The experience of effort in ADHD: a scoping review.

Background: Mental effort plays a critical role in regulating cognition. However, the experience of mental effort may differ for individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), a disorder for which sustained mental effort 'avoidance' or 'dislike' is a criterion in the DSM. We conducted a scoping review to characterize the literature on the experiences of effort in ADHD. Methods: This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology. PsycINFO (OVID), PsycINFO (ProQuest) and PubMed were searched for studies published in English before February 14, 2023. Studies must have included an ADHD population or a measure of ADHD symptomatology, in addition to a self-report measure of the experience of effort or the use of an effort preference paradigm. Two researchers reviewed all abstracts, and one researcher reviewed full-text articles. Results: Only 12 studies met the inclusion criteria. Several gaps and inconsistencies in the research were identified in terms of method, definitions of effort, measurements of ADHD, and sample characteristics. Moreover, the pattern of results on the experience of effort was mixed. Conclusion: Despite its diagnostic and conceptual significance, the experience of mental effort in ADHD is not well studied. Critical gaps were identified in the existing literature. A three-facet conceptualization of effort is proposed-specifically, task-elicited effort, volitionally exerted effort, and the affect associated with engaging in effort - to guide future explorations of the experience of effort in ADHD.

Trait Boredom as a Lack of Agency: A Theoretical Model and a New Assessment Tool.

Trait boredom plays a significant role in well-being. However, this construct suffers from conceptual ambiguity and measurement problems. The aim of this study was to propose a comprehensive theory and a strong assessment tool to address these limitations. We defined trait boredom as the frequent experience of state boredom resulting from a chronic lack of agency. We developed a six-item self-report scale of the tendency to often experience boredom. Results confirmed a uni-dimensional scale with strong psychometric properties, including adequate internal consistency (ω = .84-.93), interindividual stability (69.04% of variance accounted by a trait factor), and acceptable model fit (CFI = .977-.998, TLI = .962-.997, RMSEA = .025-.090, SRMR = .014-.029). Results confirmed the validity of the scale by showing its associations with related measures. Our findings provide clarity on trait boredom and a strong, new measure to be used in future work.

Examining the Longitudinal Associations between Adjustment Disorder Symptoms and Boredom during COVID-19.

The COVID-19 pandemic has led to a myriad of stressors, underscoring the relevance of adjustment disorder during these extraordinary times. Boredom-as a feeling and as a dispositional characteristic-is an equally pertinent experience during the pandemic that has been cross-sectionally linked to various mental health difficulties. The current longitudinal study expanded on this work, examining the associations between adjustment disorder symptoms and boredom (both as a feeling and as a trait) over time during the COVID-19 pandemic. Community participants completed questionnaires three times, rating their trait boredom at Time 1 and their feelings of boredom and adjustment disorder symptoms (preoccupation with a pandemic stressor and failure to adapt) over the past week at Times 1-3. Latent growth curve analyses found that an increase in feelings of boredom was significantly associated with increased preoccupation with a pandemic stressor and increased difficulties with adapting over time. Additionally, trait boredom significantly predicted changes in preoccupation and the failure to adapt, such that participants high in trait boredom increasingly struggled with these symptoms over time. Our results suggest that increased feelings of boredom and a trait disposition towards boredom can be detrimental to people's ability to adjust over time to the stressors associated with the pandemic. Boredom, as an aversive state and as a chronic difficulty, may be important to address in treatment approaches for adjustment disorder symptoms during COVID-19.

Distinct profiles of psychological and neuropsychological functions underlying goal-directed pursuit in schizophrenia.

OBJECTIVES: Several components are known to underlie goal-directed pursuit, including executive, motivational and volitional functions. These were explored in schizophrenia spectrum disorders in order to identify subgroups with distinct profiles. METHODS: Multiple executive, motivational and volitional tests were administered to a sample of outpatients with schizophrenia spectrum diagnoses (n = 59) and controls (n = 63). Research questions included whether distinct profiles exist and whether some functions are impacted disproportionately. These questions were addressed via cluster analysis and profile analysis, respectively. RESULTS: Some such functions were significantly altered in schizophrenia while others were unaffected. Two distinct profiles emerged, one characterized by energizing deficits, reduced reward sensitivity and few subjective complaints; while another was characterized by markedly increased punishment sensitivity, intact reward sensitivity and substantial subjective reporting of avolitional symptoms and boredom susceptibility. CONCLUSION: These findings highlight the importance of considering distinct patterns of strengths and deficits in functions governing goal-directed pursuit in schizophrenia that demarcate identifiable subtypes. These distinctions have implications for treatment, assessment and research.

Temperament Profiles Associated with Internalizing Symptoms and Externalizing Behavior in Adolescents with ADHD.

The current study investigated temperament profiles associated with internalizing symptoms and externalizing behavior in adolescents with ADHD. Participants were 121 adolescents (90 males) with ADHD, ranging in age from 13 to 18 years (M = 15.40, SD = 1.59). Emotional and behavioral ratings were obtained using the Strengths and Difficulties Questionnaire (SDQ) and temperament profiles were assessed by administering the Temperament and Character Inventory (TCI). Multivariate profile analyses and post hoc tests revealed that youth high in internalizing symptoms were significantly higher in harm avoidance and lower in self-directedness. Youth high in externalizing behavior were significantly lower in cooperativeness. No cognitive differences were observed across groups, but youth high in externalizing behavior had more ADHD symptoms and greater impairment in daily life. Findings reveal unique temperament factors associated with comorbid concerns, which may have implications for adapting and personalizing intervention efforts based on these different profiles within adolescents with ADHD.

A longitudinal approach to understanding boredom during pandemics: The predictive roles of trauma and emotion dysregulation.

Research during the COVID-19 pandemic and prior outbreaks suggest that boredom is linked to poor compliance with critical lifesaving social distancing and quarantine guidelines, as well as to numerous mental health difficulties. As such, continued understanding on what contributes to boredom is imperative. Extending beyond the roles of constraint, monotony, and trait dispositions (e.g., individual differences in boredom propensity), and informed by prior theories on the emotional contributors of boredom, the current longitudinal study examined the predictive role of "pandemic trauma" on people's boredom, with a focus on how emotion dysregulation mediates this relationship. Community participants (N = 345) completed questionnaires three times across an average of 3 1/2 weeks, rating their pandemic trauma, emotion dysregulation, and boredom over the past week each time. Pandemic trauma was assessed with items querying exposure to coronavirus, as well as the financial, resource-related, and interpersonal pandemic stressors that participants experienced. Emotion dysregulation was assessed with the Difficulties in Emotion Regulation Scale. Boredom was assessed with the short-form Multidimensional State Boredom Scale. The results of a theory-informed mediation model showed that participants' pandemic trauma at Time 1 positively and modestly predicted their boredom at Time 3 and that this relationship was partially and moderately mediated by participants' lack of emotional clarity and difficulties with engaging in goal-directed behaviors at Time 2. When people experience pandemic-related trauma, they subsequently struggle to understand their feelings and engage in goal-oriented actions, and, in turn, feel more bored. Theoretical and clinical implications as related to the emotional underpinnings of boredom are discussed.

Sitting with it: An investigation of the relationship between trait mindfulness and sustained attention.

BACKGROUND: Sustaining attention for extended periods of time is associated with negative affect and this increase in negative affect is related to poorer task performance. Trait mindfulness has been shown to be associated with better sustained attention performance. This may be because trait mindfulness is associated with better attention ability or better emotion regulation ability. AIMS: The present research aims to replicate previous findings and better understand why trait mindfulness is associated with better sustained attention performance. METHOD: Participants responded to self-report questionnaires assessing their trait mindfulness, attentional control, and experiential avoidance. Next, participants performed a sustained attention task, during which they also reported their subjective feelings of discomfort and boredom. Finally, participants reported their retrospective discomfort and boredom after the task. RESULTS: We replicated and extended previous findings by showing that the relationship between trait mindfulness and sustained attention performance was mediated by negative affect experienced during the task. Moreover, the correlation between trait mindfulness and sustained attention disappeared when controlling for experiential avoidance, but remined when controlling for attention control. CONCLUSION: Our results suggest that trait mindfulness is associated with sustained attention because of enhanced emotion regulation and that enhancing affective regulation would be an effective strategy for improving sustained attention performance.

Anticipated, experienced, and remembered subjective effort and discomfort on sustained attention versus working memory tasks.

This study examined individuals' ability to accurately anticipate how cognitively effortful and uncomfortable a task will feel based on a short sample of the task. Participants completed a sustained attention or working memory task. Post-practice, participants rated the effort and discomfort that they anticipated their task would require and engender, respectively. Participants also rated their effort and discomfort during task-administration and the effort and discomfort they recalled feeling after task-administration. Sustained attention task participants anticipated significantly less effort than working memory task participants. Sustained attention task participants felt significantly more effort during the task and remembered feeling more effort than they had anticipated. Working memory task participants felt significantly less effort during the task than they had anticipated. Sustained attention task participants anticipated, experienced, and recalled feeling more discomfort than working memory task participants. Individuals' anticipation of effort required depends on the task and is different from the effort they actually feel during the task and later recall feeling.

Mental effort and discomfort: Testing the peak-end effect during a cognitively demanding task.

We applied the peak-end paradigm that was first introduced in the pain literature to examine the experience of effort and discomfort during a cognitively demanding working memory task. A total of 401 participants were asked to rate their effort and discomfort during and after the administration of a working memory task, which systematically varied task difficulty within participants and task duration between participants. Over the course of the task, participants reported a decrease in reported effort and an increase in reported discomfort. Peak and end real-time ratings were significant predictors of retrospective ratings for effort and discomfort; average and initial ratings predicted a small amount of additional variance. The regression analyses with effort and discomfort were largely consistent, with some exceptions. End discomfort significantly predicted willingness to do the task again, but not end effort. These findings highlight the ways in which the experience of effort and discomfort are integrally related, yet importantly separate, during a cognitively demanding task.

Does state boredom cause failures of attention? Examining the relations between trait boredom, state boredom, and sustained attention.

Boredom is an important personal and social problem, but the phenomena itself remains poorly understood. Recent work has shown that boredom is highly related to attention, and that this relationship may be instrumental in revealing boredom's causes and consequences. In this paper, experimental findings on trait boredom, state boredom, and sustained attention performance are presented. We demonstrate that trait boredom uniquely predicts sustained attention performance, over and above depression and self-report attention problems. We also present exploratory findings consistent with the claim that attention failures may cause boredom and that sustained attention tasks may themselves be boring. Discussion of each of these findings, and potential ramifications for cognitive research as a whole, is included.

Differences in Perceived Mental Effort Required and Discomfort during a Working Memory Task between Individuals At-risk And Not At-risk for ADHD.

Objective: The avoidance of mental effort is a symptom criterion for Attention-Deficit/Hyperactivity Disorder (ADHD), but the experience of mental effort has received relatively little attention in the empirical study of individuals at-risk for ADHD. We explored a novel method to assess the experience of effort and discomfort during a working memory task in a sample of young adults at-risk and not at-risk for ADHD. Method: A sample of 235 undergraduate students (Mean age = 21.02, 86 males) were included in this study. Based on an ADHD-screener (ASRS), 136 participants met criteria for the ADHD-risk group and 99 were in the non-ADHD risk group. Results: Individuals at-risk for ADHD reported higher mental effort and discomfort than individuals not at-risk for ADHD, even when performance on the working memory task was comparable or statistically controlled. Mental effort required and discomfort were more strongly correlated for at-risk compared to not at-risk participants. Individuals at-risk for ADHD displayed a stronger correlation between mental effort required and actual accuracy, but individuals not at-risk for ADHD displayed a stronger association between perceived accuracy and actual accuracy for the hardest experimental conditions. The most intense moment of effort required predicted retrospective discomfort ratings of the task in the ADHD-risk group, but not in the non-risk group. Conclusion: The subjective experience of in the moment mental effort is an important and viable construct that should be more carefully defined and measured. In particular, the experience of effort required (or how taxing a task is) differentiated between individuals at-risk and individuals not at-risk for ADHD in the present study. Whereas previous ADHD research has explored effort exerted, the present work demonstrated that investigating the experience of being mentally taxed might provide a productive line of investigation that could be used to advance our understanding of the cognitive and affective mechanisms underlying the regulation of effort in individuals at-risk of ADHD.

Factor structure and validity of the State-Trait Inventory for Cognitive and Somatic Anxiety.

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA; Ree, French, MacLeod, & Locke, 2008) is a relatively new measure of anxiety. The current research investigated the factor structure and reliability of scores on the STICSA and the validity of the interpretation of STICSA scores in a sample of undergraduate students. Participants completed a battery of self-report questionnaires online, including measures of anxiety, depression, affect, and social desirability. Scores on the 4 subscales of the STICSA-Trait Cognitive, Trait Somatic, State Cognitive, and State Somatic-exhibited good internal consistencies (αs ≥ .92). Results of a confirmatory factor analysis provided support for a hierarchical model of the STICSA including a global anxiety factor plus 4 specific factors corresponding to the STICSA subscales. Support was also found for a four-factor model, with factors corresponding to the STICSA subscales. Pearson product-moment correlations with other measures of anxiety provided evidence of the convergent validity of the interpretation of STICSA scores, and Pearson product-moment correlations with measures of depression and affect provided evidence of the divergent validity of the interpretation of STICSA scores. The STICSA is the only existing self-report anxiety measure that contains scales measuring state and trait anxiety as well as cognitive and somatic anxiety. Comparisons between the convergent and divergent validity of test score interpretations of the STICSA and the State-Trait Anxiety Inventory (STAI; Spielberger et al., 1983) revealed that the STICSA has better convergent validity with measures of somatic anxiety and better divergent validity with measures of depression and affect. (PsycINFO Database Record

Boredom proneness predicts quality of life in outpatients diagnosed with schizophrenia-spectrum disorders.

BACKGROUND: There is increasing recognition of the clinical significance of boredom associated with functional impairments in schizophrenia. Previous work has highlighted the importance of motivational deficits more broadly, although no study has yet explored the unique effects of boredom on community outcomes. AIMS: This study aims to measure boredom proneness among outpatients diagnosed with schizophrenia to determine whether it is elevated in this population and to determine its relation to quality-of-life outcomes. METHODS: A self-report measure of boredom proneness along with standard measures of symptoms and functional status was administered to a community-dwelling sample of schizophrenia outpatients. RESULTS: Boredom proneness was found to be elevated in this population and was associated with reduced quality of life, specifically with leisure activity dissatisfaction and reduced sense of financial well-being. Negative symptoms were determined to be associated with reduced work and school functioning. CONCLUSION: This pattern of unique effects on quality of life highlights the clinical relevance of identifying a subjective state of boredom and has theoretical importance in distinguishing boredom proneness specifically from more general avolitional and amotivational conditions that have tended to be the focus of clinical observation and previous research.

Modeling mental health information preferences during the early adult years: a discrete choice conjoint experiment.

Although most young adults with mood and anxiety disorders do not seek treatment, those who are better informed about mental health problems are more likely to use services. The authors used conjoint analysis to model strategies for providing information about anxiety and depression to young adults. Participants (N = 1,035) completed 17 choice tasks presenting combinations of 15 four-level attributes of a mental health information strategy. Latent class analysis yielded 3 segments. The virtual segment (28.7%) preferred working independently on the Internet to obtain information recommended by young adults who had experienced anxiety or depression. Self-assessment options and links to service providers were more important to this segment. Conventional participants (30.1%) preferred books or pamphlets recommended by a doctor, endorsed by mental health professionals, and used with a doctor's support. They would devote more time to information acquisition but were less likely to use Internet social networking options. Brief sources of information were more important to the low interest segment (41.2%). All segments preferred information about alternative ways to reduce anxiety or depression rather than psychological approaches or medication. Maximizing the use of information requires active and passive approaches delivered through old-media (e.g., books) and new-media (e.g., Internet) channels.

The measurement of boredom: differences between existing self-report scales.

There are two commonly used measures of boredom: the Boredom Proneness Scale (BPS) and the Boredom Susceptibility Scale (ZBS). Although both were designed to measure the propensity to experience boredom (i.e., trait boredom), there are reasons to think they may not measure the same construct. The present research sought to evaluate this proposition in several stages. Specifically, relationships between the BPS, ZBS, and important causal (Study 1, N = 837), correlational (Study 2, N = 233), and outcome variables (Study 3, N = 137) were examined in university students. Taken together, results support the notion that the BPS and ZBS do not measure the same construct. Specifically, higher BPS scores were associated with higher levels of neuroticism, experiential avoidance, attentional and nonplanning impulsivity, anxiety, depression, dysphoria, and emotional eating. Conversely, higher ZBS scores were associated with higher levels of motor impulsivity, sensitivity to reward, gambling, and alcohol use and lower levels of neuroticism, experiential avoidance, and sensitivity to punishment.

Development and validation of the multidimensional state boredom scale.

This article describes the development and validation of the Multidimensional State Boredom Scale (MSBS)-the first and only full-scale measure of state boredom. It was developed based on a theoretically and empirically grounded definition of boredom. A five-factor structure of the scale (Disengagement, High Arousal, Low Arousal, Inattention, and Time Perception) was supported by exploratory factor analyses and confirmatory factor analyses of two independent samples. Furthermore, all subscales were significantly related to a single, second-order factor. The MSBS factor structure was shown to be invariant across gender. MSBS scores were significantly correlated with measures of trait boredom, depression, anxiety, anger, inattention, impulsivity, neuroticism, life satisfaction, and purpose in life. Finally, MSBS scores distinguished between participants who were experimentally manipulated into a state of boredom and those who were not, above and beyond measures of trait boredom, negative affect, and depression.

What are young adults saying about mental health? An analysis of Internet blogs.

BACKGROUND: Despite the high prevalence of mental health concerns, few young adults access treatment. While much research has focused on understanding the barriers to service access, few studies have explored unbiased accounts of the experiences of young adults with mental health concerns. It is through hearing these experiences and gaining an in-depth understanding of what is being said by young adults that improvements can be made to interventions focused on increasing access to care. OBJECTIVE: To move beyond past research by using an innovative qualitative research method of analyzing the blogs of young adults (18-25 years of age) with mental health concerns to understand their experiences. METHODS: We used an enhanced Internet search vehicle, DEVONagent, to extract Internet blogs using primary keywords related to mental health. Blogs (N = 8) were selected based on age of authors (18-25 years), gender, relevance to mental health, and recency of the entries. Blogs excerpts were analyzed using a combination of grounded theory and consensual qualitative research methods. RESULTS: Two core categories emerged from the qualitative analysis of the bloggers accounts: I am powerless (intrapersonal) and I am utterly alone (interpersonal). Overall, the young adult bloggers expressed significant feelings of powerlessness as a result of their mental health concerns and simultaneously felt a profound sense of loneliness, alienation, and lack of connection with others. CONCLUSIONS: The present study suggests that one reason young adults do not seek care might be that they view the mental health system negatively and feel disconnected from these services. To decrease young adults' sense of powerlessness and isolation, efforts should focus on creating and developing resources and services that allow young adults to feel connected and empowered. Through an understanding of the experiences of young adults with mental health problems, and their experiences of and attitudes toward receiving care, we provide some recommendations for improving receptivity and knowledge of mental health care services.

Manipulations of attention enhance self-regulation.

Successful goal-directed behavior requires self-regulation to override competing impulses. Emerging evidence suggests that attention may mediate such acts, but little is known about the specific operations through which attention might influence self-regulation. Here we test this often-implicit assumption by manipulating attention mechanisms in two ways: one controlling the inhibition of inappropriate responses; the other controlling the breadth of attention. Participants significantly improved their performance on a self-regulation task after practice on a response inhibition task (Experiment 1) and after the induction of a broad focus of attention in a visual discrimination task (Experiment 2). We propose that such manipulations enhance self-regulation by engaging mechanisms that enhance the salience of goal-related representations and reduce the activation of competing goal-irrelevant neural representations. By more efficiently resolving conflict among the signals vying to drive behavior, pre-engaging attention may also help to conserve resources needed for continued self-regulation.

The Unengaged Mind: Defining Boredom in Terms of Attention.

Our central goal is to provide a definition of boredom in terms of the underlying mental processes that occur during an instance of boredom. Through the synthesis of psychodynamic, existential, arousal, and cognitive theories of boredom, we argue that boredom is universally conceptualized as "the aversive experience of wanting, but being unable, to engage in satisfying activity." We propose to map this conceptualization onto underlying mental processes. Specifically, we propose that boredom be defined in terms of attention. That is, boredom is the aversive state that occurs when we (a) are not able to successfully engage attention with internal (e.g., thoughts or feelings) or external (e.g., environmental stimuli) information required for participating in satisfying activity, (b) are focused on the fact that we are not able to engage attention and participate in satisfying activity, and (c) attribute the cause of our aversive state to the environment. We believe that our definition of boredom fully accounts for the phenomenal experience of boredom, brings existing theories of boredom into dialogue with one another, and suggests specific directions for future research on boredom and attention.