Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study
- 711 Downloads
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.
KeywordsNon-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.
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.
- 3.Cornejo JW, Osio O, Sanchez Y, Carrizosa J, Sanchez G, Grisales H et al (2005) Prevalence of attention deficit hyperactivity disorder in Colombian children and teenagers. Rev Neurol 40:716–722Google Scholar
- 17.Charach A, Dashti B, Carson P et al (2011) Attention deficit hyperactivity disorder: effectiveness of treatment in at-risk young childrens; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatmentGoogle Scholar
- 20.Herrerias CT, Perrin JM, Stein MT (2001) The child with ADHD: using the AAP Clinical Practice Guideline. American Academy of Pediatrics. Am Fam Physician 63:1803–1810Google Scholar
- 22.Tzang R-F, Chang Y-C, Hung S-T, Tang C-H (2015) Under-diagnosis of attention deficit hyperactivity disorder in one of non-western country-taiwan. Int J Emerg Ment Health Hum Resil 17:206–209Google Scholar
- 27.Hender K. Effectiveness of sensory integration therapy for attention deficit hyperactivity disorder (ADHD). Evidence Centre Critical Appraisal. Series 2001. http://www.med.monash.edu.au/healthservices/cce/evidence/
- 31.NHIRD. Introduction to the National Health Insurance Research Database (NHIRD), Taiwan Taiwan: National Health Insurance Research Database; 2006. http://www.nhri.org.tw/nhird/en/index.htm
- 33.WHO. World Health Organization, Collaborating Centre for Drug Statistic Methodology: Guidelines for ATC Classification and DDD Assignment. Oslo, Norway 2009Google Scholar
- 36.Pliszka SR (2000) Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 9:525–540, viiGoogle Scholar
- 39.Huang A, Seshadri K, Matthews TA, Ostfeld BM (2013) Parental perspectives on use, benefits, and physician knowledge of complementary and alternative medicine in children with autistic disorder and attention-deficit/hyperactivity disorder. J Altern Complement Med (New York, NY) 19:746–750CrossRefGoogle Scholar
- 41.Charach A, Dashti B, Carson P, Booker L, Lim CG, Lillie E et al (2011) AHRQ comparative effectiveness reviews. In: Attention deficit hyperactivity disorder: effectiveness of treatment in at-risk young childrens; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Agency for healthcare research and quality (US)Google Scholar
- 42.Tzang RF, Wang YC, Yeh CB, Hsu CD, Liang HY, Yang PC et al (2012) Naturalistic exploration of the effect of osmotic release oral system-methylphenidate on remission rate and functional improvement in Taiwanese children with attention-deficit–hyperactivity disorder. Psychiatry Clin Neurosci 66:53–63CrossRefGoogle Scholar
- 43.Wolff C, Alfred A, Lindermüller A, Rettig K, Mattejat F, Gerwe M et al (2011) Effect of transitioning from extended-release methylphenidate onto osmotic, controlled-release methylphenidate in children/adolescents with ADHD: results of a 3-month non-interventional study. Curr Med Res Opin 27:35–44CrossRefGoogle Scholar