27th National Clinical Education Symposium Presentation Abstracts
29 APRIL 2025, TUESDAY
10:15-11:30 ORAL PRESENTATION SESSION - 5
The Relationships Between Mind-Wandering, Insomnia, Chronotype and Theory of Mind in Patients Diagnosed with Attention-Deficit/Hyperactivity Disorder
Oğuzhan Şenel1, Esat Fahri Aydın1
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1. Department of Psychiatry, Ataturk University, Erzurum, Turkey
DOI: 10.5080/kes27.abs26 Page 47-48
BACKGROUND AND AIM:Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that typically manifests in childhood and can persist into adulthood. A short attention span, hyperactivity, and impulsivity characterize ADHD. It can cause significant functional impairments in various domains of life, including psychological, social, academic, and occupational functioning. Recent studies have shown a growing interest in exploring not only the behavioral symptoms but also the cognitive symptoms and internal experiences of individuals with ADHD. One of the frequently reported internal experiences of ADHD patients is continuous mental activity and constantly shifting thoughts, their thoughts are often uncontrollable, and multiple thoughts may co-occur. This condition, referred to as mind wandering, manifests as difficulty in focusing on ones targeted tasks, with thoughts involuntarily and extensively scattered across different topics. Understanding this condition is crucial for gaining insights into the mental functioning of individuals with ADHD. Studies have also indicated that 43% to 80% of adults with ADHD experience symptoms of insomnia, a common sleep disorder that makes it difficult to fall or stay asleep or causes early awakening accompanied by an inability to return to sleep. In dividuals with sleep problems may also exhibit ADHD symptoms. Evidently, insomnia may play a crucial role in the management and treatment of ADHD. Chronotype, or circadian preference, refers to the time of day when an individual is most efficient in performing daily activities. Individuals with ADHD, research indicates, tend to exhibit a later chronotype, leaning more toward the evening type compared to the general population. The studies that investigated the relationship between ADHD and chronotype found that the evening chronotype is mainly associated with inattention, hyperactivity, impulsive behaviors, and sleep problems. Chronotype is thus also an important factor in understanding and treating ADHD. The theory of mind (ToM) concept refers to the ability to understand the mental and emotional states of others. Crucial for successful social interactions, it involves recognizing that others may hold beliefs different from ones own and may act according to those beliefs. According to a meta-analysis conducted by Bora and Pantelis, while individuals with ADHD perform better on ToM tests than individuals with autism, they perform worse than healthy controls. Research indicates that a lack of ToM skills can produce difficulties in various areas, such as attention, learning, social interaction, and communication. For neurodevelopmental disorders such as ADHD, training programs aimed at improving ones ToM skills can positively impact ones social functioning. Based on our literature review, we identified that chronotype and ToM association and mind-wanderings associations with the ToM, chronotype, and insomnia have not been explored in adult ADHD patients. Additionally, we aimed to assess which of the mainly explored factors in our study (mind wandering, ToM, and chronotype) would mediate the association between ones severity of ADHD symptoms and insomnia.
METHODS (Ethics Committee Approval must be obtained and the number should be specified.):The study included 125 patients diagnosed with ADHD without comorbid psychiatric disorders. They were assessed using the structured clinical interview for DSM-5 (SCID-5), a sociodemographic and clinical data form, the adult ADHD self-report scale (ASRS), the mind excessively wandering scale (MEWS), the insomnia severity index (ISI), the morningness-eveningness questionnaire (MEQ), the Dokuz Eylul theory of mind scale (DEToMS), and the reading the mind in the eyes test (RMET). Ethical approval was obtained from the Ataturk University Faculty of Medicine Clinical Research Ethics Committee (decision number 40, dated May 2, 2023, and numbered B.30.2.ATA.0.01.00/307). The Ataturk University Scientific Research Projects Commission supported the study (project ID number: 13784). All the participants' informed consent was obtained before the study commenced.
RESULTS:Out of the 125 participants, 49.6% (n=62) were female. The median age was 24 years (interquartile range: 2229; range:1846). According to the MEQ classification, 44.8% of the participants (n=56) were identified as having an evening chronotype, 44.0% (n=55) as having an intermediate chronotype, and 11.2% (n=14) as having a morning chronotype. While 55.2% of the participants (n=69) had a history of a psychiatric diagnosis before being diagnosed with ADHD, 46.4% of the participants (n=58) had a history of self-mutilation. Additionally, 37.6% of the participants (n=47) were using medication for ADHD. According to the results of the correlation analysis, the ASRS total score was positively correlated with the MEWS score (r=0.702; p<0.001 ), ISI score (r=0.386; p<0.001), and DEToMS total score (r=-0.193; p=0.031), while it was negatively correlated with the MEQ score (r=-0.284; p=0.001). The MEWS score was positively correlated with the ISI score (r=0.477; p<0.001) but negatively correlated with the MEQ score (r=-0.267; p=0.003) and the DEToMS total score (r=-0.217; p=0.015). The ISI score was negatively correlated with both the MEQ score (r=-0.320; p<0.001) and the DEToMS total score (r=-0.203; p=0.023). The DEToMS total score was positively correlated with the RMET score (r=0.257; p=0.004). According to the mediation analysis results, no direct relationship was identified between the total ASRS and ISI scores (?=0.106; p=0.356). However, the total ASRS score indirectly affected the ISI score through increased MEWS scores (?=0.386; p<0.001).
CONCLUSIONS:Our results revealed the factors associated with mind wandering, insomnia, chronotype, and ToM in individuals with ADHD. Mind wandering was found to be positively correlated with ADHD symptom severity and insomnia; in contrast, it was negatively correlated with the ToM skills and morning chronotype characteristics. The full mediating role of mind wandering in the relationship between ADHD symptoms and insomnia levels is a noteworthy finding that should be considered in adult ADHD patients with insomnia symptoms. Addressing mind wandering in adult ADHD patients could thus be a crucial target for improving insomnia. Overall, our findings emphasize the need for a multidimensional approach when evaluating and treating ADHD, considering not only its core symptoms but also its associated cognitive and sleep-related impairments. Further longitudinal and interventional studies are needed to validate these relationships and to explore potential treatment strategies for adult ADHD. Our results may serve as a valuable reference for interventions targeting areas such as mind wandering, insomnia, chronotype, and the ToM in adult ADHD patients. REFERENCES:Faraone SV, Bellgrove MA, Brikell et al. (2024) Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 10: 1-21. Coogan AN, McGowan NM. (2017) A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder. Atten Def Hyp Disord 9: 129-47. Franklin MS, Mrazek MD, Anderson CL et al. (2017) Tracking distraction: The Relationship Between Mind-Wandering, Meta-Awareness, and ADHD Symptomatology. J Atten Disord 21: 475-86. Wynchank D, Ten Have M, Bijlenga D et al. (2018) The Association Between Insomnia and Sleep Duration in Adults With Attention-Deficit Hyperactivity Disorder: Results From a General Population Study. J Clin Sleep Med 14: 349-57. Bora E, Pantelis C. (2016) Meta-analysis of social cognition in attention-deficit/hyperactivity disorder (ADHD): comparison with healthy controls and autistic spectrum disorder. Psychol Med 46: 699-716.