Sex differences in tactile defensiveness in children with ADHD and their siblings

Abstract

Tactile defensiveness (TD) is a disturbance in sensory processing and is observed in some children with attentiondeficit-hyperactivity disorder (ADHD). TD has been examined in male children with ADHD and in children with ADHD without differentiating by sex. As males and females with ADHD may differ in the clinical expression of the disorder and associated deficits, the aim of this study was to examine sex differences in TD in males and females with ADHD. Non-affected siblings were also examined to investigate familiality of TD. The Touch Inventory for Elementary-School-Aged Children was administered to 47 children with ADHD (35 males, 12 females; mean age 9y 8mo [SD 1y 11mo]), 36 non-affected siblings (21 males, 15 females; mean age 8y 10mo [SD 2y 4mo]), and 35 control children (16 males, 19 females; mean age 9y 5mo [SD 6mo]). Results indicated that females with ADHD displayed higher levels of TD than males with ADHD (who did not differ from control males). This suggests that TD is sex specific and may contribute to the identification of ADHD in females, thus improving diagnostic and therapeutic strength in this underreferred group. Non-affected siblings were unimpaired, regardless of sex, which suggests that TD is specific to the disorder and not part of a familial risk for ADHD.Attention-deficit-hyperactivity disorder (ADHD) 1 is a common neuropsychiatric developmental disorder, which is estimated to affect between 3 and 11% of children and adolescents. 2 The core clinical symptoms of ADHD (inattention, hyperactivity, and impulsivity) are often accompanied by associated symptoms such as sleep problems, reduced motor coordination, and impaired balance. 2 Sex possibly influences the clinical manifestation of ADHD and the extent to which associated symptoms of ADHD occur. Three studies found that females with ADHD showed relatively lower levels of hyperactivity and fewer diagnoses of conduct disorder and other comorbid disruptive behavior problems compared with males with ADHD. 3-5 However, it was also found that females with ADHD have greater intellectual impairment, 4,5 a higher prevalence of the predominantly inattentive subtype of ADHD, 3 and are more at risk for substance-use disorders. 3 One study found no sex difference with respect to impulsivity, academic performance, social functioning, and/or fine motor skills. 4 Further study may help to determine whether differences exist between males and females with ADHD.Relatively little is known about sex differences in disorders associated with ADHD, such as sensory processing disorders. Recent literature suggests that children with ADHD show a disturbance in sensory processing and integration of tactile stimuli. 6-9 One area of dysfunction in sensory processing disorders is called tactile defensiveness (TD). 10,11 TD is often observed in children with autism, learning disability,* fragile X syndrome, emotional disturbances, and specific learning difficulties. [10][11][12][13][14] Individuals with TD show a tendency to 'react negatively and emotionally to certa...

Perception in attention deficit hyperactivity disorder

“…This finding is not in line with self-and informant reports revealing increased tactile and auditory abnormalities in ADHD (Bröring et al 2008;Cheung and Siu 2009;Dunn and Bennett 2002;Engel-Yeger and Ziv-On 2011;Mangeot et al 2001;Parush et al 1997;Shimizu et al 2014). It should be noted that the recording of subjective reports does not aim at detecting pure perceptual deficits.…”

“…Two studies utilized subjective measures specific to touch and found that children with ADHD were over-responsive to tactile stimuli (Parush et al 1997;Bröring et al 2008). The studies examined tactile defensiveness of individuals, which describes a disturbance in sensory processing with the tendency to react negatively and emotionally to certain touch situations.…”

“…Individuals with ''tactile defensiveness'' avoid touch and interpret many forms of touch as threatening. Bröring et al (2008) investigated tactile defensiveness in school-aged children and reported that 17% of females and 3% of males with ADHD were classified as being tactile defensive, suggesting that levels of tactile defensiveness may vary according to gender, with female patients showing higher levels of tactile defensiveness than male patients. Results of this study stand in contrast to the study conducted by Parush et al (1997) that investigated tactile defensiveness in male preschoolers and revealed that 39.5% of participants with ADHD and no NC children were classified as being tactile defensive.…”

“…Results of this study stand in contrast to the study conducted by Parush et al (1997) that investigated tactile defensiveness in male preschoolers and revealed that 39.5% of participants with ADHD and no NC children were classified as being tactile defensive. It has been suggested that the different results may be explained by differences in measures (Bröring et al 2008). Whereas Parush et al (1997) used the Touch Inventory for Preschoolers (Royeen 1987) which is based on teacher-reports, Bröring et al (2008) used the Touch Inventory for Elementary-School-Aged Children (Royeen and Fortune 1990), based on self-reports.…”

“…It has been suggested that the different results may be explained by differences in measures (Bröring et al 2008). Whereas Parush et al (1997) used the Touch Inventory for Preschoolers (Royeen 1987) which is based on teacher-reports, Bröring et al (2008) used the Touch Inventory for Elementary-School-Aged Children (Royeen and Fortune 1990), based on self-reports.…”