Can behavioral sensory processing problems guide us to a better pharmacological management of children with attention deficit hyperactivity disorder?: a case report.
Sensory processing problems in children with attention deficit hyperactivity disorder have been the focus of many studies in recent years. It is obvious that different aspects of sensory problems such as with tactile sensory are involved in attention deficit hyperactivity disorder. However, whether the sensory information process problems can be factors in decision making regarding pharmacological management of children with attention deficit hyperactivity disorder has not been researched. This case report presents two children with attention deficit hyperactivity disorder. The mother of the first patient reported that her child's ability for detecting, identifying, and discriminating smells was very high and more than the other children at this age. As she reported, the child also liked to touch everything and everybody. He experienced nail biting after taking 20mg methylphenidate in single dosage. By decreasing of the dosage, nail biting disappeared in the three trials. The other patient started lip biting about half an hour after taking the first dosage of the medication. It continued for four hours. This report suggests that there is an association between methylphenidate and tactile sensory problems in children with attention deficit hyperactivity disorder. It is possible that methylphenidate induces or exacerbates tactile hyposensitivity. If this assumption is supported in controlled clinical trials, then tactile sensory assessment might help to make decisions for the pharmacological management of children with attention deficit hyperactivity disorder. Further studies should investigate whether attention deficit hyperactivity disorder with sensory processing problems is a phenotype with an overlap between autistic disorders and attention deficit hyperactivity disorder in which stimulants may exacerbate some sensory processing problems. Also, if this is the case, the diagnosis of attention deficit hyperactivity disorder as an exclusionary criterion for pervasive developmental disorder needs to be revised.
Ghanizadeh
Ahmad
A
Associate Professor of Child and Adolescent Psychiatry, Department of Psychiatry, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran.