Introduction 

Attention deficit hyperactivity disorder ((ADHD) is a developmental condition characterized by impulsive behaviour and inattentiveness. Contrary to popular belief, people with ADHD do not have a deficit of attention. Instead, they are hyper-aware of their surroundings, making it difficult to focus on one task at a time due to issues with processing sensory information.

Sensory integration therapies help individuals with ADHD manage difficulties in processing sensory information by offering controlled sensory experiences. This article discusses the pros and cons of these therapies for managing ADHD.

Sensory integration in ADHD

What is sensory integration?

Sensory integration is the process of interpreting and organising sensory information, allowing individuals to interact correctly with their environment. We are constantly exposed to sensory information, including touch, sight, smell, taste, hearing, and balance, which all need to be processed.

A simple example of processing multiple pieces of sensory information at once is doing a weekly food shop:² 

• Having to navigate the trolleys around people 
• Seeing and smelling all the different types of food 
• Reading your shopping list and finding the items

What causes ADHD?

ADHD is a developmental disorder that often shows symptoms during childhood and continues into adulthood. There is no single cause of ADHD; instead, it is believed to result from a combination of factors. Genetics play a significant role, as individuals are more likely to have ADHD if a parent or sibling has the condition.³          

There is evidence suggesting that individuals with ADHD have lower levels of dopamine, a brain signalling molecule involved in attention span and the reward pathway.⁴ Lower dopamine levels can make it harder to maintain motivation for tasks, explaining why shorter tasks with immediate rewards are easier to complete compared to longer, more challenging projects.^4,5

Overstimulation vs understimulation in ADHD

Individuals with ADHD are often in a constant battle of being overstimulated or understimulated, due to their difficulties with processing sensory information. 

Overstimulation** occurs when there is too much sensory input for the brain to manage. Symptoms of sensory overload include:²

• Being snappy or irritable with others 
• Prone to angry outbursts 
• Unable to ‘quiet’ your mind and focus on something 
• Easily fatigued 

Understimulation** refers to times when the brain is not receiving enough sensory input, resulting in lower dopamine levels. This can lead to demotivation. People with ADHD often seek sensory input to get short dopamine boosts through behaviours such as:²

• Daydreaming
• Fidgeting 
• Skin picking
• Nail biting 
• Getting into arguments 

Sensory integration therapies 

Sensory integration therapies don't "cure" ADHD but provide personalised plans to help individuals manage symptoms better. These techniques can be applied to daily life for improved symptom management. 

How sensory integration therapy works  

Initially, individuals with ADHD are assessed to determine their specific sensory challenges, whether they struggle more with overstimulation or understimulation. This process is called sensory profiling.¹

After evaluation, occupational therapists develop a specific plan that introduces sensory stimuli to patients with ADHD. By exposing them to different sensory experiences through various activities, individuals gradually learn to adapt and respond appropriately. The activities become more intense and complex over time as the individual learns to manage sensory input better.⁶

Some examples of activities involved in sensory integration therapy are:

• Balancing exercises, e.g., using a balance beam 
• Rhythmic movements e.g., bouncing on a space hopper or a trampoline 
• Sensory diet, e.g., a list of sensory activities to maintain a calm and organised environment 
• Deep pressure e.g., using weighted blankets

Benefits

Sensory integration therapy works best when combined with other treatments, whether this is through prescription medication or other behavioural therapies. 

When incorporated into a wider treatment plan, sensory integration therapies can provide a range of benefits to the individual with ADHD. Some of these benefits include:¹

• Increased attention span and focus, leading to better performance in school/work
• Improved emotional regulation 
• Reduced impulsive behaviour 
• Improved coordination and organisation

Limitations 

Most research on sensory integration therapy has focused on children with autism rather than ADHD. While short-term positive effects have been observed for ADHD, long-term benefits have not been extensively studied. Additionally, not everyone with ADHD has difficulty processing sensory information, so the therapy may not benefit all individuals with the disorder. 

Summary  

Sensory integration therapy offers an alternative therapeutic approach for individuals with ADHD who struggle with processing sensory information. For children, occupational therapists work with parents to continue sensory integration therapy at home. While ADHD cannot be cured, there are no negative side effects to using the techniques learned in sensory integration therapy for short-term benefits.

FAQs

Why do sensory processing issues occur in individuals with ADHD? 

The exact reason behind sensory processing issues is not known. People with ADHD often struggle to filter out unnecessary sensory information, making them easily distracted. This can prolong the time needed to complete tasks.

Can adults benefit from sensory integration therapy?

Yes, sensory integration therapy can benefit individuals of all ages. The brain retains some plasticity and adaptability into adulthood, allowing adults to manage their symptoms through therapy, just like children. 

How long does it take to see improvements in ADHD symptoms with sensory integration therapy?

There is no set timeline for improvement, as each individual's plan addresses specific needs. Consistent sessions supported by an at-home program are likely to have a positive impact on results and progress.

How can parents or caregivers support sensory integration therapy at home for a child with ADHD?

Occupational therapists often work with parents and caregivers to create a "sensory diet" for the child. This involves generating a list of soothing activities or creating a calming environment. For example, fidget toys can help children focus when they are understimulated.