People with ADHD often experience a rapid flow of thoughts that can feel overwhelming and difficult to control.
These thoughts may jump quickly from one topic to another, creating a sense of mental restlessness. This experience can manifest as racing thoughts, where ideas seem to overlap and rush through the mind at high speed.
Alternatively, it may present as mind wandering, where attention drifts away from the current task to unrelated thoughts or daydreams.
Understanding the nature of these thought patterns is crucial for diagnosing and treating ADHD, as they significantly impact daily functioning and quality of life for individuals with the disorder.
Martz, E., Weiner, L., Bonnefond, A., & Weibel, S. (2023). Disentangling racing thoughts from mind wandering in adult attention deficit hyperactivity disorder. Frontiers in Psychology, 14, 1166602. https://doi.org/10.3389/fpsyg.2023.1166602
Key Points
- The study aimed to differentiate racing thoughts from mind wandering in adults with Attention Deficit Hyperactivity Disorder (ADHD).
- Factor analysis revealed two distinct factors: “Racing/overactive thoughts” and “Mind wandering.”
- Emotional lability was the main predictor of racing thoughts in adults with ADHD.
- Mind wandering was not significantly related to ADHD symptoms or functional impairment.
- Racing thoughts were associated with functional impairment in adults with ADHD, including interpersonal problems, academic difficulties, and additional ADHD symptoms.
- The research highlights the importance of considering racing thoughts as a relevant hypothesis to explain mental restlessness in adult ADHD.
- The study’s limitations include reliance on self-report measures and lack of comparison groups.
Rationale
Mental restlessness is a common complaint among adults with ADHD, often described as thoughts being “constantly on the go” (Asherson, 2005; Weyandt et al., 2016).
Previously, this experience has been primarily attributed to excessive mind wandering (MW) (Asherson et al., 2016).
However, the description of racing thoughts, predominantly associated with bipolar disorder, also aligns with the mental restlessness reported in ADHD (Piguet et al., 2010; Weiner et al., 2018).
While studies have shown increased MW in adults with ADHD compared to healthy controls (Shaw & Giambra, 1993; Biederman et al., 2019), recent research has also found elevated rates of racing thoughts in ADHD compared to hypomanic patients with bipolar disorder (Martz et al., 2021).
This suggests that both MW and racing thoughts may contribute to mental restlessness in ADHD.
Given the potential clinical significance of distinguishing between these phenomena, this study aimed to disentangle MW from racing thoughts in adults with ADHD and investigate their associations with ADHD symptomatology and functional impairment.
Method
The study employed a quantitative approach using self-reported questionnaires to assess racing thoughts, mind wandering, and ADHD symptoms.
Factor analysis and multiple linear regressions were performed to analyze the data.
Procedure
Participants completed a set of self-reported questionnaires measuring racing thoughts, deliberate and spontaneous mind wandering, daydreaming frequency, and ADHD symptoms.
The study design was cross-sectional.
Sample
The sample consisted of 84 adults with ADHD (57.12% female, mean age 32.48 years, SD = 10.23).
Participants were recruited from outpatient psychiatry clinics at the University Hospital of Strasbourg.
ADHD and comorbidity diagnoses were established by senior psychiatrists based on DSM-5 criteria.
Measures
- Racing and Crowded Thoughts Questionnaire-13-item (RCTQ-13): Assesses three facets of racing thoughts (thought overactivation, burden of thought overactivation, and thought overexcitability) experienced in the last 24 hours.
- Mind Wandering Deliberate (MW-D) questionnaire: Measures the tendency to intentionally engage in mind wandering in daily life.
- Mind Wandering Spontaneous (MW-S) questionnaire: Evaluates the propensity for unintentional mind wandering experiences in everyday situations.
- Daydreaming Frequency Scale: Assesses the extent to which individuals experience mind wandering and daydreams in their daily lives.
- Self-Reported Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS): Evaluates global ADHD symptomatology, including inattention, hyperactivity, disorganization, and emotional dysregulation, as well as its impact on daily functioning.
Statistical measures
Factor analysis with principal component extraction and Varimax rotation was performed. Multiple linear regression analyses were conducted to examine the relationships between ADHD symptoms, racing thoughts, mind wandering, and functional impairment.
Results
Hypothesis 1: Racing thoughts and mind wandering are distinct phenomena in adults with ADHD.
Result: Confirmed. Factor analysis yielded two distinct factors: “Racing/overactive thoughts” and “Mind wandering.”
Hypothesis 2: Racing thoughts and mind wandering are associated with different ADHD symptoms.
Result: Partially confirmed. Emotional lability significantly predicted the “Racing/overactive thoughts” factor (β = 0.25, p = 0.03). No ADHD symptoms significantly predicted the “Mind wandering” factor.
Hypothesis 3: Racing thoughts and mind wandering differently contribute to functional impairment in adults with ADHD.
Result: Partially confirmed. The “Racing/overactive thoughts” factor significantly predicted functional impairment in oppositional defiant behaviors (β = 0.28, p = 0.01), additional symptoms (β = 0.33, p = 0.004), and academic difficulties (β = 0.32, p = 0.005). The “Mind wandering” factor was not significantly associated with functional impairment.
Insight
This study provides evidence that racing thoughts and mind wandering are distinct phenomena in adults with ADHD.
The finding that emotional lability predicts racing thoughts aligns with previous research linking racing thoughts to affective lability and motor hyperactivity in ADHD (Martz et al., 2021).
Surprisingly, mind wandering was not significantly associated with ADHD symptoms or functional impairment, contradicting some previous findings (Biederman et al., 2019).
The results suggest that racing thoughts may be a more clinically relevant construct than mind wandering in understanding mental restlessness in adult ADHD.
This extends previous research by highlighting the importance of considering racing thoughts as a core feature of ADHD symptomatology, particularly in relation to emotional dysregulation.
Future research could explore the neurobiological underpinnings of racing thoughts in ADHD, investigate potential interventions targeting racing thoughts, and examine how racing thoughts interact with other ADHD symptoms over time.
Strengths
This study had several methodological strengths, including:
- The study addressed an important gap in the literature by simultaneously investigating racing thoughts and mind wandering in ADHD.
- The use of validated measures for assessing racing thoughts, mind wandering, and ADHD symptoms.
- The inclusion of a relatively large sample of adults with ADHD diagnosed by experienced clinicians.
- The application of factor analysis to distinguish between racing thoughts and mind wandering.
Limitations
This study also had several methodological strengths, including:
- Reliance on self-report measures, which may be subject to recall bias and limited introspective abilities.
- Lack of comparison groups (e.g., healthy controls or individuals with bipolar disorder) limits the ability to determine the specificity of findings to ADHD.
- The cross-sectional design precludes causal inferences about the relationships between racing thoughts, mind wandering, and ADHD symptoms.
- The sample was recruited from a single clinical setting, potentially limiting generalizability.
Implications
The findings have significant implications for understanding and treating mental restlessness in adult ADHD.
By distinguishing racing thoughts from mind wandering, clinicians may be able to develop more targeted interventions.
The strong association between racing thoughts and functional impairment suggests that addressing racing thoughts could be a valuable treatment target in ADHD.
The results also highlight the importance of emotional dysregulation in ADHD, supporting recent arguments for its inclusion as a core symptom of the disorder (Shaw et al., 2014).
Clinicians should assess and address racing thoughts and emotional lability when treating adults with ADHD.
The lack of association between mind wandering and ADHD symptoms or impairment in this study calls for further investigation into the role of mind wandering in ADHD.
It may be that mind wandering represents a different aspect of cognitive functioning in ADHD that is not directly related to core symptoms or impairment.
References
Primary reference
Martz, E., Weiner, L., Bonnefond, A., & Weibel, S. (2023). Disentangling racing thoughts from mind wandering in adult attention deficit hyperactivity disorder. Frontiers in Psychology, 14, 1166602. https://doi.org/10.3389/fpsyg.2023.1166602
Other references
Asherson, P. (2005). Clinical assessment and treatment of attention deficit hyperactivity disorder in adults. Expert review of neurotherapeutics, 5(4), 525-539. https://doi.org/10.1586/14737175.5.4.525
Asherson, P., Buitelaar, J., Faraone, S. V., & Rohde, L. A. (2016). Adult attention-deficit hyperactivity disorder: key conceptual issues. The Lancet Psychiatry, 3(6), 568-578. https://doi.org/10.1016/S2215-0366(16)30032-3
Biederman, J., Lanier, J., DiSalvo, M., Noyes, E., Fried, R., Woodworth, K. Y., … & Faraone, S. V. (2019). Clinical correlates of mind wandering in adults with ADHD. Journal of psychiatric research, 117, 15-23. https://doi.org/10.1016/j.jpsychires.2019.06.012
Martz, E., Bertschy, G., Kraemer, C., Weibel, S., & Weiner, L. (2021). Beyond motor hyperactivity: Racing thoughts are an integral symptom of adult attention deficit hyperactivity disorder. Psychiatry Research, 301, 113988. https://doi.org/10.1016/j.psychres.2021.113988
Piguet, C., Dayer, A., Kosel, M., Desseilles, M., Vuilleumier, P., & Bertschy, G. (2010). Phenomenology of racing and crowded thoughts in mood disorders: a theoretical reappraisal. Journal of affective disorders, 121(3), 189-198. https://doi.org/10.1016/j.jad.2009.05.006
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276-293. https://doi.org/10.1176/appi.ajp.2013.13070966
Shaw, G. A., & Giambra, L. (1993). Task‐unrelated thoughts of college students diagnosed as hyperactive in childhood. Developmental neuropsychology, 9(1), 17-30. https://doi.org/10.1080/87565649309540541
Weiner, L., Weibel, S., de Sousa Gurgel, W., Keizer, I., Gex-Fabry, M., Giersch, A., & Bertschy, G. (2018). Measuring racing thoughts in healthy individuals: The Racing and Crowded Thoughts Questionnaire (RCTQ). Comprehensive psychiatry, 82, 37-44. https://doi.org/10.1016/j.comppsych.2018.01.006
Weyandt, L. L., Iwaszuk, W., Fulton, K., Ollerton, M., Beatty, N., Fouts, H., … & Greenlaw, C. (2003). The internal restlessness scale: performance of college students with and without ADHD. Journal of Learning Disabilities, 36(4), 382-389. https://doi.org/10.1177/00222194030360040801
Keep Learning
- How might the distinction between racing thoughts and mind wandering inform the development of more targeted treatments for ADHD?
- What neurobiological mechanisms might underlie the relationship between emotional lability and racing thoughts in ADHD?
- How do cultural factors potentially influence the experience and reporting of racing thoughts and mind wandering in adults with ADHD?
- What are the potential implications of these findings for understanding the relationship between ADHD and mood disorders, particularly bipolar disorder?
- How might longitudinal studies further our understanding of the role of racing thoughts in the developmental trajectory of ADHD from childhood to adulthood?
