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Exploring Object Permanence in ADHD

Written by:
Dorianne Green
MD

Highlights

  • Object permanence refers to the idea that objects continue to exist even when you can’t see, hear, or touch them; there is a theory that a lack thereof causes the ‘out of sight, out of mind’ problems in ADHD. 
  • Developing object permanence is a crucial childhood milestone that, on average, occurs around 8 to 9 months of age but can happen as early as 3.5 months.
  • Although it is believed that people with ADHD struggle with object permanence challenges, this is not 100% accurate as they do understand objects continue to exist even without visual cues.
  • The so-called ‘out of sight, out of mind’ difficulties experienced by ADHD patients are, in fact, due to poor working memory and not real object permanence issues.

What Is Object Permanence?

You’ve likely played peek-a-boo with a baby. It’s great fun, and this simple game will help you understand the term object permanence.

You hide your face behind your hands, and the baby gets confused or upset when they can’t see you but squeals with delight when you reappear; this little one doesn’t understand that you are still in front of them and believes you no longer exist; you are gone. This bambino still lacks object permanence. But after a while, the infant starts to look for you when you hide your face; then realizes that objects continue to exist, even when they are not immediately visible, and they have now developed object permanence.

Object permanence is the idea that objects continue to exist even when you can’t see, hear, or touch them. 

This is a key cognitive development stage first described by Swiss psychologist [1*] Jean Piaget. Although it was believed to happen around 8 to 9 months of age, some infants reach this developmental milestone as young as 3.5 months.

Separation anxiety manifests [2*] around the same time because, although the baby’s parents are out of sight, now that the infant understands object permanence, they are not out of mind.

So, as defined in developmental psychology, object permanence is straightforward; even though you have no visual cues, an object still exists. However, the understanding of object permanence in the context of attention deficit hyperactivity disorder (ADHD) is more complex.

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How Does Object Permanence Relate to ADHD?

If you or your loved one has ADHD [3*] , you will be very familiar with the concept of ‘out of sight, out of mind.’ It is a common belief that patients with ADHD lack object permanence or have object blindness, but this is not 100% accurate. Not seeing things in front of you might lead to them slipping your mind, but even though, at that moment, you may completely forget about them, you are aware that they still exist.

One theory is that object constancy issues in ADHD are a result of the common symptoms that are key for ADHD diagnosis:

  • Low attention
  • High energy and activity
  • Low impulse control

If you have a low attention span and are easily distracted, it would explain the ADHD-related ‘out of sight, out of mind’ phenomenon. Right?

But let’s delve deeper and talk about something called working memory [4*] . This is an important brain system for problem-solving and has two parts:

  1. Short-term memory: Think of short-term memory like a small cup. You can pour a limited amount of liquid (information) into it, but once it’s full, any extra fluid you try to add will spill out. 
  2. Executive attention: This part of the working memory decides what fluid (information) to pour into the cup. Should it be water, juice, or coffee? But, it can only handle a few decisions at a time and has to prioritize the information.

It is well-documented that the ADHD brain has a poor working memory [5*] . The result? Short-term memory battles to hold and prioritize ideas and objects. It’s a bit of a jumble, so anything that isn’t obviously important might be lost from short-term memory and replaced by something new. You can now understand that people with ADHD tend to forget about things when there are no visual reminders. Without the sensory cue, their conscious awareness has no active representation of the situation or its importance.

A recent study does not believe [6*] that poor working memory is linked to or causes low attention and high impulsivity behaviors, but rather is an entirely separate symptom of ADHD.

"Object permanence helps to put words to the phenomenon, but fails to completely capture it as those with ADHD do have a good deal of excellent memory capacity and often are high achieving individuals. Keep in mind that it is not intentional forgetfulness, or even a lack of caring, rather is an overflow of the scattered thinking that can be a challenge for those with ADHD."
Dr. Michael Chichak, MD
Medical provider at MEDvidi

The Impact of Object Permanence on ADHD Symptoms

Whatever the underlying cause is, the perceived ‘object permanence problems’ seen in ADHD don’t only relate to objects but might present as other permanence challenges. The short-term memory affected by ADHD struggles to hold tasks, ideas, and even the person’s own thoughts and feelings and can also result in a lack of emotional permanence.

Emotional permanence is the certainty that you are loved even when your loved ones are not around.

The Effects of Object Permanence Issues on Someone With ADHD

It makes sense that these perceived emotional and object permanence deficits can have negative effects on the lives of people with ADHD, and ‘out of sight, out of mind’ manifests in various ways.

ADHD typically presents in childhood, and the inattentive aspect might manifest in the following ways:

  • Difficulty following instructions
  • Appearing not to listen
  • Making careless mistakes in schoolwork
  • Avoiding homework
  • Losing toys, assignments, items of clothing
  • Having conflict and poor friendships with other children

It is now recognized that these can extend into adulthood, estimated to affect 5.3% of adults worldwide [7*] . ADHD symptoms might show up as:

  • Being easily distracted
  • Difficulty paying attention in large groups
  • Appearing disorganized
  • Having poor time management
  • Being overly forgetful
  • Apparent poor decision-making and procrastination
  • Forgetting daily tasks
  • Difficulty focusing on daily tasks
  • Often losing things
  • Difficulty completing large projects
  • Difficulty multitasking
  • Not paying attention to detail
  • Difficulty listening
  • Not following through on instructions or commitments
  • Not paying bills
  • Missing deadlines or appointments
  • Neglecting household chores
  • Increased driving accidents or poor driving skills
  • Forgetting to take medication

These symptoms and their knock-on effects can be divided into three broad categories:

  1. Inability to focus on or complete tasks at home and work.
  2. Failure to maintain relationships: Patients with ADHD may experience separation anxiety because they have difficulty believing they are still valued when they are away from their loved ones or work colleagues and have no tangible feedback. This insecurity can manifest as seeking constant validation, needing reassurance, and experiencing mood swings. 
  3. Tendency to develop mood disorders: It makes sense if the difficulties and symptoms surrounding tasks and relationships are not managed, the mood might be affected and possibly lead to depression and anxiety. In addition, poor sleep affects 70% [8*] of adults with ADHD.

Should you recognize these behaviors in someone undiagnosed with ADHD, encourage them to talk to a healthcare professional for an opinion. Some people might hesitate to seek help being afraid of the stigma, but remind them that an ADHD diagnosis is not only thunderclouds but also rainbows; some symptoms of ADHD can be superpowers if you learn to use them to your advantage, and the other classic ADHD behaviors are manageable.

"It helps to look at the issue of object permanence in the context of ADHD more related to memory fluidity. Patients with ADHD can struggle with the ‘out of sight, out of mind’ issue, depending on the subtype of ADHD and the severity, and this applies quite substantially to relationships.

It can be frustrating for those who have a significant other with ADHD feeling like they have just talked about something, but then it is forgotten as soon as the conversation is over. Often, a suitable treatment plan leads to vast improvement, so it is worth scheduling an appointment with a healthcare provider. "
Dr. Michael Chichak, MD
Medical provider at MEDvidi
MEDvidi’s medical team is here to help you find the right treatment and cope with ADHD symptoms.

Managing Object Permanence Issues in ADHD

As you can imagine, living or working with someone with would-be object permanence problems and who can’t follow through with tasks is very difficult; the knock-on effects cause decreased functioning in the personal and professional lives of people with ADHD.

The good news is that there are ways to help the working memory keep objects, tasks, and emotions in the short-term memory’s focus.

Advice to Keep Tasks on Track

The principle here is to have a constant visual reminder of the task at hand, thus avoiding the urge to drift to a different task.

Set Alarms

Set alarms to create reminders and push notifications on mobile devices or computer screens. The sensory cues (sight and sound) keep the short-term memory focused on the task. Importantly, setting a medication reminder is essential to control physical and mental health issues and stay healthy.

Consider One-on-one Meetings

If possible, schedule meetings individually for better focus and maintain eye contact during conversations to keep the working memory engaged.

Set Reminders

Use organizational tools and visual reminders such as calendars, structured lists, and checklists, available on mobile applications. Another option is to write things down to keep your short-term memory engaged. However, paper is easily misplaced.

Maintain a Daily Routine

Have a daily routine that helps to keep tasks on track. For example, set your clothes out for the next day, the night before. Get up, immediately make the bed, shower, get dressed, have breakfast, brush your teeth, and leave for work. Be strict about routine.

Communicate Effectively

Only open emails and text messages when there is dedicated time to read them and respond immediately.

Use Color

Use visual cues such as different colors to categorize appointments in your calendar, bright sticky notes on mirrors or doors, or put a chalkboard in your office or kitchen.

Designate Storage Areas

Have a designated area for certain objects. For example, always put your keys in a bowl at the front door, or your glasses on your bedside table.

Advice to Strengthen Relationships

Obviously, separation anxiety, which might manifest because of emotional permanence difficulties, can put a strain on adult relationships at home and work. Here is a list of strategies to protect relationships with family members and colleagues:

Talk Openly

Communicate feelings and express needs, for example, request physical contact or one-on-one time with the person.

Regulate Emotions

Acknowledge difficult emotions and regulate those emotions with mindfulness meditation. Mindfulness means observing your feelings and bodily sensations without judgment, noticing how you might have control over them, and changing these sensations with deep breaths or relaxation techniques. Mindfulness helps to remember that such physical and psychological symptoms are temporary and can be overcome.

Have Alone Time

Schedule ‘me time’ for uplifting activities away from work and personal relationships. Work in the garden, attend an art class, or go for a facial or massage. Whatever it is, quality alone time reduces dependence on others through self-fulfillment and increases self-worth.

Get Support

Join a support group. An ADHD community will provide practical advice and reduce the feeling of isolation.

When to Seek Professional Support

If you or a loved one have an ADHD diagnosis, and the so-called object permanence problems are interfering with your mental health, social relationships, or activities of daily life, it is time to seek professional support. The good news is that treatment plans can make a significant difference, and the healthcare professional will decide on the appropriate way forward. This may include individual, family, or couples therapy and possibly medication management options. At MEDvidi, you can see an online ADHD specialist in 24 hours and receive a personalized treatment plan.

Get help for ADHD online: go through an assessment and receive a detailed treatment plan.

Summing It Up

There are theories that the ‘out of sight, out of mind’ difficulties experienced in ADHD are due to object permanence issues. This is, in fact, not the case because ADHD patients are aware that even when they cannot see or hear something, it continues to exist. Instead, the symptom of distractibility is thought to result from the poor working memory of ADHD brains. The bottom line is that whatever the cause, ADHD can be managed effectively—see dedicated healthcare professionals at MEDvidi online to get the help you need.

Sources

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8 sources
  1. Object permanence | Description, Origins, According to Piaget, & Other Species | Britannica. In: Encyclopædia Britannica. ; 2024. Accessed October 1, 2024.
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  2. Malik F, Marwaha R. Cognitive Development. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
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  3. Magnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
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  4. Memory - Cognitive Process, Short-Term Storage, Retrieval | Britannica. In: Encyclopædia Britannica. ; 2024. Accessed October 1, 2024.
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  5. APA PsycNet.
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  7. Osborne JB, Zhang H, Carlson M, Shah P, Jonides J. The association between different sources of distraction and symptoms of attention deficit hyperactivity disorder. Front Psychiatry. 2023 Jul 27;14:1173989. doi: 10.3389/fpsyt.2023.1173989. PMID: 37575583; PMCID: PMC10421702.
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  8. National Institute of Mental Health. Attention-deficit/hyperactivity disorder in adults: What you need to know. www.nimh.nih.gov. Published 2021.
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Written by:
Dorianne Green
MD
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