ADHD research recap: Motivation, procrastination and the childhood experience

Hi, we are the ADHD Skills Lab podcast. My name is Skye. And my name is Sarah. And we will be your hosts, chatting to you about practical ADHD strategies you can use, the research behind some of these strategies, as well as interviewing other professionals with ADHD about how they've developed skills and working through struggles in their lives. You might know us from Unconventional Organization, where we talk about this kind of stuff all day long. So we're super excited to have you along and we're going to chat through it together.

Hi everyone. So this week we're actually starting and we've had a conversation for an hour prior to this conversation because we've been looking into a lot of different pieces of research today and looking at all around the idea of motivation and what drives us with ADHD.

Using the temporal motivation theory to explain the relation between ADHD and procrastination

And I wanted to start specifically with a paper that talks a little bit about temporal motivation theory which we will describe. for you in a second because we had to figure it out ourselves, and the relation between ADHD and procrastination. People trying to delve into this concept of ADHD and procrastination. Let's dive into what this paper is. This paper is from the Australian psychologist. Shout out to those people in Australia, it's close to where I live. Using the temporal motivation theory to explain the relation between ADHD and procrastination. And they did find some interesting significance. Do you want to talk a little bit about what they were looking for, Sarah? So, yeah, as Sky pointed out, they're just looking for a sort of a correlation between procrastination and ADHD, looking specifically at how certain motivational factors explain this relationship. What they did was basically a convenience sample. They did some scouting at a university, put out a blast on social media. They wound up with 202 adults, pretty wide range in age. and they had them complete an online survey. They were doing self-report scales for demographics, ADHD symptoms. There was a procrastination scale, which was interesting. They did do self-reports for procrastination? Yes. Again, we always want to flag how they figured out who has ADHD as well. It was a self-report. Do you have ADHD basically? Yes, that's correct. Yeah, and then there was also a piece about their three factors. your motivation framework? Yeah. So we should start by saying, okay, what is this? It's called Steel's Temporal Motivation Theory or TMT. What they essentially wanted to know was, okay, we pretty much know there's an association between ADHD and procrastination, but is anything mediating that? This is kind of interesting because we talk about this a lot in our own coaching. People call it the wall of awful, or they call it being stuck or feeling like nothing's happening and you're procrastinating. And then we often talk about breaking that down, what's going on inside that space. And that's essentially what they wanted to know as well. What's going on inside that space. And they use this motivation theory, which I will link to the article and you can have a look for yourself to see. if this was something that they used to figure out what was going on inside ADHD motivation. So do you want to tell us what all the bits mean, Sarah? So it's set up like a formula, but I'm just going to basically say that procrastination is more likely when people feel like they're not going to be able to finish, when they feel like the task is boring, and when they struggle to delay gratification. Yeah. So basically they struggled if something takes time to finish, like if it's a month long project or it's going to require many, many steps, it can't be done today. Right. And in our conversation of going through this Steels model, we came across some really interesting speed bumps. Very quickly, impulsiveness in my brain already has a meaning, right? But in this formula, impulsiveness refers to an individual's sensitivity to delay. And delay is the time it takes to complete a task. So basically, your impulsivity score will be higher if you have sort of like an intolerance to tasks that take a long time. Which is different from how you would describe it if you were getting diagnosed for ADHD or how you would describe it if we were looking at it in terms of a brain scan. So we had to go in and basically go, okay, all of these words that we connect to certain things have a different meaning in this particular theory. Got a lot of research. That was the fun part. Yeah, I mean, it's always fun when someone comes along with a totally different theory. And then the other one that we'll talk about was measuring border. They also measured the concept of task aversiveness, which is essentially how boring this is and how much you don't want to do boring things. Which is interesting because, again, coming to different ways to say different things, if we were talking about this in a coaching perspective, we would talk about task aversiveness as being like something which you might have for an emotional reason. It's interesting to just make a note. emotional regulation is kind of missing from this theory. And you can kind of see it because it is for a lot of people and a lot of research, a big factor behind procrastination. But it's not really discussed here. And so I just want to flag that in the conversation. Yeah, that's a really good shout because it's super important when sort of taking this research findings into consideration. Yes. So in terms of what they found, They did find and they've got a really cool little image on page five. If you find and read this article, the ADHD symptoms, whether you reported that you had ADHD were associated with procrastination. And then if you want to see if there was a mediating influence, so basically was there something that was a significant, significantly predicted kind of the connection between ADHD and procrastination expectancy did. So whether you expected to actually succeed at something did affect whether you were going to procrastinate on it. So essentially if somebody expected to succeed, they were less likely to procrastinate on it. And if they didn't expect to succeed, they were more likely to procrastinate on it. Again, this is very close to emotional dysregulation. And that's why I'm just flagging that because it is something that we would often talk about in coaching in that kind of space. Then they looked at impulsiveness and we just described what that means. So like how sensitive. Are you to delay if something's going to take you a week? Are you like, I'm not interested? If something's going to take you a month, are you like, I'm not interested? A version of, I guess, the Marshmallow Test, for those of you who know about that. And they found, again, there was a significant connection between them. However, how boring a task was, or task aversiveness was not connected to procrastination. So according to this one study, It didn't matter how boring the task was, it mattered if the task was something you thought that you were going to succeed at, and if you was the kind of person who could wait it out to get to that success. Those were the things that were going to help your procrastination, and if it was the opposite, those were the things that were going to make you procrastinate more. It was interesting. Obviously, this is one paper, one study, self-reported, all that kind of thing. But Sarah, what did you think about that in terms of what this could mean for ADHD and procrastination? Because... For me, it was kind of connected to the idea of we should be looking behind procrastination. And this is kind of one example of that. Yeah, I kind of feel like this is missing something. It might be that emotional piece behind, you know, our ability to do things is mediated by, you know, our emotional regulation abilities. But, you know, I think this is a really great study in that we just don't have a lot of literature around. ADHD and procrastination specifically, which is really interesting because it's such a challenge for so many of us. Yeah. Well, I think a lot of the literature is like, do we procrastinate? Yes, we do. Yeah. And it's like, we know. But like, why? Yeah. I mean, and going after that, why is going to help us sort of target more treatments and develop more strategies. You sort of have to know the root cause in order to... attack it. You pull the weed from the root, I don't know, for another metaphor. Yeah, well, you need to kind of figure out what's going on in the wall if you're going to break it down. And this is something that we often do in coaching. We're always sort of going like, okay, that didn't happen. Like, let's talk about why. Because there's often a very good why. They don't really talk about it here, but the why is often something to do with executive functioning. There is some element of my hot or cold executive functioning, you know, that emotional side or that cognitive side that is affecting my ability to do this task in a way I don't really understand and don't really have a grasp on how to fix. And so I just don't want to do it at all. That tends to be kind of what's happening. And so it was interesting to see somebody try and apply like a formulaic other paper to this concept. That being said, there were a few limitations. Do you want to take us through what some of the limitations were, Sarah? Yeah, so the sample size, first of all, was predominantly young females, which sort of makes it difficult to know whether these results would be applicable to a wider group of people. The convenience method was used that already limits sort of the demographics of the sample. They used self-reports only. But then they cited a couple of other papers that show that adults with ADHD actually tend to report their symptoms more accurately than like a partner or something like that. Yeah, I never heard that before. Well, I've never heard that in a research paper before. I've heard that so many times from like actual people who are, you know, sort of describing their symptoms. It wasn't a clinical sample, you know, so the people that were coming through were just sort of people. not specifically in the mental health sense. Yeah. I think in terms of what to take away from this, it's really a reinforcing of the concept that it might be good to start thinking about what's going on behind your procrastination. Rather than you can feel a lot of frustration, a lot of anger, a lot of shame around procrastinating. If we can try and get into a more mindful space of going, I'm not doing this, I'm putting this off. Sometimes I actually have done this with my own work where I will put a little tag in my Monday board that just says a version of like resistant. I'm just resistant to this. Like for some reason I'm not doing that. So that I can kind of get into a space where I'm just observing that and trying to think, huh, I wonder why that's happening. Sometimes that can lead to a lot of really interesting breakthroughs. Especially if you have a sense of, well, it could be this or it could be that. It can really help. versus just being like, I need to just slam into this wall and just try and get through it because I need to. And sometimes we do wait and we get the dopamine to do it and we can do it like that. But just kind of trying as much as possible. I know it's really difficult to get into more of a exploratory phase without procrastination. Yeah, and it's really important once you get into that space to sort of approach it very non-judgmentally. because it could be really easy to just get into that shame spiral of, well, I've rescheduled bookkeeping for the third time this year, so I really need to start doing that. But really what we need to be doing is saying, okay, why is this challenging for me? Am I trying to do it at the wrong time of day? And just get more analytical and more intentional, like Skye said, about the why. Yeah. And this is something that we do all the time. So it's probably a bit easier for us to like imagine what that would look like. But well, and it's super easy to say, right? Yeah. Oh yeah. So easy. I literally was like mentally thinking about, I have a task literally on my calendar, which is called like admin cannot move this for like two days from now. Just fill the things that I'm resisting. We definitely have to do it ourselves. And even though they didn't find the boring to be a significant predictor, for ADHD often that can be significant. Is it boring? Is it emotionally salient? Is it something that I have a really strong reaction to? Maybe I got a really bad email from this person last time and now I do not want to email them again. Is it too complicated? I need to break it down. Like I don't even know where to start. I need to get more information. Do I think, and this is kind of the more positive side of procrastination which we never talk about. Do I think that if I don't do this, it will go away? Sometimes that is one of the reasons we have procrastinating. Sometimes our brain is like, I don't have to do this. If I just wait a week, I'm pretty sure this is not going to be a thing anymore. Try and have some fun with it, even though that seems hard.

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First-time diagnosis of ADHD in adults: challenge to retrospectively assess childhood symptoms of ADHD from long-term memory

So do we want to talk Sarah about the second paper? the non-peer-reviewed paper here? Yeah. I think we should definitely talk about it, even though we definitely need to draw attention to the limitations in this case. Yeah. The second paper that we wanted to just describe and discuss, it's not a research paper in the concept that we usually talk about research papers, it's more of a lit review or a general discussion paper, and it's also not peer-reviewed. So we're just flagging that. It's more of an editorial piece. But the reason we wanted to talk about it was because it's something that we've discussed a lot when it comes to ADHD, which is the concept of when things are being diagnosed, there's a real focus on whether you had this as a child. So if you're getting a diagnosis of ADHD, people want to know, did you have symptoms of ADHD as a child? And sometimes people say, I need to see school reports. And I need parents to say this and that can be really complicated. You might not have a great relationship with your parents around this topic. You might not want to say this is what I'm looking for. Or you might not have your school stuff for a variety of reasons. Maybe you moved a lot. Maybe you lost it because you have ADHD. Or maybe your teacher just didn't pick up on it because you were maybe a girl and you were masking and that kind of thing. But the other side of it is that if they say, well, do you remember having ADHD symptoms? for starters, you have to remember childhood, which is like, can you remember what it was like to be five? It just in general? Absolutely not. Yeah, so this is the kind of conversational. So what we're gonna talk about this paper, because we thought it was a really interesting thing to flag, but we just want to say this isn't a peer reviewed study. This isn't, it's not even a study. So but we're just going to talk about the concept. So Sarah, do you want to take us through a little bit of what they talked about? They did a non systematic search, which basically just means that they sort of looked broadly. It's less specific than a systematic search, which makes sense. It tends to rely on something we call salience. When I've done those studies before, it's sort of like you just keep going until you find the same thing again and again, and you're like, okay, I think I'm done. That makes sense because the things that all of these studies had in common were sort of like, did it talk about ADHD? Did it talk about long-term memory recall? Does it talk about clinical interviews, developmental history and such? So basically, why did they write this paper? I mean, the authors are calling for new diagnostic standards for adult ADHD, given that recall bias is such a big factor. The current way that we sort of diagnose ADHD, as Skye mentioned, is throwing back to childhood and saying like, what physical evidence do you have? And also what mental evidence can you muster up for me? And these authors are saying that... There's no research, well, there's not enough research to establish whether or not these retroactive reports are even significant in this space. They also were looking at the idea of adult onset presentation of ADHD, which means like getting ADHD for the first time as an adult. That is not currently an accepted diagnosis. There's really no research around this. And anyway, it would have a pretty low prevalence. They just go into why it's problematic to use just memories of childhood symptoms as part of the criteria. They state that it's unreliable for both the person and the parents. Yeah, and I think that's really important. The only technically reliable evidence that you're going to find of your childhood ADHD is school reports, which is one of the reasons people use it. But it really relies on the fact that your teacher noticed that you had ADHD symptoms wrote about them in your report and then didn't diagnose you with ADHD. There's a big thing. And I can say like, cause I actually don't have all of my childhood stuff. It's with my parents and I would have to explain it and it'd be whole thing. But in terms of getting access to that information, I mean, if you look at my stuff, it says tries really hard. It's doing great in English is doing terribly in maths. I also have dyscalculia. So it doesn't necessarily. showcase that I have ADHD very easily because I was masking. It was a huge part of my personal childhood experience of ADHD is that I was working a lot. Like I was like a very stressed 10-year-old, you know, just like, got to get all of the things done by the end of the day. And that doesn't look like ADHD like you would see it now. And so maybe if I go back and see them, I would find some evidence, but mostly would be like, seems a bit. stressed and talks maybe a little bit too much, but that's kind of the closest thing. Yeah, definitely. I mean, I got really good grades in school up until my hormones kicked in and then I was like, whatever. But apart from that, you would have no idea. I was probably one of the most self-conscious 10-year-olds in the school, always sort of like, how are they looking at me? Is this a normal thing to be doing? Am I moderating my response enough right now? I feel like we would have been friends. Probably. Like that doesn't go in a report card. No, it doesn't. Especially with, you know, teachers are stressed, teachers are busy. Unless it's affecting your classroom, a lot of teachers aren't going to pick it up. So this is kind of why we wanted to flag this editorial piece because it did bring up a conversation that we've been having and a lot of people have been having. outside of the research space, which is what would it look like if we didn't require you to have childhood diagnosis? Depression, for example, if you're trying to diagnose that and I'm not a diagnostic status, I'm not going to go into that space. But they don't require you to have it in childhood. They require you to have it for a certain period of time to sort of test out if there's something that might have happened that could be contributing. So it's not. a long-term issue. So maybe there's a world in which we could say, well, if you've had ADHD symptoms for over 12 months, then maybe you have ADHD. I mean, I'm not going to speak to whether that's the case, but they're having that conversation, I guess. That is a really interesting conversation. I would love to listen. I guess we'll just continue to read and you guys can listen. Yeah. I'd love to listen to this podcast. It's so funny. Yeah, so I think it's interesting. What was the kind of conclusion that they came to, Sarah, in the end? They pretty much came right out and said that the current framework requiring proof of childhood symptoms is faulty and leads to potential under or over a diagnosis. It basically just leads to people not getting access to the help that they need, which is the opposite of what the DSM is for. Especially again if they masked their symptoms in school. Again, if they looked like they mostly had anxiety. So I guess this paper really does call for more research into it. And we, we do the same. We agree with this paper. I think it would be really cool. And if we do find anything, rest assured, we will talk about it on this podcast because it will be very interesting. Okay. So we're going to be right back, but actually we're coming back next week because there's another paper that we wanted to talk about that was so complicated and so in depth. that we ended up after like an hour of conversation about it, deciding that we want to come back next week and talk about it. So we will be back in a second, but we'll actually be back next week. So I'll see you then.

The domain-variant indirect association between electrophysiological response to reward and ADHD presentations is moderated by dopaminergic polymorphisms

Hi. So for most of you, this is a few seconds later for us, it's a whole week later because we have been. talking and reading and highlighting this article from the Journal of Comprehensive Psychiatry that looks at basically how ADHD is moderated by the brain scans, by genetic dopamine, alleles, by emotions. It's all in here, it's all in this paper. And we took some extra time to break it down for you today. So basically what they were examining in this paper, I'll just jump into that and then we'll talk a little bit more about it in depth, is they wanted to look at whether there was a difference in ADHD in not just whether we had ADHD, they looked at different severities, but also whether we presented certain genetic differences and then whether. our brains and the way we responded to rewards and the way our mood changed. They wanted to have a look at all of these different things and see if this was a very simple difference. So if you had ADHD, you had all of these things. If you didn't have ADHD, you didn't have all of these things or whether it was more complex. So maybe some people might have severe ADHD and not have a certain genetic component. Some people might and what that looked like and how that came to play. So It was a really complicated paper to read and we're going to do our best. But if you read or wrote or had anything to do with this paper, please, please reach out, send us an email, just tell me, tell me what this is about in full detail. I would love to know. So yeah, Sarah, what was the material and method? So they were looking at 305 participants in adolescence. So 14 to 17 years old. They got their sample from psychiatry clinics in Budapest. So this study was completely done in Hungary. And yeah, because there were so many variables that they were looking at, there's also a lot of different measures. So we've got ADHD classification by a parent's report. They used the DSM symptoms specifically. So like a little rating scale, they sort of classified people in two ways. So there's at-risk for ADHD and then a full diagnosis of ADHD. They looked at mood using a self-report scale called PANAS. That's like a affects, just like a bunch of moods. They looked at intelligence. Sorry, I'm just imagining how many moods I have in one day. It really depends when I do the scale. For sure, yeah. It's really interesting too, because they have like a wide range of emotions and then you could do it based on the Likert scale. So I... feel disappointed. It was just really funny, really funny scale. So they measured intelligence using the adult intelligence scale, on Weschler's scale, I think that's right. They took some DNA samples. So they sampled the saliva. They were looking for that genetic makeup, again, that allele that I mentioned. And then they were also, of course, measuring reward anticipation. So they did this using basically a computer game. They... took the kids up to an EEG machine, had them play this computer game, which was a simulated gambling, and the reward was obviously money in this scenario. And then they just sort of watched what the brain activity did. Yeah, they put people through their paces. And the intelligence scale, there were a few of those scales, like the intelligence one, that was to see, so people of a certain level of intelligence were not included in the studies. They were trying to have a more cohesive sample. I would argue one of the limitations is that their sample is almost too cohesive. Um, there's not a lot of variation in the income level or the ethnicity or any of that kind of stuff when it comes to this paper specifically in terms of what they found, they basically found that what you would expect in literature or what you've seen in literature is the case. So they found that, um, people who had ADHD, they were more likely to. struggle with attention when it came to the different tests that they did playing the gambling computer game. They also found that people with ADHD had worse scores on affectivity. And they found that people with ADHD, I guess they had the kind of genetic alleles that you would expect for people who have ADHD to have. I'm not going to go into exactly what those are. You can read it if you want, but there was certain things that. apparently turn up more if you have ADHD, which I actually wasn't as aware of, which was interesting. They also found that the genetic variation they were looking for was only found among the ADHD participants and not among the neurotypicals. Yeah, which was really interesting. I do want to look into more the genetic component of ADHD because we talk about the neurological component of ADHD, but I would imagine there's some people listening. who didn't even know there was a genetic component potentially to ADHD. Yeah, I mean, this is a lot after the experience reading this paper. I mean, I definitely am very interested in the genetic component. I just hope that the rest of the papers are less intimidating. Yeah, this was a hard one to start with. And essentially what they found and what they argued for was that, yes, there were these differences in ADHD. But also there were moderations around, you know, whether you were at high risk ADHD, whether you were at low risk, which to be fair is something they, they did use the DSM, which is really cool, but it's not like this is a thing you tend to get diagnosed with as high or low risk ADHD, at least not what I've seen. But they were arguing for complexity basically. They were saying, it's not just a you have it or you don't have it situation. you might find that you have ADHD, but actually your genetics are different from what you would expect with ADHD and therefore it's moderating maybe your affectivity or moderating your impulsivity. So they were kind of arguing that we need to have a more complex interplay, a more complex discussion of these between group comparisons in terms of ADHD and how that works. Yeah, and I mean, once we really got down to it, it was really nice to read that it's not just ADHD, yes, no. There are other things that play here that are going to impact how your symptoms present. That ultimately impacts whether or not you struggle with certain things. That's really important. Yeah, definitely. I think that's really the main takeaway from the study is that they were arguing that it's more complicated than it looks on the surface, which I feel like. I feel like for some of us is self-evident, but it's definitely true. And so they wanted to argue that we need to have more studies of like talking about how our brain works and how genetics work and how our mood works and how we present and then how that relates to some of those outcomes rather than having it be taken for granted that if you have ADHD, you're going to present as this and you're going to show up as this. I definitely think that's totally a great thing to have. And if we can bring in more of a genetic component, again, it's just gonna make the diagnostic process more complicated, but also potentially more interesting. And also potentially quicker. Yeah. I did not know that you could 23andMe your ADHD. Like that is not something that I was aware of at all. It's an add-on package you can purchase. Yeah, yeah, I mean, possibly. Yeah. So it was a tough paper to get through. We definitely took some time out. And that was what we found. We couldn't figure out exactly what was significant, what wasn't significant. They talked more about associations and correlations than anything else. And so we're going to do the same thing. If you do know the paper, you can find it in the show notes, definitely reach out to us. And if you happen to know a lot about ADHD and genetics. You can always email me, sky at unconventional organization, just chat genetics, I really want to know. Because I think it's really interesting with ADHD. That is everything for this week in the research recap, and we will be back in two weeks again with some more interesting papers that we will break down for you, and hopefully come with some practical takeaways. We'll see you next time.

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