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2. Drive problems with ADHD


2. Drive problems with ADHD

Inner drivenness, being driven and circling thoughts are ADHD symptoms. They can alternate with a lack of drive. As with attention, this is driven by intrinsic motivation: Inner restlessness relates primarily to personally motivating goals, while the lack of drive is more for uninteresting goals. We therefore suspect that the motivational regulation problem that exists in ADHD is the actual cause here too.
Inner restlessness manifests itself in inner tension, the inability to relax and inner agitation. This can even lead to an inability to relax. In order to reduce the inner restlessness, people with ADHD often try to remain constantly active. People with ADHD often find it difficult to pursue leisure activities calmly. In addition, their thoughts are often always elsewhere and they tend to drive faster than others. Addictive substances are more frequently abused in order to calm down.
Inner restlessness is more common in ADHD-HI and ADHD-C, while ADHD-I is less affected.
Aversion to inactivity is an intense aversion to not being active. Inactivity is perceived as unpleasant and can lead to dysphoria. Boredom is also perceived as strongly aversive.
In ADHD, listlessness is often accompanied by inner restlessness. In contrast to listlessness in depression, listlessness in ADHD occurs quickly and disappears quickly. Lack of drive in ADHD also increases the likelihood of depression.
People with ADHD often have difficulty resting and relaxing. The inability to relax correlates more strongly with hyperactivity than with inattention.
Aversion to inactivity and listlessness are also symptoms of stress.

Drive is an activating force that is largely independent of the will and causes mental performance in terms of speed, intensity and endurance. Drive therefore also affects physical processes. Drive controls “liveliness”, drive, initiative, dedication, attention, energy, “entrepreneurial spirit”. Drive manifests itself in expressive behavior and psychomotor skills
Motivation, on the other hand, determines the desired goal.1

2.1. Inner restlessness, being driven, circling thoughts

2.1.1. Inner drivenness, being driven, circling thoughts with ADHD

Inner drivenness as an ADHD symptom is only seemingly a contradiction to the simultaneous symptom of listlessness.

The apparent contradiction is resolved if one differentiates according to the motivation.
While a lack of drive exists primarily in relation to goals that are not personally interesting enough to motivate, there is usually sufficient drive in relation to personally motivating goals. One possible explanation for this is the stress benefit of the two symptoms. More on this at Stress benefits - the survival-promoting purpose of stress. Manifestations of Inner drivenness, being driven
  • Inner restlessness, being driven
    • Always have to do something

    • Cannot find inner peace

      • Thought circles (rumination)
    • Behavioral strategies to reduce inner restlessness
      permanent secondary employment

      • Knit
      • Paint
      • Doodle
    • Long-haul flights are often experienced as aversive due to the forced physical inactivity, possibly also long visits to the theater, cinema or restaurant2

    • Frequent attempts to complete several tasks at the same time (form of inner tension)2

  • what you are doing, usually in a rush
    • When you have finished something, look at what to do next
    • Little “being”, a lot of “doing in order to…”
    • Less focus on “doing the thing” itself than on “getting it done”
  • Difficulty pursuing leisure activities calmly This is one of the 9 most accurate symptoms of ADHD in adults.3
  • Mind wandering (rumination, off-task thoughts)4
    • Thought circles may not be optimally represented under drive problems
    • ADHD symptoms were (only) indirectly related to severity of anxiety and depression, mediated by increased excessive mind wandering and rumination and decreased mindfulness traits5
  • always thinking somewhere else Relationship partners also describe Inner drivenness as “he/she is never really there, never with me, always thinking somewhere else”
  • Driving faster than others6 Driving faster is one of the 9 most accurate symptoms of ADHD in adults.3 It may also be an expression of delay aversion.
    • More parking tickets
      Note: Driving faster can also be a symptom of (hypo)manic states or certain personality disorders, such as the feeling of being allowed to drive faster than others or of being above the law. As with almost all ADHD symptoms, a symptom alone is not meaningful. The context and the combination with other symptoms are decisive. Inner drivenness typical of ADHD-HI subtype

Inner restlessness occurs considerably more frequently and is more pronounced in ADHD-HI and ADHD-C than in ADHD-I
An evaluation of 1889 data sets of the symptom test showed 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
Impulsiveness 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 restlessness 0.81 0.25
Wender-Utah hyperactivity 0.82 0.39
Wender-Utah Impulsiveness 0.71 0.27

As of June 2020. n = 1889. The typing of ADHD-HI and ADHD-C versus ADHD-I was based on self-determined criteria. The assignment to DSM, ICD, Wender-Utah was made by means of questions that came close to 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

The following stress symptoms are known

  • (Inner) restlessness7
    Inner restlessness is a typical symptom of the approaching final state of burnout.8
  • Restlessness91011
  • Constant brooding (rumination)1213

2.2. Aversion to inactivity

2.2.1. Aversion to inactivity as an ADHD symptom

Aversion to inactivity must be distinguished from hyperactivity. While hyperactivity is defined as motor restlessness resulting from abnormal mental overexcitability, aversion to inactivity is an intense aversion to not being active. The stress benefit of aversion to inactivity differs significantly from that of hyperactivity. More on this at Stress benefits - the survival-promoting purpose of stress.

Mindfulness or similar strategies are often experienced as aversive. Boredom is extremely unpleasant

This is the opposite of rumination. Inactivity is perceived as unpleasant.
Stress benefit: Take care of your problem. Thinking and brooding is therefore often actively used to prevent boredom.
Find out more at Stress benefits - the survival-promoting purpose of stress. Dysphoria during inactivity (passivity-induced low mood, to be distinguished from depression)

The Wender-Utah criteria describe “dysphoria during inactivity” as a specific ADHD symptom. A temporary drop in mood from a neutral mood during inactivity is a classic symptom of ADHD. Dysphoria with inactivity is often mistaken for depression.
A rapid change between euphoric and dysphoric moods, on the other hand, is an indication of a bipolar tendency.

The depressed mood that occurs with dysphoria is typically only episodic and short-term and is not present in active moments and during pleasant activities. In contrast, a chronically depressed mood, especially when doing things that you actually enjoy, is a sign of depression.
A dysphoric, sad or depressed mood is also one of the central symptoms of depression.

More on the neurophysiological causes of dysphoria / dysthymia at Depression and dysphoria in ADHD. Inability to relax / cannot relax / enjoy

Forms of appearance:

  • Inability to recover is limited14
    • Self-perception reduced, here in relation to one’s own need for recovery
    • Limited ability to distance oneself from everyday tasks and activities
    • Relationship partners also describe this as “He/she is never really there, never with me, always thinking somewhere else” or “He’s always got his smartphone in his hand, always has to check something”, as already described in Inner drivenness.
    • Workaholism can be a manifestation
  • Capacity for pleasure is reduced
    • The activity of enjoyment is restricted
    • Ability to enjoy technically unimpaired
      A person with ADHD-I reports: I buy avocados from time to time because I really like them. But I rarely manage to eat them - they spoil in the fridge. When I told this to our ADHD adult group, many of them recognized themselves. Since then, we’ve called it “the avocado principle”.

Inability to recover can be recorded and diagnosed using the FABA test (questionnaire for the analysis of stress-relevant coping with demands).1516

In adults, inability to recover correlates most clearly with inner restlessness and more strongly with hyperactivity than with inattention. 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 therefore much more strongly represented 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 during inactivity 0.49
Inattention 0.48
Impulsiveness 0.46
Task switching problems 0.45
increased sensitivity 0.43
ADHD-I subtype 0.34

As at August 2020. n = 2059. The values given reflect the correlation of the 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 a subtype of depression, so-called “agitated depression”, the inner restlessness, a (usually anxious) feeling of being driven, an unproductive hectic pace, is known as agitation, accompanied by a lack of motivation.

2.3. Lack of drive

Lack of drive is just as much an ADHD symptom as Inner drivenness. Inner drivenness and listlessness are comparable to the pair of opposites known from certain stages of agitated depression: a simultaneous coexistence of exhaustion, fatigue and tiredness 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

Lack of drive is often described as an ADHD symptom.

In contrast to pure depression, ADHD causes a severely depressed mood and extreme listlessness within a short period of time, which quickly disappears.17 In contrast to the dysphoria associated with inactivity in ADHD, depressive illnesses are episodic over weeks, months or even years (and, with the exception of atypical depression, do not vary by the day or hour). In addition, depression not only affects extrinsically motivated activities, but also those that the person normally experiences as pleasant and positive, or for which they were previously personally motivated or easily motivated. During depression, all activities are typically uninteresting, not just some.

This is in line with our understanding of the benefits of stress, namely that a lack of drive during stress only exists in relation to things that are irrelevant for combating the stressor. More on this at Stress benefit - the survival-promoting purpose of stress.

2.3.2. Lack of drive as a symptom of stress

Lack of drive is a typical symptom of severe stress718 12 as well as an approaching final state of burnout.8

Lack of drive correlates much more strongly with inattention than with hyperactivity.

For delay aversion, see 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. PMID: 34119895.

  5. Kandeğer A, Odabaş Ünal Ş, Ergün MT, Yavuz Ataşlar E (2023): Excessive mind wandering, rumination, and mindfulness mediate the relationship between ADHD symptoms and anxiety and depression in adults with ADHD. Clin Psychol Psychother. 2023 Dec 5. doi: 10.1002/cpp.2940. PMID: 38053250.

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

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

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

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

  10. 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

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

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

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

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

  15. Faba-Test zur Erholungsunfähigkeit

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

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

  18. 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