Temporal discounting and emotional self-regulation in children with attention-deficit/hyperactivity disorder

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

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

Working memory and decision making in children with ADHD: an analysis of delay discounting with the use of the dual-task paradigm

BACKGROUND

Deficits in working memory tasks have been widely documented in Attention Deficit Hyperactivity Disorder (ADHD) studies. The aim of this study is to evaluate the effects of working memory load in impulsivity during decision-making processes. A delayed discounting (DD) paradigm was used, comparing children with ADHD and age-matched controls.

METHOD

Thirty-two children equally divided between typically developing and ADHD, from 8 to 10 years of age were assigned to sessions of a dual-task paradigm. In the primary task the child has to choose between two different amounts of money at different time delays, while in the secondary task the child has to repeat a random series of digits with different lengths. The experiment was conducted in a school setting.

RESULTS

Compared to peers with typical development, delayed discounting was significantly stronger in children with ADHD and discounting rates increased in both groups for heavier memory loads. Furthermore, the memory load impact on frequency of immediate rewards was stronger in children with ADHD compared to typically developing children.

DISCUSSION

Results are discussed in terms of the relation between working memory load and decision-making processes, their impact on impulsive behaviour in ADHD and the need for future research to understand possible neurocognitive correlates and use that information to develop better inclusive policies.

Temporal Reward Discounting in Children with Attention Deficit/Hyperactivity Disorder (ADHD), and Children with Autism Spectrum Disorder (ASD): A Systematic Review

Children with ADHD and ASD may present differences in the affective-motivational processes. We systematically review the literature regarding temporal discounting in children up to 12 years with ADHD and ASD. Six articles were included, five studies with ADHD children (n = 231), one with ASD children (n = 21), all including typically developing children as controls (n = 210). Five studies (four with ADHD and one with ASD) found greater temporal reward discounting for clinical groups. Occurrence of ADHD appears to rush even more the decision-making process at this stage of development, but there is still a lack in the literature, especially evaluating individuals with ASD.

Temporal discounting and attention-deficit/hyperactivity disorder in childhood: reasons for devising different tasks

INTRODUCTION

Temporal discounting (TD) describes how a certain reward is seen as less valuable the more its delivery is postponed. There are two main types of TD tasks, hypothetical and real, both of which use monetary rewards. Over the last few years, however, variants of these tasks have been adjusted to assess clinical groups of children showing impulsivity as found in attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE

To review and discuss studies conducted over the last 10 years on the use of TD tasks in the assessment of pediatric patients with ADHD.

METHOD

For this literature review, articles were non-systematically selected from PubMed, MEDLINE and SciELO databases to include experimental studies on the use of at least one TD paradigm to assess and distinguish ADHD and non-ADHD groups.

RESULTS

Of the studies assessed, 76.19% used hypothetical tasks, followed by real tasks (28.57%), and, finally, tasks using different types of reward, such as toys or rewarding activities (14.28%).

CONCLUSIONS

Although assessed in few studies, real and alternative tasks appeared to be effective in differentiating clinical groups and suitable for investigating hot executive functions in childhood.