What Is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent “inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (NIMH, 2023). Symptoms typically appear in early childhood and can persist into adulthood.
In this article we will explore the differences and similarities between maladaptive daydreaming and ADHD.
By Sara Spisto and Annalisa Milite
MD vs. ADHD: What Does the Research Say?
Research on the comorbidity of MD and ADHD has yielded mixed results. Some studies have found high rates of comorbidity, while others have found lower rates.
One of the most significant studies on MD and comorbidity with other disorders (Somer et al., 2017) found that many MDers also met the diagnostic criteria for other disorders and that 77% met the diagnostic criteria for ADHD, Inattentive type. This means that people with MD are more likely to also show symptoms of ADHD, but the reverse might not be true. Not all people with MD may necessarily have ADHD.
Subsequently, a study by Theodor-Katz et al. (2022) examined a sample of adult ADHD individuals to understand how many who were actually diagnosed might also have MD. The results of the study showed that the comorbidity between MD among people with ADHD is actually much lower, as only about 21% of the subjects also had MD.
This result helps to confirm that MD is not a form of inattentive ADHD and suggests that MD may cause attention problems and that there might be an MD-related subtype of ADHD, the Inattentive type.
ADHD and MD: How Can They Be Similar?
From a clinical point of view, some ADHD diagnostic criteria address behaviors that are also very similar in people with MD.
In other words, when making a diagnosis, certain behaviors could be due to either ADHD or MD. Doctors could, therefore, confuse the two disorders, especially since MD is so little known.
Difficulty Concentrating
The main common behavior between the two disorders is difficulty concentrating and maintaining attention consistently.
From the outside, this difficulty can be perceived in the same way, that is, that the person is “always distracted”. It is, therefore, quite common to think that they have an attention deficit problem. However, there are different causes that can lead to inattention. Evidence shows that MD is one of them.
Difficulty maintaining attention can be caused by different types of mental activities that consume the person’s cognitive resources and, therefore, interfere with their ability to pay attention, for example:
- being distracted by thoughts or external stimuli that do not allow you to concentrate on a task (ADHD)
- thoughts about past events (Rumination)
- worries about possible future events (Anxiety)
- obsessive thoughts that are not rational but that we cannot stop (OCD)
- narrative thoughts—both realistic and unrealistic (MD)
Therefore, maladaptive daydreaming can also be a cause of inattention, but it does so in a unique way.
Difficulty Organizing Time
Another similarity is the difficulty in organizing one’s time and activities.
In this case, too, the behavior is found in both conditions, but there are different mechanisms behind it.
An MDer generally tends to procrastinate because they spend a lot of time fantasizing and tend to put other activities on the back burner.
A person with ADHD also procrastinates, but it is not always linked to a specific motivation.
Other Similarities
In addition to difficulty concentrating and organizing time, other similarities between MD and ADHD include:
- Daydreaming: Both people with MD and ADHD can experience daydreaming. However, the daydreams in MD are typically more immersive and elaborate than those in ADHD.
- Restlessness: Both people with MD and ADHD may experience restlessness and fidgeting.
- Disorganization: Both people with MD and ADHD may be disorganized.
Key Differences
Despite the similarities, there are also some key differences between MD and ADHD.
- The focus of attention: In ADHD, the focus of attention is often on external stimuli. In MD, the focus of attention is often on internal stimuli, such as thoughts and fantasies.
- The intensity of symptoms: Symptoms of ADHD are typically more severe than symptoms of MD.
- The impact on functioning: ADHD can have a significant impact on a person’s functioning at school, work, and home. MD typically has a less severe impact on functioning.
As you can see, the two disorders are very different. Maladaptive daydreaming leads the person to fantasize extensively, creating elaborate stories in which they feel emotionally involved. Usually, in adulthood, those with maladaptive daydreaming are aware that their fantasies are a problem, as they are unable to control them.
A professional should, therefore, check for the presence and quality of these fantasies during the diagnosis, even if the boundaries of this disorder are not fully defined.
Unlike MD, ADHD is a neurodevelopmental disorder, meaning that it influences the individual’s neuropsychological development trajectory.
MD, on the other hand, does not yet have a precise definition, although research currently hypothesizes that it may be a dissociative disorder.
When in doubt, it is preferable to contact a professional who is able to analyze the case and assess the presence or absence of a neurodevelopmental disorder.
It is the task of the professional to carry out an accurate anamnesis (data collection on the person’s development) in order to establish what it is, even if MD is not yet diagnosable. This is because the professional is able to determine the presence of ADHD, even if they do not know about MD.
Getting a Diagnosis
If you are concerned that you or someone you know may have MD or ADHD, it is important to see a qualified mental health professional for a diagnosis. They can assess your symptoms and determine if you meet the diagnostic criteria for either disorder.
Treatment
Treatment for MD and ADHD typically involves a combination of cognitive behavior therapy and medication. Therapy can help you learn to manage your symptoms and develop coping mechanisms. Medication can help reduce symptoms of inattention and hyperactivity.
Can You Have Both Maladaptive Daydreaming and ADHD?
Yes, it is absolutely possible, although this possibility is low. Keep in mind that a professional can only intervene on what they know, so they might only diagnose attention deficit because they are not aware of the existence of MD.
If you suspect you have MD in addition to ADHD, it is important to tell your doctor during diagnosis.
Currently, many professionals are not yet aware of maladaptive daydreaming and how to diagnose it, and this makes it even more difficult to create criteria for a differential diagnosis. However, it is nevertheless important to inform the professional, who may not yet be familiar with MD, in order to identify the right treatment for the person.
Learn the concepts
In the clinical setting, differential diagnosis refers to the process of identifying the specific cause of a patient’s symptoms by considering and excluding various possible diagnoses that share common characteristics. It is a crucial step in the diagnostic process, enabling clinicians to narrow down the possibilities and reach an accurate diagnosis.
Conclusions
There are behavioral similarities between MD and ADHD. However, research has confirmed that these are two distinct and separate disorders and that although they are related, they do not have a high degree of comorbidity.
As far as the clinical field is concerned, unfortunately for many professionals, it is still not easy to recognize MD as a disorder in its own right. The only way to have it recognized by the professional is to present it as a condition that “disturbs”, or rather prevents the functioning of the subject in various areas of their life. Only by raising the problem is it possible to recognize it and consequently do something about it.
Despite everything, more and more people identify with many of the symptoms of MD. Therefore, it is a discomfort that needs to be recognized and distinguished from other conditions with which it could be confused.
