The Differential Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) And Sensory Modulation Disorder (SMD)

Abstract

Differential diagnosis of ADHD and SMD pose a great challenge to clinicians since they present in very similar ways. In other cases, they occur together. Previous studies meant to distinguish the conditions only used laboratory measurements to evaluate functions of the body. Furthermore, none of them had compared partakers suffering from the two conditions. This research was carried out on a comparative basis in regards to activities of the body (responsiveness and sensation) and participation on patients suffering from solely ADHD and MSD. All participants were taken through sensory, attention and participation testing and the results compared. The results showed major differences in the reaction to sensory stimuli between the two groups and slight variances in attention and participatory tests. The findings were in concordance with previous studies that these conditions are of diverse nature and differential diagnosis is quite possible.

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Introduction

According to the American Psychological Association (APA) (2013), Attention Deficit Hyperactivity Disorder affects about 5% of all children in the world. An insistent pattern of inattentiveness presents it, and/or hyperactivity to the extent that it causes a substantial impairment of practical enactment at home, school and in community settings. They also state that classical ADHD does not occur often, it frequently occurs together with other neurological developmental deficits predominantly related to motor, speech, intellectual and sensory operations. Regularly, sensory deficits in children with ADHD also meet the criteria for Sensory Modulation Disorder (SMD). Furthermore, patients with SMD exert an exaggerated response to benevolent sensory stimuli. These mannerisms may vary from an extreme pursuit of stimuli to lower than normal response and may include several sensory systems. The two conditions may also present together (Adesman, 2003). This makes the differential diagnosis of the disorders very puzzling. Despite the similarities, studies comparing the two conditions have confirmed that the two disorders are quite distinct and each of them has its outline. For example, they reported that kids suffering from SMD have greater EDR responses to sensual stimulation and have more somatic complaints, nervousness, and downheartedness than those with ADHD (Kuperman et al., 1996).

This motivated a comparative study done by Yochman et al. (2013) among kids who had been solely diagnosed with ADHD and SMD in an endeavor to distinguish between the conditions. The study was focused on monitoring body activities (sensation and attention) that make use of sophisticated apparatus (participation). That was because it is a fact that children with these conditions have a greatly dampened level of participation as compared to normally growing children. Besides, no such research had ever been conducted, and the findings would help in differential diagnosis and management of the two conditions.

Method

Participants

The participants of the study were 19 children diagnosed with ADHD only and another group of 19 who had been diagnosed with SMD solely. There was no variation in the presentation of the conditions due to age or sex. They were evaluated by a developmental neurologist and an occupational therapist to ascertain that their conditions existed in isolation.

Materials

A short sensory profile (SSP) was employed, and a parent report questionnaire used to estimate the sensory deficits in children between the age of 3 and 10. The questionnaire had 38 entries which covered the responsiveness to sensory stimuli such as touch, hearing, vision, smell, taste, body position and locomotion. Parents indicated where their children started to show an abnormal response to the stimuli on the Likert scale (5 points). A total score was then calculated. Conners' Parent Rating Scale-Revised: Short Form was used to evaluate the behavior allied to ADHD in children in age group 3-17 according to the guideline given in DSM-IV-TR.

Procedure

Two tests were carried out to evaluate the sensory responses. These were the fabric prickliness test and pinprick pain. The parent recorded the score. To measure attention, five tests were carried out; the sky search to test discriminatory optical attention, the score to examine continuous auditory responsiveness, creature counting to assess the switching of attention and control, sky search dual task to test the ability to handle two activities successfully and the walk, don't walk test to measure continued response and reaction to inhibition. For participation, the participation in childhood occupations questionnaire was used. It evaluated the daily activities, educational, rest and play, and the routine and conducts of children.

Results

The results showed that there were major dissimilarities between the two conditions on all sensory tests. Children with SMD had greater sensory deficits than ADHD patients. Children with ADHD had an equal performance to their counterparts in all attention assessments (Yochman, 2013). In participation evaluation, a remarkable difference was only observed in the level of enjoyment of daily activities. SMD patients enjoyed less than kids with ADHD. They also did not readily engage with their parents.

Conclusion

Considering all the limitations of the study, the research concluded that ADHD and SMD are indeed two distinct conditions. The results supported great differences in all sensory tests and no significant differences in attention and participation. The study also gave suggestions of particular medical tools which facilitate fruitful differential diagnosis. Finally, the procedure used helped raise precision in diagnosing any of the conditions. This is crucial in providing patients with the most suitable management.

References

Adesman, A. (2003). A diagnosis of ADHD? Don't overlook the probability of comorbidity. Contemp. Pediatr. 20, 91-112

APA (American Psychiatric Association). (2013). Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Association

Bar-Shalita, T., Vatine, J. J., and Parush, S. (2008). Sensory modulation disorder: a risk factor for participation in daily life activities. Dev. Med. Child Neurol. 50, 932-937.

Kuperman, S., Johnson, B., Arndt, S., Lindgren, S., & Wolraich, M. (1996). Quantitative EEG differences in a nonclinical sample of children with ADHD and undifferentiated ADD. Journal of the American Academy of Child & Adolescent Psychiatry, 35(8), 1009-1017.

Yochman, A., Alon-Beery, O., Sribman, A., & Parush, S. (2013). Differential diagnosis of sensory modulation disorder (SMD) and attention deficit hyperactivity disorder (ADHD): participation, sensation, and attention. Frontiers in human neuroscience, 7, 862.