Diminished Interoceptive Accuracy in Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Interoception is the perception of one's internal physiological state. Altered interoception may play a role in the pathogenesis of attention-deficit/hyperactivity disorder (ADHD). We reviewed the literature on interoception and ADHD symptoms (inattention, hyperactivity/impulsivity, executive function, emotional dysregulation) in individuals with and without the disorder. Studies included assessments of interoception and ADHD symptoms in (1) individuals with/without diagnoses of ADHD or (2) the general population. Interoception assessments included objective measures (heartbeat-tracking test) and self-report questionnaires. The literature search included the PubMed/MEDLINE, PsychINFO, CINAHL and Scopus databases. A protocol was prospectively registered in the PROSPERO database (CRD #42022351726); the PRISMA guidelines directed reporting. The Newcastle-Ottawa scale was adapted to evaluate study quality. Of 636 articles identified, 17 articles (based on 18 studies) met inclusion criteria. Five studies compared interoception in participants with/without ADHD, and three found that interoception was reduced in participants with ADHD. One study compared interoception between presentations of ADHD, finding no differences. Twelve studies assessed the association of ADHD symptoms and interoception in the general population. Overall, results suggested that interoception is reduced in individuals who reported higher symptoms of inattention, hyperactivity, impulsivity, emotional dysregulation, and executive dysfunction. Studies were of moderate quality; issues included small sample sizes and inadequate reporting. Individuals with ADHD may have decreased interoception compared to individuals without. Interoception is negatively associated with ADHD symptoms in the general population. Interventions focused on improving interoceptive abilities may provide an avenue for ADHD treatment. Future work should consider the role of culture in interoception.