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2. Drive problems in ADHD

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2. Drive problems in ADHD

Drive is a largely will-independent activating force that causes mental performance in terms of speed, intensity and endurance. Drive controls “liveliness,” momentum, initiative, attention, vigor, “entrepreneurial spirit. Drive manifests itself in expressive behavior and psychomotor activity.
Motivation, on the other hand, determines the desired goal.1

2.1. Inner restlessness, being driven, circling thoughts

2.1.1. Inner restlessness, being driven, circling of thoughts in ADHD

Inner restlessness / being driven as an ADHD symptom is only seemingly a contradiction to the simultaneously existing symptom of listlessness.

The supposed contradiction dissolves if one differentiates according to the motivational situation.
While lack of drive exists primarily with respect to goals that are not personally interesting enough to motivate, sufficient drive is usually present with respect to personally motivating goals. One possible explanation for this is the stress benefit of the two symptoms. For more on this, see Stress benefits - the survival-promoting purpose of stress.

2.1.1.1. Manifestations of inner restlessness, being driven
  • Inner restlessness, being driven
    • Always have to do something

    • Can not find inner peace

      • Circling of thoughts (rumination)
    • Behavioral strategies to reduce inner turmoil
      be activities constantly carried out on the side
      e.g.:

      • Knitting
      • Paint
      • Doodle
    • Long-haul flights are often experienced as aversive due to the forced physical inactivity, possibly also long theater, cinema, restaurant visits2

    • Frequent attempts to do several jobs at the same time (form of internal tension)2

  • what you are doing, usually do in a rush
    • When you are done with something, already looking at what to do next
    • Little “to be”, much “to do to…”
    • Less attention to “doing the thing” itself than to “getting it done”
  • Difficulty in quietly pursuing a leisure activity This is said to be one of the 9 most accurate symptoms of ADHD in adults.3
  • Mind wandering (Rumination, Off-Task Thoughts)4
  • always somewhere else in thoughts Relationship partners also describe being internally driven with “he/she is actually never there, never with me, always somewhere else in thoughts”
  • Driving faster than others5 Driving faster is one of the 9 most accurate symptoms of ADHD in adults.3
    • More parking tickets
      Note: driving faster than others is also a symptom for people in (hypo)manic states or with certain personality disorders, such as feeling allowed to drive faster than others or being above the law. As with almost all ADHD symptoms, a symptom alone is not meaningful. What is decisive is the context and the coincidence with other symptoms.
2.1.1.2. Inner restlessness, being driven typical for ADHD-HI subtype

Inner restlessness is much more frequent and pronounced in ADHD-HI and ADHD-C than in ADHD-I.
An analysis of 1889 records of the ADxS.org symptom tests shows the following correlations with ADHD-HI and ADHD-C (the subtypes with hyperactivity) and ADHD-I. The correlations of the DSM 5, ICD, and Wender-Utah subscales mentioned with the subtypes are for illustrative purposes.

Symptom Correlation with ADHD-HI / ADHD-C Correlation with ADHD-I
Hyperactivity 0.85 0.29
Inner restlessness 0.83 0.32
Impulsivity 0.79 0.34
Inability to recover 0.75 0.35
Impatience 0.74 0.36
Frustration Intolerance 0.69 0.40
DSM 5 hyperactivity/impulsivity 0.89 0.33
ICD 10 motor agitation 0.81 0.25
Wender-Utah Hyperactivity 0.82 0.39
Wender-Utah Impulsivity 0.71 0.27

As of June 2020. n = 1889. ADHD-HI and ADHD-C versus ADHD-I typing was based on self-identified criteria. Assignment to DSM, ICD, Wender-Utah was made using questions that approximated the respective criteria. This is a non-validated online self-test (screening).

2.1.2. Inner restlessness, being driven, circling thoughts as a symptom of stress

Known symptoms of stress are

  • (Inner) restlessness6
    Inner restlessness is a typical symptom of the approaching end state of burnout.7
  • Restlessness8910
  • Persistent rumination (rumination)1112

2.2. Aversion to inactivity

2.2.1. Aversion to inactivity as an ADHD symptom

Aversion to inactivity is to be distinguished from hyperactivity. While hyperactivity is defined as a motor restlessness resulting from abnormal mental overexcitability, aversion to inactivity is an intense aversion to not being active. The stress benefits of aversion to inactivity sch distinctly different from those of hyperactivity. See more at Stress benefits - the survival-promoting purpose of stress.

Mindfulness or similar strategies are often experienced as aversive.

2.2.1.1. Boredom is extremely unpleasant

This is the antithesis of rumination. Inactivity is perceived as unpleasant.
Stress Benefits**:** Take care of your problem. See more at Stress benefits - the survival purpose of stress.

2.2.1.2. Dysphoria with inactivity (passivity-induced mood lows, to be distinguished from depression)

The Wender-Utah criteria describe “dysphoria with inactivity” as a specific ADHD symptom. A - temporarily - slipping mood during inactivity is a classic symptom of ADHD. Dysphoria with inactivity is often mistaken for depression.

The depressed mood that occurs with dysphoria can be

  • Episodic
  • Short-term or
  • Chronic

be

Depression, in contrast, is a pattern of symptoms that has a dysphoric, sad, or depressed mood as a central symptom.

More on the neurophysiological causes of dysphoria/dysthymia at Depression and dysphoria in ADHD.

2.2.1.3. Inability to relax / relax / enjoy

Appearances:

  • Inability to recover is limited13
    • Self-perception reduced, in this case in relation to one’s own need for recreation
    • Limited ability to disengage from daily tasks and activities
    • Relationship partners also describe this with “he/she is actually never there, never with me, always thinking about something else” or “he constantly has his smartphone in his hand, always has to look up something”, as already described in Inner Drivenness.
    • Work addiction can be a manifestation
  • Enjoyment capacity is diminished
    • Activity of enjoyment is restricted
    • Ability to enjoy technically unimpaired
      An ADHD-I sufferer reports: I buy avocados from time to time because I really like them. But I rarely manage to eat them - they spoil in the refrigerator. When I told this story in our ADHD adult group, many people recognized it. Since then, it’s been called “The Avocado Principle” in our group.

Inability to recover can be recorded and diagnosed with the FABA test (questionnaire for the analysis of stress-relevant coping with demands).1415

Inability to recover correlates most clearly with Inner Restlessness and more strongly with Hyperactivity than with Inattention in adults. Inability to recover correlates much more clearly with the hyperactivity scales than with the inattention scales of DSM 5, ICD 10, and Wender-Utah, and is thus significantly more prevalent in ADHD-HI and ADHD-C than in ADHD-I.

Symptoms Inability to recover
Inner restlessness 0.78
Impatience 0.58
Hyperactivity 0.54
Frustration intolerance 0.54
Dysphoria with inactivity 0.49
Inattention 0.48
Impulsivity 0.46
Task switching issues 0.45
increased sensitivity 0.43
ADHD-HI/ADHD-C 0.75
ADHD-I subtype 0.34

As of August 2020. n = 2059. The values given reflect the correlation of symptoms relative to each other.This is a non-validated online self-test (screening).

2.2.2. Aversion to inactivity as a symptom of stress

Inner and outer restlessness are well-known symptoms of stress. In the even more extreme case of depression, inner restlessness, being driven, is known as agitation, with a simultaneous lack of motivation.

2.3. Listlessness

Listlessness is just as much an ADHD symptom as inner drive. According to this understanding, inner drive and listlessness are comparable to the pair of opposites known from certain stages of atypical depression: a simultaneous coexistence of exhaustion, languor and fatigue on the one hand and inner restlessness and tension on the other.
For Inner Restlessness, Inner Drivenness, see above.

2.3.1. Lack of drive as an ADHD symptom

Listlessness is often described as an ADHD symptom.

In contrast to pure depression, in ADHD a deep depression (probably meaning a deeply depressed feeling) And extreme listlessness occur in a short time and pass quickly.16 Unlike the dysphoria of inactivity in ADHD, depression runs episodically over weeks, months, or even years (and does not vary by the day or hour). Moreover, in depression, not only extrinsically motivated activities are affected, but also those that the person normally experiences as pleasurable and positive, or for which he or she used to be consistently personally motivated or easily motivated. During depression, typically all activities are uninteresting, not just some.

This is consistent with our understanding of stress utility, that listlessness in stress exists only in relation to things that are irrelevant to combating the stressor. See more at Stress utility - the survival-enhancing purpose of stress.

2.3.2. Listlessness as a symptom of stress

Listlessness is a typical symptom of severe stress617 11 as well as an approaching end state of burnout.7

Listlessness correlates much more strongly with inattention than with hyperactivity.

Delay aversion see under motivation problems.


  1. Mayer: Glossar Psychiatrie / Psychosomatik / Psychotherapie / Neurologie / Neuropsychologie: Antrieb

  2. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 61

  3. Barkley, Benton (2010): Das große Handbuch für Erwachsene mit ADHS, Seite 22

  4. Alperin, Christoff, Mills, Karalunas (2021): More than off-task: Increased freely-moving thought in ADHD. Conscious Cogn. 2021 Jun 10;93:103156. doi: 10.1016/j.concog.2021.103156. Epub ahead of print. PMID: 34119895.

  5. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 61

  6. Merkle (2013): Stress – was versteht man darunter?

  7. Prof. Dr. med. Volker Faust: Erschöpfungsdepression; Seelische Störungen erkennen, verstehen, verhindern, behandeln; PSYCHIATRIE HEUTE; Arbeitsgemeinschaft Psychosoziale Gesundheit

  8. Dr. Rolf Merkle, Diplom-Psychologe: Stress – was versteht man darunter?

  9. Hebold (2004): Stress und Stressverarbeitung bei Kindern und Jugendlichen, in: Schluchter, Tönjes, Elkins (Hrsg.): Menschenskinder! Zur Lage von Kindern in unserer Gesellschaft. Band zur Vortragsreihe des Humanökologischen Zentrums der BTU Cottbus, Seite 86

  10. Gruber: Fragebögen zur Stressdiagnostik; Fragebogen 1: Streß-Folgen

  11. Satow (2012): Stress- und Coping-Inventar (SCI); PSYNDEX Test-Nr. 9006508; Test im Testinventar des Leibniz‐Zentrum für Psychologische Information und Dokumentation (ZPID).

  12. Prof. Dr. med. Volker Faust: Grübeln – wissenschaftlich gesehen; Seelische Störungen erkennen, verstehen, verhindern, behandeln; Arbeitsgemeinschaft Psychosoziale Gesundheit; PSYCHIATRIE HEUTE; Seite 4

  13. Hartig (2015): Stress- und Ressourcen-Diagnostik mit internetbasierter Testung, Seite 176

  14. Faba-Test zur Erholungsunfähigkeit

  15. Emmermacher (2009): Gesundheitsmanagement und Weiterbildung: Eine praxisorientierte Methodik zur Steuerung, Qualitätssicherung und Nutzenbestimmung; Seite 112

  16. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 320

  17. Hebold (2004): Stress und Stressverarbeitung bei Kindern und Jugendlichen, in: Schluchter, Tönjes, Elkins (Hrsg.), (2004): Menschenskinder! Zur Lage von Kindern in unserer Gesellschaft. Band zur Vortragsreihe des Humanökologischen Zentrums der BTU Cottbus, Seite 86