Attention deficit/hyperactivity disorder (ADHD) is the most widely diagnosed neurodevelopmental condition, affecting as many as 5% of children and adolescents (Cortese et al., 2023) and 3% of the adult population (Ayano et al., 2023).
People with ADHD are more likely to experience physical and mental health comorbidities (Arrondo et al., 2022; Faraone et al., 2015), and previous studies suggest that people with ADHD might experience atypical sensory processing as well (Dunn et al, 2002).
The concept of sensory modulation was first described as “the interaction between the neurological threshold and self-regulation” by Winnie Dunn, in 2001. Under this framework (1997), people can fall into 4 different categories:
- Low Registration: they don’t detect all the sensory information, but they don’t proactively seek more sensory input.
- Sensory Seeking: they don’t detect all the sensory information, and they proactively seek more sensory input.
- Sensory Sensitive: they detect a lot of sensory information, but they don’t proactively try and stop this when it’s overwhelming.
- Avoiding: they detect a lot of sensory information and they actively try to avoid further sensory stimuli if it’s overwhelming.
Everyone has their own way of processing sensory information, but when these patterns become too extreme or hard to manage, they can start to interfere with daily life and impact cognitive functions and psychosocial development (Dunn, 2001); intensity and enjoyment of social interaction (Cosbey et al., 2010); and regulation of emotions and attention (DelCarmen-Wiggins et al., 2004).
This meta-analysis by Jurek et al. (2025) explores evidence of differences in Sensory Modulation between people with ADHD and those without; to inform the care and support we provide for people with ADHD.
Sensory processing atypicalities can make ordinary stimuli feel like a fire alarm – and make life challenging in ADHD.
Methods
This study was registered in PROSPERO, the international systematic review registry. The literature search covered 3 of the most established databases for publications dated up until June 30 2024. Terms related to ADHD and SPPs were appropriately refined to streamline the search.
The authors also assessed potential bias and overall study quality using a modified Newcastle–Ottawa Scale (NOS),
This systematic review focused solely on studies where ADHD was formally diagnosed, excluding self-diagnosed or non-diagnosed participants. Studies in which participants had more than 20% of comorbid autism spectrum disorder, intellectual disability, or genetic disorders were also excluded (Juret et al,, 2025).
In terms of the study design, original cohort, case-control and cross-sectional studies were included, whilst case studies were excluded.
The study looked at the following outcomes:
- Severity of sensory processing differences (measured continuously). Based on Dunn’s four sensory modulation patterns (sensitivity, low registration, seeking, avoiding) and six sensory types (touch, sound, sight, taste/smell, movement, body awareness).
- Risk of being hypersensitive or hyposensitive (measured as yes/no). Based on how participants were rated in the studies.
This systematic review evaluated binary and continuous differences in sensory processing difficulties, for people formally diagnosed with ADHD.
Results
A total of 30 studies (32 publications) were included, with 5,374 participants (1,656 with ADHD, 3,718 controls). Most studies were cross-sectional and focused on children, though some included adolescents and adults.
Females were underrepresented (average 30%) and ethnicity was poorly reported. Participants generally had average IQ, with low IQ excluded in most studies. ADHD diagnosis was based on DSM/ICD criteria or clinical judgment, though diagnostic tools varied. Reporting of comorbidities and medication status was inconsistent.
Sensory processing was measured using various tools, most commonly the Sensory Profile (SP), Short Sensory Profile (SSP), and Adolescent/Adult Sensory Profile (AASP). Risk of bias was unclear in most studies.
The following outcomes were identified:
- Meta-analysis of sensory sensitivity (13 studies) showed significantly elevated scores in individuals with ADHD.
- Sensory avoiding was higher in ADHD, but not significant in low-risk studies due to limited data and high heterogeneity.
- Low sensory registration was significantly higher in ADHD, with more pronounced effects in older participants.
- Sensory seeking was elevated overall in ADHD but not in adults, and only significant under certain study conditions; no publication bias was found.
- ADHD participants showed greater difficulty processing tactile, visual, auditory, oral, and movement-related input, but not body position.
- People with ADHD were 9 times more likely to be hypersensitive, even after correcting for publication bias.
- Hyposensitivity was nearly 10 times more likely in ADHD, seen only in adults, though based on a limited number of studies.
Across studies, a variety of tools such as the Sensory Profile (SP), Short Sensory Profile (SSP), and Adolescent/Adult Sensory Profile (AASP), were used to test sensory processing and responses.
Conclusion
This meta-analysis synthesises a medium to large set of studies into ADHD and sensory profiles and challenges, to highlight the complexity of sensory processing patterns for people with ADHD.
While there is a heterogeneity across studies’ designs and risks of bias, emerging outcomes suggest ADHD individuals’ sensory profiles can demonstrate hypersensitivity and/or hyposensitivity, in different specific sensory modalities – which lends weight to theories of multiple coexistent and atypical sensory patterns across Dunn’s 4 sensory categories, for ADHD individuals, which can be strengths or challenges in unique conditions.
Strengths and limitations
This study is the first large-scale meta-analysis focusing on sensory processing in ADHD. Strengths include the high number of studies and participants included. The methodology was systematic, following PRISMA guidelines with clear inclusion and exclusion criteria. Most studies used validated sensory processing questionnaires (SP, SSP, AASP), improving comparability. Subgroup analyses were conducted based on study population (children, adults), risk of bias, assessment tool, and exclusion of autism and IQ.
The main limitation is the high heterogeneity across studies, making it hard to tell if differences reflect true effects or inconsistent methods. Another limitation is how “sensory processing” was defined. Different tools were used across studies, so the authors created their own system to group results. While necessary to combine data, this may have introduced bias since these categories weren’t always applied consistently in the original studies, potentially influencing findings in ways the authors couldn’t fully control.
Generalisability is limited: female participants were underrepresented (average 30%) across studies, and ethnicity was mostly unreported and predominantly White where available. Although not formal exclusion criteria, this may indicate that a “hyperactive White boys” archetype still dominates clinical and research cohorts in ADHD studies. Further, medication status was often missing, so it is unclear if the objective or subjective impacts of this variable on SPPs needs to be controlled for in future research.
Reporting on participants with autism was inconsistent. 20 studies excluded ASD, one included a few, and nine gave no details. Because of this, it’s unclear how having both ADHD and ASD might impact the findings. People with ASD are known to often experience more pronounced sensory differences (Ben-Sasson et al., 2009), so not fully accounting for co-occurring ASD might limit how well the conclusions reflect sensory processing in this group.
Finally, signs of publication bias were detected for outcomes like sensory avoiding, low registration, and hypersensitivity. Statistical adjustments were made, but this bias suggests reported effects might be somewhat overestimated.
The underrepresentation of women and ethnic minorities with ADHD in studies included in this review, makes it difficult to understand what sensory processing ‘fire alarms’ look like for those communities.
Implications for practice
Thinking about SPPs (sensory processing patterns) in layman’s terms, we can think of the brain working like a fire alarm:
- The alarm’s sensitivity is the neurological threshold, and our response is the self-regulation.
- Different people’s fire alarms may be more or less sensitive to smoke, before they ring.
- One person’s alarm might only go off when the entire building is on fire (high neurological threshold), someone else’s might go off at the puff of a vape (low neurological threshold).
- Some people might not respond to the alarm being triggered and just wait for it to stop (passive responders), some might open the windows to let the smoke out or disable the alarm all together (active responders), and others might get overwhelmed.
While popular characterisations of people with ADHD can be a hyperactivity associated with perpetual stimulus seeking, this review identifies that there can be a variety of sensory processing patterns in ADHD individuals, which appear to be widely distributed across Dunn’s sensory domains.
People with ADHD can be usually hypersensitive to a variety of physical stimuli, but a cohort of people who are hyposensitive relative to undiagnosed populations should not be excluded from therapeutic design considerations.
Although not explicitly stated in this study’s analysis – given the heterogeneity of available data for review, the differences identified between ‘low registration’ SPP prevalence in older persons and ‘sensory seeking’ SPP before adulthood could also open an avenue for further research on ADHD and any trends in sensory processing patterns across the lifespan.
Learning about sensory processing profiles, can influence more inclusive therapies and support design, for people with ADHD across the lifespan — leaving no one behind when their alarm bells ring.
Statement of interests
None to declare
Links
Primary paper
Jurek L, Duchier A, Gauld C, Hénault L, Giroudon C, Fourneret P, Cortese S, Nourredine M. Sensory Processing in Individuals With Attention-Deficit/Hyperactivity Disorder Compared With Control Populations: A Systematic Review and Meta-analysis. J Am Acad Child Adolesc Psychiatry. 2025 Apr 16:S0890-8567(25)00209-6. doi: 10.1016/j.jaac.2025.02.019. Epub ahead of print. PMID: 40250555.
Other references
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