Executive and motivational processes in adolescents with Attention-Deficit-Hyperactivity Disorder (ADHD)

Decision-making in ADHD: sensitive to frequency but blind to the magnitude of penalty?

BACKGROUND

Decision-making and reinforcement sensitivity were investigated in 23 children with ADHD and 20 healthy controls using a gambling paradigm.

METHODS

Children were required to choose between three alternatives that carried (A) small rewards and small penalties (advantageous), (B) large rewards and increasing penalties and (C) small rewards and increasing penalties (both disadvantageous). Penalties increased either in frequency or magnitude in two independent conditions. Heart rate (HR) and skin conductance (SC) were measured to examine whether impaired decision-making was accompanied by autonomic abnormalities.

RESULTS

Children with ADHD showed a maladaptive response style compared to controls by demonstrating a smaller preference for the advantageous alternative, when penalties increased in magnitude. When penalties increased in frequency, children with ADHD performed like controls. Group differences in decision-making attenuated after the task was administered twice. Compared to controls, performance of children with ADHD in the magnitude condition was accompanied by increased HR acceleration following reward. In this condition, the post-selection SC of children with ADHD was larger for advantageous than for disadvantageous alternatives, in contrast to controls who showed an opposite SC pattern.

CONCLUSIONS

The current findings suggest that during decision-making, children with ADHD may be sensitive to the frequency but blind to the magnitude of penalty.

Brazilian Portuguese version of the Iowa Gambling Task: transcultural adaptation and discriminant validity

OBJECTIVE: The Iowa Gambling Task is a neuropsychological task developed in English, most widely used to assess decision-making. The aim of this work was to adapt the Iowa Gambling Task to Brazilian Portuguese, compare it with the original version and assess its validity. METHOD: We assessed 75 Brazilian adults divided into three groups: 1) 25 healthy volunteers holding the Proficiency Certificate in English tested using the English version of the Iowa Gambling Task; 2) 25 healthy volunteers who did not speak or read English tested using the Iowa Gambling Task-Portuguese; 3) 25 Attention Deficit Hyperactivity Disorder subjects tested with the Iowa Gambling Task-Portuguese. RESULTS: No difference between groups 1 and 2 was observed. Nonetheless, we found significant differences between Attention Deficit Hyperactivity Disorder subjects and the other 2 groups on blocks 3, 4, 5, and on net score. CONCLUSION: Our results are similar to those previously described in the literature concerning adults without neuropsychiatric diseases. Since those two versions were equivalent and Attention Deficit Hyperactivity Disorder subjects performed significantly worse than healthy volunteers we can conclude that the adaptation of the Iowa Gambling Task to Brazilian Portuguese is valid and can be used for research purposes in the Brazilian context.

Executive dysfunction and delay aversion in attention deficit hyperactivity disorder: nosologic and diagnostic implications

In this article the authors reflect on the role of executive function (EF) deficits and delay aversion (DAv) in the diagnosis of attention deficit hyperactivity disorder (ADHD). The authors, empirical review shows clearly that EF deficits and DAv are implicated in ADHD, although neither is necessary for ADHD nor specific to it. The constructs are somewhat dissociable from one another so that each may represent a distinctive feature associated with an ADHD subsample. The authors argue that neither EF deficits nor DAv add much value to the diagnosis of ADHD as it is currently conceptualized, but may be crucial in helping to partition heterogeneity in the condition, leading to the refinement of ADHD nosology.

Immediate gain is long-term loss: Are there foresighted decision makers in the Iowa Gambling Task?

BACKGROUND

The Somatic Marker Hypothesis suggests that normal subjects are "foreseeable" and ventromedial prefrontal patients are "myopic" in making decisions, as the behavior shown in the Iowa Gambling Task. The present study questions previous findings because of the existing confounding between long-term outcome (expected value, EV) and gain-loss frequency variables in the Iowa Gambling Task (IGT). A newly and symmetrically designed gamble, namely the Soochow Gambling Task (SGT), with a high-contrast EV between bad (A, B) and good (C, D) decks, is conducted to clarify the issue about IGT confounding. Based on the prediction of EV (a basic assumption of IGT), participants should prefer to choose good decks C and D rather than bad decks A and B in SGT. In contrast, according to the prediction of gain-loss frequency, subjects should prefer the decks A and B because they possessed relatively the high-frequency gain.

METHODS

The present experiment was performed by 48 participants (24 males and 24 females). Most subjects are college students recruited from different schools. Each subject played the computer version SGT first and completed a questionnaire for identifying their final preference. The IGT experimental procedure was mostly followed to assure a similar condition of decision uncertainty.

RESULTS

The SGT experiment demonstrated that the prediction of gain-loss frequency is confirmed. Most subjects preferred to choose the bad decks A and B than good decks C and D. The learning curve and questionnaire data indicate that subjects can not "hunch" the EV throughout the game. Further analysis of the effect of previous choice demonstrated that immediate gain increases the probability to stay at the same deck.

CONCLUSION

SGT provides a balanced structure to clarify the confounding inside IGT and demonstrates that gain-loss frequency rather than EV guides decision makers in these high-ambiguity gambles. Additionally, the choice behavior is mostly following the "gain-stay, lose-randomize" strategy to cope with the uncertain situation. As demonstrated in SGT, immediate gain can bring about a long-term loss under uncertainty. This empirical result may explain some shortsighted behaviors in real life.

Impulsivity is associated with behavioral decision-making deficits

Impaired decision-making is a key-feature of many neuropsychiatric disorders. In the present study, we examined task performance in a healthy population consisting of those whose scores indicated high and low impulsivity on several behavioral decision-making tasks reflecting orbitofrontal functioning. The measures included tasks that assess decision-making with and without a learning component and choice flexibility. The results show that subjects high on impulsivity display an overall deficit in their decision-making performance as compared with subjects low on impulsivity. More specifically, subjects with high impulsivity show weaknesses in learning of reward and punishment associations in order to make appropriate decisions (reversal-learning task and Iowa Gambling Task), and impaired adaptation of choice behavior according to changes in stimulus-reward contingencies (reversal-learning task). Simple, non-learning, components of reward- and punishment-based decision-making (Rogers Decision-Making Task) seem to be relatively unaffected. Above all, the results indicate that impulsivity is associated with a decreased ability to alter choice behavior in response to fluctuations in reward contingency. The findings add further evidence to the notion that trait impulsivity is associated with decision-making, a function of the orbitofrontal cortex.

Inhibitory control and emotional stress regulation: neuroimaging evidence for frontal-limbic dysfunction in psycho-stimulant addiction

This review focuses on neuroimaging studies that examined stress processing and regulation and cognitive inhibitory control in patients with psycho-stimulant addiction. We provide an overview of these studies, summarizing converging evidence and discrepancies as they occur in the literature. We also adopt an analytic perspective and dissect these psychological processes into their sub-components, to identify the neural pathways specific to each component process and those that are more specifically involved in psycho-stimulant addiction. To this aim we refer frequently to studies conducted in healthy individuals. Despite the separate treatment of stress/affect regulation, stress-related craving or compulsive drug seeking, and inhibitory control, neural underpinnings of these processes overlap significantly. In particular, the ventromedial prefrontal regions including the anterior cingulate cortex, amygdala and the striatum are implicated in psychostimulant dependence. Our overarching thesis is that prefrontal activity ensures intact emotional stress regulation and inhibitory control. Altered prefrontal activity along with heightened striatal responses to addicted drug and drug-related salient stimuli perpetuates habitual drug seeking. Further studies that examine the functional relationships of these neural systems will likely provide the key to understanding the mechanisms underlying compulsive drug use behaviors in psycho-stimulant dependence.

Decision-making on an explicit risk-taking task in preadolescents with attention-deficit/hyperactivity disorder

Inappropriate risk-taking and disadvantageous decision-making have been described as major behavioural characteristics of patients with attention-deficit/hyperactivity disorder (ADHD). However these behaviours are difficult to measure in laboratory contexts and recent studies have yielded inconsistent results which might be related to task characteristics. The present study adopted the Game of Dice Task, a test procedure in which risks are made explicit and the load on working memory is minimal. As a result, preadolescents with ADHD (N = 23) made significantly more risky choices and suffered major losses of money compared to normal controls (N = 24) but only when they played the game a second time. Differences in risk-taking correlated significantly with hyperactivity as rated by parents and with inhibitory control, but not with working memory performance. The results are discussed in the context of current theories of ADHD.

Dissociation of emotional decision-making from cognitive decision-making in chronic schizophrenia

Recent studies have examined the decision-making ability of schizophrenic patients using the Iowa Gambling Task (IGT). These studies, however, were restricted to the assessment of emotional decision-making. Decision-making depends on cognitive functions as well as on emotion. The purpose of this study was to examine the performance of schizophrenic patients on the IGT and the Game of Dice Task (GDT), a decision-making task with explicit rules for gains and losses. In addition, it was intended to test whether poor performance on IGT is attributable to impairments in reversal learning within the schizophrenia group using the Simple Reversal Learning Task (SRLT), which is sensitive to measure the deficit of reversal learning following ventromedial prefrontal cortex damage. A group of 23 stable schizophrenic patients and 28 control subjects performed computerized versions of the IGT, GDT, SRLT and Wisconsin Card Sorting Test (WCST). While schizophrenic patients performed poorly on the IGT relative to normal controls, there was no significant difference between the two groups on GDT performance. The performance of the schizophrenia group on the SRLT was poorer than that of controls, but was not related to IGT performance. These data suggest that schizophrenic patients have impaired emotional decision-making but intact cognitive decision-making, suggesting that these two processes of decision-making are different. Furthermore, the impairments in reversal learning did not contribute to poor performance on the IGT in schizophrenia. Therefore, schizophrenic patients have difficulty in making decisions under ambiguous and uncertain situations whereas they make choices easily in clear and unequivocal ones. The emotional decision-making deficits in schizophrenia might be attributable more to another mechanism such as a somatic marker hypothesis than to an impairment in reversal learning.

Is deck C an advantageous deck in the Iowa Gambling Task?

BACKGROUND

Dunn et al. performed a critical review identifying some problems in the Somatic Marker Hypothesis (SMH). Most of the arguments presented by Dunn focused on the insufficiencies for replication of skin conductance responses and somatic brain loops, but the study did not carefully reassess the core-task of SMH. In a related study, Lin and Chiu et al. identified a serious problem, namely the "prominent deck B phenomenon" in the original IGT. Building on this observation, Lin and Chiu also posited that deck C rather than deck A was preferred by normal decision makers due to good gain-loss frequency rather than good final-outcome. To verify this hypothesis, a modified IGT was designed that possessed high contrast of gain-loss value in each trial, with the aim of achieving a balance between decks A and C in terms of gain-loss frequency. Based on the basic assumption of IGT, participants should prefer deck C to deck A based on consideration of final-outcome. In contrast, based on the prediction of gain-loss frequency, participants should have roughly equal preferences for decks A and C.

METHODS

This investigation recruited 48 college students (24 males and 24 females) as participants. Two-stage IGT with high-contrast gain-loss value was launched to examine the deck C argument. Each participant completed the modified IGT twice and immediately afterwards was administered a questionnaire to assess their consciousness and final preferences following the game.

RESULTS

The experimental results supported the predictions regarding gain-loss frequency participants choose the deck C with nearly identical frequency to deck A, despite deck C having a better final outcome than deck A. The "sunken deck C" phenomenon is clearly identified in this version of IGT which achieves a balance in gain-loss frequency. Moreover, the "sunken deck C" phenomenon not only appears during the first stage, but also during the second stage of IGT. In addition, questionnaires indicated that normal decision makers disliked deck C at the consciousness (explicit) levels.

CONCLUSION

In the modified version of IGT, deck C was no longer preferred by normal decision makers, despite having a better long-term outcome than deck A. This study identified two problems in the original IGT. First, the gain-loss frequency between decks A and C is pseudo-balanced. Second, the covered phenomenon leads to most IGT related studies misinterpreting the effect of gain-loss frequency in situations involving long-term outcomes, and even leads to overstatement of the foresight of normal decision makers.

Testing computational models of dopamine and noradrenaline dysfunction in attention deficit/hyperactivity disorder

We test our neurocomputational model of fronto-striatal dopamine (DA) and noradrenaline (NA) function for understanding cognitive and motivational deficits in attention deficit/hyperactivity disorder (ADHD). Our model predicts that low striatal DA levels in ADHD should lead to deficits in 'Go' learning from positive reinforcement, which should be alleviated by stimulant medications, as observed with DA manipulations in other populations. Indeed, while nonmedicated adult ADHD participants were impaired at both positive (Go) and negative (NoGo) reinforcement learning, only the former deficits were ameliorated by medication. We also found evidence for our model's extension of the same striatal DA mechanisms to working memory, via interactions with prefrontal cortex. In a modified AX-continuous performance task, ADHD participants showed reduced sensitivity to working memory contextual information, despite no global performance deficits, and were more susceptible to the influence of distractor stimuli presented during the delay. These effects were reversed with stimulant medications. Moreover, the tendency for medications to improve Go relative to NoGo reinforcement learning was predictive of their improvement in working memory in distracting conditions, suggestive of common DA mechanisms and supporting a unified account of DA function in ADHD. However, other ADHD effects such as erratic trial-to-trial switching and reaction time variability are not accounted for by model DA mechanisms, and are instead consistent with cortical noradrenergic dysfunction and associated computational models. Accordingly, putative NA deficits were correlated with each other and independent of putative DA-related deficits. Taken together, our results demonstrate the usefulness of computational approaches for understanding cognitive deficits in ADHD.

A novel task for examining strategic planning: evidence for impairment in children with ADHD

Children with attention deficit hyperactivity disorder (ADHD) often show poor performance on tasks that require strategic planning. To assess this ability, we developed a paper and pencil task that required consistent use of a simple test-taking strategy to maximize the number of points. The visual discrimination task with minimal cognitive demands required children to maximize their gains by responding only to outlined high-point problems and to skip the low-point problems. The task was administered twice, the second time with explicit instructions on how to implement the strategy. Few of the children in the ADHD or control group, ages 8-13 years, were able to discover the strategy on their own, but after explicit instruction 90% of the children in the control group but only 57.5% of children with ADHD used the strategy to maximize points (p < .005). The ADHD group used the strategy less efficiently, despite the fact that they did not differ on the total number of problems completed. The findings suggest that children with ADHD have impaired ability to implement strategic approaches for tasks similar to school assignments. The task can potentially be developed as a diagnostic aid and as a basis for further research assessing strategic planning in ADHD.

Is deck B a disadvantageous deck in the Iowa Gambling Task?

Background

The Iowa gambling task is a popular test for examining monetary decision behavior under uncertainty. According to Dunn et al. review article, the difficult-to-explain phenomenon of "prominent deck B" was revealed, namely that normal decision makers prefer bad final-outcome deck B to good final-outcome decks C or D. This phenomenon was demonstrated especially clearly by Wilder et al. and Toplak et al. The "prominent deck B" phenomenon is inconsistent with the basic assumption in the IGT; however, most IGT-related studies utilized the "summation" of bad decks A and B when presenting their data, thereby avoiding the problems associated with deck B.

Methods

To verify the "prominent deck B" phenomenon, this study launched a two-stage simple version IGT, namely, an AACC and BBDD version, which possesses a balanced gain-loss structure between advantageous and disadvantageous decks and facilitates monitoring of participant preferences after the first 100 trials.

Results

The experimental results suggested that the "prominent deck B" phenomenon exists in the IGT. Moreover, participants cannot suppress their preference for deck B under the uncertain condition, even during the second stage of the game. Although this result is incongruent with the basic assumption in IGT, an increasing number of studies are finding similar results. The results of the AACC and BBDD versions can be congruent with the decision literatures in terms of gain-loss frequency.

Conclusion

Based on the experimental findings, participants can apply the "gain-stay, loss-shift" strategy to overcome situations involving uncertainty. This investigation found that the largest loss in the IGT did not inspire decision makers to avoid choosing bad deck B.

Subjective impulsivity and baseline EEG in relation to stopping performance

Impulsivity is a personality trait within the normal population, but also a feature of many psychiatric disorders that have been associated with poor inhibitory control. The aim of the present study was to examine the relation between subjective impulsivity, theta/beta EEG ratio, and inhibitory control in healthy individuals. In 15 high and 14 low impulsive healthy volunteers (as assessed by the I(7) questionnaire), resting state EEG was recorded during an eyes open condition to obtain estimates for theta and beta activity. Subsequently, a stop-signal task was presented where participants responded to go-signals and had to stop their initiated response to stop-signals. Stopping performance and EEG activity were compared between the impulsive groups as well as between high vs. low theta/beta ratio groups. Results showed that subjective impulsivity was not related to stopping behavior or to theta/beta ratio. In contrast to our expectations that individuals with high theta/beta ratios would show relatively long stopping reaction times, analyses revealed that the low theta/beta ratio group had longer stopping reaction times. Given that increased theta/beta ratio may reflect reduced cortical inhibition over subcortical drives, it is proposed that healthy individuals with relative high theta/beta ratios are more motivated to maximize inhibition-related performance.

Effects of the history of conduct disorder on the Iowa Gambling Tasks

BACKGROUND

Recent research conducted with the Iowa Gambling Task (GT) suggests decision-making impairments in substance dependence, as well as behavior disorders such as conduct disorder and attention-deficit/hyperactivity disorder. However, little is known about the past history of conduct disorder on decision making. The purpose of this study was to test the possible effect of past history of conduct disorder on GT performance and how this factor could contribute to the performance on GT in alcohol-dependent patients.

METHODS

Four subject groups were tested: (1) alcohol-dependent patients with (n = 28) and (2) alcohol-dependent patients without (n = 28), a history of conduct disorder and (3) normal controls with (n = 10) and (4) normal controls without (n = 30) a history of conduct disorder. Demographic and alcohol-related variables were evaluated, and a decision-making task, "Iowa GT," both original and variant version, were applied.

RESULTS

As a whole, normal controls with a history of conduct disorder and alcohol-dependent patients with or without a history of conduct disorder show impaired decision making because of hypersensitivity to reward and hyposensitivity to punishment. However, no significant differences were noted between alcohol-dependent patients either with or without a history of conduct disorder on gambling performance.

CONCLUSIONS

These results indicate that the history of conduct disorder may contribute to impaired decision making on GT. Furthermore, this kind of decision-making pattern may represent one of common underlying mechanisms in both conduct disorder and alcohol dependence.

Characterizing cognition in ADHD: beyond executive dysfunction

The hypothesis that Attention-Deficit/Hyperactivity Disorder (ADHD) reflects a primary inhibitory executive function deficit has spurred a substantial literature. However, empirical findings and methodological issues challenge the etiologic primacy of inhibitory and executive deficits in ADHD. Based on accumulating evidence of increased intra-individual variability in ADHD, we reconsider executive dysfunction in light of distinctions between 'hot' and 'cool' executive function measures. We propose an integrative model that incorporates new neuroanatomical findings and emphasizes the interactions between parallel processing pathways as potential loci for dysfunction. Such a reconceptualization provides a means to transcend the limits of current models of executive dysfunction in ADHD and suggests a plan for future research on cognition grounded in neurophysiological and developmental considerations.