Attention-Deficit/Hyperactivity Disorder Symptoms, Sensation-Seeking, and Sensory Modulation Dysfunction in Substance Use Disorder: A Cross Sectional Two-Group Comparative Study.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) and sensation-seeking, a trait characterized by risk-related behaviors, have been recognized as risk factors in substance use disorder (SUD). Though ADHD co-occurs with sensory modulation dysfunction (SMD), SMD has scarcely been explored in SUD. Thus, this study aimed to characterize ADHD symptomology, sensation-seeking, and SMD, as well as to explore their contribution to SUD likelihood. METHODS: A cross sectional two-group comparative study including therapeutic community residents with SUD (n = 58; study group) and healthy individuals (n = 62; comparison group) applying the MOXO continuous performance test (MOXO-CPT) evaluating ADHD-related symptoms. In addition, participants completed the ADHD Self-Report Scale-Version 1.1 for ADHD screening; the Brief Sensation Seeking Scale quantifying risk-taking behaviors; and the Sensory Responsiveness Questionnaire-Intensity Scale for identifying SMD. RESULTS: The study group demonstrated higher SMD incidence (53.57% vs. 14.52%) and lower performance in three MOXO-CPT indexes: Attention, Impulsivity, and Hyperactivity, but not in Timing, compared to the comparison group. Sensory over-responsiveness had the strongest relationship with SUD, indicating 27-times increased odds for SUD (95% CI = 5.965, 121.216; p ≤ 0.0001). A probability risk index is proposed. CONCLUSION: We found SMD with the strongest relation to SUD exceeding that of ADHD, thus contributing a new perspective for developing future therapeutic modalities. Our findings highlight the need to address SMD above and beyond ADHD symptomology throughout the SUD rehabilitation.

Participation of soldiers with DCD in the military.

Developmental coordination disorder (DCD) is a disorder affecting motor coordination which negatively impacts academic and daily activities in various environments. The military is a highly structured environment with limited freedom, placing high demand on motor coordination, organizational ability, time management, and social skills. All these present challenges to young adults with DCD. Our study aimed to describe and assess the functioning of young adults with DCD in the Israel Defense Forces. Participants included three groups of young adults recruited via the Israel Army Health Survey upon discharge from active service: probable DCD (135), suspected borderline DCD (149), and control (145). Participants completed the Adolescents & Adults Coordination Questionnaire and the Army Questionnaire. The probable-DCD group reported significantly more difficulties in their military service than did the other groups: more unit reassignments, more accidents during field operations, and more complaints related to discipline and professional behavior. Significant differences emerged between both DCD groups and the control group in "understanding of learning materials," "forgetting belongings," and "success in the army." The participants with probable DCD and suspected borderline DCD were able to integrate into the army, but the probable-DCD group performed significantly worse than the others and reported more difficulties participating in the army. These results highlight the importance of being aware of soldiers with probable DCD, in order to assign them duties that fit their abilities.

Perceived Sensitivity to Pain and Responsiveness to Non-noxious Sensation in Substance Use Disorder.

OBJECTIVE: This comparative cross-sectional study aimed to characterize individuals with substance use disorder (SUD) in self-perception of pain sensitivity, experimental auditory aversiveness, and non-noxious sensory responsiveness, as well as examine the associations with SUD. METHODS: Therapeutic community (TC) individuals with SUD (N = 63, male 88.9%) and healthy controls (N = 60, male 86.7%) completed the Pain Sensitivity Questionnaire (PSQ) and the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS), followed by a psychophysical auditory battery, the Battery of Averseness to Sounds (BAS)-Revised. RESULTS: The SUD group scored higher on the PSQ (P < 0.0001), BAS-R aversiveness (P < 0.0001), BAS-R-unpleasantness (P < 0.0001), and on the aftersensation of auditory aversiveness (P < 0.0001) and unpleasantness (P < 0.000). Fifty-four percent of the SUD group vs 11.7% of the control group were identified as having sensory modulation dysfunction (SMD; P < 0.0001). Logistic regression modeling revealed that the SRQ-IS-Aversive score had a stronger relationship, indicating a 12.6-times odds ratio for SUD (P = 0.0002). Finally, a risk score calculated from a linear combination of the logistic regression model parameters is presented based on the PSQ and SRQ. CONCLUSIONS: This is the first study to explore sensory and aversive domains using experimental and self-reporting in situ, revealing pain perception alteration that co-occurs with high prevalence of SMD, specifically of the over-responsive type. Findings may be significant in clinical practice for treating pain, and for expanding therapeutic modalities as part of broader rehabilitation in TC and beyond, to better meet personalized therapy.

Sensory Modulation Disorder (SMD) and Pain: A New Perspective.

Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition's pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.

The Home Program Evaluation Questionnaire - HoPE-Q - for Infants with Hemiplegic Cerebral Palsy: Development and Psychometric Properties.

To develop and examine the psychometric properties of the Home Program Evaluation Questionnaire (HoPE-Q), a novel tool designed to assess the effectiveness of home treatment programs for infants with hemiplegia. The HoPE-Q includes a pre- and a postintervention version and items that relate to Child's Function, Parents' Competence, and their Expectations and Satisfaction from the program. The research was performed in three stages. The first stage consisted of item construction and content validity, followed by the analyses of the tool's reliability and construct validity. The final stage involved the examination of the tool's sensitivity to determine its suitability as an outcome measure of the effectiveness of home programs for infants with hemiplegia. Results showed moderate-to-high internal consistency (α = 0.65-0.85) and high test-retest reliability in Child's Function and Parents' Competence (r = 0.75, r = 0.76) respectively (p = 0.01). Evidence for Construct Validity, was demonstrated by significant group difference in the Child's Function (t(74)=-12.3, p ≤ 0.001) and Parents' Competence (t(68) = -3.7, p = 0.01), and high sensitivity to change after treatment was presented in Child's Function (F(32,1) = 49.38) and Parents Competence (F(32,1) = 26.72) (p ≤ 0.001). Preliminary data support the validity and reliability of the HoPE-Q as well as its suitability as an outcome measure, thereby providing a means of examining the effectiveness of home intervention programs for infants with hemiplegia.

Sustained attention in sensory modulation disorder and attention deficit/hyperactivity disorder.

BACKGROUND: There are high comorbidity rates between sensory modulation disorder (SMD) and attention deficit hyperactivity disorder (ADHD). Knowledge regarding the objective neuropsychological differentiation between them is scarce. AIM: This study examines the effects of SMD and ADHD on a sustained attention task with and without aversive auditory conditions. METHOD: Sixty six young adult females were tested on the Conjunctive - Continuous Performance Task-Visual (CCPT-V) measuring sustained attention, under two conditions: 1) aversive condition (with the three most aversive sounds chosen by the participant), and 2) non-aversive condition (without sounds). RESULTS: Both the SMD and ADHD factors exhibited performance deficits in the sustained attention task. All study participants performed worse on both sustained attention and speed of processing when aversive sounds were present. CONCLUSION: We conclude that impaired sustained attention cannot differentiate between SMD and ADHD. Hence, these results should be taken under consideration in the assessment process of ADHD vs. SMD.

Brain Lesions as a Predictor of Therapeutic Outcomes of Hand Function in Infants With Unilateral Cerebral Palsy.

AIM: The present study aimed to investigate whether the response variability of infants to modified constraint-induced movement therapy and bimanual therapy are associated with different types of brain lesions. METHOD: Infants with unilateral cerebral palsy (N = 22) ages 8-15 months (mean = 10.95, standard deviation = 2.15 months) were grouped according to having either a periventricular brain lesion or a middle cerebral artery infarct lesion. Improvement in hand function was analyzed based on the mini-Assistive Hand Assessment results. RESULTS: Infants with periventricular brain lesion displayed greater positive response to upper limb treatment compared to those with middle cerebral artery infarct ( P = .02). A significant difference in improvement according to type of treatment was found in the middle cerebral artery infarct group but not in the periventricular brain lesion. CONCLUSION: The present study showed an association between the type of brain lesion and the efficacy of upper limb treatment in infants. Infants with periventricular brain lesions displayed greater positive responses than those with middle cerebral artery infarct.

A study of sensory dysregulation in children with tic disorders.

Disrupted somatosensory processing characterized by over- or under- responsiveness to environmental stimuli plays an important, yet often overlooked, role in typical development and is aberrant in various neurodevelopmental disorders. These dysfunctional somatosensory processes have been conceptualized as an entity termed somatosensory dysregulation (SMD). Since Tourette syndrome (TS) is a prototypical example of developmental psychopathological disorder, we hypothesised that SMD would be a feature found in children suffering from the disorder. Ninety-two subjects representing consecutive admissions to a tertiary paediatric Tourette syndrome clinic were admitted to the study. Comorbid conditions included ADHD, depression, anxiety disorder, and OCD. For purposes of the study, patients completed a battery of self-, caregiver-, and clinician-rated psychological instruments measuring TS core symptoms and comorbidities and quality of life. Sensory modulation was measured by self-report and by objective measures such as stimulation with Von Frey filaments. Almost 50% of the cohort had no SMD. Of the remainder, 14 (15%) had suspected SMD and 32 (34.8%) had SMD. SMD was significantly more common and severe when there were comorbidities. The presence of SMD was associated with more severe impairments in quality of life and less participation in daily activities. The SMD, as measured by subjective measures but not by objective, is probably more associated with central processing rather than peripheral perception.

Success in Adults With Probable Developmental Coordination Disorder Using Structural Equation Modeling.

OBJECTIVE: The aim of this study was to conduct a broad in-depth examination of the relationship between developmental coordination disorder (DCD) and use of executive strategies, daily life activities, emotional state, and internal factors attributed to success. METHOD: We used a large randomized cohort of young adults. Structural equation modeling was performed to test both the direct effects and the mediated effects of the independent variable (probable DCD) on dependent variables (executive functions, academic and nonacademic activities, emotional state, and attribution to success). RESULTS: Probable DCD had a direct and significant effect on all variables. Motor coordination impairments directly affected daily function in nonacademic and academic abilities and resulted in decreased use of executive strategies. Likewise, all the indirect effects hypothesized in the model were found to be significant. CONCLUSION: The model revealed the direct and indirect influences of probable DCD on a range of functions, with far-reaching clinical implications.

Perception of Aversive Auditory Stimuli Is Different in Sensory Modulation Disorder and Attention Deficit Hyperactivity Disorder.

This study examined whether sensory modulation disorder-sensory overresponsivity (SMD-SOR) and attention deficit hyperactivity disorder (ADHD) have a significant effect on the perception of aversive auditory stimuli. Participants were 66 young adult women. The diagnosis of SOR was made using the Sensory Responsiveness Questionnaire, and ADHD was diagnosed by a qualified psychiatrist or neurologist using criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Participants were presented with the Battery of Aversiveness to Sounds, short presentations of daily life sounds, and rated each sound stimulus verbally according to its perceived unpleasantness. Participants with SOR rated low-intensity aversive sounds as significantly more aversive than participants without SOR. High-intensity sounds obtained a marginal significant difference exclusively in participants with ADHD. The perception of aversive auditory stimuli in adults with SOR appears to be unique and different than the profile of adults with ADHD.

Effectiveness of Modified Constraint-Induced Movement Therapy Compared With Bimanual Therapy Home Programs for Infants With Hemiplegia: A Randomized Controlled Trial.

OBJECTIVE: We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity. METHOD: In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire. RESULTS: Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance. CONCLUSION: mCIMT and BIM are equally effective methods for treating infants with hemiplegia.

The Effect of Bimanual Training with or Without Constraint on Hand Functions in Children with Unilateral Cerebral Palsy: A Non-Randomized Clinical Trial.

AIM: To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP). METHODS: Seventeen children aged 6-11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint ("Hybrid") or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention. RESULTS: A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01]. CONCLUSION: Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.

Psychometric Properties of the Parents as Partners in Intervention (PAPI) Questionnaires.

This article describes two studies that focused on parents' expectations and satisfaction with occupational therapy intervention for their children (N = 208). The first study determined the psychometric properties of the Parents as Partners in Intervention (PAPI) Questionnaire set (n = 146). The 2nd study examined parental expectations, satisfaction, and perception of their child's functional gains from individual- (n = 30 parents) and group- (n = 32 parents) based interventions. Overall, the results of these studies further support the PAPI Questionnaire set's validity and reliability and suggest that parents' expectations are high and not necessarily in line with their actual satisfaction with the outcomes of their child's intervention and functional gains.

Sensory modulation disorder symptoms in anorexia nervosa and bulimia nervosa: A pilot study.

OBJECTIVE: Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) may exhibit reduced ability to modulate sensory, physiological, and affective responses. The aim of the present study is to assess sensory modulation disorder (SMD) symptoms in patients with AN and BN. METHOD: We assessed female adolescent and young adult inpatients with restrictive type anorexia nervosa (AN-R; n = 20) and BN (n = 20) evaluated in the acute stage of their illness, and 27 female controls. Another group of 20 inpatients with AN-R was assessed on admission and discharge, upon achieving their required weight. Participants completed standardized questionnaires assessing the severity of their eating disorder (ED) and the sensory responsiveness questionnaire (SRQ). RESULTS: Inpatients with AN-R demonstrated elevated overall sensory over-responsiveness as well as elevated scores on the taste/gustatory, vestibular/kinesthetic and somatosensory/tactile SRQ modalities compared with patients with BN and controls. Significant correlations between the severity of sensory over-responsiveness and ED-related symptomatology were found in acutely-ill patients with AN-R and to a lesser extent, following weight restoration. Elevated sensory over-responsiveness was retained in weight-restored inpatients with AN-R. Inpatients with BN demonstrated greater sensory under-responsiveness in the intensity subscale of the SRQ, but not in the frequency and combined SRQ dimensions. DISCUSSION: Female inpatients with AN-R exhibited sensory over-responsiveness both in the acute stage of their illness and following weight restoration, suggesting that sensory over-responsiveness may represent a trait related to the illness itself above and beyond the influence of malnutrition. The finding for sensory under-responsiveness in BN is less consistent.

Comparing the executive attention of adult females with ADHD to that of females with sensory modulation disorder (SMD) under aversive and non-aversive auditory conditions.

Certain behavioral expressions of sensory modulation disorder (SMD) such as distractibility, hyperactivity, and impulsivity are often similar to those of attention deficit/hyperactivity disorder (ADHD) in pediatric and adult populations. There is also a high comorbidity rate between these two diagnoses and absence of research regarding the objective neuropsychological differentiation between them. In the present study we employed a factorial design which enabled us to: (a) systematically examine the effects of SMD and ADHD on executive attention in a sample of adult females using a Stroop-like task, and (b) measure the effect of aversive conditions (sounds) on executive attention. The experimental measures used were the Stroop-like Location-Direction Task (SLDT) to assess executive attention and the battery of aversiveness to sounds (BAS), a standardized measure of aversive sounds that was developed for this study and enabled individual customization of aversive auditory sounds. Results revealed, as expected, a specific core deficit in executive attention for the ADHD factor. In addition to that, the present study provides an important, pioneering finding of SMD impairment in a unique combination of a cognitively demanding task with aversive sounds, providing preliminary objective evidence differentiating SMD from ADHD.

Executive function and attention in young adults with and without developmental coordination disorder--a comparative study.

The current research aimed at examining the executive function (EF) of young adults with Developmental Coordination Disorder (DCD) in comparison to young adults without DCD. The study used a randomized cohort (N=429) of young adults with DCD (n=135), borderline DCD (n=149) and control (n=145), from a previous study. This initial cohort was asked to participate in the current study three to four years later. Twenty-five individuals with DCD (mean age=24 years, 1 month [SD=0.88]; 18 males), 30 with borderline DCD (mean age=24 years, 2 month [SD=0.98]; 18 males) and 41 without DCD (mean age=25 years, 2 months [SD=1.91]; 20 males) participated in this study. Participants completed the BRIEF-A questionnaire, assessing EF abilities and the WURS questionnaire, assessing attention abilities. The DCD and borderline DCD groups had significantly lower EF profiles in comparison with the control group but no significant differences were found between the DCD and borderline DCD groups. While a high percentage of attention problems were found in both DCD groups, the executive functioning profiles remained consistent even when using the attention component as a covariate. The study results suggest that young adults with DCD have EF problems which remain consistent with or without attention difficulties.

Young adults with developmental coordination disorder: a longitudinal study.

We conducted a longitudinal study to assess the continuing influence of developmental coordination disorder (DCD) on quality of life and participation. Ninety-six participants (25 in the DCD group, 30 in the borderline group, and 41 in the control group) ages 22-29 yr who had been screened for DCD 3-4 yr previously completed the Participation in Every Day Activities of Life, the Life-Satisfaction Questionnaire, and the World Health Organization Quality of Life (WHOQOL-BREF) instrument. Multivariate analysis of variance revealed a significant between-groups difference, F(7, 95) = 2.89, p = .001, η = 0.173, and post hoc analyses revealed that participants in the DCD and borderline groups scored lower overall on participation, quality of life, and life satisfaction. Linear regression found the Psychological Health domain of the WHOQOL-BREF to be a significant predictor of life satisfaction (B = 0.533; p = .001).

Suitability of the Miller Function and Participation Scales (M-FUN) for use with Israeli Children.

OBJECTIVE. Our aim was to generate a Hebrew translation of the Miller Function and Participation Scales (M-FUN) and assess the validity of U.S. norms for Israeli children. METHOD. All components of the M-FUN were translated, and a pilot study revealed a need for further investigation. The Hebrew M-FUN's fine, gross, and visual-motor (VM) components and M-FUN participation questionnaires were administered to 267 Israeli children (128 boys, 139 girls; mean age = 59.21 mo, standard deviation = 17.84). RESULTS. Significant correlations supported construct validity between age and all motor and participation scores as well as age-group differences. Significant differences between the U.S. and Israeli samples were found only for the VM score. Participation and motor scores were significantly correlated. CONCLUSION. Although VM score results should be interpreted with caution, we provide evidence for use of the fine and gross motor norms and the U.S. criterion-referenced participation scores of the M-FUN with Israeli children.

Developmental outcomes at preschool age after fetal exposure to valproic acid and lamotrigine: cognitive, motor, sensory and behavioral function.

This prospective, observational study assessed the development of preschool children aged 3-6 years, 11 months (n=124) after in-utero anti-epileptic drug (AED) monotherapy exposure to valproic acid (VPA) (n=30, mean age 52.00[±15.22] months) and lamotrigine (LT) (n=42, mean age 50.12[±12.77] months), compared to non-exposed control children (n=52, mean age 59.96[±14.51] months). As a combined group, AED-exposed children showed reduced non-verbal IQ scores, and lower scores on motor measures, sensory measures, and parent-report executive function, behavioral and attentional measures. When the VPA- and LT-exposed groups were analyzed separately, no cognitive differences were found, but control-VPA and control-LT differences emerged for most motor and sensory measures as well as control-VPA parent-report behavioral and attentional differences. No differences were noted between the VPA and LT groups. These findings suggest that VPA- and LT-exposed children should be monitored on a wider range of developmental measures than currently used, and at differing developmental stages.

Differential diagnosis of sensory modulation disorder (SMD) and attention deficit hyperactivity disorder (ADHD): participation, sensation, and attention.

Differential diagnosis between sensory modulation disorder (SMD) and attention deficit hyperactivity disorder (ADHD) is often challenging, since these disorders occur at a high rate of co-morbidity and share several clinical characteristics. Preliminary studies providing evidence that these are distinct disorders have focused solely on body functions, using sophisticated laboratory measurements. Moreover, no studies have compared participation profiles of these populations. This study is the first to compare the profiles of these populations regarding both "body functions" (attention and sensation) and "participation," using measures applicable for clinical use. The study included 19 children with ADHD without SMD and 19 with SMD without ADHD (diagnosed by both pediatric neurologists and occupational therapists), aged 6-9, and matched by age and gender. All children underwent a broad battery of evaluations: the Evaluation of Sensory Processing, Fabric Prickliness Test (FPT) and Von Frey Test to evaluate sensory processing, and Test of Everyday Attention to evaluate attention components. The Participation in Childhood Occupations Questionnaire was used to evaluate participation. Results support significant group differences in all sensory components, including pain intensity to suprathreshold stimuli and pain "after sensation," as well as in tactile, vestibular, taste, and olfactory processing. No differences were found in attention components and participation. This study has both theoretical and clinical importance, inter alia, providing further evidence of two distinct disorders as well as indications of specific clinical instruments that might enable clinicians to implement differential diagnoses. In addition, results accord with other previous statements, which indicate that the clinical diagnosis of children with disabilities may not be a major factor in determining their participation profile.