European Child & Adolescent Psychiatry

, Volume 28, Issue 2, pp 247–255 | Cite as

Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study

  • Ruu-Fen Tzang
  • Yue-Cune Chang
  • Kai-Liang Kao
  • Yu-Hsin Huang
  • Hui-Chun Huang
  • Yu-Chiao Wang
  • Chih-Hsin Muo
  • Shu-I WuEmail author
  • Fung-Chang SungEmail author
  • Robert Stewart
Original Contribution


Parents of children with attention deficit hyperactivity disorder (ADHD) have been found to prefer sensory integration (SI) training rather than guideline-recommended ADHD treatment. This study investigated whether SI intervention for children with ADHD was associated with a reduced risk of subsequent mental disorders. From children < 8-years-old newly diagnosed with ADHD in a nationwide population-based dataset, we established a SI cohort and a non-SI cohort (N =  1945) matched by propensity score. Incidence and hazard ratios of subsequent psychiatric disorders were compared after a maximum follow-up of 9 years. The incidence of psychiatric disorders was 1.4-fold greater in the SI cohort, with an adjusted hazard ratio of 1.41 (95% confidence interval 1.20–1.67), comparing to the non-SI cohort. Risks were elevated for emotional disturbances, conduct disorders, and adjustment disorders independent of age, gender, or comorbidity. Among children with only psychosocial intervention, the incidence of psychiatric disorders was 3.5-fold greater in the SI cohort than in the non-SI cohort. To our knowledge, this is the first study to report an increased risk of developing psychiatric disorders for children with ADHD who received SI compared to those who did not. Potential adverse effects of SI for ADHD children should be carefully examined and discussed before practice.


Non-western country Attention deficit and hyperactivity disorder Psychiatric disorders Sensory integration Conduct disorder Affective disorder 



This research team is supported in part by the Bureau of Health Promotion, Department of Health, Taiwan (DOH99-HP-1205); Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW107-TDU-B-212-123004), the research laboratory of pediatrics, Children’s Hospital of China Medical University (grant number DMR-105-042), China Medical University Hospital (DMR-106-025), Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10701010021), NRPB Stroke Clinical Trial Consortium (MOST 106-2321-B-039-005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, Katsuzo and Kiyo Aoshima Memorial Funds, Japan, Department of Medical Research, Mackay Memorial Hospital (MMH-106-93, MMH-106-55, MMH-106-44). RS is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Biomedical Research Unit at South London and Maudsley NHS Foundation Trust and King’s College London.

Author contributions

Authors RFT, YCC, KLK, YCW, and SIW designed the study and wrote the protocol. Authors YCW, CHM, and SIW undertook the statistical analysis, and author RFT wrote the first draft of the manuscript. All authors contributed to the writing and have approved the final manuscript.

Compliance with ethical standards

Conflict of interest

RS has received research funding in the last 5 years from Roche, Janssen and GSK. All other authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of MedicineMackay Medical CollegeTaipeiTaiwan
  2. 2.Mackay Junior College of Medicine, Nursing and ManagementTaipeiTaiwan
  3. 3.Department of Psychiatry and Suicide Prevention CenterMackay Memorial HospitalTaipeiTaiwan
  4. 4.Department of MathematicsTamkang UniversityTaipeiTaiwan
  5. 5.Department of PediatricsFar Eastern Memorial HospitalTaipeiTaiwan
  6. 6.Department of Medical ResearchMackay Memorial HospitalNew Taipei CityTaiwan
  7. 7.Department of Public HealthChina Medical UniversityTaichungTaiwan
  8. 8.Management Office for Health DataChina Medical University HospitalTaichungTaiwan
  9. 9.College of MedicineChina Medical University HospitalTaichungTaiwan
  10. 10.Department of Audiology, Speech, and Language PathologyMackay Medical CollegeTaipeiTaiwan
  11. 11.Department of Health Services AdministrationChina Medical University, College of Public HealthTaichungTaiwan
  12. 12.Department of Psychological MedicineKing’s College London (Institute of Psychiatry, Psychology and Neuroscience)LondonUK

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