What is Hyperfocus ADHD

Hyperfocus

ADHD does not mean that you basically cannot concentrate. The phases in which the concentration level is increased due to the stimulus (flow state) are sometimes interpreted as a special ability.

As Hyperfocus Russell Barkley describes a non-selectively controllable, flow-like and stimulus-dependent state of increased concentration in connection with ADHD. The phenomenon is viewed by some authors as a potential resource. Barkley, on the other hand, assumes that it is a pathological phenomenon in the sense of perseveration, which has a rather restrictive effect. Other authors such as Darius Kreutek assume a euphemization of manic or hypomanic phases in an existing bipolar disorder (ADHD misdiagnosis). The phenomenon has not yet been extensively investigated because it is not taken seriously by the scientific community. The first scientific studies on hyperfocus were published in 2013.[1]

Evaluation of the term

The term can be found predominantly in the advisory literature. While there is a short outline of the hyperfocus in Krause and Krause,[2] So far, there are only a few scientific debates on the phenomenon. There is a possibility that it is an artifact (bogus phenomenon).

phenomenology

Hyperfocus in the ADHD context (after Horlitz and Schütz)

If the person concerned succeeds in hyperfocusing, according to the hypothesis he is able to deal permanently with a topic or a work despite his attention deficit. According to the hypothesis, a prerequisite for the development of hyperfocus is a strong and sustained extrinsic or intrinsic, pleasurably anticipated stimulus. The structure of the hyperfocus depends on the situational level of motivation, which can be further strengthened by extrinsic motivation (praise, rewards, support). So far it is unclear whether the build-up of hyperfocus can be specifically provoked with the help of motivational learning strategies or external or internal stimuli.

The hyperfocus is phenomenological with the concept of the Flow-Condition comparable[3] or identical.

Perception and implications of the state

Those affected report that their condition usually feels positive for them. It describes a feeling of inner calm, focusedness (in contrast to other inner restlessness and fragmentation), concentration, clarity and well-being. Affected people describe in a positive sense that they are significantly more productive than usual in a state of hyperfocus. In a negative sense, those affected report that hyperfocusing on a topic can also lead to difficulties: In conversations with fellow human beings, one cannot distance oneself from this topic, it is difficult to mentally detach oneself from this topic. Leaving the hyperfocus and the associated activity often does not succeed, so that the change to another activity is difficult, which in everyday life can lead to time delays, delays and stress.

requirements

Horlitz and Schütz worked out four basic conditions that should promote the development of hyperfocus or the achievement of increased attentiveness in ADHD:[4]

Personal relevance:
The task to which the person concerned is facing has a high subjective relevance for them. It corresponds to the greatest interest of the person concerned and / or was chosen by the person concerned.

Exploratory character:
The activity is connected with discovering something new, whereby the person concerned is confronted with the unforeseen or has to orientate himself in a new subject area.

Dynamics / Complexity:
The problem / topic to be investigated or treated is difficult to understand and complex. Changeable contexts must be included, the expansion of knowledge must be taken into account.

creativity:
The aim of the task is to create something new, whereby the nature of what has been created plays a subordinate role. It can be a picture to be painted, a travel route to be structured, economic relationships or the development of new structures of knowledge.

autonomy:
The person concerned works independently. He makes content-related and organizational decisions himself.

Horlitz and Schütz also highlight the feeling of happiness associated with the phenomenon, which is also used for the FlowPhenomenon is described.

causes

Hypotheses on possible neurobiological causes

One of the possible causes of hyperfocus in ADHD sufferers is the spontaneous, stimulus-related influencing of brain metabolic processes, which would result in an endogenously induced exocytosis of various neurotransmitters and thus increased activation. When considering an unconditional stimulus-relatedness, the low arbitrary influenceability of the state becomes clear: the performance is higher for the moment, but the ability to control remains unchanged or even decreases.

Perseveration hypothesis

Russell Barkley evaluates the phenomenon of hyperfocus deficit-oriented as perseveratory or compulsive behavior and points out that such a form of hyperfocus does not mean any gain for those affected, but is an additional burden due to the continued limited ability to control[5]. This view is supported by the observation that ADHD sufferers often find it difficult to perform shifting services, even with a high level of concentration[6]. One example is a computer-playing teenager who is unable to interrupt his game despite the threat of an educational penalty.

Hyperfocus according to Hartmann's hunter / collector theory

Critics like Thom Hartmann suspect a genetic predisposition behind the phenomenon of hyperfocus, which can be traced back to the hunting instinct of the Stone Age hunter. → See also: Hunter / Farmer Theory.

Differentiation from hypomania / bipolar disorder

Recurring phases of increased drive and elevated mood can indicate comorbid hypomania, especially if they alternate with depressive episodes. ADHD, the hyperfocus phenomenon and the hypomanic phase show overlaps which are not always easy to differentiate. For hypomania, in addition to the excessively increased self-esteem and the conspicuous and inappropriate, cross-border sociability, an increased willingness to take risks is essential.[7] If the ADHD diagnosis is known, such abnormalities in the clinical picture should not be generally explained by “hyperfocusing”. The German Medical Association points out that ADHD and bipolar disorders are phenomenologically difficult or impossible to distinguish.[8]

Potential problems

The increased level of concentration - similar to the combination of ADHD / giftedness - can lead to false expectations in the environment if it is assumed that the person concerned simply does not want to devote himself to tasks that do not interest him. The discrepancy between the attention deficit and the sporadically increased level of concentration has the consequence that those affected are repeatedly confronted with the expectation that their level of performance is only linked to their will to perform (and not to their ability to perform). This is particularly stressful for those affected, as usually neither extrinsically nor intrinsically motivated efforts of will can contribute to a spontaneous increase in concentration and performance level. It is all the more important that the environment is informed in detail about the stress of the ADHD symptoms in order to prevent psychosocial stress and the resulting secondary diseases, such as depression. → See also: psychoeducation.

Hyperfocus as a potential resource

For those affected, the temporarily increased level of concentration can be advantageous, for example if they have the opportunity to work in a job where triggering stimuli are frequent. In contrast to the normal situation, those affected are more likely to manage and complete tasks carefully and independently.

therapy

Need for treatment

Differentiating the phenomena hyperfocus and perseveratory behavior is phenomenologically and etiologically problematic. Hyperfocus, which is seen in connection with ADHD - in contrast to perseveration in the autism context - is not a described component of the disorder. There are therefore no specific treatment recommendations for the ADHD context; the terms “hyperfocus” and “perseveration” are not mentioned in the current guidelines.[9]

Drug treatment options

For the treatment of problematic, perseveratory behavior, four preparations are currently being discussed, at least in the context of autism:[10]

The SSRI fluoxetine and fluvoxamine are postulated as drugs of first choice, provided the patient does not show any significant irritability or aggression. If so, consider starting with an atypical drug (such as risperidone) first. If there are no effects on the perseveratory symptoms below the maximum SSRI dose (non-response), an atypical can also be given. Risperidone has proven to be effective so far,[16] There is currently no conclusive evidence for other atypicals.

Various studies in recent years cast doubt on the effectiveness of SSRIs in the treatment of repetitive behavior in ASD.[17] In a meta-analysis by Carrasco et al. proved the effects of SSRIs on repetitive behavior - after adjustment for publication bias[18] - no more than significant.

criticism

Hyperfocus as a pseudo-phenomenon

Gerhard Lauth postulates that there is no general weakness in behavioral regulation in ADHD sufferers. Rather, those affected lack the opportunity to motivate themselves to be attentive for a longer period of time in very specific, appropriate situations that require specific conditions (deficit of selective attention).[19] Given this assumption, the hyperfocus phenomenon could be an artifact.

Hyperfocus, Flow State, or Hypomania?

Hans-Heiner Decker describes hyperfocusing as an unconscious, motivational increase in self-esteem. Avoiding activities that reduce self-esteem and focusing on interesting activities convey an artificial appreciation or preservation of self-esteem, which can be reinforced without threats and without external criticism.[20] The same is true for the concepts of the flow state, but also for hypomanic phases described in bipolar disorder. Darius Krützek assumes that the concept of hyperfocus as such does not exist, since there are sufficient alternative explanatory models that are not causally related to ADHD, but to other disorders (e.g. bipolar disorder, autism).

See also: Criticism and Controversy.

Comments from the department

  • Miriam Bachmann (2011): "The fact that a child sits 'highly concentrated' in front of the computer for hours does not speak against the diagnosis of [ADHD]."[21]

Studies and scientific publications

  • Ashinoff, Abu-Akel (2019): Hyperfocus: the forgotten frontier of attention (PDF, 853 KB)
  • Hupfeld, Abagis, Shah (2018): Living “in the zone”: hyperfocus in adult ADHD (PDF, 949 KB)
  • Sklar, R. (2013): Hyperfocus in adult ADHD: An EEG study of the differences in cortical activity in resting and arousal states
  • Anagnostou, E., Hollander, E. (2006): 4 drugs can improve autism's repetitive behaviors (PDF, 421 KB)

Movie and TV

See also

More interesting articles

Individual evidence

  1. ↑ https: //www.researchgate.net/publication/259681620_Hyperfocus_in_adult_ADHD_An_EEG_study_of_the_differences_in_cortical_activity_in_resting_and_arousal_states
  2. ^ Johanna Krause, Klaus-Henning Krause: ADHD in adulthood. 3rd complete act. and exp. Edition. Schattauer, Stuttgart 2009, ISBN 978-3-7945-2533-1, p. 64.
  3. ↑ Misdiagnosis and Dual Diagnoses Of Gifted Children And Adults: Adhd, Bipolar ...
  4. ↑ cf. all of the following Asbatz: Horlitz, T., Schütz, A. ADHD: Heaven and under pressure. P.43
  5. ↑ http: //users.phhp.ufl.edu/jhj/barkley.ppt
  6. ↑ http://priory.com/gloss.htm#perseveration
  7. ↑ http: //dr-elze.com/hypomanie
  8. ↑ https: //www.bundesaerztekammer.de/fileadmin/user_upload/downloads/ADHSLang.pdf
  9. ↑ https: //www.awmf.org/uploads/tx_szleitlinien/028-045k_S3_ADHS_2018-06.pdf
  10. ↑ https: //mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/0504CP_Article3.pdf
  11. ↑ Hollander E, Phillips A, Chaplin W, et al. A placebo-controlled cross over trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology 2005; 30: 582-9.
  12. ↑ McDougle CJ, Naylor ST, Cohen DJ, et al. A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder. Arch Gen Psychiatry 1996; 53: 1001-8.
  13. ↑ McCracken JT, McGough J, Shah B, et al. Research Units on Pediatric Psychopharmacology Autism Network. Risperidone in children with autism and serious behavioral problems. N Engl J Med 2002; 347: 314-21.
  14. ↑ McDougle CJ, Scahill L, Aman MG, et al. Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. Am J Psychiatry 2005; 162: 1142-8.
  15. ↑ Hollander E, Soorya LV, Wasserman S, et al. Divalproex sodium vs. placebo in the treatment of repetitive behaviors in autism spectrum disorder. Int J Neuropsychopharmacol 2006; 9: 209-13.
  16. ↑ McDougle CJ, Scahill L, Aman MG, et al. Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. Am J Psychiatry 2005; 162: 1142-8.
  17. ↑ https: //www.ncbi.nlm.nih.gov/pubmed/19487623/
  18. ↑ See: https://de.wikipedia.org/wiki/Publikationsbias
  19. ^ Gerhard W. Lauth, Peter F. Schlottke: Training with attention-deficient children. 6th, completely revised edition. Beltz, Weinheim 2009, ISBN 978-3-621-27675-7.
  20. ↑ http: //www.ads-praxis.de/erwachsene/erwachsene_kinder.html
  21. ↑ http: //www.praxis-drbachmann.de/media/HB-ADHS-ASS.Buchbeitrag.pdf