ADHD, Reward and the Cycle of Contact

Contemporary ADHD research explores multiple interacting processes, including attention, executive functioning, reward-related decision-making and emotional regulation. One area of particular interest is the role of dopamine, a neurotransmitter involved in processes such as learning, reward and movement. Dopamine is clearly relevant to ADHD: medications that alter dopamine signalling can substantially reduce ADHD symptoms for many people. However, this does not mean that ADHD is simply caused by having too little dopamine. Current research suggests a much more complex picture, involving dopamine alongside other neurotransmitter systems and differences in how these systems function across brain networks (MacDonald et al., 2024).

One area researchers have explored is delay discounting, which describes how the subjective value of a reward can decrease when we have to wait for it. On average, groups of people with ADHD have shown relatively steeper delay discounting than control groups, or a greater preference for smaller immediate rewards over larger delayed ones. However, this difference varies across age groups, study designs and individual circumstances, and it should not be understood as a defining feature of every person with ADHD (Scheres et al., 2024). 

The Gestalt cycle of contact offers another way of looking at this process. It describes how a need emerges into our awareness, moves us towards action and, where possible, towards satisfaction of the need. This gives us a way to explore what captures attention, what supports or interrupts movement towards what we want or need, and how satisfaction is experienced.

This also raises an important question about what happens between wanting something and reaching satisfaction. Something else may capture attention, the original activity may lose its pull, or waiting for the outcome may become difficult. Gestalt therapy can explore this process experientially: What initially draws me towards this? What happens as I begin to move towards it? At what point does something change? What becomes more compelling, difficult or important? What happens when satisfaction is not immediate?

The cycle of contact also includes moments when satisfaction is delayed, interrupted or unavailable, and emotional responses may become particularly important here. Research suggests that, on average, adults with ADHD may experience greater difficulty regulating emotions, including more rapid shifts in emotion and stronger responses to negative experiences (Beheshti et al., 2020).

Rather than assuming that an ADHD person simply needs greater “frustration tolerance,” Gestalt therapy can explore what actually happens when movement towards something wanted or needed encounters an obstacle. What becomes figure now? What happens in the body? Does irritation, urgency or disappointment appear? Does the original activity lose its pull? Does another impulse emerge? Is there an urge to abandon, act immediately, withdraw, seek stimulation, or find another way forward?

The aim here is not to decide in advance what the person is doing or why. It is to slow the process down enough to notice how attention, emotion, bodily experience and action organise themselves in that particular moment.

Sometimes the original need cannot be satisfied at all. Something may have been lost, a relationship may not become what we hoped for, or reality may place a limit on what is possible. Here, completion does not necessarily mean gratification. Therapeutic work may involve encountering that limit, experiencing the emotional response to it, and gradually reorganising around a changed reality.

From a neuroaffirming Gestalt perspective, the aim is not to make an ADHD person function more like someone without ADHD, or simply become better at tolerating environments that do not work for them. Instead, therapy can support greater awareness of how this particular person experiences and navigates attention, motivation, needs and action in their everyday life.

This awareness can then inform practical strategies. Rather than simply applying generic “ADHD hacks,” we can explore where support is needed and experiment with strategies such as body doubling, timers, external cues or environmental changes. What works may look different for each person and across different situations, so strategies can be shaped around the person rather than the person having to adapt to the strategy.

References

Beheshti, A., Chavanon, M.-L., & Christiansen, H. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: A meta-analysis. BMC Psychiatry, 20, 120. https://doi.org/10.1186/s12888-020-2442-7

MacDonald, H. J., Kleppe, R., Szigetvari, P. D., & Haavik, J. (2024). The dopamine hypothesis for ADHD: An evaluation of evidence accumulated from human studies and animal models. Frontiers in Psychiatry, 15, 1492126. https://doi.org/10.3389/fpsyt.2024.1492126

Scheres, A., Balan, M., Paraskevopoulou, M., & Schellekens, A. (2024). Preference for immediate rewards in attention-deficit/hyperactivity disorder and substance use disorder: A shared intermediate phenotype? Current Addiction Reports, 11, 607–615. https://doi.org/10.1007/s40429-024-00558-y