A review built on the premise that people know their own senses
Victoria Dunn, Philip Hodgson and Stephanie Petty, at York St John University and Humber Teaching NHS Foundation Trust, have published a systematic review in Research in Neurodiversity asking what sensory processing is actually like for people with ADHD — and they built the inclusion criteria around a principle worth noticing before the findings.
Only self-report counted. Sensory experiences described by a parent, a teacher, a clinician or a researcher were excluded by design. Their stated reason is that individuals with ADHD are experts in their own sensory experiences, and that a valid conceptualisation has to be built with them rather than about them. They also excluded participants with co-occurring autism diagnoses, to isolate ADHD-specific signal, and excluded those taking ADHD medication — for reasons that turn out to matter enormously, and that I’ll come to last.
Fifteen thousand nine hundred and twenty-two records, ten databases, PROSPERO-registered. Thirteen studies met the criteria.
The design choice is the same one my corpus keeps arguing for and the field keeps rediscovering. Last week’s hyperfocus study found that clinician-derived definitions had missed the defining feature of the state — the split between total task control and no control over entry or exit — because nobody had asked the people inside it. Sensory processing has the same structure: it is not externally observable. What another person can see is that you left the room, snapped at them, or couldn’t concentrate. What produced it is available only to you.
What thirteen studies found, and where it interferes
The pattern across the thirteen is not subtle: self-reported sensory processing differences from peers without ADHD, spanning auditory, olfactory, gustatory, somatosensory and visual domains, and running from early childhood through to mid-adulthood.
Crucially, it runs in both directions. Hypersensitivity appeared — children with ADHD not taking medication showed markedly better odour detection than comparison participants, adults reported greater tactile sensitivity, and one study found ADHD participants detecting sounds at lower decibel thresholds than their peers. So did hyposensitivity — errors in temperature discrimination and in the sensory discrimination of pain, reduced smell identification in another sample, reduced oral touch sensitivity in another. Across studies using the standard adult sensory profile, ADHD participants scored significantly higher across all four quadrants at once: low registration, sensation seeking, sensory sensitivity, and sensation avoiding. That combination — missing some input entirely, seeking more of some, overwhelmed by other, and avoiding still other — is not a contradiction. It is what a differently-calibrated system looks like when you measure several channels rather than one.
Two studies examined what this does to daily life, and both landed on the same place: work and higher education. Sensory sensitivity scores significantly affected work participation. Among higher education students, low registration and sensory sensitivity affected study, exam performance and concentration, and one student described being unable to study in complete silence — a reversal of the standard adjustment, and exactly the sort of thing a generic quiet-room accommodation would get precisely backwards. Physical activity appeared repeatedly as a self-devised coping mechanism.
The framing the authors put on this is the demand-structure argument in occupational-therapy language, and it deserves quoting for its precision: what matters is not simply that sensory processing differences exist, but how schools, workplaces, services and public spaces are organised in ways that make those differences disabling. The sensory profile is not the impairment. The mismatch between the profile and an environment built around a different one is the impairment — which means the same person is disabled in an open-plan office and unremarkable in a room they can control.
The silence in the criteria and the treatments
Now the absence, which is the finding that should travel furthest.
ADHD’s diagnostic criteria describe inattention, hyperactivity and impulsivity. Sensory processing is not among them. Researchers have argued for years that this is an oversight — one widely-cited paper calls sensory over-responsivity an overlooked diagnostic dimension in ADHD — and the accumulating evidence, including this review, supports them. But the sharper observation the authors make concerns treatment rather than diagnosis: research-informed interventions for people with ADHD make no reference to sensory processing differences at all. Not partial reference. None.
Set that against the lived reality the same review documents and the gap is stark. A person whose concentration collapses under fluorescent light, who cannot filter background noise, who is exhausted by an open-plan office, is offered medication, behavioural strategies, or psychoeducation about “attention” — and nothing whatsoever addressing the sensory environment producing a substantial share of the difficulty. The information exists in the research literature. It has not reached the criteria that define the condition, or the interventions that treat it.
Why it hasn’t is a question about ownership rather than evidence. Sensory processing belongs, by convention, to autism: it entered the DSM-5 autism criteria, it dominates the autism-focused occupational therapy literature, and it is where clinicians expect to find it. ADHD got “attention”, and autism got “senses”. The hyperfocus study showed one attentional architecture wearing two labels; this review shows the same thing on the sensory axis — differences documented in ADHD samples with autism explicitly excluded, which means this is not co-occurring autism doing the work. It is ADHD, having a sensory dimension that nobody assigned to it. And a diagnostic system that carves by convention rather than by evidence will keep producing people who are told their difficulty isn’t part of their condition, when the literature says it is.
The signal that gets muted before anyone measures it
The most quietly consequential thing in this review is buried in its exclusion criteria. Participants taking ADHD medication were excluded — because research indicates stimulant medication alters sensory experience. The evidence is direct: unmedicated children with ADHD had significantly higher odour sensitivity than both comparison participants and the children with ADHD who were medicated.
Follow that through. Stimulant medication appears to bring sensory responses closer to typical. Most people with a formal ADHD diagnosis, in most research settings, are medicated. So a substantial part of the sensory research base has been conducted on people whose sensory differences were pharmacologically damped at the moment of measurement — which is one plausible reason the dimension has looked small enough to leave out of the criteria. The review had to deliberately exclude medicated participants to see the phenomenon at all. Four of the thirteen studies didn’t report medication status, which the authors flag as a limitation of their own work.
There’s a practical corollary for anyone who has noticed the world getting louder as their medication wears off. That is not an impression, and it is not sensitivity to being tired. It is a documented pharmacological effect, currently absent from the leaflet, the criteria and the conversation.
The rest of the honest picture: small samples throughout, no matched comparison groups in several studies, no longitudinal designs, so nothing here establishes how sensory processing changes across a life — and no data at all on adults over fifty, who are still working, studying and navigating environments that may be quietly costing them. The authors call for larger samples, validated measures, and co-production with people who have ADHD. What they have established, though, is enough to act on: the sensory dimension is real, it is documented across the lifespan, it interferes measurably with work and study, and the answer to it is environmental adaptation rather than remediation of the person. A quiet space, a lamp instead of an overhead light, permission to move, headphones, a room the person controls. None of it requires a criterion change to implement — only the recognition that the difficulty was never imaginary.
Citations
Dunn, V. S., Hodgson, P. & Petty, S. (2026) — A Systematic Review of the Sensory Processing Experiences of People with ADHD: Characterising Sensory Profiles and Exploring their Relationship with Participation Barriers in Daily Living — Research in Neurodiversity
Lane, S. J. & Reynolds, S. (2019) — Sensory Over-Responsivity as an Added Dimension in ADHD — Frontiers in Integrative Neuroscience
Jurek, L., Duchier, A., Gauld, C. et al. (2025) — Sensory Processing in Individuals With ADHD Compared to Control Populations: A Systematic Review and Meta-Analysis — Journal of the American Academy of Child and Adolescent Psychiatry
Grinblat, N. & Rosenblum, S. (2022) — Work participation, sensory processing and sleep quality in adults with attention-deficit hyperactive disorder — Work
Frost-Karlsson, M., Capusan, A. J., Olausson, H. et al. (2024) — Altered somatosensory processing in adult attention deficit hyperactivity disorder — BMC Psychiatry
