Interoceptive awareness in patients with attention-deficit/hyperactivity disorder (ADHD)

  • Katrin Kutscheidt
  • Thomas DreslerEmail author
  • Justin Hudak
  • Beatrix Barth
  • Friederike Blume
  • Thomas Ethofer
  • Andreas J. Fallgatter
  • Ann-Christine Ehlis
Original Article


Attention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric disorder normally diagnosed in childhood and persisting into adulthood in up to two-thirds of the patients. Its core symptoms comprise inattention and hyperactive–impulsive behaviours. Several studies suggest that patients with ADHD show alterations in self-regulation and self-monitoring. So far, it has not been described whether these deficits also affect the awareness of one’s own bodily signals, that is, interoceptive awareness. To investigate possible alterations in interoceptive awareness, 14 adult patients with ADHD and 16 healthy controls performed a heartbeat detection task, in which they had to count their heartbeat without any external help (e.g. visualization on a screen). As an indicator of the individual interoceptive awareness ability, a score based on the comparison between recorded and counted heart beats was calculated. Our results showed that patients with ADHD performed significantly worse on this task than controls, which indicates that they were less aware of internal bodily signals while additionally experiencing deficits in regulating and monitoring their own (overt) behaviours.


ADHD Interoception Interoceptive awareness Self-regulation 


Compliance with ethical standards

Conflict of interest

The authors declare that they do not have any conflicts of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. Axelrod MI, Zhe EJ, Haugen KA, Klein JA (2009) Self-management of on-task homework behavior: a promising strategy for adolescents with attention and behavior problems. Sch Psychol Rev 38(3):325–333Google Scholar
  2. Barkley RA (1997) Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 121(1):65–94. Google Scholar
  3. Barth B, Strehl U, Fallgatter AJ, Ehlis AC (2016) Near-infrared spectroscopy based neurofeedback of prefrontal cortex activity: a proof-of-concept study. Front Hum Neurosci 10:633. Google Scholar
  4. Barth B, Mayer K, Strehl U, Fallgatter AJ, Ehlis AC (2017) EMG biofeedback training in adult attention-deficit/hyperactivity disorder: an active (control) training? Behav Brain Res 329:58–66. Google Scholar
  5. Bisch J, Kreifelts B, Bretscher J, Wildgruber D, Fallgatter A, Ethofer T (2016) Emotion perception in adult attention-deficit hyperactivity disorder. J Neural Transm (Vienna) 123(8):961–970. Google Scholar
  6. Bohus M, Kleindienst N, Limberger MF, Stieglitz R-D, Domsalla M, Chapman AL, Steil R, Philipsen A, Wolf M (2009) The short version of the Borderline Symptom List (BSL-23): development and initial data on psychometric properties. Psychopathology 42(1):32–39Google Scholar
  7. Cameron OG (2001) Interoception: the inside story—a model for psychosomatic processes. Psychosom Med 63(5):697–710Google Scholar
  8. Ehlers A, Breuer P (1996) How good are patients with panic disorder at perceiving their heartbeats? Biol Psychol 42(1):165–182Google Scholar
  9. Ehlis A-C, Baehne CG, Jacob CP, Herrmann MJ, Fallgatter AJ (2008) Reduced lateral prefrontal activation in adult patients with attention-deficit/hyperactivity disorder (ADHD) during a working memory task: a functional near-infrared spectroscopy (fNIRS) study. J Psychiatr Res 42(13):1060–1067. Google Scholar
  10. Ehlis A-C, Deppermann S, Fallgatter AJ (2018) Performance monitoring and post-error adjustments in adults with attention-deficit/hyperactivity disorder: an EEG analysis. J Psychiatry Neurosci 43(5):170118. Google Scholar
  11. Einthoven W (1901) Un nouveau galvanometre: Soc. Holl. des SciencesGoogle Scholar
  12. Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Borges G, de Girolamo G, Florescu S, Gureje O, Collaborators WHOWMHS (2017) The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Atten Defic Hyperact Disord 9(1):47–65. Google Scholar
  13. Giacobini M, Medin E, Ahnemark E, Russo LJ, Carlqvist P (2018) Prevalence, patient characteristics, and pharmacological treatment of children, adolescents, and adults diagnosed with ADHD in Sweden. J Atten Disord 22(1):3–13. Google Scholar
  14. Hartmann AS, Rief W, Hilbert A (2011) Psychometric properties of the GERMAN version of the Barratt Impulsiveness Scale, Version 11 (BIS-11) for adolescents 1, 2. Percept Mot Skills 112(2):353–368Google Scholar
  15. Hautzinger M, Keller F, Kühner C (2006) Beck Depressions-Inventar Revision. Hogrefe, GöttingenGoogle Scholar
  16. Heinrich H, Gevensleben H, Strehl U (2007) Annotation: neurofeedback–train your brain to train behaviour. J Child Psychol Psychiatry 48(1):3–16Google Scholar
  17. Herrmann MJ, Mader K, Schreppel T, Jacob C, Heine M, Boreatti-Hümmer A, Ehlis AC, Scheuerpflug P, Pauli P, Fallgatter AJ (2010) Neural correlates of performance monitoring in adult patients with attention deficit hyperactivity disorder (ADHD). World J Biol Psychiatry 11(2–2):457–464Google Scholar
  18. Hilbert A, Tuschen-Caffier B, Karwautz A, Niederhofer H, Munsch S (2007) Eating disorder examination-questionnaire. Diagnostica 53(3):144–154Google Scholar
  19. Hudak J, Blume F, Dresler T, Haeussinger FB, Renner TJ, Fallgatter AJ, Gawrilow C, Ehlis AC (2017) Near-infrared spectroscopy-based frontal lobe neurofeedback integrated in virtual reality modulates brain and behavior in highly impulsive adults. Front Hum Neurosci 11:425. Google Scholar
  20. Laux L, Glanzmann P, Schaffner P, Spielberger CD (1981) Das State-Trait-Angstinventar. Hogrefe, GöttingenGoogle Scholar
  21. Lehrl S (1999) Mehrfachwahl-Wortschatz-Intelligenztest: MWT-B: SpittaGoogle Scholar
  22. Matthias E, Schandry R, Duschek S, Pollatos O (2009) On the relationship between interoceptive awareness and the attentional processing of visual stimuli. Int J Psychophysiol 72(2):154–159Google Scholar
  23. Meule A, Vögele C, Kübler A (2015) Psychometrische Evaluation der deutschen Barratt Impulsiveness Scale–Kurzversion (BIS-15). Diagnostica 3:126–133Google Scholar
  24. Mitchell JT, McIntyre EM, English JS, Dennis MF, Beckham JC, Kollins SH (2017) A pilot trial of mindfulness meditation training for ADHD in adulthood: impact on core symptoms, executive functioning, and emotion dysregulation. J Atten Disord 21(13):1105–1120. Google Scholar
  25. Noreika V, Falter CM, Rubia K (2013) Timing deficits in attention-deficit/hyperactivity disorder (ADHD): evidence from neurocognitive and neuroimaging studies. Neuropsychologia 51(2):235–266. Google Scholar
  26. Pollatos O, Kirsch W, Schandry R (2005) On the relationship between interoceptive awareness, emotional experience, and brain processes. Cogn Brain Res 25(3):948–962Google Scholar
  27. Pollatos O, Kurz A-L, Albrecht J, Schreder T, Kleemann AM, Schöpf V, Kopietz R, Wiesmann M, Schandry R (2008) Reduced perception of bodily signals in anorexia nervosa. Eat Behav 9(4):381–388Google Scholar
  28. Pollatos O, Traut-Mattausch E, Schandry R (2009) Differential effects of anxiety and depression on interoceptive accuracy. Depress Anxiety 26(2):167–173Google Scholar
  29. Ramos Olazagasti MA, Klein RG, Mannuzza S, Belsky ER, Hutchison JA, Lashua-Shriftman EC, Castellanos FX (2013) Does childhood attention-deficit/hyperactivity disorder predict risk-taking and medical illnesses in adulthood? J Am Acad Child Adolesc Psychiatry 52(2):153–162. Google Scholar
  30. Reid R, Trout AL, Schartz M (2005) Self-regulation interventions for children with attention deficit/hyperactivity disorder. Except Child 71(4):361–377Google Scholar
  31. Richards TL, Deffenbacher JL, Rosen LA, Barkley RA, Rodricks T (2006) Driving anger and driving behavior in adults with ADHD. J Atten Disord 10(1):54–64. Google Scholar
  32. Rösler M, Retz-Junginger P, Retz W, Stieglitz RD (2008) Homburger ADHS-Skalen für Erwachsene: HASE. Hogrefe, GöttingenGoogle Scholar
  33. Schachar RJ, Chen S, Logan GD, Ornstein TJ, Crosbie J, Ickowicz A, Pakulak A (2004) Evidence for an error monitoring deficit in attention deficit hyperactivity disorder. J Abnorm Child Psychol 32(3):285–293Google Scholar
  34. Schandry R (1981) Heart beat perception and emotional experience. Psychophysiology 18(4):483–488Google Scholar
  35. Shaw P, Stringaris A, Nigg J, Leibenluft E (2014) Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 171(3):276–293Google Scholar
  36. Singh SD, Ellis CR, Winton AS, Singh NN, Leung JP, Oswald DP (1998) Recognition of facial expressions of emotion by children with attention-deficit hyperactivity disorder. Behav Modif 22(2):128–142Google Scholar
  37. Sueyoshi T, Sugimoto F, Katayama JI, Fukushima H (2014) Neural correlates of error processing reflect individual differences in interoceptive sensitivity. Int J Psychophysiol 94(3):278–286Google Scholar
  38. Wender PH, Wolf LE, Wasserstein J (2001) Adults with ADHD. Ann N Y Acad Sci 931(1):1–16Google Scholar
  39. Westby CE, Cutler SK (1994) Language and ADHD: understanding the bases and treatment of self-regulatory deficits. Top Lang Disord 14(4):58–76Google Scholar
  40. Wiersema JR, van der Meere JJ, Roeyers H (2005) ERP correlates of impaired error monitoring in children with ADHD. J Neural Transm (Vienna) 112(10):1417–1430. Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Katrin Kutscheidt
    • 1
    • 2
  • Thomas Dresler
    • 1
    • 3
    Email author
  • Justin Hudak
    • 1
    • 3
  • Beatrix Barth
    • 1
    • 4
  • Friederike Blume
    • 3
    • 5
  • Thomas Ethofer
    • 1
  • Andreas J. Fallgatter
    • 1
    • 3
    • 6
  • Ann-Christine Ehlis
    • 1
    • 3
  1. 1.Department of Psychiatry and PsychotherapyUniversity Hospital TübingenTübingenGermany
  2. 2.International Max Planck Research School (IMPRS)TübingenGermany
  3. 3.LEAD Graduate School & Research NetworkTübingenGermany
  4. 4.Graduate School of Neural and Behavioral SciencesUniversity of TübingenTübingenGermany
  5. 5.Department of Psychology, School PsychologyUniversity of TübingenTübingenGermany
  6. 6.Centre for Integrative NeuroscienceTübingenGermany

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