Hyperfocus. Is it real?

[Orrex]

I've known a number of adults with ADHD (generally self-diagnosed in these cases), and all of them have referred to their seemingly miraculous ability to "hyperfocus," during which they profess to overcome their short attention spans and achieve great feats of mental acuity, etc.

But I confess that I don't quite believe it.

Does this phenomenon actually exist? Wikipedia, the unimpeachable authority on all things Science(!), notes that

Hyperfocus is not recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and no article using the term appears in PubMed. Psychiatry describes only the distraction aspect of hyperfocus, referring to ADHD as 'inattentiveness and impulsiveness'.

So what's the verdict? I certainly wouldn't call bullshit on any of the people I know who've claimed it, largely because there'd be no point.

Anyway, I'm skeptical, and I'd value some informed insight on the subject.

[bluedawg12]

1. Interesting question.

For starters, I would want to know if these people were providing anecdotals about ADHD or ADD and whether or not they were under treatment with stimulants or not.

I have spoken to families who tell me that “Johnny” has (some degree of) ADHD, but when he gets started on his favorite video game then he will focus for hours. Johnny usually is there to confirm these stories. :)

Unless hyperfocus was a pathologic condition it would have no reason to be listed in the DSM-IV as a stand alone and it is not a recognized feature of ADHD or ADD currently. However, I am not too skeptical on this. I can see a person who might usually have trouble focusing in routine matters possibly experiencing moments of intense focus if something catches their interest, at least, I don’t see it as mutually exclusive. It just seems that there isn't much on this yet, except for video game studies in kids with ADHD that I just found! :P


Here more from that venerable source: wikipsych:

http://psychology.wikia.com/wiki/Hyperfocus

>>Besides hyperfocus, various special abilities have been suggested to occur in ADHD, including vigilance, response-readiness, enthusiasm, and flexibility. But current ADHD research does not recognize these characteristics. Greater creativity has also been suggested, but formal measures of this are no higher in children with ADHD than in control groups.

Nevertheless, psychiatric research suggests that there are several reasons for the persistence of the notion that people with ADHD have the ability to hyperfocus. For example, a well-recognised comorbidity of ADHD with autistic spectrum disorders, of which excess focus is a part. Special abilities do occur in some ADHD people, so it is easy to generalize from this minority to the whole ADHD group. ADHD is a remarkably common, but primarily genetically determined disorder (affecting 4-8% of school age children), so it is difficult to see why evolution hasn't removed it unless it bestows some benefit.

Professional psychiatry does not completely discount the existence of hyperfocus, as many adults with ADHD attribute accomplishments in their lives to this mental ability. As ADHD in adults is a relatively new area of learning in comparison with the condition in children, many clinicians feel that hyperfocus is an aspect of adult ADHD which is not well understood and merits more thorough research. <<

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Here’s a profile for ADHD:

Rev Neurol. 2006 Dec 1-15;43(11):678-84.

Rodriguez-Jiménez R, Cubillo A, Jiménez-Arriero MA, Ponce G, Aragüés-Figuero M, Palomo T.
Unidad de Alcoholismo y Patología Dual, Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Avenida Córdoba s/n, E-28045 Madrid, Spain. [e-mail]

INTRODUCTION: Several different follow-up studies have shown that attention deficit hyperactivity disorder (ADHD) can persist into adulthood. AIM: To review the findings in adults with ADHD related to alterations in the executive functions. DEVELOPMENT: Research conducted among children with ADHD has revealed the existence of alterations in different tasks that evaluate the executive functions, such as the planning test, sustained attention tasks, cognitive flexibility, verbal fluency and working memory tasks, as well as several inhibition response tasks. In adults with ADHD, despite the lower number of reports in the literature and the methodological shortcomings that exist in some studies, analogous results have also been described with respect to executive functioning, namely, disorders affecting inhibition response, the capacity for planning, difficulties in cognitive flexibility and verbal fluency, and problems with working memory, which include aspects of spatial working memory, logical or visual memory. CONCLUSIONS: The findings we have available at present enable us to confirm the persistence of executive dysfunctions in adult patients with ADHD that are similar to those observed in children with ADHD.

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NEJM 354:2637-2641 June 22, 2006 Number 25

ADHD in Adults

Susan Okie, M.D.


<snip>
Researchers have amassed considerable evidence that ADHD has a biologic basis. Family studies show that the heritability of the disorder is high, similar to that of schizophrenia or bipolar illness. Each sibling of a child with ADHD has about a 20 percent chance of having it too, and 15 to 20 percent of parents of affected children also have the disorder, said Stephen V. Faraone, a professor of psychiatry, neuroscience, and physiology at State University of New York Upstate Medical University. Anatomical studies comparing the brains of people with ADHD with those of unaffected people show reductions in volume throughout the cerebrum and cerebellum, amounting to about a 4 percent reduction in overall brain volume. Faraone said such findings may reflect "subtle changes in neural networks." Functional brain-imaging studies in affected children show abnormal activation of a number of cerebral areas during the performance of cognitive tasks, suggesting subtle differences in brain functioning. Genetic studies have so far implicated at least seven genes in influencing susceptibility to ADHD; most code for proteins that affect the levels or functioning of a neurotransmitter — dopamine, norepinephrine, or serotonin — at nerve synapses in the brain. Stimulant drugs that are effective against ADHD are thought to work by altering the levels of dopamine and norepinephrine at the synapse. Prenatal environmental factors such as pregnancy or delivery complications, prematurity, and fetal exposure to alcohol or tobacco also appear to be risk factors.5

Psychiatrists say that the diagnosis of ADHD is applied to people whose symptoms range in severity and probably stem from various combinations of biologic and environmental factors. "In my view, the science is not really at the level where we can say there is a single known physiological cause," said Taylor. "There are many causes, each of small effect . . . and the model of a single disease is not well applied. What does apply is the model of chronic disability." Moreover, not everyone with ADHD needs treatment, points out Rosenbaum. "If it's not severe, you may decide that . . . you would rather live with it."

Despite the evidence of a biologic basis for ADHD, debate continues (chiefly among nonpsychiatrists) about whether some behavior that fits the syndrome may represent a variant of normal functioning that is maladaptive in today's sedentary, performance-oriented society and that has therefore been targeted for treatment. "I think adult ADHD has to be looked at in relation to the need for drug companies to create a new market," said Ilina Singh, a sociologist at the London School of Economics who has studied the marketing of methylphenidate and related stimulants. Until very recently, "ADHD was always a disorder found in childhood," she said, noting that this view may have begun to change after psychiatrists Edward M. Hallowell and John J. Ratey suggested in a popular book, Driven to Distraction, that Albert Einstein may have had ADHD. Diagnosing the disorder for the first time in adults "is an extraordinary shift," she said.

Singh and others express concern about the facts that pharmaceutical companies have paid for many of the ADHD treatment studies and that several leading experts on the condition have received research funding from, or have other financial relationships with, manufacturers of ADHD drugs. A recent article reported that 13 of the 21 members of the DSM-IV panel that sets diagnostic standards for ADHD and other psychiatric disorders usually diagnosed in childhood have such financial ties.6

Stimulants are known to increase vigilance and improve performance on learning tasks in normal persons as well as those with ADHD. Advertisements for Adderall show men apparently working as architects, scientists, or chefs and contain slogans such as "Aim higher," "Reach new heights," and "Efficacy that measures up to life's demands." "The modern advertising of these drugs is not to treat deficiency," Singh said. "It captures adults' desire to optimize their life, to enhance their life. . . . Does everybody have the right to access these drugs? What happens if more and more people in the workplace have this competitive edge?"

But physicians who regularly treat the disorder say that such skepticism reflects a lack of awareness about the ability of ADHD to disrupt the lives of affected adults as well as children. "This is not just performance enhancement that we're talking about," said Daniel Shapiro, a behavioral pediatrician who practices in Rockville, Maryland. "This is relief of genuine suffering."
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And the videogame theory:

Eur Psychiatry. 2008 Mar;23(2):134-41.
Attention deficit/hyperactivity disorder and video games: a comparative study of hyperactive and control children.Bioulac S, Arfi L, Bouvard MP.
Centre Hospitalier Charles Perrens, Service universitaire de psychiatrie de l'enfant et de l'adolescent, 121, rue de la Béchade, 33076 Bordeaux cedex, France. [e-mail]

INTRODUCTION: This study describes and compares the behavior of hyperactive and control children playing video games. SUBJECTS AND METHODS: The sample consisted of 29 ADHD children and 21 controls aged between 6 and 16 years playing video games. We used the Child Behavior Checklist and the Problem Videogame Playing scale (PVP scale). This instrument gives objective measures of problem use, which can be considered as an indication of addictive videogame playing. We designed a questionnaire for the parents, eliciting qualitative information about their child's videogame playing. There were no significant differences concerning frequency or duration of play between ADHD children and controls but differences were observed on the PVP scale. None of the controls scored above four whereas 10 hyperactive children answered affirmatively to five or more questions. These children presented a greater intensity of the disorder than the other ADHD children. CONCLUSION: While no differences concerning video game use were found, ADHD children exhibited more problems associated with videogame playing. It seems that a subgroup of ADHD children could be vulnerable to developing dependence upon video games.
.........

1: Ann Gen Psychiatry. 2006 Oct 24;5:16. Links
A cross-sectional analysis of video games and attention deficit hyperactivity disorder symptoms in adolescents.Chan PA, Rabinowitz T.
Department of Internal Medicine, Rhode Island Hospital, Brown University, Providence, RI 02912, USA. [e-mail]

BACKGROUND: Excessive use of the Internet has been associated with attention deficit hyperactivity disorder (ADHD), but the relationship between video games and ADHD symptoms in adolescents is unknown. METHOD: A survey of adolescents and parents (n = 72 adolescents, 72 parents) was performed assessing daily time spent on the Internet, television, console video games, and Internet video games, and their association with academic and social functioning. Subjects were high school students in the ninth and tenth grade. Students were administered a modified Young's Internet Addiction Scale (YIAS) and asked questions about exercise, grades, work, and school detentions. Parents were asked to complete the Conners' Parent Rating Scale (CPRS) and answer questions regarding medical/psychiatric conditions in their child. RESULTS: There was a significant association between time spent playing games for more than one hour a day and YIAS (p < 0.001), overall grade point average (p < or = 0.019), and the "Inattention" and "ADHD" components of the CPRS (p < or = 0.001 and p < or = 0.020, respectively). No significant association was found between body mass index (BMI), exercise, number of detentions, or the "Oppositional" and "Hyperactivity" components of CPRS and video game use. CONCLUSION: Adolescents who play more than one hour of console or Internet video games may have more or more intense symptoms of ADHD or inattention than those who do not. Given the possible negative effects these conditions may have on scholastic performance, the added consequences of more time spent on video games may also place these individuals at increased risk for problems in school.

..........

J Atten Disord. 2005 May;8(4):160-8.
Inhibition, ADHD, and computer games: the inhibitory performance of children with ADHD on computerized tasks and games.Shaw R, Grayson A, Lewis V.
The Open University, Flecknoe, Nr Rugby, Warwickshire, UK. [e-mail]

Contrary to empirical reports of inhibitory dysfunction in ADHD, parental reports suggest that when playing computer games, the inhibitory abilities of children with ADHD are unimpaired. This small-scale preliminary investigation into this phenomenon looks at inhibition of an ongoing response and activity exhibited by children with ADHD between 6 and 14 years old on two commercially available games, on the Conners's Continuous Performance Test II (CPT II), and on a more game-like version of the same task that incorporates characteristics commonly found in commercially available computer games. The performance of participants with ADHD on commercially available games is equivalent to that of typically developing participants and is significantly better on the more game-like version of the CPT II.
..........

[bluedawg12]

2. Here’s a another thought

If these are self reported episodes of hyperfocus, then, perhaps by subjective experience for someone who has difficulty maintaining attention, any activity that appears to focus attention longer than they are accustomed to is perceived as hyperfocus.

The question,for example, do kids with ADHD play video games for longer periods of play? It seems not.

Or do kids with ADHD who enjoy video games and feel that they are hyperfocused, actually performing better on the game?

Is hyperfocus implied to mean, hyper performance? Sort of like a Clark Kent transformation from someone who has inattention to someone who is for a brief moment the "focus equivalent" of an X-man and get’s everything super correct?

Apparently not according to this and other studies.

J Atten Disord. 2004 Feb;7(3):137-49.
Executive function and ADHD: a comparison of children's performance during neuropsychological testing and real-world activities.Lawrence V, Houghton S, Douglas G, Durkin K, Whiting K, Tannock R.
Graduate School of Psychology, University of Western Australia.

OBJECTIVE: Current understanding of executive function deficits in Attention-Deficit/Hyperactivity Disorder (ADHD) is derived almost exclusively from neuropsychological testing conducted in laboratory settings. This study compared children's performance on both neuropsychological and real-life measures of executive function and processing speed. METHOD: The Stroop and Wisconsin Card Sorting Task (WCST) were selected as neuropsychological measures, whereas route tasks in a videogame and at the zoo were used to index real-life measures. Participants comprised a community sample of 22 unmedicated boys with ADHD individually matched on age and IQ with 22 normally developing control boys. RESULTS: There were no group differences in executive function on the Stroop or zoo tasks, but the ADHD group exhibited deficits in set-shifting as assessed by the WCST (perseverative errors and responses) and videogame play (fewer challenges completed). Also, the ADHD group showed slowed processing speed on the Stroop (slower color naming) and zoo activity (longer time to complete task), as well as a slower rate of acquisition of the sorting rule on the WCST (more trials to complete first category). Efficient and flexible videogame play (number of challenges completed) was related positively to efficacy on the Stroop (number of items named correctly in the interference and two control conditions) and inversely related to set-shifting problems on the WCST (perseverative responses and errors). Also, problems in goal-directed behavior at the zoo (number of deviations from designated route) were related to problems in set-shifting on the WCST (perseverative responding). CONCLUSIONS: Children with ADHD exhibit impairments in executive function and processing speed in real-world activities as well as in neuropsychological testing. Cognitive deficits detected by standardized neuropsychological testing are related to performance difficulties in real-world activities.

PMID: 15260171
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[LeftishBrit]

3. 'Hyperfocus' is not much studied as it's not a disorder in itself

However, there is certainly evidence that some people are particularly good at focusing attention on one topic for long periods and ignoring distractions, while others are better at multi-tasking and paying less focused but broader attention to several stimuli at once. There's some evidence that men tend to be better at the former and women at the latter, though, like most things that involve gender differences, this is often exaggerated in 'popular' psychology.

It is also known that people on the autistic spectrum can show attentional abnormalities, and that these can be in both directions: people may not notice things that would be obvious to others, or have a general difficulty in concentrating, and on the other hand may have a heightened ability to attend to some stimuli that others would ignore, and may show very focused concentration on a specific activity or object. Often the same people show both at different times or different situations.

This has been studied far less in ADHD, but it wouldn't surprise me if such a phenomenon exists, even if it is distorted in 'pop' psychological accounts.

[moggie]

4. I used to be able to focus very well

Back when I still had energy, if I had a project I was particularly interested in I could work at it for 24 hours at a stretch, shutting out most other stimuli and achieving much greater productivity than I had at other times. Whether this counted as hyperfocus I don't know. I knew the term, but applying it to myself would have seemed like self-promotion: rather, I thought it a personal flaw that I wasn't like this all the time!

[bluedawg12]

5. I thought the same thing at first

that it might be some paradoxical trait. But, now that I read the articles about the video game tests, it dawned on me that hyperfocus would be a pretty easy thing to test and confirm. For example, why aren't there studies that show that folks with either ADHD or ADD excell in certain things, seeing as how they have all sorts of cognitive tests to administer?

I am not saying it's not true. And heaven knows, I would love to think that there are somethings that people could excell at even if they don't excell at others in terms of concentration and organization in more traditional tests, but, by now that should have come out in data.

Still, that's not saying that the way the brain works isn't perplexing and indviduals vary greatly and there aren't some instances where people have some paradoxical trait, but, as far as a group it seems like it's been studied for exatly that, concentration and focus.

On an anecdotal level, I have a good friend who has a mild form of ADD and has some of the characteristics the articles mention like language skill problems and some ogranizatonal skill stuff, yet, she wil read a medical journal and understand the most complex thing and repeat it weeks later out of the blue. Her brother has a lot of fairly severe ADD type issues and yet, besides being the sweetest guy in the world who is as handsome as Christopher Reeves was in his prime, he has problems with work and focus, speech and focus and then, he turns around and draws brilliant cartoons that could almost be in the New Yorker.