Emotional and sensory dysregulation as a possible missing link in attention deficit hyperactivity disorder: A review

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is a common developmental disorder affecting 5-7% of adults and children. We surveyed the literature to examine ADHD through three pillars: developmental characteristics, symptomatology, and treatment strategies. Firstly, in terms of developmental characterstics, early life stress may increase the risk of developing ADHD symptoms according to animal models’ research. Secondly, the current core symptoms of ADHD are comprised of inattention, hyperactivity, and impulsivity. However, the up-to-date literature indicates individuals with ADHD experience emotional and sensory dysregulation as well, which early-life stress may also increase the risk of. Finally, we discuss the therapeutic benefits of methylphenidate on both the current core ADHD symptoms and the sensory and emotional dysregulation found in those with ADHD. In summation, we surveyed the recent literature to analyze (i) the potential role of early-life stress in ADHD development, (ii) the involvement of emotional and sensory dysregulation in ADHD symptomatology and finally, (iii) the therapeutic intervention with methylphenidate, aiming to reduce the potential effect of early life stress in ADHD, and mainly emotional and sensory dysregulation. The apparent but currently less recognized additional symptoms of emotional and sensory dysregulation in ADHD call for further investigation of these possible causes and thus increasing treatments efficacy in individuals with ADHD.

Do Not Think of a Purple Wolf—Keratoconus, ADHD, and Itch

“…2,4,5 Some individuals with ADHD and other psychiatric conditions have been shown to experience heightened sensory responsiveness to auditory and visual stimulation. 3,6 This heightened sensory responsiveness may predispose them to feeling itches and, consequently, to rub their eyes. 6 Additionally, individuals with ADHD may have reduced ability to avoid eye rubbing urges compared with their peers.…”

“…6 Additionally, individuals with ADHD may have reduced ability to avoid eye rubbing urges compared with their peers. 3 But what are we to do with that new knowledge? In 2008, the New Yorker published an article by Atul Gawande, MD, MPH, titled "The Itch," 7 an engaging read about the intrinsic power of the itching sensation.…”

“…Why would ADHD, caused by differences in executive function of the prefrontal cortex, have anything to do with keratoconus, a corneal disorder of collagen? One plausible connection between these 2 conditions may be repetitive eye rubbing, either as a chronic stress response, as proposed by Safir and colleagues and others, or due to heighted sensation of the eye. It remains unclear whether early keratoconus promotes eye rubbing or whether instincts to rub eyes contribute to keratoconus, but eye rubbing is certainly associated with keratoconus .…”

“…It remains unclear whether early keratoconus promotes eye rubbing or whether instincts to rub eyes contribute to keratoconus, but eye rubbing is certainly associated with keratoconus . Some individuals with ADHD and other psychiatric conditions have been shown to experience heightened sensory responsiveness to auditory and visual stimulation . This heightened sensory responsiveness may predispose them to feeling itches and, consequently, to rub their eyes .…”

“…This heightened sensory responsiveness may predispose them to feeling itches and, consequently, to rub their eyes . Additionally, individuals with ADHD may have reduced ability to avoid eye rubbing urges compared with their peers …”