Maladaptive daydreaming may be a better diagnosis for some than ADHD - study

Findings from a new study suggest that there is a subgroup of those diagnosed with ADHD who would benefit more from a diagnosis of Maladaptive Daydreaming.

 Main - Adhd (photo credit: PR)
Main - Adhd
(photo credit: PR)

It’s not at all certain whether Joseph, the son of Jacob who gave him a coat of many colors, suffered from maladaptive daydreaming (MD) but his jealous brothers who tried to kill him may have thought so.

MD is a condition in which people slip into involved highly detailed and realistic daydreams that can last hours at the cost of normal functioning. It has not yet been recognized as a formal psychiatric syndrome.

Nearly two decades ago, some researchers including L. D. Butler in the journal Psychiatric Clinics of North America, referred to daydreaming as a helpful adaptive consciousness state – “for example, as creating a platform for processing daily experiences and problem-solving in a way that cannot be resolved under standard, goal-oriented, logical thinking.” Daydreaming was claimed back in 1958 by H. Hartman in an article published by the International Universities Press to promote future planning, creative thinking, decoupling of attention and the implementation of multiple goals.

But today, Dr. Nirit Soffer-Dudek – a psychologist at Ben-Gurion University of the Negev (BGU) and one of the world’s foremost experts in the phenomenon – is trying to get its diagnosis added to the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

She contends that MD, which has not yet been recognized formally as a psychiatric syndrome, may be a better diagnosis for some people with such symptoms than attention-deficit hyperactivity disorder (ADHD).

 Dr. Nirit Soffer-Dudek of the Consciousness and Psychopathology Laboratory in the Department of Psychology at Ben Gurion University of the Negev (credit: BEN GURION UNIVERSITY OF THE NEGEV) Dr. Nirit Soffer-Dudek of the Consciousness and Psychopathology Laboratory in the Department of Psychology at Ben Gurion University of the Negev (credit: BEN GURION UNIVERSITY OF THE NEGEV)

Soffer-Dudek of the Consciousness and Psychopathology Laboratory in BGU’s psychology department has promoted rigorous research on the subject.

Maladaptive daydreamers often report that existing diagnostic labels are unhelpful for them. “Some individuals who become addicted to their fanciful daydreams experience great difficulty in concentrating and focusing their attention on academic and vocational tasks, yet they find that an ADHD diagnosis and the subsequent treatment plan does not necessarily help them,” she said.

Previous studies had found high levels of ADHD in those also presenting with MD, thereby raising the question of whether MD was separate from ADHD. The current study was published recently in the Journal of Clinical Psychology under the title “Could immersive daydreaming underlie a deficit in attention? The prevalence and characteristics of maladaptive daydreaming in individuals with attention-deficit/hyperactivity disorder.”

A call for voluntary participation in a study of ADHD was published in online ADHD communities, word of mouth and via an advertisement posted in two mental health clinics. MD was not mentioned in the recruitment advertisement to avoid biases in the procedure of sample recruitment. The recruiting advertisement asked participants who had been diagnosed with ADHD and had documentation to support this that they could present.

A total of 110 people who identified themselves as suffering from formally diagnosed ADHD completed an online survey. “It is reasonable to assume that in the absence of financial reward, our sample comprised genuine ADHD respondents who were motivated to support a research study about their condition,” the team wrote.

Doctoral candidate Nitzan Theodor-Katz, together with Soffer-Dudek, Prof. Eli Somer and Dr. Rinatya Maaravi Hesseg of the University of Haifa, assessed 83 adults diagnosed with ADHD for MD, inattention symptoms, depression, loneliness and self-esteem issues. Participants who exceeded the study’s cutoff score for suspected MD were invited to participate in a structured diagnostic interview for MD.

About 20% met the proposed diagnostic criteria for MD, with significantly higher rates of depression, loneliness, and lowered self-esteem, compared to those with ADHD that did not meet the criteria for MD.

“MD has unique clinical characteristics that are distinct from ADHD,” they wrote in their 20-page published study. “We suggest that in some cases presenting with ADHD symptoms, an MD conceptualization may better explain the clinical picture. Future research should aim at a better differentiation of daydreaming, ADHD, and related constructs such as mind-wandering. Our findings suggest that there is a subgroup of those diagnosed with ADHD who would benefit more from a diagnosis of MD.”