Vestibular System Dysfunction and Clinical Interventions in Attention-Deficit/Hyperactivity Disorder (ADHD)
DOI:
https://doi.org/10.54097/p6qrve80Keywords:
Attention-Deficit/Hyperactivity Disorder (ADHD), Vestibular Dysfunction, Postural Control, Vestibulo-Ocular Reflex (VOR), Multi-sensory Integration AbnormalitiesAbstract
This paper comprehensively summarizes existing objective research evidence on vestibular dysfunction in Attention Deficit Hyperactivity Disorder (ADHD), and systematically analyzes its clinical manifestations, impacts on cognitive impairment and clinical assessment approaches. Numerous clinical observations indicate that such patients commonly suffer from poor physical balance and disordered sensory information integration, accompanied by evident developmental lag of the visual-vestibular system compared with healthy peers. The decreased central inhibitory efficiency of vestibulo-ocular reflex serves as a crucial objective marker for cerebellar-vestibular damage. Vestibular deficits further impair patients' executive functions. It not only aggravates inherent behavioral abnormalities of ADHD, but also greatly elevates the risk of comorbidities including learning disabilities and dyslexia. Objective detection techniques such as cervical vestibular evoked myogenic potential, functional head impulse test and eye tracking can precisely reflect vestibular function. Acting as reliable physiological assessment indicators, these methods effectively overcome the drawbacks of conventional subjective behavioral diagnosis. Cerebellovestibular dysfunction and abnormal sensory integration are distinctive objective physiological characteristics of certain ADHD subtypes. Long-term follow-up studies are still required to clarify the independent pathological correlation between vestibular impairment and comorbid disorders. Rigorous randomized controlled trials should also be conducted to establish standardized non-pharmacological intervention and treatment protocols.
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Isaac, V., Olmedo, D., Aboitiz, F., & Delano, P. H. (2017). Altered cervical vestibular-evoked myogenic potential in children with attention deficit and hyperactivity disorder. Frontiers in Neurology, 8, 90. https://doi.org/10. 3389/fneur. 2017. 00090.
[2] Arnold, L. E. (2001). Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD). Annals of the New York Academy of Sciences, 931, 310-341. https://doi.org/ 10. 1111/j.1749-6632.2001.tb05778.x.
[3] Mulligan, S. (1996). An analysis of score patterns of children with attention disorders on the sensory integration and praxis tests. American Journal of Occupational Therapy, 50, 647-654. https://doi.org/10.5014/ajot.50.9.647.
[4] Mao, H., Kuo, L., Yang, A., & Su, C. (2014). Balance in children with attention deficit hyperactivity disorder-combined type. Research in Developmental Disabilities, 35, 1252-1258. https://doi.org/10.1016/j.ridd.2014.04.013.
[5] Van Hecke, R., Deconinck, F. J. A., Wiersema, J. R., Clauws, C., Danneels, M., Dhooge, I., Leyssens, L., Van Waelvelde, H., & Maes, L. (2021). Balanced growth project: A protocol of a single-centre observational study on the involvement of the vestibular system in a child's motor and cognitive development. BMJ Open, 11, e049165. https://doi.org/10.1136/bmjopen-2021-049165.
[6] May-Benson, T. A., Gentil, J. L. D. M., & Teasdale, A. (2020). Characteristics and prevalence of gravitational insecurity in children with sensory processing dysfunction. Research in Developmental Disabilities, 101, 103640. https://doi.org/10. 1016/j. ridd.2020.103640.
[7] Shum, S. B. M., & Pang, M. Y. C. (2009). Children with attention deficit hyperactivity disorder have impaired balance function: Involvement of somatosensory, visual, and vestibular systems. The Journal of Pediatrics, 155, 245-249. https://doi. org/ 10.1016/j.jpeds.2009.02.019.
[8] Sweere, D. J. J., Pel, J. J. M., Kooiker, M. J. G., van Dijk, J. P., van Gemert, E. J. J. M., Hurks, P. P. M., Klinkenberg, S., Vermeulen, R. J., & Hendriksen, J. G. M. (2022). Clinical utility of eye tracking in assessing distractibility in children with neurological disorders or ADHD: A cross-sectional study. Brain Sciences, 12, 1369. https://doi.org/10. 3390/ brainsci 12101369.
[9] Gur-Hartman, T., Tarrasch, R., Zerem, A., Sokol-Novinsky, R., Elyoseph, Z., Lerman-Sagie, T., & Mintz, M. (2024). Consequences of vestibular hypofunction in children with ADHD/DCD. European Journal of Paediatric Neurology, 52, 1-9. https://doi.org/10.1016/j.ejpn.2024.07.007.
[10] Hong, N., Kim, J., Kwon, J., Eom, H., & Kim, E. (2022). Effect of distractors on sustained attention and hyperactivity in youth with attention deficit hyperactivity disorder using a mobile virtual reality school program. Journal of Attention Disorders, 26, 358-369. https://doi.org/10.1177/10870547211067322.
[11] Aydinli, F. E., Çak, T., Kirazli, M. Ç., Çinar, B. Ç., Pektaş, A., Çengel, E. K., & Aksoy, S. (2018). Effects of distractors on upright balance performance in school-aged children with attention deficit hyperactivity disorder, preliminary study. Brazilian Journal of Otorhinolaryngology, 84, 280-289. https://doi.org/10.1016/j.bjorl.2017.03.004.
[12] Jostrup, E., Nyström, M., Claesdotter-Knutsson, E., Tallberg, P., Gustafsson, P., Paulander, O., & Söderlund, G. (2023). Effects of stochastic vestibular stimulation on cognitive performance in children with ADHD. Experimental Brain Research, 241, 2693-2703. https://doi.org/10.1007/s00221-023-06698-4.
[13] Camarata, S., Miller, L. J., & Wallace, M. T. (2020). Evaluating sensory integration/sensory processing treatment: Issues and analysis. Frontiers in Integrative Neuroscience, 14, 556660. https://doi.org/10.3389/fnint.2020.556660.
[14] Korkmaz, H., Aydin, E., Ocal, F. C. A., & Satar, B. (2024). Evaluation of the effects of optokinetic stimuli and dual-task performance on vestibulo-ocular reflex function in children with attention deficit and hyperactivity disorder. Clinical Otolaryngology, 49, 754-764. https://doi.org/10. 1111/coa. 13 443.
[15] Goulardins, J. B., Marques, J. C. B., Casella, E. B., Nascimento, R. O., & Oliveira, J. A. (2013). Motor profile of children with attention deficit hyperactivity disorder, combined type. Research in Developmental Disabilities, 34, 40-45. https://doi. org/ 10.1016/j.ridd.2012.08.013.
[16] Ren, Y., Yu, L., Yang, L., Cheng, J., Feng, L., & Wang, Y. (2014). Postural control and sensory information integration abilities of boys with two subtypes of attention deficit hyperactivity disorder: A case-control study. Chinese Medical Journal, 127, 4197-4203. https://doi.org/10.3760/ cma.j. issn. 0366-6999.20142408.
[17] Jansen, I., Philipsen, A., Dalin, D., Wiesmeier, I. K., & Maurer, C. (2019). Postural instability in adult ADHD - A pilot study. Gait & Posture, 67, 284-289. https://doi.org/ 10.1016/j. gaitpost. 2018. 10.022.
[18] Lotfi, Y., Rezazadeh, N., Moossavi, A., Haghgoo, H. A., Rostami, R., Bakhshi, E., Badfar, F., Moghadam, S. F., Sadeghi-Firoozabadi, V., & Khodabandelou, Y. (2017). Preliminary evidence of improved cognitive performance following vestibular rehabilitation in children with combined ADHD (cADHD) and concurrent vestibular impairment. Auris Nasus Larynx, 44, 700-707. https://doi.org/10. 1016/j.anl. 2017. 02.006.
[19] Li, J., Wang, W., Cheng, J., Li, H., Feng, L., Ren, Y., Liu, L., Qian, Q., & Wang, Y. (2023). Relationships between sensory integration and the core symptoms of attention-deficit/hyperactivity disorder: The mediating effect of executive function. European Child & Adolescent Psychiatry, 32, 2235-2246. https://doi.org/10.1007/s00787-023-02124-1.
[20] Lotfi, Y., Rezazadeh, N., Moossavi, A., Haghgoo, H. A., Rostami, R., Bakhshi, E., Badfar, F., Moghadam, S. F., Sadeghi-Firoozabadi, V., & Khodabandelou, Y. (2017). Rotational and collic vestibular-evoked myogenic potential testing in normal developing children and children with combined attention deficit/hyperactivity disorder. Ear and Hearing, 38, e352-e358. https://doi.org/10.1097/ AUD. 00000 00000000433.
[21] Niklasson, M., Niklasson, I., & Norlander, T. (2009). Sensorimotor therapy: Using stereotypic movements and vestibular stimulation to increase sensorimotor proficiency of children with attentional and motor difficulties. Perceptual and Motor Skills, 108, 643-669. https://doi.org/10.2466/ pms. 108. 3. 643-669.
[22] Zimmer, M., & Desch, L. (2012). Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics, 129, 1186-1189. https://doi.org/10.1542/peds.2012-0876.
[23] Gao, D., Chen, J., Li, F., & Chen, Y. (2026). Vestibular evoked myogenic potentials reveal impairments in vestibular nerve pathways in children with attention deficit hyperactivity disorder. Audiology Research, 16, 59. https://doi.org/ 10.3390/ audiolres16020059.
[24] Watkyns, A. F., Cloete, L. G., & Parham, L. D. (2024). Sensory reactivity assessment in children: A systematic review. Developmental Medicine & Child Neurology, 66, 422-439. https://doi.org/10.1111/dmcn.15779.
[25] Caldani, S., Baghdadi, M., Moscoso, A., Acquaviva, E., Gerard, C., Marcelli, V., Peyre, H., Atzori, P., Delorme, R., & Bucci, M. P. (2020). Vestibular functioning in children with neurodevelopmental disorders using the functional head impulse test. Brain Sciences, 10, 887. https://doi.org/ 10.3390/ brainsci10110887.
[26] Clark, D. L., Arnold, L. E., Crowl, L., Bozzolo, H., Peruggia, M., Ramadan, Y., Bornstein, R., Hollway, J. A., Thompson, S., Malone, K., Hall, K. L., Shelton, S. B., Bozzolo, D. R., & Cook, A. (2008). Vestibular stimulation for ADHD: Randomized controlled trial of comprehensive motion apparatus. Journal of Attention Disorders, 11, 599-611. https://doi.org/ 10.1177/ 108 7054707305119.
[27] Jung, H., Woo, Y. J., Kang, J. W., Choi, Y. W., & Kim, K. M. (2014). Visual perception of ADHD children with sensory processing disorder. Psychiatry Investigation, 11, 119-123. https://doi.org/10.4306/pi.2014.11.2.119.
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