Does sensory modulation dysfunction contribute to emotional dysregulation in children with ADHD?: Analysis plan

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Up to 50% of children with ADHD may also experience symptoms of emotional dysregulation, such as anger, irritability, and aggression. Emotional dysregulation contributes to adverse health outcomes such as depression and peer problems, yet it is poorly understood and effective treatment options are lacking. Emerging evidence suggests that sensory processing may play a role in emotional dysregulation. Forty to 50% of children with ADHD may also experience sensory modulation dysfunction, or SMD. SMD is characterized by hypo- or hyperreactivity to pain and sensation. Only one study investigated the relationship of SMD and emotional dysregulation in ADHD; they found a correlation of r=0.45. If SMD drives emotional dysregulation in ADHD, treating SMD has the potential to improve emotional regulation. Further evaluating the relationship between SMD and emotional dysregulation in ADHD is the crucial first step in developing effective treatment options. Methods: Data for this analysis are derived from the baseline assessment of a multi-site, randomized, controlled trial: The Micronutrients for ADHD in Youth (MADDY) Study. The study enrolled children aged 6-12 with a diagnosis of ADHD and symptoms of emotional dysregulation. Using a cross-sectional study design, we will measure the association between emotional dysregulation and SMD at baseline. Emotional dysregulation was measured using the Strengths and Difficulties Questionnaire (SDQ) and a composite score from the Child and Adolescent Symptom Inventory, Version-5 (CASI-5). SMD will be assessed using three subscales from the Temperament in Middle Childhood Questionnaire (TMCQ). To test our hypothesis, we will use simple linear regression. Models will be adjusted for potential confounding variables. Conclusion: Our results will serve to better characterize the relationship between SMD and emotional dysregulation in children with ADHD, which may inform treatment options and diminish adverse health outcomes.