Research Article: Interoceptive awareness in attention deficit hyperactivity disorder

Date Published: October 12, 2018

Publisher: Public Library of Science

Author(s): Jan R. Wiersema, Elke Godefroid, Jane Elizabeth Aspell.


ADHD is considered a disorder of self-regulation. Recent research has shown that awareness of bodily states, referred to as interoceptive awareness, crucially contributes to self-regulatory processes. Impaired self-regulation in ADHD has been explained in terms of arousal regulation deficits in ADHD (the state regulation deficit (SRD) account). There is now ample support for the SRD account, however the exact reason for arousal regulation difficulties is not yet known. The SRD account explicitly refers to the ability to monitor one’s momentary bodily state as a prerequisite for effective state regulation. However, surprisingly, no study to date has tested the ability to become aware of bodily signals, i.e. interoceptive awareness, in ADHD. In the current study, we therefore compared interoceptive awareness between 24 adults with ADHD and 23 controls by means of both an objective (heartbeat perception task) and subjective measure (questionnaire) of interoceptive awareness. Results revealed a strikingly similar performance for both groups on both measures, suggesting preserved interoceptive awareness in adult ADHD.

Partial Text

Attention-deficit/hyperactivity disorder (ADHD) [1] is a common neurodevelopmental disorder characterized by symptoms of inattention, and/or hyperactivity and impulsivity, which often persists into adulthood [2,3]. ADHD leads to impairments in social and cognitive functioning in an array of settings. Several etiological models have been introduced in the literature and although they all have their own focus, they have in common that they consider ADHD as a disorder of self-regulation, comprising dysregulation of behavior, cognition, and emotions [4–8].

As information regarding the momentary bodily state is of crucial importance for effective self-regulation, and in particular state regulation, ADHD may be associated with lower IA. Surprisingly, this hypothesis has not yet been tested. The aim of the present study was thus to investigate IA in adult ADHD by means of an objective and subjective measure. The heartbeat perception task was administered to gain an objective measure of IA, while a questionnaire was used (the awareness subscale of the BPQ) to assess a self-report measure of IA. Performance on the heartbeat perception task was strikingly similar in adults with ADHD compared to healthy controls. Moreover, adults with ADHD and typically developed adults also did not differ on the self-report measure of IA. Findings therefore suggest preserved monitoring of bodily state in adult ADHD, which tentatively suggests that the state regulation deficit and related self-regulatory difficulties in ADHD may not be due to an inability to monitor the current bodily state.




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