Interplay of premenstrual syndrome, sensory processing, and ADHD symptom severity in adult women

Introduction

Women with attention-deficit/hyperactivity disorder (ADHD) remain systematically underdiagnosed across the lifespan, largely due to inattentive symptom presentations and compensatory masking behaviours [1]. Cyclical hormonal fluctuations during the premenstrual luteal phase further intensify irritability, cognitive dysfunction, and emotional dysregulation, heightening vulnerability to premenstrual syndrome (PMS) [2,3]. Sensory processing differences constitute an additional axis of ADHD heterogeneity; within Dunn’s framework, heightened sensory sensitivity and sensation avoiding are consistently associated with emotional dysregulation and functional impairment [4]. Sensory tolerance thresholds also diminish during the luteal phase, profoundly modulating the overall symptom experience [5]. Despite the clinical relevance of these intersecting domains, no study has simultaneously examined PMS severity, ADHD burden, and sensory processing in adult women, leaving female-specific phenotypes substantially undercharacterised in current clinical practice.Aims: This study investigated the complex interrelationships among PMS severity, ADHD symptom burden, sensory processing profiles, and overall quality of life in adult women with ADHD. We hypothesised that heightened sensory sensitivity and sensation avoiding would be independently associated with greater PMS severity and exacerbated ADHD symptomatology.

Methods

This cross-sectional study enrolled 147 female outpatients (aged 18–45) with DSM-5-confirmed ADHD via structured clinical interviews. Ethical approval was obtained from the Clinical Research Ethics Committee of Erenkoy Mental and Nervous Diseases Training and Research Hospital (No: 10). After providing informed written consent, participants completed a comprehensive clinical battery including the Wender Utah Rating Scale, Adult ADHD Self-Report Scale (ASRS), Premenstrual Syndrome Scale, Premenstrual Symptoms Impact Scale, Premenstrual Change Coping Inventory, Adolescent/Adult Sensory Profile, and EUROHIS-QOL-8. Pearson correlations and hierarchical multiple linear regression models were conducted using IBM SPSS Statistics 26.0; all underlying statistical assumptions, including normality and multicollinearity, were strictly verified prior to analysis.

Results

PMS severity demonstrated significant moderate positive correlations with adult ADHD (r=0.501, p<0.001) and childhood ADHD symptoms (r=0.449, p<0.001). Sensory domains—namely low registration (r=0.330), sensory sensitivity (r=0.332), and sensation avoiding (r=0.269)—were positively associated with PMS severity (all p≤0.001), while overall quality of life was negatively correlated (r=-0.332, p<0.001). Hierarchical regression revealed that childhood and adult ADHD symptom burdens collectively accounted for 32.7% of the variance in PMS severity (R²=0.327, p<0.001), whereas sensory domains did not contribute independently. Conversely, when predicting adult ADHD severity, the initial baseline model identified PMS severity as a significant predictor (β=0.369, p=0.001). The subsequent inclusion of sensory domains significantly increased the total explained variance to 43.7% (R²=0.437), with low registration (β=0.225, p=0.003) and sensory sensitivity (β=0.260, p=0.012) emerging as significant independent contributors alongside PMS severity.

Conclusions

This study provides robust empirical evidence for a clinically meaningful relationship between ADHD symptom severity and PMS burden in adult women. While sensory processing differences do not independently predict PMS severity, specific traits—particularly low registration and heightened sensory sensitivity—act as significant compounding factors that critically amplify ADHD symptomatology in the context of premenstrual hormonal fluctuation. These findings underscore the imperative for multidimensional, sex-informed clinical frameworks. Incorporating menstrual cycle-sensitive assessments and targeted sensory-based interventions is strictly essential to optimise therapeutic outcomes and improve daily functioning for women living with ADHD.

References

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