8. Perceptual symptoms of ADHD
Author: Ulrich Brennecke
Review: Dipl.-Psych. Waldemar Zdero
Attention can directly influence sensory cells. For example, attention can influence the activity of sensory hairs in the ear. It therefore stands to reason that perceptual symptoms in ADHD are not only influenced by inadequate filtering of incoming sensory stimuli, but also at the level of activation and alignment of the sensory cells1
- 8.1. Increased sensitivity / sensory overload
- 8.2. Empathy with ADHD
- 8.3. Time perception problems with ADHD (chronasthenia)
- 8.4. Chronic pain, increased sensitivity to pain in ADHD
- 8.5. Self-esteem problems
- 8.6. Self-perception worsens
8.1. Increased sensitivity / sensory overload
In the following, we speak of heightened sensitivity. In contrast, high sensitivity is an Aron construct (validated only to a limited extent to date) that includes other elements in addition to increased sensitivity (in particular a certain form of perception/perception processing), which does not play a role here.
A Korean study found increased sensitivity (SOR) in 18% of all children and in more than 50% of all children with externalizing or internalizing disorders2
The function of dopamine in the brain is to “de-noise” transmitted signals, i.e. to suppress irrelevant signals. ADHD is associated with a lack of dopamine. It is therefore not surprising that ADHD is associated with increased perception (in the sense of increased permeability) of irrelevant signals, which is reflected in increased distractibility on the one hand and increased perceptual sensitivity on the other.
8.1.1. Increased sensitivity / stimulus filter too wide open as an ADHD symptom
Openness to stimuli3 is a symptom of ADHD4, which has sometimes also been called stimulus filter weakness. However, this term only refers to one part of ADHD.
Maladaptive reactivity to sensory input is frequently observed in neurodevelopmental disorders such as ADHD or ASD.56
People with ADHD suffer from overload (overstimulation in the sense of sensory overload) - they perceive incoming stimuli, especially visual, acoustic and tactile stimuli, to an increased degree. They are so overwhelmed by normal environmental stimuli that they are unable to filter out background noise7
Lachenmaier’s filter model is very helpful in understanding the effects of the missing stimulus filters.8
ADHD is almost always accompanied by increased sensitivity. In our ADxS online symptom test, 87% of 200 diagnosed people with ADHD showed signs of increased sensitivity. This corresponds roughly to the value for attention problems, so it is very high. Increased sensitivity is an increased intensity of perception. Other studies also found a correlation of increased sensitivity with ADHD symptoms9 and also with lower quality of life,10 whereby increased sensitivity in ADHD is often associated with comorbid ODD or anxiety and exists regardless of the subtype.11 An evaluation of almost 1900 data sets of the ADxS online symptom test (as of June 2020) also found that increased sensitivity correlated to the same extent with ADHD-HI as with ADHD-I. Interestingly, another study found a correlation of SOR (Sensory-Over-Responsivity) in ADHD with an increased cortisol stress response (which we believe is more common in the ADHD-I subtype), while non-SOR ADHD people with ADHD showed a flattened cortisol stress response (which we believe is more common in ADHD-HI). SOR was not associated with certain externalizing behaviors, but was associated with avoidance of sensory stimuli.12 Another study also found increased sensitivity in adult persons with ADHD.13
A study of children aged 8 to 12 found that SOR was more likely to correlate with anxiety and ADHD was more likely to correlate with stimulus seeking and stimulus insensitivity.14
ADHD shares with increased sensitivity the stimulus filter that is too wide open, probably controlled by the thalamus.
Examples:
- Light sensitivity
- Visual sensitivity
- Noise/noise sensitivity
- Acoustic sensitivity
- Jumpiness
- Emotional sensitivity
- The feelings of others are transferred to you
- Feeling the moods of others unpleasantly intense
- Movies
- Can easily make you cry
- Don’t like watching (certain) movies because the sensations are too intense
- Perceive tastes / smells more intensely
- Olfactory sensitivity
- This is said to correlate (independently of ADHD) with an increased sensitivity in the selection of preferred foods15
- Tactile sensitivity16
- Rough fabrics are unpleasant
- Temperature sensitivity
- Particular sensitivity to high or low temperatures
- Want to change the temperature earlier than others
- Hypoglycemia / hunger / thirst is difficult to bear
- Sensitivity to pain
- Rarer than other features
In particular, increased tactile sensitivity in ADHD is said to correlate with increased anxiety.17 A correlation was also found between SOR and anxiety.18
Around half of all people with ADHD also fulfill the criteria of the Sensory Over-Responsivity Test.1917 It has been hypothesized that SOR could correlate with a GABA deficiency
Compared to non-affected individuals, children with both ADHD and ASD showed increased stimulus sensitivity. While ASD showed higher auditory stimulus processing than ADHD, ADHD was associated with higher visual stimulus processing than ASD. Sensitivity to stimuli decreased with age in all groups. ADHD was found to have deviant patterns of perception and processing of sensory stimuli:20
- Tend to search for sensory input (search pattern)
- Are more aware of sensory stimuli (sensory patterns)
- Are more easily disturbed by certain stimuli (avoidance patterns)
- Perceive sensory stimuli more weakly (lower registration/attendant pattern)
Children with ADHD show increased sensory sensitivity and have problems with proprioception, vision, auditory and tactile sensory processing. These sensory processing deficits are associated with functional, social, behavioral and learning difficulties.21
One study surprisingly found a slight negative correlation of increased sensitivity and the ADHD Polygenic Risc Score.22
8.1.2. Increased sensitivity and correlation with ADHD subtypes
According to the evaluation of almost 1900 data sets of the ADxS.org symptom test, increased sensitivity correlates equally highly with ADHD-HI and ADHD-I (0.50 to 0.51). Looking at the individual sub-areas of sensitivity separately, there are indications of different correlations with the subtypes:
| Sensitivity sub-area | Correlation with ADHD-HI and ADHD-C | Correlation with ADHD-I |
|---|---|---|
| Light sensitivity | 0.20 | 0.41** |
| Noise sensitivity | 0.22 | 0.34 |
| Startle response | 0.20 | 0.25 |
| rough fabrics unpleasant | 0.18 | 0.20 |
| The mood of others is transmitted | 0.28 | 0.25 |
| Temperature sensitivity | 0.21 | 0.11 |
| Not being able to ignore conversations at the side table | 0.35 | 0.30 |
| Can’t ignore the TV in a pub | 0.40 | 0.29 |
| Total distractibility (for comparison) | 0.50 | 0.38 |
Light sensitivity is the only significant value (p = 0.001)
Limitations:
The question on temperature sensitivity was aimed at whether the respondent was one of the first to want a change in temperature. In addition to the feeling, this also includes the willingness to make the statement, which is likely to influence the result. This is a non-validated online self-test (screening).
8.1.3. Increased sensitivity as a stress symptom
A (stress-related) increase in noradrenaline levels directly triggers increased perceptual sensitivity.23 The increase in noradrenaline is mediated by the nucleus coeruleus.24 The nucleus coeruleus is activated by stress (among other things) and in turn activates other stress systems such as the sympathetic nervous system.25 Increased sensitivity is therefore also a possible symptom of stress.26
8.1.3.1. Jumpiness as a stress symptom
The stress hormone CRH immediately causes increased startle reactions.2728
8.1.3.2. Increased alertness / attention as a stress symptom
Increased alertness and attention can also be a direct effect of the stress hormone CRH.2728
8.1.3.3. Increased acoustic perception as a stress symptom
The stress hormone CRH triggers increased acoustic perception.2729
8.1.3.4. Overstimulation as a symptom of stress
The feeling of sensory overload is seen as a symptom of stress.26
8.1.3.5. Traumas in youth change skin sensitivity
Women who were exposed to interpersonal violence exclusively during adolescence (development), but not during childhood or adulthood, showed new protein biomarkers (gene) associated with a sensory cell system in the skin, the Merkel cells. The mechanosensory signaling of Merkel cells is important for gentle and social touch, inflammation-induced pain and the neuroendocrine stress response of the skin. The keratinocyte-derived Merkel cells mature during the identified vulnerable phase of adolescence. Many of the genes identified belonged to a known 17q21 gene cluster.30
8.2. Empathy with ADHD
Empathy is the ability to empathize and understand the feelings and experiences of others. The multidimensional empathy concept distinguishes between cognitive empathy (understanding the emotional states of others, similar to the Theory of Mind) and emotional empathy (the emotional reaction to the emotional state of others).31 The third element is emotion recognition, see there.
There are various concepts that describe how empathy arises.
Comorbid PTSD or intrusions can reduce cognitive empathy. 31
8.2.1. Emotion recognition impaired
Emotion recognition is a sub-area of empathy32 and refers to the ability to recognize emotions based on language, facial expressions or behaviour.33
In ADHD (as in autism) there appears to be impaired recognition of the emotions of others, although stimulus processing is impaired at a different level of processing than in ASD.343536 A meta-analysis found that the studies that found impaired emotion recognition were of poorer quality than those that did not, which calls the results into question37
In addition, many people with ADHD have considerable difficulty recognizing and controlling the expression of their own emotions.38
Emotional dysregulation in ADHD can be caused by deficits in recognizing and / or assigning emotional stimuli.39
People with ADHD are less able to recognize emotions in faces.40 Children with ADHD, ASD or language development disorder showed a similar developmental delay in their ability to recognize emotions.41 A meta-analysis confirmed a deficit in the recognition of facial expressions (Facial Expression Recognition Deficit, FER) in ADHD. This also occurs in ASD, borderline, Parkinson’s and schizophrenia.42 Boys with ADHD showed deviating brain activity when perceiving the faces of family members.43 ADHD correlated with greater activation of the right nucleus accumbens in the perception of fearful and happy faces.44
A meta-analysis found in 16 of 17 studies that ADHD children and adolescents show difficulty processing emotional information conveyed by visual scenes.45
The fact that the perception of emotions in faces shown seems to be altered in people with ADHD, even if the persons with ADHD are no longer diagnosed with ADHD in adulthood,46 could be an interesting aspect of the change in empathy in ADHD
Similarly, people with disorganized attachment styles showed a reduced ability to read emotions from faces, which correlated more strongly with ODD than with ADHD. This also correlated with increased emotional reactivity.47 This is somewhat similar to a pattern known in borderline
This seems to contrast with our data from the ADxS.org symptom test on the question “Do you sometimes find the moods of others unpleasantly intense?”, which was answered in the affirmative significantly more often by people with ADHD than by those without. On a 5-point scale (-2 quite a little, -1 rather a little, 0 neither, 1 rather clearly, 2 quite clearly), people with ADHD achieved an average score of 1.0, while people without ADHD achieved an average score of 0.4 (n = 1889, as of June 2020). On closer inspection, however, a distinction should be made between the ability to recognize the emotions of others and the ability to distance oneself from the emotions of others (which is the aim of the symptom test question).
8.2.2. Empathic ability impaired in ADHD?
One study found a reduced capacity for empathy in people with ADHD.48 In their self-perception, people with ADHD report an increased and sometimes excessive capacity for empathy.49
In ADHD, the ability to empathize may often be impaired. However, it is not fundamentally non-existent, which distinguishes ADHD from psychopathy
Rather, it seems that people with ADHD are often unable to access or use their empathic ability. Since empathy, like attention (see there), follows motivation or is at least regulated by it5051 , it seems conclusive to us that in ADHD it is not so much empathy itself that is impaired in empathy, nor the ability to control empathy (the “technical” ability to direct empathy), but rather that the control profile that directs empathy through motivation is impaired or inappropriate, as is also the case with attention.
The fact that the ability to empathize is not non-existent in ADHD, but rather buried, is shown in 1:1 encounters in a quiet environment or in hyperfocus - e.g. when in love. People with ADHD-HI and ADHD-C are also described as very charming, empathic and accommodating. This may have a different effect on individual people with ADHD, especially those with an existing comorbidity from the aggression spectrum. However, this appears to be due more to the comorbidity.
There are reports of conspicuously high μ-frequencies in the EEG of people with ADHD.52 This high activity of brain waves in the μ-frequency range is representative of an underfunction of the mirror neurons, which are responsible for the ability to empathize with a counterpart. The phenomenon of a lack of μ-frequency suppression when observing others also occurs in autistic people (mirror neuron hypothesis).53
μ-rhythms can be suppressed by clenching the fist. However, to date, fist clenching has not been observed to influence empathic ability in ADHD or in non-affected individuals. Therefore, μ-frequency activity appears to be correlated rather than causally related to empathic ability. In addition, the data from the ADxS.org symptom test show that the statement “Moods of others are transferred to me” is significantly more common in ADHD than in non-affected people. This also contradicts the assumption that the ability to empathize is impaired in ADHD.
Stimulants significantly improved empathic ability and reduced narcissistic traits in adults with ADHD.54
8.2.3. Empathy impaired - especially in ADHD-HI subtype?
It therefore seems to be less due to a lack of “technical” ability to empathize, but rather to the fact that the exercise of empathy is buried by other things (inner restlessness, sensory overload). Nevertheless, a reduced exercise of empathy is a symptom that frequently occurs in ADHD. We have the (subjective) impression that reduced empathy (exercise) is more common in people with ADHD-HI and increased empathy is more common in people with ADHD-I. Hyperactive/impulsive people with ADHD-HI and ADHD-C often appear less empathic to the outside world. It is certain that ADHD is almost always associated with increased sensitivity. In our online study, we found signs of increased sensitivity in 87% of 200 diagnosed people with ADHD. This corresponds roughly to the value for attention problems, so it is very high. Increased sensitivity is a more intensive perception of external stimuli. Empathy is the ability to put oneself in other people’s shoes and to understand or sympathize with their feelings (cognitive empathy) and the ability to sympathize with these feelings (emotional empathy). The data on the correlation of individual parts of increased sensitivity with the ADHD subtypes (see above under Increased sensitivity) indicate that the statement “The moods of others are transferred to me” applies significantly more strongly to those with ADHD than to those without, whereby this even affects the ADHD-HI subtype a little more than the ADHD-I subtype, which could indicate that the subtypes have at least the same level of empathy.
The worse off a person is, the higher their inner tension or anxiety, the higher the stress level, the lower the empathy shown.55 This could be seen as a fairly healthy stress reaction: When it comes to survival, everyone is out for themselves. Once the stress and anxiety are gone, it is possible to empathize with others again. Findings that a blockade of glucocorticoid receptors increases empathy also point in this direction.56 In conjunction with a study in which children with ADHD showed a flattened cortisol response to the TSST, the stronger their psychopathic traits (callous unemotional traits = CU traits) such as lack of empathy, emotional coldness, etc., the lower their cortisol response. 57 and other studies that also found a correlation between callous unemotional traits and externalizing symptoms5859 or impulsivity60 in ADHD, suggest that a flattened cortisol stress response, which is common in ADHD-HI, is associated with a lower capacity for empathy, so that a distinction should be made between the subtypes.
The permanently persistent inner overactivation in the ADHD-HI and ADHD-C presentation forms, the permanent inner restlessness (which, according to the data of the ADxS online symptom test, is reflected in a strongly impaired ability to recover in ADHD-HI, which is also increased in ADHD-I compared to non-affected people, but not as much as in ADHD-HI) seems to demand so many resources from people with ADHD that they can barely exercise their ability to empathize - which is actually present, although sometimes untrained due to lack of use. People with ADHD-I, on the other hand, seem to be able to exercise their empathic abilities to a particularly high degree. It is conceivable that this is less a Consequences of different personality aspects in ADHD-HI and ADHD-I, but rather that this results from the fact that ADHD-HI is characterized by a chronically activated HPA axis (due to a lack of ability to recover due to a typically flattened cortisol stress response, which is no longer able to shut down the HPA axis), while ADHD-I is characterized by an excessive endocrine stress response, whose high cortisol stress response reliably shuts down stress-induced activation of the HPA axis. According to our understanding, these endocrinological patterns could possibly explain a different frequency of empathy in ADHD-HI and ADHD-I.
This is in line with research findings on PTSD/PTSD, which indicate that communication between the cerebral hemispheres is essential for recognizing and processing emotions. This communication between the cerebral hemispheres is functionally disturbed in PTSD/PTSD without any anatomical interruption of communication, as is the case in epilepsy when the corpus callosum is severed as a last resort, which also leads to alexithymic (emotionally blind) behavior.61 In states of strong emotional or cognitive stress, events in the right hemisphere are also functionally separated from the left hemisphere in neurologically intact people by inhibiting transmission between the brain hemispheres 62
Furthermore, early childhood stress is probably associated with reduced emotional empathy, but not reduced cognitive empathy.63
The fact that acute pain tends to increase empathy could be an interesting aspect in relation to self-harm behavior in borderline patients.6465 A distinction could then be made between short-term stress (increasing empathy) and chronic stress (decreasing empathy). Empathy is also increased in rats under low acute pain stress, while it is reduced under severe pain stress.66
See also: Brain hemispheres in ADHD.
8.3. Time perception problems with ADHD (chronasthenia)
The perception of time is very often disturbed in ADHD.
The perception of time is altered in ADHD.
This concerns the perception of different lengths of time, although perception for these different time windows is carried out by different regions of the brain.67
While time in the world around us has a uniform speed, the perception of this speed varies from person to person68
In ADHD, there are deficits in reproducing and estimating fixed durations. Children with ADHD tend to state the interval of a certain period of time longer than it was when estimating it, while they keep it too short when they are supposed to reproduce it.6970 People with ADHD therefore have a consistently deviating internal clock. The speed of cognitive functions based on temporal processing is increased. As a result, time passes subjectively faster for people with ADHD than for those not affected, so that real time is perceived as “sluggish”. According to the authors, this disorder in the subjective perception of time should explain the increased avoidance of delays, the stronger perception of boredom, the unpleasant perception of waiting times and the devaluation of distant rewards.
We consider this to be a misinterpretation. If time passes subjectively faster, a distant reward should become relatively more valuable compared to those who are not affected, as the reward subjectively occurs earlier. The correlation is nevertheless undisputed, we merely doubt the causality.
One hypothesis explains impulsivity symptoms of ADHD in particular with inter-individual differences in the perception of time of people with ADHD.7167 The time estimation of children with ADHD was even worse if they had particularly high impulsivity.72
One study found evidence that hyperactivity could be due less to reduced impulse inhibition than to an altered perception of time.73
A faster subjective time in ADHD was interpreted as an additional factor for a devaluation of distant rewards.67 However, this seems questionable to us, because if an objective period of time is subjectively perceived faster, this should be accompanied by a subjectively shorter perceived time, which should tend to counteract a devaluation of distant rewards.
However, there appears to be a more direct link between the devaluation of more distant rewards and impulsivity: subjective time perception can be experimentally assessed using hyperbolic delay discounting procedures to model the influence of time perception on decision making. Hyperbolic delay discounting describes the tendency (known from ADHD) to prefer smaller immediate rewards over larger but delayed rewards.67 This method thus assumes a direct link between the devaluation of more distant rewards and impulsivity.
Addiction research also reports a correlation between impulsivity and a devaluation of more distant rewards, which is attributed to an altered perception of time.74
In the hyperbolic discounting model, valuations fall relatively quickly at the beginning (e.g. for days 1 to 7), and more slowly for later periods (e.g. day 8 and later). IProbands considered it equivalent to receive USD 15 immediately, USD 30 after three months, USD 60 after one year or USD 100 after three years. Accordingly, the discount rates fell from 277% to 139% to 63% as the delay increased.75
This distinguishes the hyperbolic discounting model from a linear discounting model, in which the valuation decreases by the same amount for each unit of waiting time.
In a video game in which rewards were temporally decoupled from the action, people with ADHD performed just as well as non-affected people in terms of executive function.76 One study reports that self-perception of attention difficulties in ADHD (and ASD) does not correlate with actual performance in attention tests.77
The perception of time is regulated in the brain by a complex network of timers, accumulators and comparison elements. The hippocampus and the entorhinal cortex are responsible for the longer measures of time and the cerebellum for the measures of time of fractions of a second, which are required in particular for brain-muscle coordination.78
It is possible that the less accurate time estimation in ADHD is only a result of a generally increased intraindividual variability in ADHD. The estimation of the number of beads in glass containers is also less accurate in ADHD, as is the variability of estimates for an identical situation.79
Barkley80 sees time perception problems as a separate and significant symptom of ADHD. Studies report that people with ADHD are less able to estimate how long they need to complete a task - and consequently what they can accomplish within a given period of time. This normalizes under medication.71 No differences were found between the ADHD subtypes.81 Time perception and time processing problems affect children and adults with ADHD82 and are already an indication of possible ADHD in preschool children.83
Time perception problems often result in a frustratingly negative perception of one’s own performance, which could at least partly be a consequence of a faulty perception of time. This in turn reinforces a negative self-perception. (See also: Performance problems as an ADHD symptom)
The altered perception of time in ADHD can lead to a divergence of life rhythms throughout the day, which can cause additional difficulties when living with family members.84 This is reminiscent of the idea of “social jet lag” due to the day/night rhythm being shifted backwards. More on this at Social jet lag due to shifted circadian rhythm
Changed perception of time as a stress benefit?
A changed perception of time could represent a stress benefit. In acute danger, it makes sense to prioritize things that are not essential for survival as less important. A change in the perception of time could support the prioritization of things that are necessary for survival. Find out more at ⇒ Stress benefits - the survival-promoting purpose of stress
An individual who is in acute danger (survival-threatening stress) has a greater chance of survival if he or she treats all distant things as less important and all immediate things as more important. Since everything that is further away is not as important in the emergency mode of the survival assurance program, it could also be less important to be able to accurately estimate the temporal distance and the time required for tasks that are further away.
Time understanding of highly industrialized countries as a contributory cause?
Rossi85 notes that the understanding of time in highly industrialized countries is very strict for cultural reasons. Even in highly developed Mediterranean countries, one encounters a different understanding of time than in Germany or the USA. This is all the more true for large parts of the world. He therefore questions whether this is really already a pathological symptom.
However, since it has been empirically proven that people with ADHD have time perception and scheduling problems significantly more often than other members of the same cultural group, the phenomenon is definitely a relevant ADHD problem and not a question of cultural fit
ADHD also occurs in the countries mentioned by Rossi with such a different perception of time.
At the same time, Rossi himself mentions a lack of sense of time as a symptom of ADHD-I (without hyperactivity).86
8.3.1. Time expenditure estimation error in ADHD
With ADHD, the ability to estimate how much time an action or task will take is limited.878889
Persons with ADHD are less good at estimating longer time intervals than people without ADHD.
Forms of appearance:
- Completing work too late
- Constantly arriving late
- Multiple causes:
- Time estimation error
- Waiting is unbearable (Delay Aversion)
- Waiting is rest and inactivity (with the Consequences of dysphoria during inactivity)
Every living being is driven by the desire to maintain the best possible mood
The time until X is fully utilized for activities. As something usually goes wrong and time estimation is a problem with ADHD, people with ADHD are often late. It is better to do this or that quickly than run the risk of arriving too early and then having to wait. This results in frequent lateness. - Now is always
- The perception of what is important has shifted towards the present
- Multiple causes:
- Time passes extremely quickly for interesting things / work
- Others are kept waiting
Consequences are that others feel disrespected (even if this was not the motive of the person with ADHD) and understandably react with rejection. This triggers the already miniaturized self-esteem of the person with ADHD.
8.3.2. Time processing changes in ADHD
In order to distinguish the length of two time intervals, one of which lasted 1 second, the other had to last 1.184 seconds for people without ADHD, while for people with ADHD it had to last 1.238 seconds and thus be 30% longer.90 Other studies have come to similar conclusions.91 In ADHD, the ability to reproduce a time interval of the correct length is also impaired. This impairment correlates with impulsivity.92 Both tonic and phasic dopamine levels (measured using the beta power before the start of the interval) correlate with performance in timing. Dopamine plays an important role in interval timing even in the range of naturally occurring fluctuations.93
Time perception in ADHD focused on the present and positive future?
8.3.3. Time perception in ADHD focused on the present / positive future?
There are still too few studies on this aspect to be able to make a reliable statement in relation to ADHD.
A number of studies have focused on individual differences in the perception of time, in particular the distribution of attention to time perspectives such as the future, past and present.94 One standard for assessing time perspective is the Zimbardo Time Perspective Inventory (ZTPI). The ZTPI estimates the intensity with which perception focuses on the past, present and future and whether the time perspective tends to be perceived positively or negatively.71 Various types of disorders can be attributed to imbalances in the perception of time.
The five dimensions of the ZTPI include:
- Past positive dimension
- Positive memories of the past
- Past negative dimension
- Unpleasant or traumatic experiences from the past
- Typical e.g. with PTSD
- Dimension of contemporary hedonism
- Dimension of contemporary fatalism
- Dimension of the future
As mentioned at the beginning, there are still too few studies on this aspect in relation to ADHD to be able to make a reliable statement.
One (as yet unverified) thought is that an altered perception of time in the sense of a focus on the present (in the sense of a perceived “now is always”) could intensify the subjective perception of stress through increased helplessness. If there is no perspective that an unpleasant condition, a pain, will also pass again, this is likely to significantly increase the subjective stress caused by this perception. This could help explain the increased subjective perception of stress in ADHD.
8.4. Chronic pain, increased sensitivity to pain in ADHD
See under Chronic pain / muscle tension in ADHD
8.5. Self-esteem problems
ADHD is often accompanied by self-esteem problems.101
From a psychological point of view, self-esteem problems could be interpreted as the result of the experience of not meeting environmental requirements.
However, our impression is that the self-esteem of people with ADHD is often significantly lower than would be appropriate for the actual functional problems. We therefore suspect that self-esteem problems are an original ADHD symptom and not merely a learning experience. We therefore tend to view self-esteem problems in ADHD not as a perceptual consequence, but as a perceptual problem or as a form of emotional dysregulation.
You therefore have Self-esteem problems In the article Emotional dysregulation / Emotional symptoms of ADHD.
8.6. Self-perception worsens
A meta-analysis (k = 18) found that increased ADHD symptoms (inattention, hyperactivity, impulsivity, emotional dysregulation, executive dysfunction) correlated with worsened self-perception.102
Studies (possibly included in the meta-analysis) came to the same conclusion.103
Interoceptive accuracy mediates the longitudinal relationship between inattentive symptoms of attention deficit hyperactivity disorder (ADHD) and eating disorders.104
Busse, Grothe (2022): Struktur und Funktion – Die neue Komplexität neuronaler Netzwerke; Youtube Video, deutsch ↥
Schwarzlose RF, Tillman R, Hoyniak CP, Luby JL, Barch DM (2023): Sensory Over-responsivity: A Feature of Childhood Psychiatric Illness Associated With Altered Functional Connectivity of Sensory Networks. Biol Psychiatry. 2023 Jan 1;93(1):92-101. doi: 10.1016/j.biopsych.2022.09.004. PMID: 36357217. ↥
Engel-Yeger B (2024): The development and validation of the “SENSE” - Sensory and Behavioral Modulation Questionnaire for adults. Res Dev Disabil. 2024 Mar 11;147:104715. doi: 10.1016/j.ridd.2024.104715. PMID: 38471295. ↥
Molholm, Murphy, Bates, Ridgway, Foxe (2020): Multisensory Audiovisual Processing in Children With a Sensory Processing Disorder (I): Behavioral and Electrophysiological Indices Under Speeded Response Conditions. Front Integr Neurosci. 2020 Feb 11;14:4. doi: 10.3389/fnint.2020.00004. PMID: 32116583; PMCID: PMC7026671. ↥
Rani I, Agarwal V, Arya A, Mahour P (2022): Sensory Processing in Children and Adolescents with Attention Deficit Hyperactivity Disorder. J Atten Disord. 2022 Oct 14:10870547221129306. doi: 10.1177/10870547221129306. PMID: 36239408. n = 72 ↥
Blum, Chen, Braverman, Comings, Chen, Arcuri, Blum, Downs, Waite, Notaro, Lubar, Williams, Prihoda, Palomo, Oscar-Berman (2008): Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatr Dis Treat. 2008 Oct;4(5):893-918. doi: 10.2147/ndt.s2627. PMID: 19183781; PMCID: PMC2626918. ↥
Grossman A, Avital A (2023): Emotional and sensory dysregulation as a possible missing link in attention deficit hyperactivity disorder: A review. Front Behav Neurosci. 2023 Mar 2;17:1118937. doi: 10.3389/fnbeh.2023.1118937. PMID: 36935890; PMCID: PMC10017514. REVIEW ↥
Pfeiffer, Brusilovskiy, Bauer, Salzer (2014): Sensory processing, participation, and recovery in adults with serious mental illnesses. Psychiatr Rehabil J. 2014 Dec;37(4):289-96. doi: 10.1037/prj0000099. ↥
Ghanizadeh (2011): Sensory processing problems in children with ADHD, a systematic review. Psychiatry Investig. 2011 Jun;8(2):89-94. doi: 10.4306/pi.2011.8.2.89. REVIEW ↥
Reynolds, Lane, Gennings (2010): The moderating role of sensory Overresponsivity in HPA activity: a pilot study with children diagnosed with ADHD. J Atten Disord. 2010 Mar;13(5):468-78. doi: 10.1177/1087054708329906. ↥
Grinblat, Rosenblum (2022): Work participation, sensory processing and sleep quality in adults with attention deficit hyperactive disorder. Work. 2022 Jun 9. doi: 10.3233/WOR-211129. PMID: 35694942. n = 121 ↥
Brandes-Aitken A, Powers R, Wren J, Chu R, Shapiro KA, Steele M, Mukherjee P, Marco EJ (2024): Sensory processing subtypes relate to distinct emotional and behavioral phenotypes in a mixed neurodevelopmental cohort. Sci Rep. 2024 Nov 26;14(1):29326. doi: 10.1038/s41598-024-78573-2. PMID: 39592662; PMCID: PMC11599893. ↥
Smith, Rogers, Blissett, Ludlow (2020): The relationship between sensory sensitivity, food fussiness and food preferences in children with neurodevelopmental disorders. Appetite. 2020 Jul 1;150:104643. doi: 10.1016/j.appet.2020.104643. PMID: 32105808. ↥
Frost-Karlsson M, Capusan AJ, Olausson H, Boehme R (2024): Altered somatosensory processing in adult attention deficit hyperactivity disorder. BMC Psychiatry. 2024 Aug 13;24(1):558. doi: 10.1186/s12888-024-06002-9. PMID: 39138461; PMCID: PMC11323665. ↥
Lane, Reynolds (2019): Sensory Over-Responsivity as an Added Dimension in ADHD. Front Integr Neurosci. 2019 Sep 6;13:40. doi: 10.3389/fnint.2019.00040. eCollection 2019. ↥ ↥
Lane, Reynolds, Dumenci (2012): Sensory overresponsivity and anxiety in typically developing children and children with autism and attention deficit hyperactivity disorder: cause or coexistence? Am J Occup Ther. 2012 Sep-Oct;66(5):595-603. doi: 10.5014/ajot.2012.004523. ↥
Ben-Sasson, Soto, Heberle, Carter, Briggs-Gowan (2014): Early and Concurrent Features of ADHD and Sensory Over-Responsivity Symptom Clusters; Research Article; Journal of Attention Disorders, Volume: 21 issue: 10, page(s): 835-845; https://doi.org/10.1177/1087054714543495 ↥
Little, Dean, Tomchek, Dunn (2018): Sensory Processing Patterns in Autism, Attention Deficit Hyperactivity Disorder, and Typical Development. Phys Occup Ther Pediatr. 2018 Aug;38(3):243-254. doi: 10.1080/01942638.2017.1390809. PMID: 29240517. n = 239 ↥
Sanz-Cervera, Pastor-Cerezuela, González-Sala, Tárraga-Mínguez, Fernández-Andrés (2019): Sensory Processing in Children with Autism Spectrum Disorder and/or Attention Deficit Hyperactivity Disorder in the Home and Classroom Contexts. Front Psychol. 2017 Oct 11;8:1772. doi: 10.3389/fpsyg.2017.01772. Erratum in: Front Psychol. 2019 Mar 05;10:443. PMID: 29075217; PMCID: PMC5641858. ↥
Weyn S, Lionetti F, Klein DN, Aron E, Aron A, Hayden EP, Dougherty LR, Singh S, Waszczuk M, Kotov R, Docherty A, Shabalin A, Pluess M (2025): Observer-rated environmental sensitivity and its characterization at behavioral, genetic, and physiological levels. Dev Psychopathol. 2025 Jan 8:1-15. doi: 10.1017/S0954579424001883. PMID: 39773816. ↥
Hüther (1997): Biologie der Angst – Wie aus Stress Gefühle werden; S. 62 ↥
Aston-Jones (1986): The Locus Ceoruleus – Behavioral functions of locus coeruleus derived from cellular attributes; Physiological Psychology, 1985, Vol. 13 (3), 118-126 ↥
Jacobs, Abercrombie, Fornal, Levine, Morilak, Stafford (1991): Single-unit and physiological analyses of brain norepinephrine function in behaving animals. Prog Brain Res. 1991;88:159-65 ↥
Lauff in Friedrich (2009): Umgang mit Konflikten und Gewalt an der Schnittstelle zwischen Psychologie, Pädagogik und Sozialer Arbeit, Lulu, Seite 122 ↥ ↥
Rensing, Koch, Rippe, Rippe (2006): Mensch im Stress; Psyche, Körper Moleküle, Seite 96, Seite 151 ↥ ↥ ↥
Egle, Joraschky, Lampe, Seiffge-Krenke, Cierpka (2016): Sexueller Missbrauch, Misshandlung, Vernachlässigung – Erkennung, Therapie und Prävention der Folgen früher Stresserfahrungen; 4. Aufl., S. 45 ↥ ↥
Egle, Joraschky, Lampe, Seiffge-Krenke, Cierpka (2016): Sexueller Missbrauch, Misshandlung, Vernachlässigung – Erkennung, Therapie und Prävention der Folgen früher Stresserfahrungen; 4. Aufl., S. 45 ↥
Korgan AC, Prendergast K, Rosenhauer AM, Morrison KE, Jovanovic T, Bale TL (2025): Trauma and Sensory Systems: Biological Mechanisms Involving the Skin and the 17q21 Gene Cluster. Biol Psychiatry. 2025 May 1;97(9):854-861. doi: 10.1016/j.biopsych.2024.11.003. PMID: 39521032; PMCID: PMC11991886. REVIEW ↥
Vater, Röpke, Renneberg (2011): Kognition und soziale Wahrnehmung. In: Dulz, Herpertz, Kernberg, Sachsse (Herausgeber) (2011): Handbuch der Borderline-Störungen. ↥ ↥
Derntl, Kryspin-Exner, Fernbach, Moser, Habel (2009): Emotion recognition accuracy in healthy young females is associated with cycle phase. Horm Behav. 2008;53(1):90-95. doi:10.1016/j.yhbeh.2007.09.006 ↥
Tye, Battaglia, Bertoletti, Ashwood, Azadi, Asherson, Bolton, McLoughlin (2014): Altered neurophysiological responses to emotional faces discriminate children with ASD, ADHD and ASD+ADHD; Biol Psychol. 2014 Dec;103:125-34. doi: 10.1016/j.biopsycho.2014.08.013. ↥
Raz, Dan (2015): Altered event-related potentials in adults with ADHD during emotional faces processing; Clin Neurophysiol. 2015 Mar;126(3):514-23. doi: 10.1016/j.clinph.2014.06.023. ↥
Oerlemans, van der Meer, van Steijn, de Ruiter, de Bruijn, de Sonneville, Buitelaar, Rommelse (2014): Recognition of facial emotion and affective prosody in children with ASD (+ADHD) and their unaffected siblings. Eur Child Adolesc Psychiatry. 2014 May;23(5):257-71. doi: 10.1007/s00787-013-0446-2. ↥
Shepard EC, Ruben M, Weyandt LL (2025): Emotion Recognition Accuracy Among Individuals With ADHD: A Systematic Review. J Atten Disord. 2025 Feb;29(3):174-194. doi: 10.1177/10870547241297005. PMID: 39614669; PMCID: PMC11781233. ↥
Brown (2015): ADHD – From Stereopypic to Science in Educational Leadership, 10/2015, S. 52 – 56 ↥
Shaw, Stringaris, Nigg, Leibenluft (2014): Emotion Dysregulation in Attention Deficit Hyperactivity Disorder; The American Journal of Psychiatry, Volume 171, Issue 3, March 2014, pp. 276-293; http://dx.doi.org/10.1176/appi.ajp.2013.13070966 ↥
Buongiorno, Vaucheret, Giacchino, Mayoni, Polin, Pardo-Campos (2020): Reconocimiento de emociones faciales en niños con trastorno por déficit de atención/hiperactividad [Facial emotion recognition in children with attention-deficit/hyperactivity disorder]. Rev Neurol. 2020 Feb 16;70(4):127-133. Spanish. doi: 10.33588/rn.7004.2019268. PMID: 32043534. ↥
Löytömäki, Ohtonen, Laakso, Huttunen (2019): The role of linguistic and cognitive factors in emotion recognition difficulties in children with ASD, ADHD or DLD. Int J Lang Commun Disord. 2019 Dec 3. doi: 10.1111/1460-6984.12514. n = 156 ↥
Olaya-Galindo MD, Vargas-Cifuentes OA, Vélez Van-Meerbeke A, Talero-Gutiérrez C. Establishing the Relationship Between Attention Deficit Hyperactivity Disorder and Emotional Facial Expression Recognition Deficit: A Systematic Review. J Atten Disord. 2023 Feb 26:10870547231154901. doi: 10.1177/10870547231154901. PMID: 36843351. METASTUDIE ↥
Shimamura, Inoue, Ichikawa, Nakato, Sakuta, Kanazawa, Yamaguchi, Kakigi, Sakuta (2019): Hemodynamic response to familiar faces in children with ADHD. Biopsychosoc Med. 2019 Nov 28;13:30. doi: 10.1186/s13030-019-0172-1. eCollection 2019. ↥
Perlstein S, Hawes SW, Byrd AL, Barzilay R, Gur RE, Laird AR, Waller R (2024): Unique versus shared neural correlates of externalizing psychopathology in late childhood. J Psychopathol Clin Sci. 2024 Aug;133(6):477-488. doi: 10.1037/abn0000923. PMID: 38869879; PMCID: PMC11293992. ↥
Leroy, Spotorno, Faure (2020): Emotional scene processing in children and adolescents with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry. 2020 Feb 7:10.1007/s00787-020-01480-0. doi: 10.1007/s00787-020-01480-0. PMID: 32034554. REVIEW ↥
Lindholm, Lieslehto, Nikkinen, Moilanen, Hurtig, Veijola, Miettunen, Kiviniemi, Ebeling (2019): Brain response to facial expressions in adults with adolescent ADHD. Psychiatry Res Neuroimaging. 2019 Oct 30;292:54-61. doi: 10.1016/j.pscychresns.2019.09.003. ↥
Forslund, Peltola, Brocki (2019): Disorganized attachment representations, externalizing behavior problems, and socioemotional competences in early school-age. Attach Hum Dev. 2019 Sep 19:1-26. doi: 10.1080/14616734.2019.1664603. ↥
Abdel-Hamid M, Niklewski F, Heßmann P, Guberina N, Kownatka M, Kraemer M, Scherbaum N, Dziobek I, Bartels C, Wiltfang J, Kis B (2019): Impaired empathy but no theory of mind deficits in adult attention deficit hyperactivity disorder. Brain Behav. 2019 Oct;9(10):e01401. doi: 10.1002/brb3.1401. PMID: 31475781; PMCID: PMC6790334. n = 60 ↥
http://www.adhspedia.de/wiki/Selbstwahrnehmung_von_ADHS-Betroffenen#cite_note-3 ↥
Cameron CD, Conway P, Scheffer JA (2022): Empathy regulation, prosociality, and moral judgment. Curr Opin Psychol. 2022 Apr;44:188-195. doi: 10.1016/j.copsyc.2021.09.011. PMID: 34695643. REVIEW ↥
Kirch (2015): Vorstellung des Empathie-Projektions-Tests: Die Unterscheidung zwischen Übertragung eigener Gefühle und echter Einfühlung, S. 53 ↥
Strehl (Hrsg.) (2013): Neurofeedback, Kohlhammer, Kapitel 6.2.3. ↥
Strehl (Hrsg.) (2002): Neurofeedback, Kapitel 6.2.3. unter Verweis auf Kropotov 2009 ↥
Takım U, Belli H, Gökçay H, Köse H, Arslan Akgül H, Çakır A (2024): Examination of Changes in Levels of Empathy and Narcissistic Pathology After Treatment of Adult with Attention-Deficit/Hyperactivity Disorder. Alpha Psychiatry. 2024 Sep 1;25(5):598-603. doi: 10.5152/alphapsychiatry.2024.241630. PMID: 39553487; PMCID: PMC11562234. ↥
Park, Kim, Kim, Yi, Jeong, Chae, Hwang, Roh (2015): The relationships between empathy, stress and social support among medical students. Int J Med Educ. 2015 Sep 5;6:103-8. doi: 10.5116/ijme.55e6.0d44. ↥
Martin, Hathaway, Isbester, Mirali, Acland, Niederstrasser, Slepian, Trost, Bartz, Sapolsky, Sternberg, Levitin, Mogil (2015): Reducing social stress elicits emotional contagion of pain in mouse and human strangers. Curr Biol. 2015 Feb 2;25(3):326-332. doi: 10.1016/j.cub.2014.11.028. ↥
Stadler, Kroeger, Weyers, Grasmann, Horschinek, Freitag, Clement (2011): Cortisol reactivity in boys with attention-deficit/hyperactivity disorder and disruptive behavior problems: the impact of callous unemotional traits. Psychiatry Res 187:204–209, n = 36 ↥
Piatigorsky, Hinshaw (2004): Psychopathic traits in boys with and without attention-deficit/hyperactivity disorder: concurrent and longitudinal correlates. J Abnorm Child Psychol. 2004 Oct;32(5):535-50. doi: 10.1023/b:jacp.0000037782.28482.6b. PMID: 15500032. ↥
Waschbusch, Baweja, Babinski, Mayes, Waxmonsky (2020): Irritability and Limited Prosocial Emotions/Callous-Unemotional Traits in Elementary-School-Age Children. Behav Ther. 2020 Mar;51(2):223-237. doi: 10.1016/j.beth.2019.06.007. PMID: 32138934. n = 219 ↥
Meijer, Klein, Hannon, van der Meer, Hartman, Oosterlaan, Heslenfeld, Hoekstra, Buitelaar, Mill, Franke (2020): Genome-Wide DNA Methylation Patterns in Persistent Attention-Deficit/Hyperactivity Disorder and in Association With Impulsive and Callous Traits. Front Genet. 2020 Jan 31;11:16. doi: 10.3389/fgene.2020.00016. PMID: 32082368; PMCID: PMC7005250. ↥
Henry (1997): Psychological and physiological responses to stress: the right hemisphere and the hypothalamo-pituitary-adrenal axis, an inquiry into problems of human bonding. Acta Physiol Scand Suppl. 1997;640:10-25. PMID: 9401599. REVIEW ↥
Galin (1974): Implications for psychiatry of left and right cerebral specialization. A neurophysiological context for unconscious processes. Arch Gen Psychiatry. 1974 Oct;31(4):572-83. doi: 10.1001/archpsyc.1974.01760160110022. PMID: 4421063. ↥
Grimm, Wirth, Fan, Weigand, Gärtner, Feeser, Dziobek, Bajbouj, Aust (2017): The interaction of corticotropin-releasing hormone receptor gene and early life stress on emotional empathy. Behav Brain Res. 2017 Jun 30;329:180-185. doi: 10.1016/j.bbr.2017.04.047. ↥
Tomova, Majdandžic, Hummer, Windischberger, Heinrichs, Lamm (2017): Increased neural responses to empathy for pain might explain how acute stress increases prosociality. Soc Cogn Affect Neurosci. 2017 Mar 1;12(3):401-408. doi: 10.1093/scan/nsw146. ↥
Wolf, Schulte, Drimalla, Hamacher-Dang, Knoch, Dziobek (2015): Enhanced emotional empathy after psychosocial stress in young healthy men. Stress. 2015;18(6):631-7. doi: 10.3109/10253890.2015.1078787. ↥
Karakilic, Kizildag, Kandis, Guvendi, Koc, Camsari, Camsari, Ates, Arda, Uysal (2018): The effects of acute foot shock stress on empathy levels in rats. Behav Brain Res. 2018 Sep 3;349:31-36. doi: 10.1016/j.bbr.2018.04.043. ↥
White E, Dalley JW (2024): Brain mechanisms of temporal processing in impulsivity: Relevance to attention-deficit hyperactivity disorder. Brain Neurosci Adv. 2024 Aug 13;8:23982128241272234. doi: 10.1177/23982128241272234. PMID: 39148691; PMCID: PMC11325328. REVIEW ↥ ↥ ↥ ↥
Wittmann M (2009): The inner experience of time. Philos Trans R Soc Lond B Biol Sci. 2009 Jul 12;364(1525):1955-67. doi: 10.1098/rstb.2009.0003. PMID: 19487197; PMCID: PMC2685813. REVIEW ↥
Smith A, Taylor E, Rogers JW, Newman S, Rubia K (2002): Evidence for a pure time perception deficit in children with ADHD. J Child Psychol Psychiatry. 2002 May;43(4):529-42. doi: 10.1111/1469-7610.00043. PMID: 12030598. ↥
Toplak ME, Dockstader C, Tannock R (2006): Temporal information processing in ADHD: findings to date and new methods. J Neurosci Methods. 2006 Feb 15;151(1):15-29. doi: 10.1016/j.jneumeth.2005.09.018. PMID: 16378641. REVIEW ↥
Ptacek, Weissenberger, Braaten, Klicperova-Baker, Goetz, Raboch, Vnukova, Stefano (2019): Clinical Implications of the Perception of Time in Attention Deficit Hyperactivity Disorder (ADHD): A Review. Med Sci Monit. 2019 May 26;25:3918-3924. doi: 10.12659/MSM.914225. PMID: 31129679; PMCID: PMC6556068. REVIEW ↥ ↥ ↥
González-Garrido AA, Gómez-Velázquez FR, Zarabozo D, López-Elizalde R, Ontiveros A, Madera-Carrillo H, Vega OL, De Alba JL, Tuya JM (2008): Time reproduction disturbances in ADHD children: an ERP study. Int J Neurosci. 2008 Jan;118(1):119-35. doi: 10.1080/00207450601042177. PMID: 18041610. ↥
Sonuga-Barke EJ, Saxton T, Hall M (1998): The role of interval underestimation in hyperactive children’s failure to suppress responses over time. Behav Brain Res. 1998 Jul;94(1):45-50. doi: 10.1016/s0166-4328(97)00168-x. PMID: 9708838. ↥
Paasche C, Weibel S, Wittmann M, Lalanne L (2019): Time perception and impulsivity: A proposed relationship in addictive disorders. Neurosci Biobehav Rev. 2019 Nov;106:182-201. doi: 10.1016/j.neubiorev.2018.12.006. PMID: 30529361. REVIEW ↥
Thaler R (1981): Some empirical evidence on dynamic inconsistency, Economics Letters, Volume 8, Issue 3, 1981, Pages 201-207, ISSN 0165-1765, https://doi.org/10.1016/0165-1765(81)90067-7. ↥
Delisle J, Braun CM (2011): A context for normalizing impulsiveness at work for adults with attention deficit/hyperactivity disorder (combined type). Arch Clin Neuropsychol. 2011 Nov;26(7):602-13. doi: 10.1093/arclin/acr043. PMID: 21653627. ↥
Waldren LH, Leung FYN, Hargitai LD, Burgoyne AP, Liceralde VRT, Livingston LA, Shah P (2024): Unpacking the overlap between Autism and ADHD in adults: A multi-method approach. Cortex. 2024 Apr;173:120-137. doi: 10.1016/j.cortex.2023.12.016. PMID: 38387375. ↥
Grafik aus White E, Dalley JW (2024): Brain mechanisms of temporal processing in impulsivity: Relevance to attention-deficit hyperactivity disorder. Brain Neurosci Adv. 2024 Aug 13;8:23982128241272234. doi: 10.1177/23982128241272234. PMID: 39148691; PMCID: PMC11325328. ↥
Barneron M, Saka N, Shlepack S, Khattab A, Pollak Y (2024): Increased intra-individual variability among individuals with ADHD: first evidence from numerosity judgment and verbal and quantitative reasoning. Psychol Med. 2024 Oct 23;54(13):1-8. doi: 10.1017/S0033291724001892. PMID: 39439306; PMCID: PMC11536105. n = 203.000 ↥
Barkley, Benton (2010): Das große Handbuch für Erwachsene mit ADHS ↥
Bauermeister, Barkley, Martinez, Cumba, Ramirez, Reina, Matos, Salas (2005): Time estimation and performance on reproduction tasks in subtypes of children with attention deficit hyperactivity disorder. J Clin Child Adolesc Psychol. 2005 Mar;34(1):151-62. doi: 10.1207/s15374424jccp3401_14. PMID: 15677289. ↥
Valko L, Schneider G, Doehnert M, Müller U, Brandeis D, Steinhausen HC, Drechsler R. Time processing in children and adults with ADHD. J Neural Transm (Vienna). 2010 Oct;117(10):1213-28. doi: 10.1007/s00702-010-0473-9. PMID: 20821338. ↥
Zheng Q, Cheng YY, Sonuga-Barke, Shum KK. (2022): Do Executive Dysfunction, Delay Aversion, and Time Perception Deficit Predict ADHD Symptoms and Early Academic Performance in Preschoolers. Res Child Adolesc Psychopathol. 2022 Jun 11. doi: 10.1007/s10802-022-00937-x. PMID: 35689730. ↥
Rasmussen GV, Meinert L, Flaherty MG (2024): Time and ADHD in Danish Families: Mutual Affect Through Rhythm. Med Anthropol. 2024 Oct 2;43(7):626-640. doi: 10.1080/01459740.2024.2410244. PMID: 39431902. ↥
Rossi (2012): ADHS-Buch, heute leider nicht mehr frei downloadbar, Seite 359 ↥
Tobia, Bonifacci, Bernabini, Marzocchi (2019): Teachers, not parents, are able to predict time processing skills in preschoolers. Br J Dev Psychol. 2019 Jul 2. doi: 10.1111/bjdp.12294. ↥
Barkley, Murphy, Bush (2001): Time perception and reproduction in young adults with attention deficit hyperactivity disorder. Neuropsychology. 2001 Jul;15(3):351-60. doi: 10.1037//0894-4105.15.3.351. PMID: 11499990. ↥
Walg, Oepen, Prior (2015): Adjustment of Time Perception in the Range of Seconds and Milliseconds: The Nature of Time-Processing Alterations in Children With ADHD. J Atten Disord. 2015 Sep;19(9):755-63. doi: 10.1177/1087054712454570. PMID: 22851208. n = 60 ↥
Smith, Taylor, Rogers Newman, Rubia (2002): Evidence for a pure time perception deficit in children with ADHD. J Child Psychol Psychiatry. 2002 May;43(4):529-42. n = 44 ↥
Toplak, Tannock (2002): Time perception: modality and duration effects in attention-deficit/hyperactivity disorder (ADHD). J Abnorm Child Psychol. 2005 Oct;33(5):639-54. ↥
Barkley, Edwards, Laneri, Fletcher, Metevia (2001): Executive functioning, temporal discounting, and sense of time in adolescents with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). J Abnorm Child Psychol. 2001 Dec;29(6):541-56. ↥
Kononowicz T, van Rijn H (2014): Tonic and phasic dopamine fluctuations as reflected in beta-power predict interval timing behavior. Procedia - Social and Behavioral Sciences 126 ( 2014 ) 47 doi: 10.1016/j.sbspro.2014.02.313 ScienceDirect ↥
Sword, Brunskill, Zimbardo (2014): Time Perspective Therapy: A New Time-Based Metaphor Therapy for PTSD, Journal of Loss and Trauma, 19:3, 197-201, DOI: 10.1080/15325024.2013.763632 ↥
Weissenberger, Klicperova-Baker, Zimbardo, Schonova, Akotia, Kostal, Goetz, Raboch, Ptacek (2016): ADHD and Present Hedonism: time perspective as a potential diagnostic and therapeutic tool. Neuropsychiatr Dis Treat. 2016 Nov 16;12:2963-2971. doi: 10.2147/NDT.S116721. PMID: 27895485; PMCID: PMC5118029. ↥
Gruber, Cunningham, Kirkland, Hay (2012): Feeling stuck in the present? Mania proneness and history associated with present-oriented time perspective. Emotion. 2012 Feb;12(1):13-7. doi: 10.1037/a0025062. PMID: 21910544. ↥
El Haj, Kapogiannis, Antoine (2020): The (fatalistic) present as experienced by individuals with Alzheimer’s disease: a preliminary study. Neurol Sci. 2020 Feb;41(2):427-433. doi: 10.1007/s10072-019-04121-w. PMID: 31713192., n = 63 ↥ ↥ ↥
Kent, van Doorn, Hohwy, Klein (2019): Bayes, time perception, and relativity: The central role of hopelessness. Conscious Cogn. 2019 Mar;69:70-80. doi: 10.1016/j.concog.2019.01.012. PMID: 30711789. ↥
El Haj, Kapogiannis, Antoine (2020): The (fatalistic) present as experienced by individuals with Alzheimer’s disease: a preliminary study. Neurol Sci. 2020 Feb;41(2):427-433. doi: 10.1007/s10072-019-04121-w. PMID: 31713192. ↥
Carelli, Wiberg (2012): Time out of mind: temporal perspective in adults with ADHD. J Atten Disord. 2012 Aug;16(6):460-6. doi: 10.1177/1087054711398861. PMID: 21490173., n = 90 ↥
Nigg JT (2013): Attention-deficit/hyperactivity disorder and adverse health outcomes. Clin Psychol Rev. 2013 Mar;33(2):215-28. doi: 10.1016/j.cpr.2012.11.005. PMID: 23298633; PMCID: PMC4322430. REVIEW ↥
M Bruton A, Levy L, Rai NK, Colgan DD, M Johnstone J (2025): Diminished Interoceptive Accuracy in Attention-Deficit/Hyperactivity Disorder: A Systematic Review. Psychophysiology. 2025 Feb;62(2):e14750. doi: 10.1111/psyp.14750. PMID: 39905593; PMCID: PMC11842156. REVIEW ↥
Kutscheidt, Dresler, Hudak, Barth, Blume, Ethofer, Fallgatter, Ehlis (2019): Interoceptive awareness in patients with attention-deficit/hyperactivity disorder (ADHD). Atten Defic Hyperact Disord. 2019 Apr 1. doi: 10.1007/s12402-019-00299-3. ↥
Martin E, Dourish CT, Higgs S (2023): Interoceptive accuracy mediates the longitudinal relationship between attention deficit hyperactivity disorder (ADHD) inattentive symptoms and disordered eating in a community sample. Physiol Behav. 2023 Sep 1;268:114220. doi: 10.1016/j.physbeh.2023.114220. PMID: 37142150. ↥