Pain sensitivity and perceptual sensitivity are associated with severity of emotional dysregulation in children with ADHD: a cross-sectional analysis using the Temperament in Middle Childhood Questionnaire

Abstract

Purpose

Nearly 50% of children with attention-deficit/hyperactivity disorder (ADHD) experience emotional dysregulation or sensory over-responsiveness; this study examines their association.

Methods

This cross-sectional analysis (n = 124) used data from the Micronutrients for ADHD in Youth (MADDY) Study, which enrolled children aged 6–12 with ADHD and emotional dysregulation. Sensory responsiveness was assessed using two subscales from the factor-analyzed Temperament in Middle Childhood Questionnaire: Pain Sensitivity and Perceptual Sensitivity. Emotional dysregulation was assessed using the Emotional-Problems and Conduct-Problems subscales from the Strengths and Difficulties Questionnaire and a composite score from the Child & Adolescent Symptom Inventory-5. Multivariable linear regression measured the association of pain and perceptual sensitivity with the severity of emotional dysregulation.

Results

In adjusted models, pain sensitivity was positively associated with Emotional Problems (β = 0.97; 95% CI: 0.52, 1.41; p < 0.0001), Conduct Problems (β = 0.83; 95% CI: 0.44, 1.21; p = 0.0001), and CASI-5 composite (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Perceptual sensitivity was positively associated with Emotional Problems (β = 0.75; 95% CI: 0.15, 1.35; p = 0.01) but not Conduct Problems (β = 0.27; 95% CI: −0.24, 0.77; p = 0.30) or CASI-5 composite (β = 0.12; 95% CI: −0.01, 0.24; p = 0.07).

Conclusion

Pain sensitivity was associated with the severity of emotional dysregulation in this ADHD sample. To better understand possible causal links, longitudinal studies are warranted.

Implications for rehabilitation

• Emotional dysregulation and sensory over-responsiveness are both common in children with ADHD and contribute to added challenges in school and family life.

• Two types of sensory over-responsiveness, pain sensitivity and perceptual sensitivity, were associated with emotional dysregulation in children with ADHD in our study.

• Sensory over-responsiveness may be a modifiable treatment target.

Keywords:

• ADHD
• attention
• emotion regulation
• irritability
• anger
• pain
• sensory sensitivity
• over-responsiveness

Disclosure statement

Dr. Arnold has received research funding from Curemark, Forest, Lilly, Neuropharm, Novartis, Noven, Otsuka, Roche/Genentech, Shire, Supernus, and YoungLiving (as well as NIH and Autism Speaks), has consulted with CHADD, Neuropharm, Organon, Pfizer, Sigma Tau, Shire, Tris Pharma, and Waypoint, and been on advisory boards for Arbor, Ironshore, Novartis, Noven, Otsuka, Pfizer, Roche, Seaside Therapeutics, Sigma Tau, Shire. The other authors have no conflicts of interest to disclose.

Additional information

Funding

Dr. Bruton’s

work was supported by Oregon Health & Science University and by grants from NIH (NIH-NCCIH T32 #AT002688). Funding for the MADDY study has come through private donations to the Nutrition and Mental Health Research Fund, managed by the Foundation for Excellence in Mental Health Care (FEMHC), as well as from a direct grant from FEMHC and funding from the Gratis Foundation. Dr. Johnstone received support from NIH-NCCIH 5R90AT00892403 through the National University for Natural Medicine. Dr. Johnstone's work on study inception and design was funded by NIH-NCCIH T32 AT002688, as well as through support from the Department of Child and Adolescent Psychiatry, Oregon Health & Science University and Oregon Clinical & Translational Research, through the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR000128. Dr. Leung's position is supported by the Emmy Droog (endowed) chair in Complementary and Alternative Healthcare. The study at the Canadian site is funded by the Nutrition and Mental Health Research Fund, administered by the Calgary Foundation. The other authors have no funding sources to disclose.