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9. Motivation problems in ADHD


9. Motivation problems in ADHD

Motivation is a readiness to act as an activating moment to achieve a certain goal. The conversion of motivation (readiness to act) to action takes place through the drive.1 Another definition of motivation is the process of initiating, controlling, and maintaining physical and mental activities, including the mechanisms for preferring an activity and controlling the strength and persistence of responses.2

Motivation problems of both intrinsic and extrinsic motivation are a typical symptom of ADHD.3

In our view, delay aversion, devaluation of later rewards, and procrastination of subjectively unimportant things can at the same time be an expression of a stress-related change in motivation and represent functional stress symptoms to combat an acute stressor: Now is the time to defend against danger, everything that can happen even later is unimportant for the time being. Everything that is important must be tackled immediately. Everything that is not so important that it absolutely must happen immediately can wait until the stressor is defeated.

9.1. Procrastination (procrastination)

9.1.1. Procrastination as an ADHD symptom

We consider procrastination as a consequence of the devaluation of more distant rewards (delay discounting). Procrastination could represent the antithesis of delay aversion in the sense of a regulation disorder.

9.1.2. Procrastination: not being able to get things done until the last minute

Not being able to get things done until the last minute is another description of procrastination. The explanation arises from the stress benefit of procrastination, that in existence-threatening stress, things that are not immediately necessary are faded out in order to direct the concentration to the things that are acutely important now. Those who can distinguish unimportant things from important ones in acute distress have a survival advantage. It was not so helpful in survival to admire the beautiful flowers at the roadside during the escape from the saber-toothed tiger or to want to take the ripe fruits from the bush behind as a supply for the winter.

The problem with ADHD is not a fundamentally wrong prioritization (in the sense of a general “technical” inability to do so), but an inappropriate prioritization program (stress reactions without adequate stressors). In ADHD sufferers, it is not the neurophysiological ability to distinguish important from unimportant that is impaired, but rather an emergency program is activated without there being an appropriate reason for this. This emergency program makes sense (for all higher organisms) in acute survival-threatening stress. In this case, the focus is shifted to the things that are important in the immediate here and now - everything else is blanked out or shifted.

The actual ability to concentrate and pay attention is not impaired in ADHD. It is the directability of attention that functions differently in affected persons than in non-affected persons.

9.1.3. Procrastination as a symptom of stress

Many sources, especially from management literature, report that procrastination causes stress via the time pressure it creates.
However, medical research shows that procrastination can also be a consequence of stress,4 although the correlation is somewhat weaker than that of anxiety, depression or fatigue.56

In our view, the evolutionary-biological stress benefit of procrastination is, as in the case of pleasure inability, a focus on the most important stressor. Less important things are devalued in their importance, the immediately important things are upgraded, as would be correct in survival-relevant situations. The evaluation of what is important and what is unimportant for one’s own survival must inevitably always be made by the affected living being itself. In survival-threatening situations, it is helpful to evaluate one’s own needs more strongly than the needs and requirements of others (extrinsic motives). Therefore, attention follows personal interests, while less interesting demands are devalued. See more at Stress utility-the survival-enhancing purpose of stress.
As a result, all things that do not have to be done right now as a matter of urgency will be perceived as less important and less worthwhile by stressed individuals and ADHD sufferers alike than by non-stressed individuals.
As a result, subjectively unpleasant things are postponed to a relatively greater extent and often only completed at the last minute - only then do they slip into the focus shifted to the here and now due to stress. By then, they are too far away to be interesting.
Strong stress says: survive now - enjoy and recover later.
In a healthy (short-term) stress response, this is correct and helpful.

9.2. Delay Discounting / Reward Discounting

Other names of “Delay Discounting” are “Temporal Discounting”, “Intertemporal Choice” or “Impulsive Choice”.7

Devaluation of later rewards / delay discounting can be seen as a reversal of delay aversion (aversion to waiting, impatience). Both can be seen as an expression of a stress-related change in motivation. One review considers Delay Discounting as a subtype of Impulsivity.8 The core message is: Survival is now. Now is the time to defend against relevant threats; anything later is currently unimportant. Everything that is important must happen immediately, Everything that is not so important that it does not need to happen immediately can wait until the stressor is defeated.

9.2.1. Devaluation of later reward as ADHD symptom

ADHD sufferers typically suffer from reward deferral aversion: preferring a smaller reward immediately rather than the larger reward later.9108

For everyone, immediate rewards are intuitively more rewarding than later rewards. However, the decrease in the value of later, delayed rewards is significantly higher for ADHD sufferers than for nonaffected individuals. While immediate rewards are valued by ADHD sufferers in the same way as by nonaffected individuals, ADHD sufferers value later-occurring rewards as significantly lower or less attractive than nonaffected individuals.

ADHD sufferers therefore show significantly weaker motivation from rewards that lie in the future. There is a stronger incentive from immediately available rewards.

Manifestations of preference for immediate reward / devaluation of delayed reward are:

  • Addiction problems

Addiction and pursuit of immediate reward

The stronger incentive of immediate reward seems to be related to an addictive affinity.
ADHD sufferers may have significantly fewer dopamine D2 and D3 receptors in the brain’s reinforcement center (the striatum) than non-affected individuals. In one study, the number of these receptors correlated with attention: the fewer D2 and D3 receptors in the reward center, the lower the attention capacity of those affected.11 Attention problems could then have the same cause as the problems of the reward system.
In contrast, another study suggests increased D2 receptor density in the striatum in ADHD sufferers.12

  • Procrastination
    Devaluing tasks that are not immediately important is a related response.

9.2.2. Devaluation of later reward as a symptom of stress

Also called Discounting of Delayed Rewards or Temporal Discounting13141516

Rewards that are immediate are valued by stress sufferers in the same way as by people without stress.
Rewards that are more distant in time are considered even less attractive than by people without stress.


  • Procrastination
  • Addictive tendencies
  • Clutter
  • Poorer ability to self-regulate
    • Self-regulatory ability is an even better predictor of career success than intelligence

Addiction problems are closely related to the preference for immediate reward. Addiction problems are typical stress symptoms

  • Drug / nicotine / alcohol abuse (addiction)1718
  • Smoking correlates with stress14

9.3. Delay Aversion (Delay Aversion)

Delay aversion can be described as the mirror image of delay discounting and the antithesis of procrastination in the sense of a regulatory disorder.
Delay aversion occurs in both children and adults with ADHD. Delay aversion is a temporally persistent motivational deficit that can be reduced or eliminated by increased subjective motivational incentives.19

9.3.1. Delay aversion in ADHD Impatience; waiting is perceived as unpleasant
  • When others are slow to understand, it drives them crazy
  • Parents get upset when their kids are slow to understand homework20
  • Tasks are started without first listening to the instructions or reading the manual.
    This is one of the 9 most common symptoms of ADHD in adults21
    • Operating instructions before commissioning equipment are read diagonally at best
    • Assembly instructions for furniture are read reluctantly
  • Particularly strong aversion to traffic jams, queues; up to the point that these can make aggressive,20 whereby the latter should probably concern the ADHD-I subtype less
  • Difficulty waiting for your turn
  • Inner restlessness, when one is not supposed to act oneself, but to accompany the actions of others
    • E.g. tendency to perform tasks of others by oneself instead of letting them do it (possibly slower / worse, because learning first)
  • Tendency to interrupt others
  • Answers are made before question has been heard to the end
  • Exuberant ideas need to be communicated quickly before they are in danger of being forgotten20
  • Drive faster than others20
    This is also one of the 9 most accurate symptoms of ADHD in adults.21

Note: These behaviors are also found in sufferers of e.g. acute (hypo)mania, narcissistic or obsessive-compulsive personality disorder.

  • The fact that boredom is perceived as extremely unpleasant is more likely to be due to dysphoria in inactivity

9.3.2. Correlation of delay aversion with other symptoms

Based on current data from the ADxS symptom test (June 2020, n = 1,889), delay aversion does not appear to result solely from an inhibition issue as it underlies impulsivity, but correlates significantly more strongly with Inner Restlessness and Frustration Intolerance than with Impulsivity and than Impulsivity with these. Similarly, the correlation with emotional dysregulation seems elevated compared to impulsivity
Interestingly, the correlation of procrastination aversion to procrastination seems considerably lower than to impulsivity and the correlation of procrastination to impulsivity equal to that to procrastination aversion.

Symptoms delay aversion/impatience impulsivity
Inner restlessness 0.85 0.69
Frustration Intolerance 0.79 0.57
Impulsivity 0.67
Delay aversion/impatience 0.67
Reward deferral problems 0.58 0.46
Inability to recover 0.57 0.45
Inattention 0.56 0.53
Hyperactivity 0.55 0.59
increased sensitivity 0.53 0.43
Rejection Sensitivity 0.53 0.41
Procrastination 0.34 0.34

As of June 2020. n = 1,889- The values given reflect the correlation of symptoms relative to each other.This is a non-validated online self-test (screening).

9.3.2. Delay aversion as a symptom of stress

Delay aversion is also understood as an impulsivity response. It correlates with impulsivity under stress, in women at the same time with increasing heart rate.2223

Stress-reducing measures simultaneously reduce delay aversion.13

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

  2. Zimbardo (2004): Psychologie, zitiert nach Mayer: Glossar Psychiatrie / Psychosomatik / Psychotherapie / Neurologie / Neuropsychologie: Motivation

  3. Smith, Langberg, Cusick, Green, Becker (2019): Academic Motivation Deficits in Adolescents with ADHD and Associations with Academic Functioning. J Abnorm Child Psychol. 2019 Nov 18. doi: 10.1007/s10802-019-00601-x.

  4. Kim, Hong, Lee, Hyun (2017): Effects of time perspective and self-control on procrastination and Internet addiction. J Behav Addict. 2017;6(2):229-236. doi:10.1556/2006.6.2017.017

  5. Klein, Brähler, Dreier, Reinecke, Müller, Schmutzer, Wölfling, Beutel (2016): The German version of the Perceived Stress Scale – psychometric characteristics in a representative German community sample. BMC Psychiatry. 2016 May 23;16:159. doi: 10.1186/s12888-016-0875-9. PMID: 27216151; PMCID: PMC4877813.

  6. Beutel, Klein, Aufenanger, Brähler, Dreier, Müller, Quiring, Reinecke, Schmutzer, Stark, Wölfling (2016); Procrastination, Distress and Life Satisfaction across the Age Range – A German Representative Community Study. PLoS One. 2016 Feb 12;11(2):e0148054. doi: 10.1371/journal.pone.0148054. PMID: 26871572; PMCID: PMC4752450.

  7. Mitchell (2019): Linking Delay Discounting and Substance Use Disorders: Genotypes and Phenotypes. Perspect Behav Sci. 2019 Jul 10;42(3):419-432. doi: 10.1007/s40614-019-00218-x. PMID: 31976442; PMCID: PMC6768927.

  8. Levitt, Sanchez-Roige, Palmer, MacKillop (2020): Steep Discounting of Future Rewards as an Impulsivity Phenotype: A Concise Review. Curr Top Behav Neurosci. 2020;47:113-138. doi: 10.1007/7854_2020_128. PMID: 32236897.

  9. de Castro Paiva, de Souza Costa, Malloy-Diniz, Marques de Miranda, Jardim de Paula (2019). Temporal Reward Discounting in Children with Attention Deficit/Hyperactivity Disorder (ADHD), and Children with Autism Spectrum Disorder (ASD): A Systematic Review. Dev Neuropsychol. 2019 Sep;44(6):468-480. doi: 10.1080/87565641.2019.1667996. REVIEW

  10. Yu, Sonuga-Barke, Liu (2018): Preference for Smaller Sooner Over Larger Later Rewards in ADHD: Contribution of Delay Duration and Paradigm Type. J Atten Disord. 2018 Aug;22(10):984-993. doi: 10.1177/1087054715570390. Epub 2015 Feb 11. PMID: 25672671.

  11. Volkow, Wang, Newcorn, Kollins, Wigal, Telang, Fowler, Goldstein, Klein, Logan, Wong, Swanson (2011): Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway; Mol Psychiatry. 2011 Nov;16(11):1147-54. doi: 10.1038/mp.2010.97.

  12. Ilgin, Senol, Gucuyener, Gokcora, Sener (2001): Is increased D2 receptor availability associated with response to stimulant medication in ADHD. Dev Med Child Neurol. 2001 Nov;43(11):755-60. n = 9

  13. Buhusi, Olsen, Yang, Buhusi (2016): Stress-Induced Executive Dysfunction in GDNF-Deficient Mice, A Mouse Model of Parkinsonism. Front Behav Neurosci. 2016 Jun 21;10:114. doi: 10.3389/fnbeh.2016.00114. eCollection 2016

  14. Fields, Leraas, Collins, Reynolds (2009): Delay discounting as a mediator of the relationship between perceived stress and cigarette smoking status in adolescents.Behav Pharmacol. 2009 Sep;20(5-6):455-60. doi: 10.1097/FBP.0b013e328330dcff

  15. Braun, Helmeke, Poeggel, Bock (2005): Tierexperimentelle Befunde zu den hirnstrukturellen Folgen früher Stresserfahrungen. In: Egle, Hoffmann, Joraschky (Hrsg.) Sexueller Missbrauch, Misshandlung, Vernachlässigung. 3. Aufl, S. 44 – 58

  16. Eckerle (2010): Neurobiologische Forschungsergebnisse über den Zusammenhang zwischen Hochbegabung und psychischen Störungen (z.B. ADS) in der Adoleszenz.

  17. Hebold, 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

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

  19. Marx (2014): Das Konzept der Verzögerungsaversion bei Personen mit einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) – Entwicklungsaspekte, Bedingungsfaktoren und differentialdiagnostische Befunde. Dissertation.

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

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

  22. Diller, Patros, Prentice (2011): Temporal discounting and heart rate reactivity to stress. PR.Behav Processes. 2011 Jul;87(3):306-9. doi: 10.1016/j.beproc.2011.05.001.

  23. da MattaI, GonçalvesIIi, BizarroI (2012): Delay discounting: concepts and measures; Psychology & Neuroscience; On-line version ISSN 1983-3288; Psychol. Neurosci. vol.5 no.2 Rio de Janeiro July/Dec. 2012

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