20. Regulation problems in ADHD

Several ADHD symptoms are also described as regulation problems.
Regulation problems are therefore not a separate, additional symptom of ADHD, but describe a mechanism that occurs with different symptoms.

Attention problems in ADHD alternate between increased distractibility and increased difficulty switching attentional focus when needed. While attentional capacity per se is not impaired, a distinct problem is that the regulation of attention is subject to a different regime, mode, profile: Attentional focus is more subject to being guided by stimuli that are personally perceived as relevant, while extrinsic demands are more difficult to respond to than in unaffected individuals.

Perceptual problems combine the increased sensitivity that is almost immanent in ADHD with a partial empathy deficit that often exists at the same time, which can be a defense mechanism against excessive demands and stimulus overload.

Examples of symptom pairs that could be linked by regulatory problems:

• Mood swings
  The alternation between high as heaven and sad to death
• Procrastination / Impatience
  Putting off uninteresting or anxiety-provoking activities for as long as possible versus the impatience typical of ADHD
• Listlessness / aversion to inactivity
• Impulsivity / decision-making problems

In addition, there are symptoms that may be causal consequences rather than being interconnected by regulatory problems:

• Self-esteem problems are often accompanied by dysfunctional perfectionism. However, this is not likely to be a regulatory problem, but rather a causal consequence of the self-esteem problems.
• Increased sensitivity / weakness of feeling and empathy
  Lack of emotion (spurious alexithymia) could be a reaction or defense mechanism against sensation-induced stimulus overload

Some symptom pairs are more likely to be typical stress response phenotypes of ADHD-HI and ADHD-I than regulatory problems.

• Increased anxiety (in ADHD-I) and increased risk-taking (in ADHD-HI) do not appear to be a pair of symptoms linked by regulation problems. Rather, these symptoms appear to be associated with the respective stress phenotypes of ADHD-HI (as an externalizing stress response phenotype) and ADHD-I (as an internalizing stress response phenotype). However, an anxiety disorder is apparently also said to increase the likelihood of increased risk behaviors, although this was not confirmed by the ADxS.org symptom test data (see above).
• The same is likely to be true for impulsive interference in conversations of others (ADHD-HI) versus social withdrawal (ADHD-I).