Some people diagnosed with ADHD might actually have another disorder

The signs of maladaptive daydreaming are similar to those of attention deficit hyperactivity disorder, resulting in treatments that don't always work.

Maija Kappler 4 minute read April 19, 2022
woman daydreaming

Maladaptive daydreaming is a disorder which causes people to experience daydreams that are immersive and sometimes debilitating. GETTY

A study from Israel is raising questions about attention deficit hyperactivity disorder (ADHD). According to its authors, while some people diagnosed with the condition are experiencing difficulty concentrating and a lack of focus, it’s not because of ADHD. Rather, they have maladaptive daydreaming — they experience daydreams that are immersive and sometimes debilitating.

Maladaptive daydreaming (MD) is not a symptom of ADHD, but something else, researchers posit: “continuous, imaginative, vivid fantasies with an unfolding storyline that involves a strong yearning for fantasy.” Many people who experience this kind of daydreaming might meet the criteria for ADHD, but their attention deficit “is secondary to their core problem of becoming addicted to their immersive, fanciful daydreaming,” the study says.

Researchers from Ben-Gurion University of the Negev in Beerseba, Israel looked at 98 people who had been diagnosed with ADHD. Participants, who were not told in advance about maladaptive daydreaming, were asked to rate their response to questions about their inclination to daydreaming on an eleven-point scale ranging from “never” to “extremely frequently.” They were asked, for instance, how strong their urge was to start daydreaming when they woke up in the morning, how distressed they felt about their daydreams, and how often their daydreams were accompanied by physical acts, like pacing or moving their hands.

Fifty-nine of the participants — 60 per cent— had responses that met the criteria for maladaptive daydreaming. But not all of them responded to it, so only 44 were then asked further questions to determine whether their daydreaming had a more likely source, like a drug addiction or certain personality disorders. They were also asked about the nature of their daydreams, and whether or not they were considered detrimental. People who said their daydreams changed rapidly and were unguided thoughts or worries were categorized as having only ADHD, as were people whose daydreams were controllable and had no negative effects on their everyday life. Seventeen people met the proposed diagnostic criteria for maladaptive daydreaming — 20 per cent of the final sample.

Scientists found that their main hypothesis — that some of the people diagnosed with ADHD actually have MD — was “supported” by the research. “MD is an independent mental phenomenon, which often creates a deficit in attention as a side effect, causing MDers in some cases to also meet criteria for ADHD, but not necessarily vice versa,” they wrote. “Moreover, we found that ADHD symptoms did not differ in severity across the groups, again supporting the idea that MD is not secondary to ADHD, nor is ADHD a predisposition to MD, but rather, MD is a discrete construct.”

But the two can be easy to confuse, researchers explained, because of the “blurred boundaries between the concept of daydreaming and closely related concepts such as distraction” and “imaginative involvement.” They added that the two conditions likely need different treatment since “the dynamic of the internal experience” is also different.

“Specifically, MD-related absorption in vivid and fanciful daydreaming alters the sense of agency and includes a motivation to direct attention inwardly while being purposefully oblivious to the surrounding reality,” they write. “Conversely, [mind wandering in ADHD] is not actively self-directed; it is associative, unguided, and fragmentary.”

Dr. Nirit Soffer-Dudek, one of the study’s co-authors, wants to see MD added to the Statistical Manual of Mental Disorders (DSM-VI).

“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 told her university’s news outlet. “Formally classifying MD as a mental disorder would enable psychological practitioners to better assist many of their patients.”

In Canada, ADHD affects between five and nine per cent of children and between three and five per cent of adults, according to the Centre for ADHD Awareness Canada. Researchers used to believe that children grew out of ADHD when they became teenagers, but more recent studies have found that about 80 per cent of children with the disorder maintain it through their teenage years, and more than half — at least 60 per cent — still have it as adults. Adult ADHD was added to the DSM-VI in 2013.

Maija Kappler is a reporter and editor at Healthing. You can reach her at
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