of persistent ADHD and uniquely contributes to impairment across multiple life domains. The current research indicates that sensory sensitivity, or the tendency to be more aware or process sensory stimuli more deeply than others, directly contributes to this relationship. As such, sensory sensitivity may increase the likelihood that children will demonstrate impulsive emotional responses. This is supported by previous research showing that elementary school students with sensory over-responsivity demonstrate higher frequencies of internalizing, externalizing, and dysregulation problems, and lower levels of adaptive social behaviors, when compared to children without sensory sensitivity (Ben-Sasson et al., 2009). Importantly, sensory sensitivity has been shown to predict response to psychological treatment (Pluess & Boniwell, 2015) and treatment of sensory over-responsivity using occupational therapy has been shown to improve children’s attention and social skills (Miller, Coll, & Schoen, 2007; Suarez, 2012). Thus, assessing sensory sensitivity in children presenting with symptoms of ADHD and emotional lability may inform inclusion of sensory integration techniques or occupational therapy referrals to improve overall treatment efficacy and quality of life for these children and their families.

Study Limitations and Future Directions

The findings of the current study should be considered preliminary as they are based solely on parent report of children’s sensory sensitivity and emotional lability. Parents may have previously received information regarding the co-occurrence of sensory and emotional difficulties, thereby influencing their responses to the questionnaires. Moreover, reliance on parent report of children’s sensory and emotional experiences limits the generalizability of these findings across contexts, such as to the school setting where children often exhibit ADHD-related difficulties. If the moderating effect of sensory sensitivity on the relationship between hyperactivity and emotional lability is no longer significant when including teacher report, it may suggest that other variables contribute to this relationship. To address these limitations, future research would benefit from including multiple informants, such as teachers, other caregivers, or children themselves in rating children’s sensory sensitivity and emotional lability at home and in school. Additionally, inclusion of objective behavioral measures of sensory sensitivity such as the Sensory Challenge Protocol (McIntosh, Miller, Shyu, & Hagerman, 1999) would reduce reporting and recruitment biases and should be considered in future work.

Another limitation is that the cross-sectional nature of the analyses does not allow for determinations of causality; it is unclear whether emotional lability in children with elevated ADHD symptoms adversely impacts their ability to tolerate uncomfortable sensations, or whether sensory sensitivities in children with ADHD symptomatology lead to greater emotional lability. This information would be clinically useful when determining treatment targets. Longitudinal studies can help disentangle the direction of the relationship between sensory sensitives and emotional lability and provide insight into whether this relationship persists as children enter adolescence and young adulthood when hyperactive-impulsive symptoms decrease (Biederman, Mick, & Faraone, 2000). In addition, future research should investigate whether specific modalities of sensory sensitivities (e.g., tactile, auditory) play a greater role in the relationship between ADHD and emotional lability. Such work would facilitate the development of targeted treatment plans and has the potential to improve treatment outcomes for these youth.

Clinical Implications

Although preliminary, these findings have clear implications for the clinical assessment and treatment of children with ADHD. First, children with ADHD and co-occurring emotional lability should be assessed for sensory sensitivity to determine if such sensory symptoms are contributing to children’s emotional distress. While a full review of sensory processing measures used in early childhood is beyond the scope of this paper (see Jorquera-Cabrera et al., 2017 for a complete review of sensory measures used in children 3–11), 2 sensory sensitivity questionnaires have been validated for use in children without developmental disabilities: The SSP (ages 0–14; Dunn, 2014) and the Sensory Processing Measure (ages 2–12; Parham, Ecker, Miller Kuhaneck, Henry, & Glennon, 2007). Both of these measures include parent report and an accompanying school companion form. Youth self-report questionnaires of sensory experiences are also available for children ages 8 and older (e.g. Sensory Sensitivity Questionnaire; Minshew & Hobson, 2008). Behavioral tasks measuring children’s sensory sensitivity have been developed for use in laboratory settings (e.g. Sensory Challenge Protocol; McIntosh, et al., 1999), but are time consuming and may be difficult to complete in a traditional psychotherapeutic setting. As such, considerable work remains to be done in developing and validating time-limited assessments for childhood sensory sensitivity that can be routinely administered in the context of a busy clinic.

Regarding treatment, most of the literature has focused on the integration of psychological techniques into occupational therapy interventions. For example, there is evidence to suggest that protocols integrating emotion focused strategies into occupational therapy techniques, , such as The Alert Program (“How does your engine run?”; Williams, 1994), are effective in treating youth with complex clinical presentations (Kreider, Bendixen, Huang, & Lim, 2014; Wells, Chasnoff, Schmidt, Telford, & Schwartz, 2012) and are acceptable among occupational therapists working with children with emotional disturbances (Barnes, Beck, Vogel, Grice, & Murphy, 2003). Integration of such programs into well-validated treatments for youth with ADHD may be effective at improving sensory sensitivity and behavioral dysregulation. For example, the Alert Program is designed to help students improve their awareness of body sensations and arousal states and work to mitigate those experiences through sensory integration techniques (e.g. jumping jacks if the engine is running too slowly, drinking ice water through a straw if the engine is running too quickly). Similarly, many ADHD treatments help children to recognize their own level of alertness and provide strategies, such as movement breaks, to improve behavioral regulation. Integration of sensory awareness with such behavioral strategies may help children to self-select the most effective coping strategy for regulating their behavior, arousal, and emotions in the moment. Research is needed to evaluate the integration of such sensory and arousal awareness programs into well-validated treatments for youth with ADHD. Such work has the potential to improve attention, behavior, and emotional functioning in youth across the ADHD spectrum.

In conclusion, this is the first paper to demonstrate the effect of sensory sensitivity on the relationship between symptoms of ADHD and emotional lability/negativity. These findings serve to inform clinicians that treatment of children with ADHD and emotional lability may benefit from incorporating multi-sensory interventions for improving emotional self-regulation in these youth.

Acknowledgements and Funding:

This work was supported by a grant awarded to Dr. Roy from the National Institute of Mental Health (R01MH091140-01A1). We thank Sheina Godovich, Erica Meyers, Vasco Lopes, Samantha Adelsberg, Valerie Scelsa, and Randi Bennett for their hard work in recruiting and evaluating our pediatric participants. And we also thank the children and their families for participating in this research.

References

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Arlington, VA: American Psychiatric Publishing. [Google Scholar]
  2. Anastopoulos AD, Smith TF, Garrett ME, Morrissey-Kane E, Schatz NK, Sommer JL, … Ashley-Koch A (2010). Self-regulation of emotion, functional impairment, and comorbidity among children with AD/HD. Journal of Attention Disorders, 15, 583–592. doi: 10.1177/1087054710370567 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barkley RA (2010). Deficient emotional self-regulation: A core component of attention-deficit/hyperactivity disorder. Journal of ADHD and Related Disorders, 1, 5–37. [Google Scholar]
  4. Barkley RA, & Fischer M (2010). New research: The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 503–513. doi: 10.1016/j.jaac.2010.01.019 [DOI] [PubMed] [Google Scholar]
  5. Barnes KJ, Beck AJ, Vogel KA, Grice KO, & Murphy D (2003). Perceptions regarding school-based occupational therapy for children with emotional disturbances. American Journal of Occupational Therapy, 57, 337–341. doi: 10.5014/ajot.57.3.337 [DOI] [PubMed] [Google Scholar]
  6. Barton EE, Reichow B, Schnitz A, Smith IC, & Sherlock D (2015). A systematic review of sensory-based treatments for children with disabilities. Research in Developmental Disabilities, 37, 64–80. doi: 10.1016/j.ridd.2014.11.006 [DOI] [PubMed] [Google Scholar]
  7. Ben-Sasson A, Soto TW, Heberle AE, Carter AS, & Briggs-Gowan MJ (2017). Early and concurrent features of ADHD and sensory over-responsivity symptom clusters. Journal of Attention Disorders, 21, 835–845. doi: 10.1177/1087054714543495 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ben-Sasson A, Soto TW, Martínez-Pedraza F, & Carter AS (2013). Early sensory over-responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress. Journal of Child Psychology and Psychiatry, 54, 846–853. doi: 10.1111/jcpp.12035 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ben-Sasson A, Carter AS, & Briggs-Gowan MJ (2009). Sensory over-responsivity in elementary school: Prevalence and social-emotional correlates. Journal of Abnormal Child Psychology, 37, 705–716. doi: 10.1007/s10802-008-9295-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Biederman J, Mick E, & Faraone SV (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry, 157, 816–818. doi: 10.1176/appi.ajp.157.5.816 [DOI] [PubMed] [Google Scholar]
  11. Biederman J, Spencer TJ, Petty C, Hyder LL, O’Connor KB, Surman CB, & Faraone SV (2012). Longitudinal course of deficient emotional self-regulation CBCL profile in youth with ADHD: Prospective controlled study. Neuropsychiatric Disease and Treatment, 8, 267–276. doi: 10.2147/NDT.S29670 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Boterberg S, & Warreyn P (2016). Making sense of it all: The impact of sensory processing sensitivity on daily functioning of children. Personality and Individual Differences, 92, 80–86. doi: 10.1016/j.paid.2015.12.022 [DOI] [Google Scholar]
  13. Bunford N, Evans SW, & Wymbs F (2015). ADHD and emotion dysregulation among children and adolescents. Clinical Child and Family Psychology Review, 18, 185–217. doi: 10.1007/s10567-015-0187-5 [DOI] [PubMed] [Google Scholar]
  14. Case-Smith J, Weaver LL, & Fristad MA (2014). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19, 133–148. doi: 10.1177/1362361313517762 [DOI] [PubMed] [Google Scholar]
  15. Cheng M, & Boggett-Carsjens J (2005). Consider sensory processing disorders in the explosive child: Case report and review. The Canadian Child and Adolescent Psychiatry Review, 14, 44–48. [PMC free article] [PubMed] [Google Scholar]
  16. Collins A, & Dworkin RJ (2011). Pilot study of the effectiveness of weighted vests. American Journal of Occupational Therapy, 65, 688–694. doi: 10.5014/ajot.2011.000596 [DOI] [PubMed] [Google Scholar]
  17. DuBois D, Lymer E, Gibson BE, Desarkar P, & Nalder E (2017). Assessing Sensory Processing Dysfunction in Adults and Adolescents with Autism Spectrum Disorder: A Scoping Review. Brain Sciences, 7, 108. doi: 10.3390/brainsci7080108 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Dunn W, & Bennett D (2002). Patterns of sensory processing in children with attention deficit hyperactivity disorder. Occupational Therapy Journal of Research: Occupation, Participation and Health, 22, 4–15. doi: 10.1177/153944920202200102 [DOI] [Google Scholar]
  19. Dunn W, & Brown C (1997). Factor analysis on the sensory profile from a national sample of children without disabilities. American Journal of Occupational Therapy, 51, 490–495. doi: 10.5014/ajot.51.7.490 [DOI] [PubMed] [Google Scholar]
  20. Dunn W (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children, 9, 23–35. doi: 10.1097/00001163-199704000-00005 [DOI] [Google Scholar]
  21. Dunn W (2014). Sensory Profile 2: User’s Manual: Psych Corporation. [Google Scholar]
  22. Dunn W, Little L, Dean E, Robertson S, & Evans B (2016). The state of the science on sensory factors and their impact on daily life for children. Occupational Therapy Journal of Research: Occupation, Participation and Health, 36, 3S–26S. doi: 10.1177/1539449215617923 [DOI] [PubMed] [Google Scholar]
  23. Engel-Yeger B, & Ziv-On D (2011). The relationship between sensory processing difficulties and leisure activity preference of children with different types of ADHD. Research in Developmental Disabilities, 32, 1154–1162. doi: 10.1016/j.ridd.2011.01.008 [DOI] [PubMed] [Google Scholar]
  24. Graziano PA, & Garcia A (2016). Attention-deficit hyperactivity disorder and children’s emotion dysregulation: A meta-analysis. Clinical Psychology Review, 46, 106–123. doi: 10.1016/j.cpr.2016.04.011 [DOI] [PubMed] [Google Scholar]
  25. Hong S-B, Dwyer D, Kim J-W, Park E-J, Shin M-S, Kim B-N, … Hong Y-C (2014). Subthreshold attention-deficit/hyperactivity disorder is associated with functional impairments across domains: A comprehensive analysis in a large-scale community study. European Child & Adolescent Psychiatry, 23, 627–636. doi: 10.1007/s00787-013-0501-z. [DOI] [PubMed] [Google Scholar]
  26. Jorquera-Cabrera S, Romero-Ayuso D, Rodriguez-Gil G, & Trivino-Juarez JM (2017). Assessment of Sensory Processing Characteristics in Children between 3 and 11 Years Old: A Systematic Review. Frontiers in Pediatrics, 5, 57. doi: 10.3389/fped.2017.00057 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Kalff AC, De Sonneville LM, Hurks PP, Hendriksen JG, Kroes M, Feron FJ, … Jolles J (2005). Speed, speed variability, and accuracy of information processing in 5 to 6-year-old children at risk of ADHD. Journal of the International Neuropsychological Society, 11, 173–183. doi: 10.1017/S1355617705050216 [DOI] [PubMed] [Google Scholar]
  28. Kaufman AS, & Kaufman NL (2004). Kaufman Brief Intelligence Test Second Edition (KBIT-2). Circle Pines, MN: American Guidance Service. [Google Scholar]
  29. Kaufman J, Birmaher B, Brent D, & Rao U (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980–988. doi: 10.1097/00004583-199707000-00021 [DOI] [PubMed] [Google Scholar]
  30. Kreider CM, Bendixen RM, Huang YY, & Lim Y (2014). Review of occupational therapy intervention research in the practice area of children and youth 2009–2013. American Journal of Occupational Therapy, 68, e61–73. doi: 10.5014/ajot.2014.011114 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Larsson H, Anckarsater H, Råstam M, Chang Z, & Lichtenstein P (2012). Childhood attention‐deficit hyperactivity disorder as an extreme of a continuous trait: A quantitative genetic study of 8,500 twin pairs. Journal of Child Psychology and Psychiatry, 53, 73–80. doi: 10.1111/j.1469-7610.2011.02467.x. [DOI] [PubMed] [Google Scholar]
  32. Mangeot SD, Miller LJ, McIntosh DN, McGrath-Clarke J, Simon J, Hagerman RJ, & Goldson E (2001). Sensory modulation dysfunction in children with attention-deficit–hyperactivity disorder. Developmental Medicine And Child Neurology, 43, 399–406. doi: 10.1017/S0012162201000743 [DOI] [PubMed] [Google Scholar]
  33. Marcus DK, & Barry TD (2011). Does attention-deficit/hyperactivity disorder have a dimensional latent structure? A taxometric analysis. Journal of Abnormal Psychology, 120, 427–442. doi: 10.1037/a0021405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. McIntosh DN, Miller LJ, Shyu V, & Hagerman RJ (1999). Sensory-modulation disruption, electrodermal responses, and functional behaviors. Developmental Medicine & Child Neurology, 41, 608–615. doi: 10.1111/j.1469-8749.1999.tb00664.x [DOI] [PubMed] [Google Scholar]
  35. Merwin RM, Moskovich AA, Wagner HR, Ritschel LA, Craighead LW, & Zucker NL (2013). Emotion regulation difficulties in anorexia nervosa: Relationship to self-perceived sensory sensitivity. Cognition and Emotion, 27, 441–452. doi: 10.1080/02699931.2012.719003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Miller LJ, Anzalone ME, Lane SJ, Cermak SA, & Osten ET (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. The American Journal of Occupational Therapy, 61, 135–140. doi: 10.5014/ajot.61.2.135 [DOI] [PubMed] [Google Scholar]
  37. Miller LJ, Coll JR, & Schoen SA (2007). A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy, 61, 228–238. doi: 10.5014/ajot.61.2.228 [DOI] [PubMed] [Google Scholar]
  38. Minshew NJ, & Hobson JA (2008). Sensory sensitivities and performance on sensory perceptual tasks in high-functioning individuals with autism. Journal of Autism and Developmental Disorders, 38, 1485–1498. doi: 10.1007/s10803-007-0528-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Parham LD, Ecker C, Miller Kuhaneck H, Henry DA, & Glennon TJ (2007). Sensory Processing Measure (SPM): Manual. Los Angeles: Western Psychological Services. [Google Scholar]
  40. Parush S, Sohmer H, Steinberg A, & Kaitz M (2007). Somatosensory function in boys with ADHD and tactile defensiveness. Physiology & Behavior, 90, 553–558. doi: 10.1016/j.physbeh.2006.11.004 [DOI] [PubMed] [Google Scholar]
  41. Pluess M, & Boniwell I (2015). Sensory-processing sensitivity predicts treatment response to a school-based depression prevention program: Evidence of vantage sensitivity. Personality and Individual Differences, 82, 40–45. doi: 10.1016/j.paid.2015.03.011 [DOI] [Google Scholar]
  42. Reynolds S, & Lane SJ (2009). Sensory overresponsivity and anxiety in children with ADHD. American Journal of Occupational Therapy, 63, 433–440. doi: 10.5014/ajot.2012.004523 [DOI] [PubMed] [Google Scholar]
  43. Reynolds S, Lane SJ, & Gennings C (2010). The moderating role of sensory overresponsivity in HPA activity: A pilot study with children diagnosed with ADHD. Journal of Attention Disorders, 13, 468–478. doi: 10.1177/1087054708329906 [DOI] [PubMed] [Google Scholar]
  44. Rosenthal MZ, Ahn R, & Geiger PJ (2011). Reactivity to sensations in borderline personality disorder: A preliminary study. Journal of Personality Disorders, 25, 715–721. doi: 10.1521/pedi.2011.25.5.715 [DOI] [PubMed] [Google Scholar]
  45. Shaw P, Stringaris A, Nigg J, & Leibenluft E (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171, 276–293. doi: 10.1176/appi.ajp.2013.13070966 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Sobanski E, Banaschewski T, Asherson P, Buitelaar J, Chen W, Franke B, … Faraone SV (2010). Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): Clinical correlates and familial prevalence. Journal Of Child Psychology And Psychiatry, And Allied Disciplines, 51, 915–923. doi: 10.1111/j.1469-7610.2010.02217.x [DOI] [PubMed] [Google Scholar]
  47. Spencer TJ, Faraone SV, Surman CB, Petty C, Clarke A, Batchelder H, … Biederman J (2011). Toward defining deficient emotional self-regulation in children with attention-deficit/hyperactivity disorder using the Child Behavior Checklist: A controlled study. Postgraduate Medicine, 123, 50–59. doi: 10.3810/pgm.2011.09.2459 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Stringaris A, & Goodman R (2009). Mood lability and psychopathology in youth. Psychological Medicine, 39, 1237–1245. doi: 10.1017/S0033291708004662 [DOI] [PubMed] [Google Scholar]
  49. Suarez MA (2012). Sensory processing in children with autism spectrum disorders and impact on functioning. Pediatric Clinics of North America, 59, 203–214. doi: 10.1016/j.pcl.2011.10.012 [DOI] [PubMed] [Google Scholar]
  50. Tseng M-H, Fu C-P, Cermak SA, Lu L, & Shieh J-Y (2011). Emotional and behavioral problems in preschool children with autism: Relationship with sensory processing dysfunction. Research in Autism Spectrum Disorders, 5, 1441–1450. doi: 10.1016/j.rasd.2011.02.004 [DOI] [Google Scholar]
  51. van Stralen J (2016). Emotional dysregulation in children with attention-deficit/hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, 8, 175–187. doi: 10.1007/s12402-016-0199-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Wan Yunus F, Liu KP, Bissett M, & Penkala S (2015). Sensory-Based Intervention for Children with Behavioral Problems: A Systematic Review. Journal of Autism and Developmental Disorders, 45, 3565–3579. doi: 10.1007/s10803-015-2503-9 [DOI] [PubMed] [Google Scholar]
  53. Wells AM, Chasnoff IJ, Schmidt CA, Telford E, & Schwartz LD (2012). Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: an adaptation of the Alert Program(R). American Journal of Occupational Therapy, 66, 24–34. doi: 10.5014/ajot.2012.002691 [DOI] [PubMed] [Google Scholar]
  54. Wehmeier PM, Schacht A, & Barkley RA (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. Journal of Adolescent Health, 46, 209–217. doi: 10.1016/j.jadohealth.2009.09.009 [DOI] [PubMed] [Google Scholar]
  55. Williams MS (1994). How Does Your Engine Run? : Leader’s Guide to the Alert Program for Self Regulation. Albuquerque, NM: Therapy Works Inc. [Google Scholar]
  56. Yochman A, Parush S, & Ornoy A (2004). Responses of preschool children with and without ADHD to sensory events in daily life. American Journal of Occupational Therapy, 58, 294–302. doi: 10.5014/ajot.58.3.294 [DOI] [PubMed] [Google Scholar]

RESOURCES