Impulsive and risky decision-making in adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): The need for a developmental perspective

AbstractRisk evaluation is a critical component of decision making. Risk tolerance is relevant in both daily decisions and pathological disorders such as attention-deficit hyperactivity disorder (ADHD), where impulsivity is a cardinal symptom. Methylphenidate, a commonly prescribed drug in ADHD, improves attention but has mixed reports on risk-based decision making. Using a double-blinded placebo protocol, we studied the risk attitudes of ADHD patients and age-matched healthy volunteers while performing the 2-step sequential learning task and examined the effect of methylphenidate on their choices. We then applied a novel computational analysis using the hierarchical drift–diffusion model to extract parameters such as threshold (‘a’—amount of evidence accumulated before making a decision), drift rate (‘v’—information processing speed) and response bias (‘z’ apriori bias towards a specific choice) focusing specifically on risky choice preference. Critically, we show that ADHD patients on placebo have an apriori bias towards risky choices compared to controls. Furthermore, methylphenidate enhanced preference towards risky choices (higher apriori bias) in both groups but had a significantly greater effect in the patient population independent of clinical scores. Thus, methylphenidate appears to shift tolerance towards risky uncertain choices possibly mediated by prefrontal dopaminergic and noradrenergic modulation. We emphasise the utility of computational models in detecting underlying processes. Our findings have implications for subtle yet differential effects of methylphenidate on ADHD compared to healthy population.

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Eating Disorders Impact on Vigilance and Decision Making of a Community Sample of Treatment Naive Attention-Deficit/Hyperactivity Disorder Young Adults

Frontiers in Psychiatry ◽

10.3389/fpsyt.2018.00531 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 3

Author(s):

Bruno Palazzo Nazar ◽

Amanda Pompeu Trindade ◽

Monica Leslie ◽

Leandro Fernandes Malloy-Diniz ◽

Joseph Sergeant ◽

...

Keyword(s):

Decision Making ◽

Attention Deficit Hyperactivity Disorder ◽

Eating Disorders ◽

Young Adults ◽

Attention Deficit ◽

Community Sample ◽

Hyperactivity Disorder ◽

Treatment Naïve

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Disentangling ADHD's Presentation-Related Decision-Making—A Meta-Analytic Approach on Predominant Presentations

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.519840 ◽

2021 ◽

Vol 12 ◽

Author(s):

Marcel Schulze ◽

David Coghill ◽

Silke Lux ◽

Alexandra Philipsen

Keyword(s):

Decision Making ◽

Attention Deficit Hyperactivity Disorder ◽

Reinforcement Learning ◽

Risk Taking ◽

Attention Deficit ◽

Meta Analysis ◽

Analytic Approach ◽

Effect Sizes ◽

Hyperactivity Disorder ◽

The Relationship

Background: Deficient decision-making (DM) in attention deficit/hyperactivity disorder (ADHD) is marked by altered reward sensitivity, higher risk taking, and aberrant reinforcement learning. Previous meta-analysis aggregate findings for the ADHD combined presentation (ADHD-C) mostly, while the ADHD predominantly inattentive presentation (ADHD-I) and the predominantly hyperactive/impulsive presentation (ADHD-H) were not disentangled. The objectives of the current meta-analysis were to aggregate findings from DM for each presentation separately.Methods: A comprehensive literature search of the PubMed (Medline) and Web of Science Database took place using the keywords “ADHD,” “attention-deficit/hyperactivity disorder,” “decision-making,” “risk-taking,” “reinforcement learning,” and “risky.” Random-effects models based on correlational effect-sizes were conducted. Heterogeneity analysis and sensitivity/outlier analysis were performed, and publication biases were assessed with funnel-plots and the egger intercept.Results: Of 1,240 candidate articles, seven fulfilled criteria for analysis of ADHD-C (N = 193), seven for ADHD-I (N = 256), and eight for ADHD-H (N = 231). Moderate effect-size were found for ADHD-C (r = 0.34; p = 0.0001; 95% CI = [0.19, 0.49]). Small effect-sizes were found for ADHD-I (r = 0.09; p = 0.0001; 95% CI = [0.008, 0.25]) and for ADHD-H (r = 0.1; p = 0.0001; 95% CI = [−0.012, 0.32]). Heterogeneity was moderate for ADHD-H. Sensitivity analyses show robustness of the analysis, and no outliers were detected. No publication bias was evident.Conclusion: This is the first study that uses a meta-analytic approach to investigate the relationship between the different presentations of ADHD separately. These findings provide first evidence of lesser pronounced impairment in DM for ADHD-I and ADHD-I compared to ADHD-C. While the exact factors remain elusive, the current study can be considered as a starting point to reveal the relationship of ADHD presentations and DM more detailed.

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