Reply to critical comments on the article ‘Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study’

Abstract

Lai et al. present comments on our article, entitled “Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study” [1]. They propose that our study failed to address the effectiveness of sensory integration (SI) therapy for children with ADHD. They challenge our study design, although they fail to indicate that SI therapy is not currently in the clinical practice guidelines from the American Academy of Pediatrics for the treatment of ADHD. To date, there is still no clear indication of how often or with what dosage a child with ADHD should receive SI therapy to demonstrate the treatment effectiveness. Methylphenidate (MPH) therapy and psychosocial interventions are the management approaches adopted by clinical practice guidelines to improve ADHD symptoms, such as inattention, hyperactivity, or impulsivity [2, 3]. Although MPH therapy is not recommended for children under 7 years of age as the first-line treatment, research evidence has suggested that multi-model management strategies (including parent or teacher behavioral training, or social skills training) are more suitable for younger children with ADHD [2–4]. Evidence on the effectiveness of SI is limited due to small study samples [5], lack of a clear definition of SI intervention dosage [6], poor compliance or premature termination of the intervention [5, 7], heterogeneous sample, or inappropriate selection on outcome measures [8]. Using the large pediatric data set of Taiwan, our study found that, among children with ADHD recorded as receiving SI therapy, 77.8% received no ADHD medications and 56.5% received no psychosocial interventions. These observations suggest that parents may choose SI for their children with ADHD, but do not seek evidence-based multi-model management. From our findings, and as acknowledged in the manuscript, we are unable to infer a causal association between SI and psychiatric disorder. Additional studies are needed to evaluate the effectiveness of SI therapy. Some parents of children with ADHD are more likely to prefer alternative treatments (such as SI) than guidelineindicated management approaches provided by child and Dr. Shu-I Wu and Dr. Fung-Chang Sung contributed equally to this article.