Adolescent decision-making is a topic of great public and scientific interest. However, much of the neuroimaging research in this area contrasts only one facet of decision-making (e.g., neural responses to anticipation or receipt of monetary rewards). Few studies have directly examined the processes that occur immediately before making a decision between two options that have varied and unpredictable potential rewards and penalties. Understanding adolescent decision-making from this vantage point may prove critical to ameliorating risky behavior and improving developmental outcomes. In this study, participants aged 14–16 years engaged in a driving simulation game while undergoing fMRI. Results indicated activity in ventral striatum preceded risky decisions and activity in right inferior frontal gyrus (rIFG) preceded safe decisions. Furthermore, participants who reported higher sensation-seeking and sensitivity to reward and punishment demonstrated lower rIFG activity during safe decisions. Finally, over successive games, rIFG activity preceding risky decisions decreased, whereas thalamus and caudate activity increased during positive feedback (taking a risk without crashing). These results indicate that regions traditionally associated with reward processing and inhibition not only drive risky decision-making in the moment but also contribute to learning about risk tradeoffs during adolescence.
Self-initiated continuation of and adherence to HIV pre-exposure prophylaxis (PrEP) after PrEP demonstration project roll-off in men who have sex with men: associations with risky decision making, impulsivity/disinhibition, and sensation seeking