Blog Post

autism ADHD reward deficiency syndrome

How Reward Deficiency Syndrome Affects Autistics and ADHDers


Reward deficiency syndrome is a common but often under-recognized challenge experienced by many neurodivergents. In this blog post, you’ll learn about how dopamine dysregulation affects daily life.

Introduction

Reward deficiency syndrome (RDS) is increasingly recognized as a key factor in understanding the behaviors and challenges faced by NDs, particularly ADHDers and autistics. By exploring the nuances of dopamine dysregulation and its effects, we can gain valuable insights into how RDS influences behavior and develop more effective coping strategies for the challenges it presents.

What is Reward Deficiency Syndrome?

RDS is a condition characterized by an inclination toward addictive, impulsive, and compulsive behaviors because of the brain’s underproduction of dopamine. Dopamine is crucial in the brain’s reward system, influencing pleasure, satisfaction, and overall well-being. Researchers believe ADHD may be a subset of RDS.

Individuals with RDS often engage in novelty-seeking behaviors, pursuing activities that offer stimulation or reward. This can sometimes lead to substance or process addictions, such as gaming, excessive social media use, or even dangerous sports. Carrie Fisher’s humorous quip, “Instant gratification takes too long,” captures the essence of the intense need for immediate satisfaction often experienced by those with RDS.

Coping Mechanisms and “Self-Medication”

Individuals with RDS often resort to various activities to manage their dopamine dysregulation. Some common “self-medication” behaviors include:

  • Exercise: Beneficial in moderation but can lead to issues like rhabdomyolysis if overdone.
  • Social Media Usage: Offers quick dopamine hits but can become addictive.
  • Gaming: Provides a sense of accomplishment but can dominate time and resources.
  • Impulse Buying: Offers temporary satisfaction but can lead to financial problems.
  • Compulsive Collecting: Can be a harmless hobby, though the cumulative expenses involved can become significant.
  • Binge Eating: Provides comfort but leads to health issues.
  • Workaholism: Offers a sense of purpose but can result in burnout.

Dopamine Dysregulation and Its Effects

ADHD, Autism, and RDS

In ADHDers, dopamine dysregulation is thought to contribute significantly to impulsive, hyperactive, and inattentive behavior. The chronic underproduction of dopamine, it is argued, leads to a constant search for activities that can provide the needed stimulation, sometimes resulting in substance use disorders. For instance, around 20% of ADHDers struggle with alcohol use disorder, and approximately 34-46% of adults seeking treatment for cannabis use disorder are ADHDers. Autistics also exhibit dopaminergic dysfunction, which may contribute to co-occurring anxiety.

Executive Dysfunction and Social Difficulties

Dopamine dysregulation impacts cognition and attention, contributing to executive dysfunction (ED) in ADHDers and social difficulties among autistics. Some researchers believe that similar dopaminergic issues in autistics may lead to ED. 

Hyper-Fixation

ND hyper-fixations may be attempts to resolve dopamine imbalances. What begins as a comforting but obsessive routine for some autistics can come to dominate their lives, depending on their stress levels. Similarly, stimulation-seeking ADHDers may adopt strategies like the “many mountains approach” (constantly seeking new challenges) or the “many irons approach” (juggling multiple tasks) to regulate dopamine levels.

Workaholism

Workaholism is one popular form of hyper-fixation, and is more likely if a job offerscontinuous stimulation. This condition, characterized by self-imposed demands and an all-consuming focus on work, often results in excessively long working hours and a disregard for personal life.

For NDs, workaholism can also become a coping mechanism, compensating for perceived deficiencies and leading to an identity tied solely to productivity and achievements. This overemphasis on work prevents addressing other life aspects, turning individuals into “human doings” rather than “human beings.”

The Dopamine Crash

Hyper-fixations, such as workaholism, maintain a state of intense stimulation, but stepping away from these fixations often leads to a dopamine “crash.” This aftermath can mirror withdrawal symptoms, causing anxiety, emptiness, and depression. The cycle of extreme activity followed by periods of near-catatonic depression is common among workaholics, leading to mental burnout and physical breakdown.

The Weekend Woes

A milder version of the dopamine crash often manifests as the “post-work plunge” or “weekend woes.” Any NDs, having depleted their executive functioning resources and dopamine levels throughout the workweek, struggle to manage necessary life tasks during their downtime. This accumulation of pending responsibilities often leads to feelings of being overwhelmed, triggering guilt and a downward spiral into helplessness.

Concluding Thoughts

Understanding RDS and its impact on autistics and ADHDers is crucial for developing effective coping strategies. By recognizing the signs of RDS and implementing balanced approaches to manage dopamine levels, individuals can lead healthier, more fulfilling lives.

 

References

Andreassen, C. S., Griffiths, M. D., Sinha, R., Hetland, J., & Pallesen, S. (2016). The relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PloS ONE, 11(5), e0152978. https://doi.org/10.1371/journal.pone.0152978

Attwood, T. (2007). The complete guide to Asperger’s syndrome. Jessica Kingsley Publishers.

Blum, K., Baron, D., Lott, L., Ponce, J. V., Siwicki, D., Boyett, B., Steinberg, B., Modestino, E. J., Fried, L., Hauser, M., Simpatico, T., Downs, B. W., McLaughlin, T., Hajela, R., & Badgaiyan, R. D. (2020). In search of reward deficiency syndrome (RDS)-free controls: The “holy grail” in genetic addiction risk testing. Current Psychopharmacology, 9(1), 7–21.

Blum, K., Chen, A. L., Braverman, E. R., Comings, D. E., Chen, T. J., Arcuri, V., Blum, S. H., Downs, B. W., Waite, R. L., Notaro, A., Lubar, J., Williams, L., Prihoda, T. J., Palomo, T., & Oscar-Berman, M. (2008). Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatric Disease and Treatment, 4(5), 893–918. https://doi.org/10.2147/ndt.s2627

Blum, K., McLaughlin, T., Bowirrat, A., Modestino, E. J., Baron, D., Gomez, L. L., Ceccanti, M., Braverman, E. R., Thanos, P. K., Cadet, J. L., Elman, I., Badgaiyan, R. D., Jalali, R., Green, R., Simpatico, T. A., Gupta, A., & Gold, M. S. (2022). Reward deficiency syndrome (RDS) surprisingly Is evolutionary and found everywhere: Is it “blowin’ in the wind”?. Journal of Personalized Medicine, 12(2), 321. https://doi.org/10.3390/jpm12020321

Bunford, N., Evans, S. W., & Wymbs, F. (2015). ADHD and emotion dysregulation among children and adolescents. Clinical Child and Family Psychology Review, 18(3), 185–217. https://doi.org/10.1007/s10567-015-0187-5

Cepeda, N. J., Cepeda, M. L., & Kramer, A. F. (2000). Task switching and attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 28(3), 213–226. https://doi.org/10.1023/a:1005143419092

Corbisiero, S., Stieglitz, R. D., Retz, W., & Rösler, M. (2013). Is emotional dysregulation part of the psychopathology of ADHD in adults? Attention Deficit and Hyperactivity Disorders, 5(2), 83–92. https://doi.org/10.1007/s12402-012-0097-z

Dhamija, D., Bello, A. O., Khan, A. A., Gutlapalli, S. D., Sohail, M., Patel, P. A., Midha, S., Shukla, S., & Mohammed, L. (2023). Evaluation of efficacy of cannabis use in patients with attention deficit hyperactivity disorder: A systematic review. Cureus, 15(6), e40969. https://doi.org/10.7759/cureus.40969

Finke, N. (1987, July 31). Carrie Fisher: Over the edge and back. Los Angeles Times. https://www.latimes.com/archives/la-xpm-1987-07-31-vw-148-story.html

Francisco, A. P., Lethbridge, G., Patterson, B., Goldman Bergmann, C., & Van Ameringen, M. (2023). Cannabis use in attention-deficit/hyperactivity disorder (ADHD): A scoping review. Journal of Psychiatric Research, 157, 239–256. https://doi.org/10.1016/j.jpsychires.2022.11.029

Gujska, J. H., Silczuk, A., Madejek, R., & Szulc, A. (2023). Exploring the link between attention-deficit hyperactivity disorder and cannabis use disorders: A review. Medical Science Monitor, 29, Article e939749. https://doi.org/10.12659/MSM.939749

Hoofs, V., Princen, M. M., Poljac, E., Stolk, A., & Poljac, E. (2018). Task switching in autism: An EEG study on intentions and actions. Neuropsychologia, 117, 398-407. https://doi.org/10.1016/j.neuropsychologia.2018.07.008

Karaca, S., Saleh, A., Canan, F., & Potenza, M. N. (2017). Comorbidity between behavioral addictions and attention deficit/hyperactivity disorder: A systematic review. International Journal of Mental Health and Addiction, 15(3), 701–724. https://doi.org/10.1007/s11469-016-9660-8

Kohls, G., Schulte-Rüther, M., Nehrkorn, B., Müller, K., Fink, G. R., Kamp-Becker, I., Herpertz-Dahlmann, B., Schultz, R. T., & Konrad, K. (2013). Reward system dysfunction in autism spectrum disorders. Social Cognitive and Affective Neuroscience, 8(5), 565–572. https://doi.org/10.1093/scan/nss033

Kriete, T., & Noelle, D. C. (2015). Dopamine and the development of executive dysfunction in autism spectrum disorders. PloS one, 10(3), e0121605.  https://doi.org/10.1371/journal.pone.0121605

Luderer, M., Ramos Quiroga, J. A., Faraone, S. V., Zhang James, Y., & Reif, A. (2021). Alcohol use disorders and ADHD. Neuroscience and Biobehavioral Reviews, 128, 648–660. https://doi.org/10.1016/j.neubiorev.2021.07.010

Nieoullon A. (2002). Dopamine and the regulation of cognition and attention. Progress in Neurobiology, 67(1), 53–83. https://doi.org/10.1016/s0301-0082(02)00011-4

Predescu, E., Sipos, R., Costescu, C. A., Ciocan, A., & Rus, D. I. (2020). Executive functions and emotion regulation in attention-deficit/hyperactivity disorder and borderline intellectual disability. Journal of Clinical Medicine, 9(4), Article 986. https://doi.org/10.3390/jcm9040986

Robinson, B. E. (2014). Chained to the desk (3rd ed.). NYU Press.

Supekar, K., Kochalka, J., Schaer, M., Wakeman, H., Qin, S., Padmanabhan, A., & Menon, V. (2018). Deficits in mesolimbic reward pathway underlie social interaction impairments in children with autism. Brain, 141(9), 2795–2805. https://doi.org/10.1093/brain/awy191

Vaa, T. (2014). ADHD and relative risk of accidents in road traffic: A meta-analysis. Accident Analysis and Prevention, 62, 415–425. https://doi.org/10.1016/j.aap.2013.10.003