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Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study

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Abstract

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.

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Acknowledgments

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.

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Author notes

  1. Drs. Shu-I Wu and Fung-Chang Sung contributed equally to this article.

Authors and Affiliations

  1. Department of Medicine, Mackay Medical College, Taipei, Taiwan

    Ruu-Fen Tzang, Yu-Hsin Huang & Shu-I Wu

  2. Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan

    Ruu-Fen Tzang & Hui-Chun Huang

  3. Department of Psychiatry and Suicide Prevention Center, Mackay Memorial Hospital, No. 92, Section 2, Zhongshan N. Road, Taipei, 10449, Taiwan

    Ruu-Fen Tzang, Yu-Hsin Huang & Shu-I Wu

  4. Department of Mathematics, Tamkang University, Taipei, Taiwan

    Yue-Cune Chang

  5. Department of Pediatrics, Far Eastern Memorial Hospital, Taipei, Taiwan

    Kai-Liang Kao

  6. Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan

    Hui-Chun Huang

  7. Department of Public Health, China Medical University, Taichung, Taiwan

    Hui-Chun Huang & Fung-Chang Sung

  8. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Yu-Chiao Wang & Chih-Hsin Muo

  9. College of Medicine, China Medical University Hospital, Taichung, Taiwan

    Chih-Hsin Muo

  10. Department of Audiology, Speech, and Language Pathology, Mackay Medical College, Taipei, Taiwan

    Shu-I Wu

  11. Department of Health Services Administration, China Medical University, College of Public Health, 91 Hseuh Shih Road, Taichung, 404, Taiwan

    Fung-Chang Sung

  12. Department of Psychological Medicine, King’s College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK

    Robert Stewart

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  1. Ruu-Fen Tzang
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Contributions

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.

Corresponding authors

Correspondence to Shu-I Wu or Fung-Chang Sung.

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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.

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Tzang, RF., Chang, YC., Kao, KL. et al. Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study. Eur Child Adolesc Psychiatry 28, 247–255 (2019). https://doi.org/10.1007/s00787-018-1171-7

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  • DOI: https://doi.org/10.1007/s00787-018-1171-7

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