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

Abstract

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.

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References

  • 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):325–333

    Google Scholar 

  • Barkley RA (1997) Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 121(1):65–94. https://doi.org/10.1037/0033-2909.121.1.65

    Article  PubMed  Google Scholar 

  • 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. https://doi.org/10.3389/fnhum.2016.00633

    Article  PubMed  PubMed Central  Google Scholar 

  • 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. https://doi.org/10.1016/j.bbr.2017.04.021

    Article  PubMed  Google Scholar 

  • 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. https://doi.org/10.1007/s00702-016-1513-x

    Article  Google Scholar 

  • 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):32–39

    Article  Google Scholar 

  • Cameron OG (2001) Interoception: the inside story—a model for psychosomatic processes. Psychosom Med 63(5):697–710

    CAS  Article  Google Scholar 

  • Ehlers A, Breuer P (1996) How good are patients with panic disorder at perceiving their heartbeats? Biol Psychol 42(1):165–182

    CAS  Article  Google Scholar 

  • 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. https://doi.org/10.1016/j.jpsychires.2007.11.011

    Article  PubMed  Google Scholar 

  • 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. https://doi.org/10.1503/jpn.170118

    Article  PubMed  Google Scholar 

  • Einthoven W (1901) Un nouveau galvanometre: Soc. Holl. des Sciences

  • 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. https://doi.org/10.1007/s12402-016-0208-3

    Article  PubMed  Google Scholar 

  • 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. https://doi.org/10.1177/1087054714554617

    Article  PubMed  Google Scholar 

  • 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):353–368

    Article  Google Scholar 

  • Hautzinger M, Keller F, Kühner C (2006) Beck Depressions-Inventar Revision. Hogrefe, Göttingen

    Google Scholar 

  • Heinrich H, Gevensleben H, Strehl U (2007) Annotation: neurofeedback–train your brain to train behaviour. J Child Psychol Psychiatry 48(1):3–16

    Article  Google Scholar 

  • 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):457–464

    Article  Google Scholar 

  • Hilbert A, Tuschen-Caffier B, Karwautz A, Niederhofer H, Munsch S (2007) Eating disorder examination-questionnaire. Diagnostica 53(3):144–154

    Article  Google Scholar 

  • 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. https://doi.org/10.3389/fnhum.2017.00425

    Article  PubMed  PubMed Central  Google Scholar 

  • Laux L, Glanzmann P, Schaffner P, Spielberger CD (1981) Das State-Trait-Angstinventar. Hogrefe, Göttingen

    Google Scholar 

  • Lehrl S (1999) Mehrfachwahl-Wortschatz-Intelligenztest: MWT-B: Spitta

  • 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):154–159

    Article  Google Scholar 

  • Meule A, Vögele C, Kübler A (2015) Psychometrische Evaluation der deutschen Barratt Impulsiveness Scale–Kurzversion (BIS-15). Diagnostica 3:126–133

    Google Scholar 

  • 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. https://doi.org/10.1177/1087054713513328

    Article  PubMed  Google Scholar 

  • 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. https://doi.org/10.1016/j.neuropsychologia.2012.09.036

    Article  PubMed  Google Scholar 

  • Pollatos O, Kirsch W, Schandry R (2005) On the relationship between interoceptive awareness, emotional experience, and brain processes. Cogn Brain Res 25(3):948–962

    Article  Google Scholar 

  • 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):381–388

    Article  Google Scholar 

  • Pollatos O, Traut-Mattausch E, Schandry R (2009) Differential effects of anxiety and depression on interoceptive accuracy. Depress Anxiety 26(2):167–173

    Article  Google Scholar 

  • 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. https://doi.org/10.1016/j.jaac.2012.11.012

    Article  Google Scholar 

  • Reid R, Trout AL, Schartz M (2005) Self-regulation interventions for children with attention deficit/hyperactivity disorder. Except Child 71(4):361–377

    Google Scholar 

  • 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. https://doi.org/10.1177/1087054705284244

    Article  PubMed  Google Scholar 

  • Rösler M, Retz-Junginger P, Retz W, Stieglitz RD (2008) Homburger ADHS-Skalen für Erwachsene: HASE. Hogrefe, Göttingen

    Google Scholar 

  • 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):285–293

    Article  Google Scholar 

  • Schandry R (1981) Heart beat perception and emotional experience. Psychophysiology 18(4):483–488

    CAS  Article  Google Scholar 

  • Shaw P, Stringaris A, Nigg J, Leibenluft E (2014) Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 171(3):276–293

    Article  Google Scholar 

  • 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):128–142

    CAS  Article  Google Scholar 

  • 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):278–286

    Article  Google Scholar 

  • Wender PH, Wolf LE, Wasserstein J (2001) Adults with ADHD. Ann N Y Acad Sci 931(1):1–16

    CAS  Article  Google Scholar 

  • Westby CE, Cutler SK (1994) Language and ADHD: understanding the bases and treatment of self-regulatory deficits. Top Lang Disord 14(4):58–76

    Article  Google Scholar 

  • 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. https://doi.org/10.1007/s00702-005-0276-6

    CAS  Article  Google Scholar 

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Correspondence to Thomas Dresler.

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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.

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

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This article is dedicated to the loving memory of Katrin Kutscheidt, who was killed in a road accident while attending the SFN conference 2015 in Chicago, USA. This article is based on her first unfinished draft which was later finalized by the co-authors.

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Kutscheidt, K., Dresler, T., Hudak, J. et al. Interoceptive awareness in patients with attention-deficit/hyperactivity disorder (ADHD). ADHD Atten Def Hyp Disord 11, 395–401 (2019). https://doi.org/10.1007/s12402-019-00299-3

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  • DOI: https://doi.org/10.1007/s12402-019-00299-3

Keywords

  • ADHD
  • Interoception
  • Interoceptive awareness
  • Self-regulation