Hyperfocus in adult ADHD: An EEG study of the differences in cortical activity in resting and arousal states
Abstract and Figures
Attention deficit/hyperactivity disorder (ADHD), characterised by problems relating to attention, impulsive behaviour and hyperactivity, has become widely accepted to be a neurodevelopmental disorder that persists into adulthood for a large proportion of the ADHD population. ADHD symptoms are reported to undergo developmental transformation from childhood to adulthood, resulting in a significantly different clinical picture of adult ADHD. This signals a need to move away from reliance on childhood models of the disorder. Current conceptions of both childhood and adult ADHD do not discuss the occurrence of hyperfocus (or flow), a symptom which seems to connote an extreme form of sustained attention and which has been noted in clinical work. The possibility that hyperfocus could occur in ADHD is unexpected and poses a challenge to current formulations of inattention in ADHD. Media settings have been identified as providing the conditions needed for one to enter the hyperfocus state. This study set out to explore the possible symptom of hyperfocus in ADHD and to attempt to identify the neural correlates thereof, using electroencephalograph (EEG). A sample of 10 participants (5 ADHD, 5 non-ADHD) was recruited using the Adult ADHD Self Report Scale V-1.1 (ASRS V-1.1) Screener and a biographical questionnaire. A quasi-experimental research design was employed, whereby EEG recordings of frontal, frontal midline and parietal regions were taken for each participant during resting states (Eyes Closed and Eyes Open) and whilst playing a first person shooter game. Post-test survey questionnaires were also administered to examine the participants’ time perception during game play. Between-group and within-group differences in absolute and relative power scores were examined, using non-parametric statistical methods (Mann-Whitney-U test and Wilcoxon Signed Rank Test) to analyse the data. Possible markers for hyperfocus were identified, namely significantly lower alpha and beta levels in the ADHD group, as well as a decrease in slow-wave activity over time, as well as post-test survey data that indicated a greater degree of distorted time perception in the ADHD group during game play. Significant between- and within-group differences found in the parietal region highlight the need for further research into the role of the parietal lobe in attention functions and in ADHD. Further, significant changes in cortical activity in the progression from Eyes Closed to Eyes Open in both groups warrant further investigation.
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... Most of the reports that failed to meet all of the secondary inclusion criteria described studies that found no significant band (de Jong, 2000;Jaworska et al., 2013;Kiiski et al., 2017;Liechti et al., 2013;Loo et al., 2009;Markovska-Simoska & Pop-Jordanova, 2017;Ponomarev et al., 2014;Sklar, 2013;van Dongen-Boomsma et al., 2010;White et al., 2005). It is important to note that the two studies reporting consistent theta power increases in ADHD subjects both met all inclusion criteria (Bresnahan & Barry, 2002;Buyck & Wiersema, 2015), while two of the three studies reporting inconsistent theta power differences did not employ reliable procedures for identifying ADHD symptomology (Rasey, 1998;Woltering et al., 2012). ...
... Power differences in the alpha band are more consistent than those in the theta band, but also show some contradictions. Loo et al. (2009), Sklar (2013, and Woltering et al. (2012) all report lower alpha power in ADHD subjects, the former two studies with large effect sizes. The study by Loo et al. further delineates the frequencies with lower power in ADHD subjects to the 8 to 10 Hz range, which corresponds to the high end of the range of frequencies found in the rhythmic attention literature (VanRullen, 2018). ...
... diminished perception of unrelated external stimuli (Ashinoff & Abu-Akel, 2021). Individuals with ADHD have been found to be more prone to hyperfocus (Hupfeld et al., 2019;Ozel-Kizil et al., 2016), although the evidence for this effect is mixed (Groen et al., 2020;Sklar, 2013). The tendency to experience hyperfocus is thought to contribute to attentional deficits in ADHD by making subjects more likely to become intensely absorbed in stimuli that are not related to the task at hand, particularly stimuli that offer immediate gratification or strong intrinsic rewards (Groen et al., 2020). ...
In recent decades, a growing body of evidence has confirmed the existence of rhythmic fluctuations in attention, but the effect of inter-individual variations in these attentional rhythms has yet to be investigated. The aim of this review is to identify trends in the attention deficit/hyperactivity disorder (ADHD) literature that could be indicative of between-subject differences in rhythmic attention. A narrative review of the rhythmic attention and electrophysiological ADHD research literature was conducted, and the commonly-reported difference in slow-wave power between ADHD subjects and controls was found to have the most relevance to an understanding of rhythmic attention. A systematic review of the literature examining electrophysiological power differences in ADHD was then conducted to identify studies with conditions similar to those utilised in the rhythmic attention research literature. Fifteen relevant studies were identified and reviewed. The most consistent finding in the studies reviewed was for no spectral power differences between ADHD subjects and controls. However, the strongest trend in the studies reporting power differences was for higher power in the delta and theta frequency bands and lower power in the alpha band. In the context of rhythmic attention, this trend is suggestive of a slowing in the frequency and/or increase in the amplitude of the attentional oscillation in a subgroup of ADHD subjects. It is suggested that this characteristic electrophysiological modulation could be indicative of a global slowing of the attentional rhythm and/or an increase in the rhythmic recruitment of neurons in frontal attention networks in individuals with ADHD.
... A PubMed search for the same terms in the title or abstract returned 19 results. Of these, 7 are empirical studies explicitly focused on assessing cognitive and neural states associated with hyperfocus (in ADHD: Sklar, 2013;Ozel-Kizil et al., 2013, 2016in schizophrenia: Luck et al., 2014;Sawaki et al., 2017;Kreither et al., 2017;Hahn et al., 2016;Gray et al., 2014). An additional result is a paper that has developed a new questionnaire to assess hyperfocus experiences (Hupfeld, Abagis, & Shah, 2019). ...
... For example, Kahl and Wahl (2006) reported that adults with ADHD could "hyperfocus" on activities in which they have special interest but did not define what cognitive or subjective experiences are associated with hyperfocusing. It is important to note that in most of these papers, these are the only references or descriptions of hyperfocus at any point throughout (with some exceptions; See Sklar, 2013), and they rarely provide an operational definition that can be tested. When it is defined, it is rarely operationally defined in a way that can be used for quantitative research. ...
... Second, it is very difficult to experimentally manipulate a subject into a hyperfocus state (Sklar, 2013). The nature of hyperfocus is such that a person must be completely absorbed in a task that is interesting or fun. ...
‘Hyperfocus’ is a phenomenon that reflects one’s complete absorption in a task, to a point where a person appears to completely ignore or ‘tune out’ everything else. Hyperfocus is most often mentioned in the context of autism, schizophrenia, and attention deficit hyperactivity disorder, but research into its effect on cognitive and neural functioning is limited. We propose that hyperfocus is a critically important aspect of cognition, particularly with regard to clinical populations, and that it warrants significant investigation. Hyperfocus, though ostensibly self-explanatory, is poorly defined within the literature. In many cases, hyperfocus goes undefined, relying on the assumption that the reader inherently knows what it entails. Thus, there is no single consensus to what constitutes hyperfocus. Moreover, some studies do not refer to hyperfocus by name, but describe processes that may be related. In this paper, we review how hyperfocus (as well as possibly related phenomena) has been defined and measured, the challenges associated with hyperfocus research, and assess how hyperfocus affects both neurotypical and clinical populations. Using this foundation, we provide constructive criticism about previously used methods and analyses. We also propose an operational definition of hyperfocus for researchers to use moving forward.
... For example, HF is often regarded as similar or equivalent to "flow" (Ashinoff & 95 Abu-Akel, 2021;Rapaport et al., n.d.), but measures of HF and flow can be inversely associated 96 (Grotewiel et al., 2023). A major limitation of prior research is that HF studies have generally 97 used either self-report data, such as surveys and qualitative reflections (e.g., Garau et al., n.d.;98 Grotewiel et al., 2022;Hupfeld et al., 2019;Ozel-Kizil et al., 2016;Poole et al., 2023;Rapaport 99 et al., n.d.), or laboratory tasks (e.g., Luck et al., 2014;Sawaki et al., 2017;Sklar, 2013), rather 100 than both together. Thus, it is unclear how self-reports about real-world HF experiences are 101 related to specific attentional processes studied in more controlled settings. ...
Purpose: The autistic-developed monotropism account suggests autism is characterized by hyper-focus towards interests, although hyper-focus research has not explored associations among self-/caregiver-report and lab-based measures. Other findings suggest autistic attention has an enhanced capacity and/or is unusually prone to involuntary capture. This study used questionnaires and lab-based tasks to investigate autistic attention and probe its relations to inattention/distractibility, sensory experiences, and anxiety.Methods: 18 autistic and 22 comparison adolescents completed self-report measures of hyper-focus, anxiety, and sensory experiences, and laboratory psychoacoustic tasks, visual working memory and cross-modal attention capture accuracy and reaction time tasks, and a hyper-focus paradigm relying on the N2pc and Pd event-related potentials. Participants’ caregivers completed proxy hyper-focus, anxiety, sensory experiences, and inattention questionnaires.Results: Autistic participants had elevated hyper-focus per self- and caregiver-report questionnaires, and exhibited less visual working memory capacity, potentially reflecting difficulty attending to multiple targets. However, groups did not differ in event-related potentials indexing hyper-focus, or behavioural cross-modal attention capture. Different types of attention measures were generally not related to one another. Participants and their caregivers overall viewed hyper-focus’ impact as modestly positive, with individual opinions differing. Self-reported hyper-focus was related to self-reported misophonia and sensory hyperreactivity.Conclusions: Questionnaires suggest hyper-focus is elevated in autism and has mixed, nuanced real-world impacts. However, some laboratory paradigms with explicit instructions in highly controlled, often non-naturalistic environments may struggle capture real-world autistic attentional experiences; additional research is needed to align laboratory and questionnaire measures. This study also suggests autistic perceptual capacities are not globally enhanced.
... During hyperfocus episodes, people with ADHD describe feeling unaware of the passage of time and cannot abandon the object of their curiosity (Ashinoff & Abu-Akel, 2021;Brown, 2005;Conner, 1994;Groen et al., 2020). In summary, hyperfocus can be seen as a specific and extreme type of sustained attention (Sklar, 2013). The interplay between hyperfocused and distracted behavior in ADHD likely depends on several factors, such as the motivational salience of the current stimulus compared to incoming stimuli, the frequency of new information arising, and the individual's inherent interest in the current stimulus. ...
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by symptoms that include inattention, hyperactivity, and impulsivity. Recent research suggests that individuals with ADHD might exhibit higher levels of curiosity, which may be linked to their tendencies toward distractibility and impulsivity. This paper proposes an evolutionary mismatch hypothesis for high trait curiosity in ADHD, positing that ‘hypercuriosity’, which may have been adaptive in ancestral environments characterized by scarce resources and unpredictable risks, has become mismatched in industrialized societies where environments are more stable and information rich. The theory predicts that individuals with ADHD will demonstrate heightened levels of novelty-seeking and exploratory behaviors, manifesting as symptoms labeled as distractibility and impulsivity in modern environments. The paper explores the potential evolutionary benefits of high trait curiosity, the consequences of an evolutionary mismatch, and the implications for research and practice. The limitations of the theory are addressed, such as the need for more targeted research on curiosity in ADHD and potential differences among ADHD subtypes. Future research directions are proposed to refine and test the hypothesis, ultimately contributing to a more nuanced understanding of ADHD and informing the development of strength-based interventions. This theoretical framework offers a novel perspective on the adaptive value of ADHD traits and their manifestation in modern societies.
... Hyperfocusing has not previously been defined in scientific research or examined as a symptom of ADHD, but has been suggested as a separate dimension of adult ADHD [10,19]. The ability to focus has in sport been considered to be key for performance [20] and for this reason "hyper focusing" can be an asset in sport, and may even be crucial for high performance [21]. In light of this knowledge, inattention and hyperactivity as well as selective attention do not necessarily have to be problematic symptoms for an individual with ADHD traits, but can be regarded in terms of hyper focusing. ...
The current study investigates the possibility that athletes have more parallel ADHD symptoms than non-athletes. High-level youth sport athletes were compared with non-athletes in leisure time (i.e., sport) and in the school in ADHD symptoms. Athletes and students were evaluated by a trained psychotherapist using Adult ADHD Self-Report Scale (ASRS) on activities at school and during activities in leisure/sports time. They also filled in the Autism Spectrum Questionnaire (AQ) as a self-report assessment. Results showed significant differences in ASRS-scores for athletes in school and in their sport, with high scores in school and low scores in sport. No differences were found in AQ between the groups. The findings indicate that many athletes might display a cognitive profile of parallel of ADHD criteria. Future research needs to further investigate potential benefits of the cognitive profile in athletes and how they handle different contexts including sport and school settings.
... This may cause a cycle of procrastination, work binges, exhaustion, and–in some cases–a fear of imperfection. Although ADHD is associated with lack of focus, such individuals often have the ability to hyper-focus once they find something interesting–often being unable to detach themselves from the task (e.g., flow) [27,28]. Secondly, the present authors' argue that the impulsive nature of individuals with ADHD causes them to say 'yes' and taking on many tasks without them thinking ahead, and taking on more work than they can realistically handle–eventually leading to workaholic levels of activity. ...
Despite the many number of studies examining workaholism, large-scale studies have been lacking. The present study utilized an open web-based cross-sectional survey assessing symptoms of psychiatric disorders and workaholism among 16,426 workers (Mage = 37.3 years, SD = 11.4, range = 16–75 years). Participants were administered the Adult ADHD Self-Report Scale, the Obsession-Compulsive Inventory-Revised, the Hospital Anxiety and Depression Scale, and the Bergen Work Addiction Scale, along with additional questions examining demographic and work-related variables. Correlations between workaholism and all psychiatric disorder symptoms were positive and significant. Workaholism comprised the dependent variable in a three-step linear multiple hierarchical regression analysis. Basic demographics (age, gender, relationship status, and education) explained 1.2% of the variance in workaholism, whereas work demographics (work status, position, sector, and annual income) explained an additional 5.4% of the variance. Age (inversely) and managerial positions (positively) were of most importance. The psychiatric symptoms (ADHD, OCD, anxiety, and depression) explained 17.0% of the variance. ADHD and anxiety contributed considerably. The prevalence rate of workaholism status was 7.8% of the present sample. In an adjusted logistic regression analysis, all psychiatric symptoms were positively associated with being a workaholic. The independent variables explained between 6.1% and 14.4% in total of the variance in workaholism cases. Although most effect sizes were relatively small, the study’s findings expand our understanding of possible psychiatric predictors of workaholism, and particularly shed new insight into the reality of adult ADHD in work life. The study’s implications, strengths, and shortcomings are also discussed.
Cambridge Core - Philosophy of Mind and Language - The Attending Mind - by Carolyn Dicey Jennings
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The aim of the present research was to increase the understanding of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) from a cognitive behavioral perspective. The investigation was made to examine the effect of modified cognitive behavioral therapy (CBT) using visualization. Basing our research on Salkovskis’ cognitive model of OCD, the aim was to investigate whether obsessive compulsive disorder (OCD) in individuals with ASD differs from OCD in patients with OCD alone, and to identify cognitive differences between individuals with a combination of ASD and OCD and a non-clinical control group. Further, to investigate the possibility that the criteria for ADHD, as given on the Adult ADHD Self-Report Scale (ASRS), are overrepresented in sports athletes compared to non-athletes, and that these criteria may be an advantage for athletes’ achievement rather than causing problems for these individuals.
In Study I, therapy was given with modified CBT including visualization. Results showed that modified CBT, resulted in significant reduction in anxiety levels, and behavioral changes in the target behaviors.
In Study II, three groups, individuals with ASD and OCD, individuals with only OCD, and non-clinical controls, were compared. Results showed a significant difference between participants with both ASD and OCD and participants with OCD only.
In Study III, the interest was to examining whether athletes, compared to non-athletes, have more ADHD-like symptoms in the two settings i.e. in school and leisure time/ sport activity and whether the cognitive profile that includes these criteria could be of advantage to their sport performance. The results showed significant differences between the groups and within the athlete’s group, in school and in leisure time/the sports activity, concerning ASRS scores.
One general conclusion from these investigations is that the cognitive profiles of ASD and ADHD need to be recognized and taken into consideration early in the daily life both at home and in school, to reduce the risk of comorbidity.
http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-71857
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
The attempt to understand the pathophysiology of Attention-Deficit/Hyperactivity Disorder (ADHD) must include a multitude of perspectives and approaches. Perhaps the one that captured the greatest interest during the 1990s was the use of a variety of neuroimaging techniques. Because no particular neuroimaging technique is sufficient to answer all pertinent questions, a number of approaches have been pursued, often in parallel. Thus, a strictly historical review will be avoided. I will first focus on studies of brain anatomy, followed by a summary of recent func-tional imaging reports, and touch briefly on electrophysiological approaches.
Objective: Directed attention, the ability to allocate and direct attention toward a salient stimulus, is impaired in attention deficit hyperactivity disorder (ADHD). This construct is often assessed with target detection or oddball tasks, and individuals with ADHD perform poorly on such tasks. However, to date, the specific brain structures or neural mechanisms underlying target detection dysfunction in individuals with ADHD have not been identified. The authors' goal was to investigate neural correlates of target detection dysfunction in ADHD using event-related fMRI. Method: Behavioral and brain activation data were collected while subjects performed a visual oddball task. Participants included 14 right-handed male adolescents with ADHD (combined type) and 12 typically developing age- and handedness-matched male comparison subjects. Results: Individuals with ADHD made significantly more errors of commission than comparison subjects. Further, relative to comparison subjects, individuals with ADHD showed significantly less activation in the bilateral parietal lobes (including the superior parietal gyrus and supramarginal and angular gyri of the inferior parietal lobe), right precuneus, and thalamus. Conclusions: Adolescents with ADHD demonstrated significant impairments in their ability to direct and allocate attentional resources. These difficulties were associated with significant aberrations in the parietal attentional system, which is known to play a significant role in attention shifting and detecting specific or salient targets. Thus, dysfunction in the parietal attentional system may play a significant role in the behavioral phenotype of ADHD.