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Chan WWY, Shum KKM, Downs J, Liu NT, Sonuga-Barke EJS. Attention-deficit/hyperactivity disorder (ADHD) in cultural context II: a comparison of the links between ADHD symptoms and waiting-related responses in Hong Kong and UK. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02506-7. [PMID: 38935132 DOI: 10.1007/s00787-024-02506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
The concept of attention-deficit/hyperactivity disorder (ADHD) is considered to have cross-cultural validity, but direct comparisons of its psychological characteristics across cultures are limited. This study investigates whether preschool children's ADHD symptoms expressed in two cultures with different views about child behaviour and parenting, Hong Kong and the UK, show the same pattern of associations with their waiting-related abilities and reactions, an important marker of early self-regulation. A community sample of 112 preschoolers (mean age = 46.22 months; 55 from UK, 57 from HK) completed three tasks measuring different waiting elements - waiting for rewards, choosing the amount of time to wait, and having to wait unexpectedly when a task is interrupted. Participants' waiting-related behavioural and emotional reactions were coded. Parents rated their children's ADHD symptoms and delay aversion. Our findings revealed that the associations between ADHD symptoms and waiting-related responses were comparable in both UK and HK samples. This suggests that the core psychological characteristics of ADHD, particularly in relation to waiting behaviours, may exhibit similarity across cultural contexts. Future research can extend this cross-cultural analysis to other ADHD-related psychological domains and explore additional cultural settings.
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Affiliation(s)
- Wendy W Y Chan
- School of Academic Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | | | - Johnny Downs
- School of Academic Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ngai Tsit Liu
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark.
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, DeCrespigny Park, SE5 8AF, UK.
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2
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Wagner D, Mason SG, Eastwood JD. The experience of effort in ADHD: a scoping review. Front Psychol 2024; 15:1349440. [PMID: 38895497 PMCID: PMC11184226 DOI: 10.3389/fpsyg.2024.1349440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/29/2024] [Indexed: 06/21/2024] Open
Abstract
Background Mental effort plays a critical role in regulating cognition. However, the experience of mental effort may differ for individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), a disorder for which sustained mental effort 'avoidance' or 'dislike' is a criterion in the DSM. We conducted a scoping review to characterize the literature on the experiences of effort in ADHD. Methods This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology. PsycINFO (OVID), PsycINFO (ProQuest) and PubMed were searched for studies published in English before February 14, 2023. Studies must have included an ADHD population or a measure of ADHD symptomatology, in addition to a self-report measure of the experience of effort or the use of an effort preference paradigm. Two researchers reviewed all abstracts, and one researcher reviewed full-text articles. Results Only 12 studies met the inclusion criteria. Several gaps and inconsistencies in the research were identified in terms of method, definitions of effort, measurements of ADHD, and sample characteristics. Moreover, the pattern of results on the experience of effort was mixed. Conclusion Despite its diagnostic and conceptual significance, the experience of mental effort in ADHD is not well studied. Critical gaps were identified in the existing literature. A three-facet conceptualization of effort is proposed-specifically, task-elicited effort, volitionally exerted effort, and the affect associated with engaging in effort - to guide future explorations of the experience of effort in ADHD.
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Affiliation(s)
- Danika Wagner
- The Boredom Lab, Department of Psychology, York University, Toronto, ON, Canada
| | - Samantha G. Mason
- The Boredom Lab, Department of Psychology, York University, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Research Institute, Toronto, ON, Canada
| | - John D. Eastwood
- The Boredom Lab, Department of Psychology, York University, Toronto, ON, Canada
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3
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Brassard SL, Liu H, Dosanjh J, MacKillop J, Balodis I. Neurobiological foundations and clinical relevance of effort-based decision-making. Brain Imaging Behav 2024:10.1007/s11682-024-00890-x. [PMID: 38819540 DOI: 10.1007/s11682-024-00890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 06/01/2024]
Abstract
Applying effort-based decision-making tasks provides insights into specific variables influencing choice behaviors. The current review summarizes the structural and functional neuroanatomy of effort-based decision-making. Across 39 examined studies, the review highlights the ventromedial prefrontal cortex in forming reward-based predictions, the ventral striatum encoding expected subjective values driven by reward size, the dorsal anterior cingulate cortex for monitoring choices to maximize rewards, and specific motor areas preparing for effort expenditure. Neuromodulation techniques, along with shifting environmental and internal states, are promising novel treatment interventions for altering neural alterations underlying decision-making. Our review further articulates the translational promise of this construct into the development, maintenance and treatment of psychiatric conditions, particularly those characterized by reward-, effort- and valuation-related deficits.
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Affiliation(s)
- Sarah L Brassard
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
- Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
| | - Hanson Liu
- Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Jadyn Dosanjh
- Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - James MacKillop
- Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, Hamilton, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Iris Balodis
- Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada.
- Michael G. DeGroote Centre for Medicinal Cannabis Research, Hamilton, ON, Canada.
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4
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Smith T, Fitch A, Deavours A, Kirkpatrick K. Active and passive waiting in impulsive choice: Effects of fixed-interval and fixed-time delays. Learn Behav 2024:10.3758/s13420-023-00622-z. [PMID: 38216839 PMCID: PMC11239795 DOI: 10.3758/s13420-023-00622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
Behavioral interventions to improve self-control, preference for a larger-later (LL) reward over a smaller-sooner (SS) reward, involve experience with delayed rewards. Whether they involve timing processes remains controversial. In rats, there have been inconsistent results on whether timing processes may be involved in intervention-induced improvements in self-control. Interventions that improved self-control with corresponding timing improvements used fixed-interval (FI) delays, whereas interventions that failed to find corresponding timing improvements used fixed-time (FT) delays. The FI schedule includes a response contingency (active waiting), whereas the FT schedule delivers reward automatically (passive waiting). The present study compared the effects of FI and FT schedules in interventions and impulsive choice tasks to evaluate effects on self-control and timing behavior. The impulsive choice task evaluated preference for an SS option (one pellet after 10-, 15-, 20-, 25-, and 30-s delays) versus an LL option (two pellets after a 30-s delay). The intervention task included forced-choice SS (one pellet after 10 s) and LL (two pellets after 30 s) sessions under FI or FT schedules. FI schedules produced greater sensitivity to SS delay in the impulsive choice task. Both FI and FT interventions increased LL choices. Following choice testing, temporal bisection and peak interval tasks revealed better timing precision for rats with an FI delay experience. Overall, the FI choice contingency was associated with improved temporal attention and timing precision.
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Affiliation(s)
- Travis Smith
- Department of Psychological Sciences, Kansas State University, 492 Bluemont Hall, 1114 Mid-Campus Drive N., Manhattan, KS, 66506, USA.
| | - Anderson Fitch
- Department of Psychological Sciences, Kansas State University, 492 Bluemont Hall, 1114 Mid-Campus Drive N., Manhattan, KS, 66506, USA
| | - Aubrey Deavours
- Department of Psychological Sciences, Kansas State University, 492 Bluemont Hall, 1114 Mid-Campus Drive N., Manhattan, KS, 66506, USA
| | - Kimberly Kirkpatrick
- Department of Psychological Sciences, Kansas State University, 492 Bluemont Hall, 1114 Mid-Campus Drive N., Manhattan, KS, 66506, USA
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Smith TR, Southern R, Kirkpatrick K. Mechanisms of impulsive choice: Experiments to explore and models to map the empirical terrain. Learn Behav 2023; 51:355-391. [PMID: 36913144 PMCID: PMC10497727 DOI: 10.3758/s13420-023-00577-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/14/2023]
Abstract
Impulsive choice is preference for a smaller-sooner (SS) outcome over a larger-later (LL) outcome when LL choices result in greater reinforcement maximization. Delay discounting is a model of impulsive choice that describes the decaying value of a reinforcer over time, with impulsive choice evident when the empirical choice-delay function is steep. Steep discounting is correlated with multiple diseases and disorders. Thus, understanding the processes underlying impulsive choice is a popular topic for investigation. Experimental research has explored the conditions that moderate impulsive choice, and quantitative models of impulsive choice have been developed that elegantly represent the underlying processes. This review spotlights experimental research in impulsive choice covering human and nonhuman animals across the domains of learning, motivation, and cognition. Contemporary models of delay discounting designed to explain the underlying mechanisms of impulsive choice are discussed. These models focus on potential candidate mechanisms, which include perception, delay and/or reinforcer sensitivity, reinforcement maximization, motivation, and cognitive systems. Although the models collectively explain multiple mechanistic phenomena, there are several cognitive processes, such as attention and working memory, that are overlooked. Future research and model development should focus on bridging the gap between quantitative models and empirical phenomena.
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Chong TTJ, Fortunato E, Bellgrove MA. Amphetamines Improve the Motivation to Invest Effort in Attention-Deficit/Hyperactivity Disorder. J Neurosci 2023; 43:6898-6908. [PMID: 37666665 PMCID: PMC10573750 DOI: 10.1523/jneurosci.0982-23.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 09/06/2023] Open
Abstract
Prevailing frameworks propose that a key feature of attention-deficit/hyperactivity disorder (ADHD) is lower motivation. An important component of motivation is the willingness to engage in cognitively or physically effortful behavior. However, the degree to which effort sensitivity is impaired in ADHD has rarely been tested, and the efficacy of stimulant medication in ameliorating any such impairments is unclear. Here, we tested 20 individuals with ADHD (11 males, 9 females) who were managed with amphetamine-based medication (dexamfetamine, lisdexamfetamine), and 24 controls (8 males, 16 females). Individuals with ADHD were tested over two counterbalanced sessions, ON and OFF their usual amphetamine-based medication. In each session, participants performed an effort-based decision-making task, in which they were required to choose how much cognitive or physical effort they were willing to engage in return for reward. Our results revealed three main findings. First, individuals with ADHD had lower motivation relative to controls to invest effort in both the cognitive and physical domains. Second, amphetamine increased motivation uniformly across both domains. Finally, the net effect of amphetamine treatment was to mostly restore motivation across both domains of effort relative to healthy controls. These data provide clear evidence for a heightened sensitivity to both cognitive and physical effort in ADHD, and reveal the efficacy of amphetamine-based drugs in restoring effort sensitivity to levels similar to controls. These findings confirm the existence of reduced motivational drive in ADHD, and more broadly provide direct causal evidence for a domain-general role of catecholamines in motivating effortful behavior.SIGNIFICANCE STATEMENT A core feature of attention-deficit/hyperactivity disorder (ADHD) is thought to be a heightened aversion to effort. Surprisingly, however, the degree to which effort sensitivity is impaired in ADHD has rarely been tested. More broadly, the relative efficacy of catecholamines in motivating the investment of cognitive and physical effort is unclear. We tested 20 individuals with ADHD ON and OFF amphetamines, and compared their behavior on an effort-based decision-making task to 24 controls. When tested OFF medication, the ADHD group was less cognitively and physically motivated than controls. However, amphetamines led to a comparable increase in motivation across both domains. This demonstrates the efficacy of catecholamines in facilitating domain-general effort, and highlights the broader potential of such drugs to treat disorders of motivation.
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Affiliation(s)
- Trevor T-J Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria 3004, Australia
- Department of Clinical Neurosciences, St Vincent's Hospital, Melbourne, Victoria 3065, Australia
| | - Erika Fortunato
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
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7
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Rosch KS, Batschelett MA, Crocetti D, Mostofsky SH, Seymour KE. Sex differences in atypical fronto-subcortical structural connectivity among children with attention-deficit/hyperactivity disorder: Associations with delay discounting. Behav Brain Res 2023; 452:114525. [PMID: 37271314 PMCID: PMC10527538 DOI: 10.1016/j.bbr.2023.114525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Atypical fronto-subcortical neural circuitry has been implicated in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD), including connections between prefrontal cortical regions involved in top-down cognitive control and subcortical limbic structures (striatum and amygdala) involved in bottom-up reward and emotional processing. The integrity of fronto-subcortical connections may also relate to interindividual variability in delay discounting, or a preference for smaller, immediate over larger, delayed rewards, which is associated with ADHD, with recent evidence of ADHD-related sex differences. METHODS We applied diffusion tensor imaging to compare the integrity of the white matter connections within fronto-subcortical tracts among 187 8-12 year-old children either with ADHD ((n = 106; 29 girls) or typically developing (TD) controls ((n = 81; 28 girls). Analyses focused on diagnostic group differences in fractional anisotropy (FA) within fronto-subcortical circuitry implicated in delay discounting, connecting subregions of the striatum (dorsal executive and ventral limbic areas) and amygdala with prefrontal regions of interest (dorsolateral [dlPFC], orbitofrontal [OFC] and anterior cingulate cortex [ACC]), and associations with two behavioral assessments of delay discounting. RESULTS Children with ADHD showed reduced FA in tracts connecting OFC with ventral striatum, regardless of sex, whereas reduced FA in the OFC-amygdala and ventral ACC-amygdala tracts were specific to boys with ADHD. Across diagnostic groups and sex, reduced FA in the dorsal ACC-executive striatum tract correlated with greater game time delay discounting. CONCLUSIONS These results suggest a potential neurobiological substrate of heightened delay discounting in children with ADHD and support the need for additional studies including larger sample sizes of girls with ADHD to further elucidate ADHD-related sex differences in these relationships.
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Affiliation(s)
- Keri S Rosch
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, USA; Neuropsychology Department, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, USA.
| | | | - Deana Crocetti
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, USA; Department of Neurology, Johns Hopkins University, USA
| | - Karen E Seymour
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, USA; Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
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8
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Fox AE, Nicholson AM, Singha D, Thieret BAS, Ortiz M, Visser EJ. Timing and delay discounting in attention-deficit/hyperactivity disorder: A translational approach. Dev Psychobiol 2023; 65:e22399. [PMID: 37338253 DOI: 10.1002/dev.22399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/16/2023] [Accepted: 04/20/2023] [Indexed: 06/21/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that often presents with abnormal time perception and increased impulsive choice behavior. The spontaneously hypertensive rat (SHR) is the most widely used preclinical model of the ADHD-Combined and ADHD-Hyperactive/Impulsive subtypes of the disorder. However, when testing the spontaneously hypertensive rat from Charles River (SHR/NCrl) on timing and impulsive choice tasks, the appropriate control strain is not clear, and it is possible that one of the possible control strains, the Wistar Kyoto from Charles River (WKY/NCrl), is an appropriate model for ADHD-Predominately Inattentive. Our goals were to test the SHR/NCrl, WKY/NCrl, and Wistar (WI; the progenitor strain for the SHR/NCrl and WKY/NCrl) strains on time perception and impulsive choice tasks to assess the validity of SHR/NCrl and WKY/NCrl as models of ADHD, and the validity of the WI strain as a control. We also sought to assess impulsive choice behavior in humans diagnosed with the three subtypes of ADHD and compare them with our findings from the preclinical models. We found SHR/NCrl rats timed faster and were more impulsive than WKY/NCrl and WI rats, and human participants diagnosed with ADHD were more impulsive compared to controls, but there were no differences between the three ADHD subtypes.
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Affiliation(s)
- Adam E Fox
- Department of Psychology, St. Lawrence University, Canton, New York, USA
| | - Alycia M Nicholson
- Department of Psychology, St. Lawrence University, Canton, New York, USA
| | - Depika Singha
- Department of Psychology, St. Lawrence University, Canton, New York, USA
| | - Bryana A S Thieret
- Department of Psychology, St. Lawrence University, Canton, New York, USA
| | - Marcelo Ortiz
- Department of Psychology, St. Lawrence University, Canton, New York, USA
| | - Emma J Visser
- Department of Psychology, St. Lawrence University, Canton, New York, USA
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van de Groep S, Sweijen SW, de Water E, Crone EA. Temporal discounting for self and friends in adolescence: A fMRI study. Dev Cogn Neurosci 2023; 60:101204. [PMID: 36736019 PMCID: PMC9918426 DOI: 10.1016/j.dcn.2023.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023] Open
Abstract
Adolescence is characterized by impulsivity but also by increased importance of friendships. This study took the novel perspective of testing temporal discounting in a fMRI task where choices could affect outcomes for 96 adolescents (aged 10-20-years) themselves and their best friend. Decisions either benefitted themselves (i.e., the Self Immediate - Self Delay' condition) or their friend (i.e., 'Friend Immediate - Friend Delay' condition); or juxtaposed rewards for themselves and their friends (i.e., the 'Self Immediate - Friend Delay' or 'Friend Immediate - Self Delay' conditions). We observed that younger adolescents were more impulsive; and all participants were more impulsive when this was associated with an immediate benefit for friends. Individual differences analyses revealed increased activity in the subgenual anterior cingulate cortex extending in the ventral striatum for immediate relative to delayed reward choices for self. Temporal choices were associated with activity in the prefrontal cortex, parietal cortex, insula, and ventral striatum, but only activity in the right inferior parietal lobe was associated with age. Finally, temporal delay choices for friends relative to self were associated with increased activity in the temporo-parietal junction and precuneus. Overall, this study shows a unique role of the social context in adolescents' temporal decision making.
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Affiliation(s)
- Suzanne van de Groep
- Erasmus SYNC Lab, the Netherlands; Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, the Netherlands; Brain and Development Research Center, the Netherlands; Leiden Institute for Brain and Cognition, the Netherlands.
| | - Sophie W. Sweijen
- Erasmus SYNC Lab, the Netherlands,Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, the Netherlands,Brain and Development Research Center, the Netherlands,Leiden Institute for Brain and Cognition, the Netherlands
| | - Erik de Water
- Great Lakes Neurobehavioral Center, Edina, MN, United States
| | - Eveline A. Crone
- Erasmus SYNC Lab, the Netherlands,Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, the Netherlands,Brain and Development Research Center, the Netherlands,Leiden Institute for Brain and Cognition, the Netherlands
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10
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Morsink S, Van der Oord S, Antrop I, Danckaerts M, Scheres A. Studying Motivation in ADHD: The Role of Internal Motives and the Relevance of Self Determination Theory. J Atten Disord 2022; 26:1139-1158. [PMID: 34794343 PMCID: PMC9066661 DOI: 10.1177/10870547211050948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Motivation is what moves us to act, what engages us in goal-directed behavior. The Self Determination Theory (SDT) is a motivational framework conceptualizing motivation-or internal motives-as a continuum of motivation qualities fueled by satisfaction of the three basic psychological needs Autonomy, Relatedness, and Competence. ADHD has been associated with motivational alterations that contribute to academic difficulties. However, ADHD theories and research are mainly focused on the effects of reinforcement on behavior, with little attention for the broader definition of motivation, that is, internal motives. Therefore, the main objective here was to introduce the SDT as theoretical framework within which we can develop relevant research questions about motivation in the field of ADHD. METHOD To this end, we (i) present the SDT as a comprehensive motivational framework, and (ii) describe current motivation-related ADHD theories and research. RESULTS Based on this, we suggest how SDT can be used as a guiding framework in generating relevant research questions that can help broaden our understanding of the role motivation plays in individuals with ADHD. CONCLUSION We conclude that ADHD research on motivation would benefit from (i) including internal motives as potential key mediators in the relation between environmental factors and behavior/symptoms; (ii) studying potential negative effects of external reinforcers intrinsic motivation, affect, and well-being. Finally, we conclude that this framework carries value for further development of clinical interventions for those with ADHD.
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Affiliation(s)
| | | | | | | | - Anouk Scheres
- Radboud University, Nijmegen, The Netherlands,Anouk Scheres, Behavioural Science Institute, Radboud University,
Thomas van Aquinostraat 4, Nijmegen 6525 GD, The Netherlands.
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11
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Madigan MA, Gupta A, Bowirrat A, Baron D, Badgaiyan RD, Elman I, Dennen CA, Braverman ER, Gold MS, Blum K. Precision Behavioral Management (PBM) and Cognitive Control as a Potential Therapeutic and Prophylactic Modality for Reward Deficiency Syndrome (RDS): Is There Enough Evidence? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116395. [PMID: 35681980 PMCID: PMC9180535 DOI: 10.3390/ijerph19116395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/20/2022]
Abstract
This brief commentary aims to provide an overview of the available and relatively new precision management of reward deficiencies manifested as substance and behavioral disorders. Current and future advances, concepts, and the substantial evidential basis of this potential therapeutic and prophylactic treatment modality are presented. Precision Behavioral Management (PBM), conceptualized initially as Precision Addiction Management (PAM), certainly deserves consideration as an important modality for the treatment of impaired cognitive control in reward processing as manifested in people with neurobiologically expressed Reward Deficiency Syndrome (RDS).
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Affiliation(s)
- Margaret A. Madigan
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX 78701, USA; (M.A.M.); (C.A.D.); (E.R.B.)
| | - Ashim Gupta
- Future Biologics, Lawrenceville, GA 30043, USA;
| | - Abdalla Bowirrat
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - David Baron
- Center for Psychiatry, Medicine, & Primary Care (Office of Provost), Division of Addiction Research & Education, Western University Health Sciences, Pomona, CA 91766, USA;
| | - Rajendra D. Badgaiyan
- Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, Long School of Medicine, University of Texas Medical Center, San Antonio, TX 78229, USA;
| | - Igor Elman
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Catherine A. Dennen
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX 78701, USA; (M.A.M.); (C.A.D.); (E.R.B.)
| | - Eric R. Braverman
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX 78701, USA; (M.A.M.); (C.A.D.); (E.R.B.)
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Kenneth Blum
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX 78701, USA; (M.A.M.); (C.A.D.); (E.R.B.)
- Center for Psychiatry, Medicine, & Primary Care (Office of Provost), Division of Addiction Research & Education, Western University Health Sciences, Pomona, CA 91766, USA;
- Institute of Psychology, ELTE Eötvös Loránd University, Egyetem tér 1-3, 1053 Budapest, Hungary
- Department of Psychiatry, School of Medicine, University of Vermont, Burlington, VT 05405, USA
- Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton VA Medical Centre, Dayton, OH 45324, USA
- Correspondence:
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12
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Dekkers TJ, de Water E, Scheres A. Impulsive and risky decision-making in adolescents with attention-deficit/hyperactivity disorder (ADHD): The need for a developmental perspective. Curr Opin Psychol 2021; 44:330-336. [PMID: 34953445 DOI: 10.1016/j.copsyc.2021.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/11/2023]
Abstract
Impulsive and risky decision-making peaks in adolescence, and is consistently associated with the neurodevelopmental disorder Attention-Deficit/Hyperactivity Disorder (ADHD), regardless of age. In this brief review, we demonstrate the similarity of theoretical models explaining impulsive and risky decision-making that originate in two relatively distinct literatures (i.e., on adolescence and on ADHD). We summarize research thus far and conclude that the presence of ADHD during adolescence further exacerbates the tendency that is already present in adolescents to make impulsive and risky decisions. We also conclude that much is still unknown about the developmental trajectories of individuals with ADHD with regard to impulsive and risky decision making, and we therefore provide several hypotheses that warrant further longitudinal research.
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Affiliation(s)
- Tycho J Dekkers
- University of Amsterdam, Department of Psychology, Amsterdam, the Netherlands; Levvel, Academic Center for Child and Adolescent Psychiatry en Specialized Youthcare, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands; Amsterdam University Medical Centers, Department of Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Erik de Water
- Great Lakes Neurobehavioral Center, Edina, MN, United States
| | - Anouk Scheres
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands.
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13
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Scheres A, Solanto MV. Do ADHD Symptoms, Executive Function, and Study Strategies Predict Temporal Reward Discounting in College Students with Varying Levels of ADHD Symptoms? A Pilot Study. Brain Sci 2021; 11:brainsci11020181. [PMID: 33540665 PMCID: PMC7912943 DOI: 10.3390/brainsci11020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to examine the relationship between temporal reward discounting and attention deficit hyperactivity disorder (ADHD) symptoms in college students. Additionally, we examined whether temporal reward discounting was associated with executive functioning in daily life and with learning and study strategies in this group. Thirty-nine college students (19 with ADHD and 20 controls) participated after meeting criteria for ADHD or non-ADHD based on standardized assessment. Strong preferences for small immediate rewards were specifically associated with the ADHD symptom domain hyperactivity–impulsivity. Additionally, these preferences were associated with daily life executive function problems and with weak learning and study strategies. This suggests that steep temporal discounting may be a key mechanism playing a role in the daily life challenges that college students with ADHD symptoms face. If these findings are replicated in larger samples, then intervention strategies may profitably be developed to counteract this strong preference for small immediate rewards in college students with ADHD symptoms.
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Affiliation(s)
- Anouk Scheres
- Behavioural Science Institute, Radboud University, 6525 GA Nijmegen, The Netherlands
- Correspondence:
| | - Mary V. Solanto
- Zucker School of Medicine at Hofstra-Northwell, New York, NY 11042, USA;
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14
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Abstract
ADHD is defined by behavioral symptoms that are not well characterized in relation to ADHD’s neurobiological mechanisms. This approach has limited our ability to define ADHD nosology and predict outcomes because it does not systematically examine facets of the disorder such as the inability to maintain cognitively effortful activities, as promoted in the NIMH RDoC approach. Existing data indicate ADHD is associated with differences in reward valuation and processing, but we do not know whether ADHD is also associated with higher levels of aversion to exerting cognitive effort and/or altered reward x effort interactions. Our ongoing study addresses this knowledge gap by examining individuals’ preferences between rewards associated with minimal effort and reward alternatives with a higher payoff but higher effort costs (“effort discounting”); thereby permitting us to characterize differences in biases and tradeoffs during effort-related decision-making in ADHD. The study takes advantage of a well-defined sample of ADHD-diagnosed and healthy control individuals to address three aims. First, we determine whether ADHD is associated with steeper discounting of larger, more effortful rewards. Second, we examine the subjective perception of effort in youth diagnosed with ADHD and healthy controls using tasks requiring varying levels of cognitive effort. Third, we explore relationships amongst indices of effort discounting, theoretically-related traits (e.g., grit, distress tolerance), biomarkers of effort-related decision-making (eye movements and pupil size), and various cognitive measures. Successful completion of the aims will permit us to better characterize ADHD-healthy control differences and lay a foundation for more computational approaches to ADHD diagnostic criteria.
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van der Oord S, Tripp G. How to Improve Behavioral Parent and Teacher Training for Children with ADHD: Integrating Empirical Research on Learning and Motivation into Treatment. Clin Child Fam Psychol Rev 2020; 23:577-604. [PMID: 32968886 PMCID: PMC7585566 DOI: 10.1007/s10567-020-00327-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 12/17/2022]
Abstract
Attention deficit hyperactivity disorder [ADHD] is one of the most common psychiatric disorders of childhood with poor prognosis if not treated effectively. Recommended psychosocial evidence-based treatment for preschool and school-aged children is behavioral parent and teacher training [BPT]. The core elements of BPT are instrumental learning principles, i.e., reinforcement of adaptive and the ignoring or punishment of non-adaptive behaviors together with stimulus control techniques. BPT is moderately effective in reducing oppositional behavior and improving parenting practices; however, it does not reduce blinded ratings of ADHD symptoms. Also after training effects dissipate. This practitioner review proposes steps that can be taken to improve BPT outcomes for ADHD, based on purported causal processes underlying ADHD. The focus is on altered motivational processes (reward and punishment sensitivity), as they closely link to the instrumental processes used in BPT. Following a critical analysis of current behavioral treatments for ADHD, we selectively review motivational reinforcement-based theories of ADHD, including the empirical evidence for the behavioral predictions arising from these theories. This includes consideration of children's emotional reactions to expected and unexpected outcomes. Next we translate this evidence into potential ADHD-specific adjustments designed to enhance the immediate and long-term effectiveness of BPT programs in addressing the needs of children with ADHD. This includes the use of remediation strategies for proposed deficits in learning not commonly used in BPT programs and cautions regarding the use of punishment. Finally, we address how these recommendations can be effectively transferred to clinical practice.
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Affiliation(s)
- Saskia van der Oord
- Behavior, Health and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands.
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, 1919-1 Tancha, Onna, Kunigami District, Okinawa Prefecture, 904-0495, Japan.
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16
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The associations of comorbid substance use disorders and psychiatric conditions with adolescent brain structure and function: A review. J Neurol Sci 2020; 418:117099. [DOI: 10.1016/j.jns.2020.117099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 07/15/2020] [Accepted: 08/14/2020] [Indexed: 12/30/2022]
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17
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Mphahlele RM, Pillay BJ, Meyer A. Delay aversion in school-aged children with attention-deficit hyperactivity disorder. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1177/0081246320964350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study considered whether children with attention-deficit hyperactivity disorder displayed a stronger preference for smaller, more immediate rewards over larger, but delayed rewards (delay aversion) when compared to typically developing controls and, furthermore, whether age and gender influenced their preference in any way. Children, between 6 and 15 years of age, living in Limpopo province of South Africa, participated in the study. Two hundred sixteen children in total (108 with attention-deficit hyperactivity disorder and 108 matched controls without attention-deficit hyperactivity disorder symptoms) were assessed, on a task of delay aversion. The Two Choice Impulsivity Paradigm, which assesses immediate and delayed responses, was administered to both the attention-deficit hyperactivity disorder and control groups. The performance of both groups was compared on the Two Choice Impulsivity Paradigm, and the scores were analysed as a function of gender and age. The attention-deficit hyperactivity disorder group chose significantly more immediate, smaller responses than the neurotypical control group, which preferred significantly more delayed but larger responses. Gender and age did not affect the response choices for both immediate and delayed measurements. Children with attention-deficit hyperactivity disorder show a greater need for more immediate gratification, even if the reward is smaller, than the neurotypical control group who could delay gratification to receive a larger reward. Gender and age did not influence their preferences.
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Affiliation(s)
- Ramatladi Meriam Mphahlele
- Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Basil Joseph Pillay
- Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Anneke Meyer
- Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
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18
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Nigg JT, Karalunas SL, Feczko E, Fair DA. Toward a Revised Nosology for Attention-Deficit/Hyperactivity Disorder Heterogeneity. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:726-737. [PMID: 32305325 PMCID: PMC7423612 DOI: 10.1016/j.bpsc.2020.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is among the many syndromes in the psychiatric nosology for which etiological signal and clinical prediction are weak. Reducing phenotypic and mechanistic heterogeneity should be useful to arrive at stronger etiological and clinical prediction signals. We discuss key conceptual and methodological issues, highlighting the role of dimensional features aligned with Research Domain Criteria and cognitive, personality, and temperament theory as well as neurobiology. We describe several avenues of work in this area, utilizing different statistical, computational, and machine learning approaches to resolve heterogeneity in ADHD. We offer methodological and conceptual recommendations. Methodologically, we propose that an integrated approach utilizing theory and advanced computational logic to address targeted questions, with consideration of developmental context, can render the heterogeneity problem tractable for ADHD. Conceptually, we conclude that the field is on the cusp of justifying an emotionally dysregulated subprofile in ADHD that may be useful for clinical prediction and treatment testing. Cognitive profiles, while more nascent, may be useful for clinical prediction and treatment assignment in different ways depending on developmental stage. Targeting these psychological profiles for neurobiological and etiological study to capture different pathophysiological routes remains a near-term opportunity. Subtypes are likely to be multifactorial, cut across multiple dimensions, and depend on the research or clinical outcomes of interest for their ultimate selection. In this context parallel profiles based on cognition, emotion, and specific neural signatures appear to be on the horizon, each with somewhat different utilities. Efforts to integrate such cross-cutting profiles within a conceptual dysregulation framework are well underway.
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Affiliation(s)
- Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
| | - Sarah L Karalunas
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Eric Feczko
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon
| | - Damien A Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon
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19
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Houtepen JABM, Sijtsema JJ, Van der Lem R, Scheres A, Bogaerts S. Cognitive-motivational, interpersonal, and behavioral functioning in relationship to treatment and research engagement in forensic patients with ADHD. J Clin Psychol 2020; 76:2345-2371. [PMID: 32659042 PMCID: PMC7689781 DOI: 10.1002/jclp.23016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/31/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023]
Abstract
Objectives To provide more insight into treatment and research responsivity in offenders with attention‐deficit hyperactivity disorder (ADHD). Method Via self‐reports and patients' scores on cognitive computer tasks, it was examined whether poorer cognitive‐motivational, interpersonal, and behavioral functioning were related to treatment no‐shows, longer treatment time duration intervals, and no‐show at the research appointment in 52 forensic outpatients with ADHD (Mage = 35.3, SD = 9.38). Treatment adherence was tracked for 10 appointments after research participation. Results Regression analyses showed that higher self‐reported impulsivity was associated with research no‐show, and more alcohol use with longer treatment time intervals. Yet, self‐reported delay aversion was associated with fewer treatment no‐shows, and, uncontrolled for alcohol use, impulsivity was associated with shorter treatment time intervals in a subsample of patients. Conclusions These preliminary results indicate that externalizing behaviors increase the risk for nonadherence in forensic ADHD patients, but that cognitive‐motivational problems also motivate patients to be more engaged.
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Affiliation(s)
- Jenny A B M Houtepen
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jelle J Sijtsema
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Rosalind Van der Lem
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands
| | - Anouk Scheres
- Department of Developmental Psychology, Radboud University, Radboud, The Netherlands
| | - Stefan Bogaerts
- Fivoor Research and Treatment Innovation, Forensic Outpatient Center Rotterdam, Rotterdam, The Netherlands.,Department of Developmental Psychology, School of Social and Behavioral Sciences, Developmental Psychology, Tilburg University, Tilburg, The Netherlands
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20
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Paraskevopoulou M, van Rooij D, Schene AH, Scheres AP, Buitelaar JK, Schellekens AFA. Effects of Substance Misuse and Family History of Substance Use Disorder on Delay Discounting in Adolescents and Young Adults with Attention-Deficit/Hyperactivity Disorder. Eur Addict Res 2020; 26:295-305. [PMID: 32659779 PMCID: PMC7513619 DOI: 10.1159/000509147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/20/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) often co-occur. Both disorders are characterized by impulsive choice. However, little is known about the effects of substance misuse (SM) and family history of SUD (FH) on impulsive choice in ADHD-SUD comorbidity. Impulsive choice is also linked to callous-unemotional (CU) traits, which are suggested to play a role in ADHD-SUD comorbidity. Our aim was to examine the effects of (1) FH and (2) SM on impulsive choice, while exploring the role of CU traits. METHODS Impulsive choice was assessed with the delay discounting (DD) task. We compared task performance across (1) ADHD patients and controls with or without FH of SUD (ADHD FH+: n = 86; ADHD FH-: n = 63; control FH+: n = 49; control FH-: n = 72; mean age of the whole sample [n = 270]: 16.39, SD: 3.43) and (2) family history-matched ADHD groups with and without SM and controls (ADHD + SM: n = 62; ADHD-only: n = 62; controls: n = 62; mean age of the whole sample [n = 186]: 18.01, SD: 2.71). Effects of CU traits were explored by adding this as a covariate in all analyses. RESULTS (1) There was no main effect of FH on DD. (2) We found increased DD in ADHD + SM compared to ADHD-only and no difference between ADHD-only and controls. Finally, increased DD was associated with increased callous traits only in ADHD FH+ and control FH+. CONCLUSIONS In adolescents and young adults with ADHD, high impulsive choice might only be present in those with comorbid SM and in an FH+ subgroup with high callous traits. This suggests that impulsive choice in ADHD might result from (1) effects of SM and (2) a combined effect of SUD vulnerability and high callousness. Future studies should investigate efficacy of early interventions, targeting CU traits.
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Affiliation(s)
- Maria Paraskevopoulou
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands,*Maria Paraskevopoulou, Departments of Psychiatry & Cognitive Neuroscience, Radboud University Medical Center & Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, NL–6525 Nijmegen (The Netherlands),
| | - Daan van Rooij
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Aart H. Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anouk P.J. Scheres
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands,Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
| | - Arnt F. A. Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
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21
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Scholten H, Scheres A, de Water E, Graf U, Granic I, Luijten M. Behavioral trainings and manipulations to reduce delay discounting: A systematic review. Psychon Bull Rev 2019; 26:1803-1849. [PMID: 31270766 PMCID: PMC6863952 DOI: 10.3758/s13423-019-01629-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In everyday decision-making, individuals make trade-offs between short-term and long-term benefits or costs. Depending on many factors, individuals may choose to wait for larger delayed reward, yet in other situations they may prefer the smaller, immediate reward. In addition to within-subject variation in the short-term versus long-term reward trade-off, there are also interindividual differences in delay discounting (DD), which have been shown to be quite stable. The extent to which individuals discount the value of delayed rewards turns out to be associated with important health and disorder-related outcomes: the more discounting, the more unhealthy or problematic choices. This has led to the hypothesis that DD can be conceptualized as trans-disease process. The current systematic review presents an overview of behavioral trainings and manipulations that have been developed to reduce DD in human participants aged 12 years or older. Manipulation studies mostly contain one session and measure DD directly after the manipulation. Training studies add a multiple session training component that is not per se related to DD, in between two DD task measurements. Ninety-eight studies (151 experiments) were identified that tested behavioral trainings and manipulations to decrease DD. Overall, results indicated that DD can be decreased, showing that DD is profoundly context dependent and changeable. Most promising avenues to pursue in future research seem to be acceptance-based/mindfulness-based trainings, and even more so manipulations involving a future orientation. Limitations and recommendations are discussed to identify the mechanistic processes that allow for changes in discount rate and behavior accordingly.
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Affiliation(s)
- Hanneke Scholten
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands.
| | - Anouk Scheres
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Erik de Water
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uta Graf
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Isabela Granic
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | - Maartje Luijten
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
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22
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Addicott MA, Schechter JC, Sapyta JJ, Selig JP, Kollins SH, Weiss MD. Methylphenidate increases willingness to perform effort in adults with ADHD. Pharmacol Biochem Behav 2019; 183:14-21. [PMID: 31226260 DOI: 10.1016/j.pbb.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/31/2019] [Accepted: 06/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND A reduced willingness to perform effort based on the magnitude and probability of potential rewards has been associated with diminished dopamine function and may be relevant to attention-deficit/hyperactivity disorder (ADHD). Here, we investigated the influence of ADHD status and methylphenidate on effort-based decisions. We hypothesized that ADHD participants would make fewer high-effort selections than non-ADHD subjects, and that methylphenidate would increase the number of high-effort selections. Furthermore, we hypothesized there would be associations among ADHD severity and methylphenidate-related changes in effort-based and attentional performance across all participants. METHODS AND PARTICIPANTS ADHD (n = 23) and non-ADHD (n = 23) adults completed the Effort Expenditure for Rewards Task in which participants select between low-effort and high-effort options to receive monetary rewards at varying levels of reward magnitude and probability. A test of attentional performance was also completed. RESULTS Overall, participants made more high-effort selections as potential reward magnitude and probability increased. ADHD participants did not make fewer high-effort selections than non-ADHD participants, but ADHD participants showed greater methylphenidate-related increases in high-effort selections. ADHD participants had worse attentional performance than non-ADHD participants. ADHD severity was associated with methylphenidate-related changes in high-effort selections, but not changes in attentional performance. CONCLUSIONS These results indicate that methylphenidate increases the willingness to perform effort in individuals with ADHD, possibly due to disorder-related motivational deficits. This provides support for theories of insufficient effort allocation among individuals with ADHD. TRIAL REGISTRATION Clinicaltrials.gov Identifier, NCT02630017.
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Affiliation(s)
| | | | | | - James P Selig
- University of Arkansas for Medical Sciences, United States of America
| | - Scott H Kollins
- Duke University School of Medicine, United States of America
| | - Margaret D Weiss
- University of Arkansas for Medical Sciences, United States of America
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Smith T, Panfil K, Bailey C, Kirkpatrick K. Cognitive and behavioral training interventions to promote self-control. JOURNAL OF EXPERIMENTAL PSYCHOLOGY-ANIMAL LEARNING AND COGNITION 2019; 45:259-279. [PMID: 31070430 DOI: 10.1037/xan0000208] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This review article discusses various cognitive and behavioral interventions that have been developed with the goal of promoting self-controlled responding. Self-control can exert a significant impact on human health and impulsive behaviors are associated with a wide range of diseases and disorders, leading to the suggestion that impulsivity is a trans-disease process. The self-control interventions include effort exposure, reward discrimination, reward bundling, interval schedules of reinforcement, impulse control training, and mindfulness training. Most of the interventions have been consistently shown to increase self-control, except for mindfulness training. Some of the successful interventions are long-lasting, whereas others may be transient. Most interventions are domain-specific, targeting specific cognitive and behavioral processes that relate to self-control rather than targeting overall self-control. For example, effort exposure appears to primarily increase effort tolerance, which in turn can improve self-control. Similarly, interval schedules primarily target interval timing, which promotes self-controlled responses. A diagram outlining a proposed set of intervention effects on self-control is introduced to motivate further research in this area. The diagram suggests that the individual target processes of the interventions may potentially summate to produce general self-control, or perhaps even produce synergistic effects. In addition, it is suggested that developing a self-control profile may be advantageous for aligning specific interventions to mitigate specific deficits. Overall, the results indicate that interventions are a promising avenue for promoting self-control and may help to contribute to changing health outcomes associated with a wide variety of diseases and disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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24
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Mies GW, Moors P, Sonuga-Barke EJ, van der Oord S, Wiersema JR, Scheres A, Lemiere J, Danckaerts M. A Pilot Study of Behavioral, Physiological, and Subjective Responses to Varying Mental Effort Requirements in Attention-Deficit/Hyperactivity Disorder. Front Psychol 2019; 9:2769. [PMID: 30687201 PMCID: PMC6336710 DOI: 10.3389/fpsyg.2018.02769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 12/24/2018] [Indexed: 01/17/2023] Open
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) is presumed to involve mental effort application difficulties. To test this assumption, we manipulated task difficulty and measured behavioral, as well as subjective and psychophysiological indices of effort. Methods: Fifteen adolescent ADHD boys and 16 controls performed two tasks. First, subjective estimates and behavioral and pupillary measures of effort were recorded across five levels of N-back task difficulties. Second, effort discounting was assessed. In the latter, participants made repeated choices between performing a difficult N-back task for a high reward versus an easier N-back task for a smaller reward. Results: Increasing task difficulty led to similar deteriorations in performance for both groups – although ADHD participants performed more poorly at all difficulty levels than controls. While ADHD and control participants rated the tasks equally difficult and discounted effort similarly, those with ADHD displayed slightly different pupil dilation patterns with increasing task difficulty. Conclusion: The behavioral results did not provide evidence for mental effort problems in adolescent boys with ADHD. The subtle physiological effects, however, suggest that adolescents with ADHD may allocate effort in a different way than controls.
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Affiliation(s)
- Gabry W Mies
- Center for Developmental Psychiatry, UPC-KU Leuven, Leuven, Belgium.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Pieter Moors
- Laboratory for Experimental Psychology, Department of Brain and Cognition, KU Leuven, Leuven, Belgium
| | - Edmund J Sonuga-Barke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Saskia van der Oord
- Department of Clinical Psychology, KU Leuven, Leuven, Belgium.,Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jan R Wiersema
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Anouk Scheres
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jurgen Lemiere
- Center for Developmental Psychiatry, UPC-KU Leuven, Leuven, Belgium
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25
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Mies GW, de Water E, Wiersema JR, Scheres A. Delay discounting of monetary gains and losses in adolescents with ADHD: Contribution of delay aversion to choice. Child Neuropsychol 2018; 25:528-547. [PMID: 30111229 DOI: 10.1080/09297049.2018.1508563] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Adolescents with attention-deficit/hyperactivity disorder (ADHD) are known to have stronger preferences for smaller immediate rewards over larger delayed rewards in delay discounting tasks than their peers, which has been argued to reflect delay aversion. Here, participants performed a delay discounting task with gains and losses. In this latter condition, participants were asked whether they were willing to wait in order to lose less money. Following the core assumption of the delay aversion model that individuals with ADHD have a general aversion to delay, one would predict adolescents with ADHD to avoid waiting in both conditions. Adolescents (12-17 years) with ADHD (n = 29) and controls (n = 28) made choices between smaller immediate and larger delayed gains, and between larger immediate and smaller delayed losses. All delays (5-25 s) and gains/losses (2-10 cents) were experienced. In addition to an area under the curve approach, a mixed-model analysis was conducted to disentangle the contributions of delay duration and immediate gain/delayed loss amount to choice. The ADHD group chose the immediate option more often than controls in the gain condition, but not in the loss condition. The contribution of delay duration to immediate choices was stronger for the ADHD group than the control group in the gain condition only. In addition, the ADHD group scored higher on self-reported delay aversion, and delay aversion was associated with delay sensitivity in the gain condition, but not in the loss condition. In sum, we found no clear evidence for a general aversion to delay in adolescents with ADHD.
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Affiliation(s)
- Gabry W Mies
- a Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
| | - Erik de Water
- a Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
| | - Jan R Wiersema
- b Department of Experimental Clinical and Health Psychology , Ghent University , Ghent , Belgium
| | - Anouk Scheres
- a Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
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