20. Regulatory problems with ADHD

Author: Ulrich Brennecke
Review: Dipl.-Psych. Waldemar Zdero

A number of ADHD symptoms are also described as regulatory problems.
Regulation problems or problems in self-regulation are therefore not a separate, additional symptom of ADHD, but describe a mechanism that occurs with various symptoms and is dependent on individual, situational and motivational aspects.

Attention problems in ADHD alternate between increased distractibility and increased difficulty in switching attentional focus when required. While the ability to pay attention is not impaired per se, there is a clear problem in that the regulation of attention is subject to a different regime, mode, profile: Attentional direction is more subject to direction by stimuli that are personally perceived as relevant, while extrinsic demands are more difficult to respond to than in non-affected individuals.
We perceive a similar pattern between procrastination (procrastination) for things that are perceived as uninteresting and increased impatience in relation to intrinsically desired things.

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

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

• Distractibility / task switching problems, hyperfocus
• Procrastination / impatience
  Postponing uninteresting or anxiety-inducing activities for as long as possible as opposed to the impatience typical of ADHD
• Lack of drive / aversion to inactivity
• Impulsiveness / decision-making problems
• Mood swings
  The change between rejoicing and being saddened to death

In addition, there are symptoms that could possibly be causal consequences rather than being linked to each other by regulatory problems:

• Self-esteem problems often go hand in hand with dysfunctional perfectionism. However, this is unlikely to be a regulatory problem. Dysfunctional perfectionism is more likely to be a consequence of self-esteem problems.
• Increased sensitivity / emotional and empathic weakness
  Lack of emotion (false alexithymia) could be a reaction or defense mechanism against the sensory overload caused by sensory overstimulation

Some symptom pairs are associated with the typical stress response phenotypes of ADHD-HI and ADHD-I rather than being regulatory problems.

Increased anxiety (in ADHD-I) and increased risk-taking (in ADHD-HI) do not appear to be a pair of symptoms that are linked intraindividually (within a person) by regulatory problems. These symptoms rather seem to be related to the respective stress phenotypes ADHD-HI / ADHD-C (as externalizing stress response phenotypes) and ADHD-I (as internalizing stress response phenotype). However, an anxiety disorder is apparently also said to increase the likelihood of increased risk behavior, although this was not confirmed by the data from the ADxS.org symptom test (see above).
The same is likely to apply to impulsive interference in the conversations of others (ADHD-HI) versus social withdrawal (ADHD-I).