Sensory processing and executive functioning interaction in neurodevelopmental disorders and at-risk conditions: A systematic review and meta-analysis

This systematic review and meta-analysis investigated the relationship between sensory processing (SP) and executive functioning (EF) in children and adolescents (ages 0-18) diagnosed with neurodevelopmental disorders (NDDs) or at-risk conditions, such as prematurity and genetic syndromes. Adhering to PRISMA guidelines, the results of 30 peer-reviewed studies were analyzed by qualitative and quantitative analyses to evaluate the strength and nature of these associations. The findings revealed a consistent and significant correlation between SP and EF, with effect sizes (r) ranging from r =.19 to r =.77. Meta-analytic synthesis confirmed a medium effect size (d =.58). While substantial heterogeneity was observed (I^2 = 82.9%), it was not moderated by the specific diagnosis of NDDs, age, EF component or correlation adjustment status. Notably, assessment modality served as a significant moderator: performance-based measures demonstrated higher associative strength and lower heterogeneity compared to questionnaire-based or combined assessment. Regression models indicated that SP measures statistically accounted for a substantial portion of EF variance (28-71%), while comparative analyses showed moderate-to-large differences in EF performance (η² =.10-.34) between typical and atypical sensory profiles. Furthermore, mediation analyses suggested significant indirect associations involving EF, particularly emotion regulation and inhibitory control, in the relationship between sensory processing and adaptive and functional outcomes. The evidence underscores a robust interdependence between sensory processing and executive functions in clinical and at-risk pediatric populations. These findings highlight the potential relevance of considering both sensory and executive domains in assessment and intervention planning.