Some people with ADHD, or attention deficit hyperactivity disorder, could be better served with a diagnosis of 'maladaptive daydreaming', according to a recent study.
Daydreaming is a normal phenomenon where the mind becomes immersed in an imaginary environment. For most, it's a fun, short distraction from the real world, but for others, daydreaming can become excessive, lasting even hours on end.
In fact, some people can spend up to half their waking hours in their own internal world, which, as you can imagine, makes it difficult to participate in daily life.
Maladaptive daydreaming (MD) is not currently considered a psychiatric disorder in its own right; instead, its characteristic influence over attention means it's usually lumped in as a symptom of disorders such as ADHD.
Among people who experience MD, studies show around 77 percent are also diagnosed with ADHD. But just because these conditions overlap, doesn't mean they are the same thing. Psychologists have recently found evidence MD is actually its own distinct disorder.
ADHD is typically characterized by a "disregulated attention system", which can lead to periods of hyperfocus and seeming inattention. Maladaptive daydreaming, on the other hand, is somewhat more like a behavioral addiction, drawing the mind back into complex and vivid states of imagination.
Among a small group of 83 people with ADHD, researchers found just over 20 percent also met the criteria for MD; that's much lower than the percentage of people with MD who also meet the criteria for ADHD.
This suggests the two disorders really are distinct from one another.
"If we would have found symmetrically high rates of MD among ADHD adults, it would have been fair to claim that the newer concept of MD is superfluous, as it is almost equivalent to the already-existing diagnosis of ADHD," the authors explain.
"However, the asymmetry found in this study agrees with our theoretical claim that MD is an independent mental phenomenon, which often creates a deficit in attention as a side-effect."
Further research is needed to support the idea of MD as a distinct psychiatric disorder, but evidence from this small study suggests MD is essentially different from typical ADHD.
In questionnaires, participants who met the criteria for maladaptive daydreaming said they had difficulty giving their full attention to a task until it was completed, but not in the same way as described by ADHD markers.
Instead, participants said they self-directed their own daydreams, absorbing themselves in vivid and fanciful situations that made it hard to focus on external tasks.
Loss of attention seemed to be secondary to their compulsion for daydreaming.
"We maintain that the diagnosis of ADHD does not adequately describe the problem in such cases," the authors conclude.
The hypothesis is further supported by the fact that participants who met the criteria for both MD and ADHD reported significantly greater levels of psychological distress than those who only met the criteria for ADHD.
According to the authors, this suggests that excessive daydreaming could be rooted in a desire to escape depressive thoughts, low self-esteem, or loneliness.
That finding is important because if MD and ADHD have different underlying mechanisms, it's possible they might not respond to the same interventions.
"If your ADHD stems from general mind-wandering with ever-changing distractions (which is characteristic of typical ADHD), you may need different treatment than if you find yourself compulsively drawn to engage in elaborate, narrative, vivid, and highly emotional fantasies (characteristic of MD)," psychologist Nirit Soffer-Dudek explained to PsyPost.
"If it is the latter, we suggest seeking psychological help, and introducing to the clinician the concept of MD, which has been researched extensively in the past years, but is still quite unknown."
Without a proper understanding of MD, it's not even clear how many people might have the disorder.
During COVID-19 lockdowns, MD seems to have become a bigger issue, adding weight to the idea that daydreaming is our mind's way of coping with trauma and not simply indulging in wandering thoughts.
The study was published in the Journal of Clinical Psychology.