Making Object Permanence Disappear from the ADHD Discussion

Out of sight out of mind is not a failure of object permanence.

Inattentiveness in ADHD manifests by misplacing objects, forgetting tasks when one is in the middle of them, and failing to notice items that are right out in the open. Recently, I have heard a number of these incidents being described as problems with object permanence. Do those with ADHD really suffer from deficits in object permanence?

People have cited the following types of examples as problems with object permanence in those with ADHD:

- Katy gets upset when her husband cleans out the garage and packs everything away in cabinets and stacked on shelves. She no longer can see everything, and find what she is looking for when it is all stashed away.

- Jimmy is trying to work on his math homework. When his mother asks where his math book is, he replies “No idea.” When she asks whether he has looked for the book, he gives her a blank stare, because that had not even occurred to him.

- Jenny dumps a load of clean laundry on her bed for sorting and folding, but then the doorbell rings. After answering the door, she drifts into other tasks. Five hours later, when she goes to bed, she is surprised to find a pile of unfolded clothes still blanketing it.

- Tired from work, Joey drops his jacket and sweatpants on the floor near his desk. He steps around them for days. A week later, when he needs to wear them to go out, he can’t recall where he put them.

- Jessie sits on a park bench, munching a few candy bars while texting with friends. The wrappers drops from their hand, but when they get up and walk away, they have no awareness they have been littering.

-At her first dental appointment in four years, Laurel acknowledges that she knows the importance of brushing her teeth, but “Kinda forgot about it for the last four, five months.”

Some authors even talk about a loss of “emotional object permanence” in those with ADHD to describe being unable to emotionally connect with individuals when they are not immediately present.

- Barbara, shelters in place from COVID, several miles from her girlfriend, Tammy. If a day passes without texts or instant messaging from Tammy, Barbara worries that Tammy no longer cares about her.

- Pedro feels numb at his grandmother’s funeral. His therapist tells him that it is because of his ADHD he can not fully remember her once she is dead and gone.

Some of these examples describe troubles with remembering items when they are no longer immediately at the forefront of consciousness. Some relate to not being able to recognize items when they do remain visible. And still others capture difficulties remembering qualities of a relationship when we are no longer in the presence of another person. And emotional numbness could be caused by clearly remembering conflicting feelings, feeling overwhelmed by feelings, or being ashamed of expressing feelings. Does object permanence really apply to these situations?

The Swiss developmental psychologist, Jean Piaget, defined object permanence as the ability to understand that an object still exists even when one can no longer directly perceive it through any of one’s senses. If one can’t see, hear, touch, taste or smell it, the object ceases to be. While most adults have no trouble with this concept, babies do not appear to innately understand that items continue to exist when they are not being sensed.

If an infant a few months old is gazing at a pretty red ball, and you cover it with a blanket, the baby blithely stop looking. Within a few months, if you repeat the situation, the baby expresses frustration, apparently grasping that something has disrupted the pleasure of looking at the ball. But it is usually not until most babies are 8–12 months old that they will try to remove the blanket, or otherwise demonstrate that they know that the ball is still present, and is just under the cover.

Piaget believed that the development of object permanence required the active involvement of the infant with its environment to activate innate neurologic processes. More recent work suggests that cultural beliefs can also shape how we create an understanding of object permanence. Different experimental paradigms, including those where babies follow the trajectory of moving objects, also indicate that many babies achieve some aspects of object permanence earlier than once thought.

Researchers of object permanence have to infer what babies are actually thinking, based on the direction and avidity of their gaze, or changes in their heart rate or other physiologic signs of arousal. Infants can’t tell us what they’re thinking. Other mammals, and some birds, such as crows, also display at least some stages of object permanence. (Unfortunately to you cat-lovers, dogs seem to be more advanced in this regard.) Often pet owners, while playing fetch with Rover, will mix in a fake-out throw and watch their dog dash off in pursuit, halt abruptly in confusion, and then gaze accusingly at the owner when they detect the un-thrown ball still in hand.

People with ADHD don’t have impairment with actual object permanence. They know the items still exist somewhere, even when out of sight. They are just less likely to maintain an active representation of the item in their conscious awareness. The use of the term object permanence, in the context of ADHD, implies a more fundamental disturbance in cognitive abilities than that displayed by those with ADHD.

Perhaps the concept of object constancy more closely captures what occurs in many of these ADHD related anecdotes. We usually define object constancy as the ability to maintain a positive emotional bond with another even where distance and conflicts intrude. The term object constancy comes from Object Relations Theory, which studies the attachment patterns humans develop during the first few years of life, and explores how people comprehend and interact with themselves and others. Confusingly, the “object” of object constancy refers primarily to people, unlike the objects of “object permanence” which include all material things. We would have to stretch the meaning of object constancy to include the ADHD examples above.

We associate difficulties with object constancy most classically with personality disorders. Individuals with narcissistic or borderline personality disorders often fail to integrate all of the good and bad thoughts and feelings they have towards another individual. The complexities of a relationship can be incinerated by the intense feelings in the moment; how one feels right now about the other defines everything. Researchers and clinicians continue to explore the ways in which ADHD may predispose some people to also develop personality disorders. Often people mistakenly attribute ADHD-driven behavior to personality disorders.

The English language constantly borrows phrases from technical fields. Many psychological terms with precise definitions have entered common usage, but often with a warped or distorted sense of the original meaning. We often now refer to anyone feeling sad as being depressed, and describe a wide variety of high energy or aggravated states as “manic”. I feel that such usage often causes confusion rather than providing clarification and enhancing comprehension. Often, when such terms are loosely employed they can cloak misunderstanding in sophisticated terms that inhibit further exploration of the underlying ideas.

I think it’s more accurate to stick to more colloquial phrases, such as out-of-sight is out-of-mind for forgetting about an item or task when it is no longer right in front of us. At the risk of inciting too much argument, I’ll also offer up a phrase I’ve coined for not being aware of an item that has remained in one’s immediate presence: in sight but no insight. Although I think that it’s useful to delve into aspects of inattentiveness, I’m permanently objecting to the use of the term object permanence when it’s applied to ADHD.

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