Altered body ownership and multisensory integration in children and adolescents with attention-deficit/hyperactivity disorder

Background

Attention-deficit/hyperactivity disorder (ADHD) is increasingly conceptualised within a neurodevelopmental framework involving alterations in attentional control, sensory processing, and multisensory integration. Given that multisensory integration is fundamental to body ownership, paradigms such as the Rubber Hand Illusion (RHI) provide a relevant experimental framework for probing visuotactile integration, a form of multisensory integration that relies on proprioceptive processing. However, research on multisensory integration processes underlying the RHI in paediatric ADHD populations remains relatively limited in the existing literature.

Aims

This study aimed to compare RHI performance between children and adolescents with ADHD and healthy controls, and to examine associations between RHI indices and behavioural profiles.

Methods

A total of 49 participants were included: 22 children and adolescents with ADHD and 27 healthy controls. Participants underwent a standard RHI paradigm involving synchronous visuotactile stimulation of a visible rubber hand and the participant’s hidden hand. Illusion onset latency (RHI time, seconds) and proprioceptive drift (cm) were recorded.

Behavioural functioning was assessed using the Strengths and Difficulties Questionnaire (SDQ), completed by adolescents, parents, and teachers. In addition, teachers of children with ADHD additionally completed the Conners Teacher Rating Scale (CTRS).

Statistical analyses included independent samples t-tests for age comparisons, Mann–Whitney U tests for group comparisons, and Spearman correlation analyses for associations between RHI indices and questionnaire subscales. Statistical significance was set at p < 0.05.

Results

No significant group differences were observed in age (Control: 158.63 ± 33.74 months, ADHD: 157.43 ± 23.61 months), gender, or dominant hand. Illusion onset latency was significantly prolonged in the ADHD group (p < 0.05), with no group difference found for proprioceptive drift.

ADHD participants showed significantly higher SDQ scores across adolescent, parent, and teacher reports, including hyperactivity/inattention, conduct problems, peer difficulties, emotional symptoms, externalising behaviours, and total difficulties (all p < 0.05), alongside reduced prosocial behaviour in parent and teacher ratings.

In controls, proprioceptive drift correlated positively with adolescent-reported hyperactivity/inattention and total difficulties, and negatively with teacher-reported peer problems. Illusion onset latency showed negative correlations with multiple teacher-reported SDQ domains. In the ADHD group, proprioceptive drift correlated negatively with parent-reported total difficulties and CTRS subscales. No significant associations were found between illusion onset latency and behavioural measures.

Conclusions

The present results suggest that differences in visuotactile integration in children and adolescents with ADHD may be reflected by prolonged RHI onset latency. Although proprioceptive drift did not differ between groups, distinct correlation patterns suggest altered relationships between multisensory integration and behavioural profiles in ADHD. These findings support the involvement of atypical multisensory integration processes in the neurocognitive profile of ADHD and highlight the relevance of visuotactile processing in understanding its sensory and behavioural characteristics. Larger sample sizes and further longitudinal studies are needed to establish stronger causal relationships and better understand the underlying neurobiological mechanisms involved.

References

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