What is ADHD Paralysis?
ADHD paralysis, also known as "ADHD freeze," is a state of overwhelm that can occur when an individual with ADHD needs to complete a task. This condition is characterised by an inability to switch from one task to another or feeling "stuck" in a task. It often appears that the individual is procrastinating or lacking motivation, but in reality, they are experiencing psychological overwhelm [1, 2].
ADHD paralysis is often associated with too many requirements, stimulation, or expectations all at once. It's not that the individual doesn't want to complete the task, but their goal-directed behaviour is frozen.
This paralysis often results from a combination of anxiety, overstimulation, and difficulties with executive function. It can manifest as constantly delaying or avoiding tasks, feeling overwhelmed at the thought of the task, experiencing anxiety when engaging in the activity, or wanting to do something but not being able to start, even if the task is simple [2].
ADHD is associated with specific motivation deficits. Studies show that people with ADHD tend to have higher levels of amotivation and extrinsic motivation, while their intrinsic motivation is often lower. This may indicate that children with ADHD need more substantial incentives to change their behaviour and struggle with delaying gratification.[1].
ADHD paralysis and polyvagal theory
The polyvagal theory, proposed by Stephen Porges, provides a unique perspective on the adaptive responses of the mammalian autonomic nervous system.
This theory suggests that the vagus nerve operates through two independent pathways, the ventral and dorsal vagal pathways [3]. The ventral vagus is a myelinated nerve that evolved in mammals and controls the facial and head muscles, working alongside cranial nerves to create the ventral vagal complex. This complex allows for social engagement by sharing safety signals and calming the body's stress responses.[3]
This theory suggests that the vagus nerve operates through two independent pathways, the ventral and dorsal vagal pathways [3]. The ventral vagus is a myelinated nerve that evolved in mammals and controls the facial and head muscles, working alongside cranial nerves to create the ventral vagal complex. This complex allows for social engagement by sharing safety signals and calming the body's stress responses.[3]
In a safe environment, mammals adapt using the social engagement system. However, depending on the degree of risk exposure in the environment, activation of the sympathetic nervous system triggers the fight-or-flight response, and the dorsal vagal system initiates the immobilisation shutdown response [3]. This involuntary neural process, by which the nervous system evaluates risk, is called neuroception [3].
The polyvagal theory can be used to explain ADHD paralysis, although the exact mechanisms are not fully understood, and more research is needed. ADHD paralysis refers to the difficulty individuals with ADHD often experience when initiating tasks. This could be linked to the polyvagal theory through the concept of neuroception, where the nervous system evaluates risk and may trigger a shutdown response in certain situations. This could manifest as paralysis or an inability to start tasks in individuals with ADHD.
Treating ADHD paralysis
Pharmacological therapy: One of the primary ways to treat ADHD, including symptoms like task paralysis, is through pharmacological treatment.
Stimulants like amphetamines and methylphenidates are commonly used to prevent the reabsorption of dopamine at the presynaptic and postsynaptic membranes. This process increases dopamine levels in the brain[4, 5].
Non-stimulant medications, such as atomoxetine, which is a selective norepinephrine reuptake inhibitor, can also be used, mainly when stimulants are not well-tolerated [6].
Psychotherapy: In addition to medication, psychotherapy, including behaviour therapy, can be beneficial. Cognitive-behavioral training programs designed specifically for patients can help them achieve short and long-term goals [4]. Education or training for parents to give them the skills and strategies to help their children is critical [4].
Physiotherapy: In some instances, ADHD may come with motor issues, which can make it harder to complete tasks. In these situations, referring the child to a pediatric physiotherapist or a rehabilitation doctor can be helpful. Physical therapy has been shown to significantly enhance motor skills in children with both ADHD and developmental coordination disorder (DCD)[7, 8].
It's important to note that each individual's experience with ADHD and task paralysis is unique, and treatment plans should be tailored to their specific needs. Regular monitoring and adjustments to the treatment plan might be necessary [4].