Ghanizadeh Ahmad
Associate Professor of Child and Adolescent Psychiatry, Department of Psychiatry, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran.
Psychiatry (Edgmont). 2009 Dec;6(12):40-3.
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.
近年来，注意力缺陷多动障碍（ADHD）儿童的感觉处理问题一直是众多研究的焦点。很明显，诸如触觉等感觉问题的不同方面都与注意力缺陷多动障碍有关。然而，感觉信息处理问题是否会成为ADHD儿童药物治疗决策的影响因素，目前尚未得到研究。本病例报告介绍了两名ADHD儿童。第一名患者的母亲报告称，她孩子检测、识别和区分气味的能力非常高，超过了这个年龄段的其他孩子。据她所说，这个孩子还喜欢触摸所有东西和每个人。他在单次服用20毫克哌甲酯后出现咬指甲的行为。通过减少剂量，在三次试验中咬指甲的行为消失了。另一名患者在服用第一剂药物约半小时后开始咬嘴唇。这种情况持续了四个小时。本报告表明，哌甲酯与ADHD儿童的触觉感觉问题之间存在关联。哌甲酯有可能诱发或加剧触觉低敏。如果这一假设在对照临床试验中得到支持，那么触觉感觉评估可能有助于为ADHD儿童的药物治疗做出决策。进一步的研究应调查伴有感觉处理问题的ADHD是否是一种自闭症谱系障碍和ADHD存在重叠的表型，其中兴奋剂可能会加剧一些感觉处理问题。此外，如果是这种情况，将ADHD诊断作为广泛性发育障碍的排除标准需要修订。
