Interoceptive awareness in attention deficit hyperactivity disorder

Abstract

ADHD is considered a disorder of self-regulation. Recent research has shown that awareness of bodily states, referred to as interoceptive awareness, crucially contributes to self-regulatory processes. Impaired self-regulation in ADHD has been explained in terms of arousal regulation deficits in ADHD (the state regulation deficit (SRD) account). There is now ample support for the SRD account, however the exact reason for arousal regulation difficulties is not yet known. The SRD account explicitly refers to the ability to monitor one’s momentary bodily state as a prerequisite for effective state regulation. However, surprisingly, no study to date has tested the ability to become aware of bodily signals, i.e. interoceptive awareness, in ADHD. In the current study, we therefore compared interoceptive awareness between 24 adults with ADHD and 23 controls by means of both an objective (heartbeat perception task) and subjective measure (questionnaire) of interoceptive awareness. Results revealed a strikingly similar performance for both groups on both measures, suggesting preserved interoceptive awareness in adult ADHD.

Time Processing, Interoception, and Insula Activation: A Mini-Review on Clinical Disorders

“…This pattern was confirmed in a meta-analysis of fMRI studies of timing in ADHD (Hart et al, 2012). Finally, a recent study by Wiersema and Godefroid (2018) did not reveal a significant difference between patients and healthy controls in the execution of interoceptive tasks, suggesting preserved interoceptive awareness in this clinical population. Overall, the research examined previously does not provide support to the hypothesis of a linking between interoception and timing deficits in ADHD.…”

Decreased interoceptive accuracy in children with autism spectrum disorder and with comorbid attention deficit/hyperactivity disorder

“…Interoception is crucial for self‐ and emotion‐related regulation (Craig, 2009), and as children with ADHD have been found to have emotion regulation problems (Shaw et al, 2014), research on the divergent interoceptive performance in children with ADHD is warranted. To‐date, only two studies measured IA comparing adults with pre‐existing ADHD diagnosis and controls (Kutscheidt et al, 2019; Wiersema & Godefroid, 2018), both adopted the classic heartbeat tracking task. The former study suggested preserved IA in ADHD adults, but the latter showed contrary results indicating that ADHD adults were also experiencing difficulties in detecting their own internal bodily signals.…”

Questionnaires of interoception do not assess the same construct

“…The BPQ-BA by Porges [27] is a very common reference as a questionnaire of interoception in the recent literature (e.g. [4,[35][36][37][38][39][40][41]) although clearly exteroceptive signals are also included (e.g. "During most situations I am aware of noises associated with my digestion").…”