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Nejati V, Peyvandi A, Nazari N, Dehghan M. Cognitive Correlates of Risky Decision-Making in Individuals with and without ADHD: A Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-024-09646-2. [PMID: 38902592 DOI: 10.1007/s11065-024-09646-2] [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: 12/23/2023] [Accepted: 05/27/2024] [Indexed: 06/22/2024]
Abstract
This meta-analytic study aims to investigate the cognitive correlates of risky decision-making in individuals with attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) individuals. A systematic analysis of existing literature was conducted, encompassing 38 studies (496 ADHD and 1493 TD). Findings revealed a consistent propensity for riskier decision-making in individuals with ADHD, supported by significant correlations with attention, cognitive flexibility, inhibitory control, time perception, and working memory. The study underscores the relevance of these cognitive functions in shaping decision-making tendencies, with nuanced patterns observed within the ADHD and TD subgroups. Individuals with ADHD often demonstrate altered patterns of correlation, reflecting the specific cognitive challenges characteristic of the disorder.
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Affiliation(s)
- Vahid Nejati
- Department of Psychology, Shahid Beheshti University, PO Box 1983969411, Tehran, Iran.
| | - Aida Peyvandi
- Department of Psychology, Shahid Beheshti University, PO Box 1983969411, Tehran, Iran
| | - Nasim Nazari
- Department of Psychology, Shahid Beheshti University, PO Box 1983969411, Tehran, Iran
| | - Mahshid Dehghan
- Department of Psychology, Shahid Beheshti University, PO Box 1983969411, Tehran, Iran
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2
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Ward JH, Becker K, Smith J, Price A, Newlove-Delgado T. Patient, supporter and primary healthcare professional perspectives on health risks in over 16s with attention deficit hyperactivity disorder (ADHD) in England: a national survey study. BMC Health Serv Res 2024; 24:751. [PMID: 38898441 PMCID: PMC11188530 DOI: 10.1186/s12913-024-11188-5] [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: 08/07/2023] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Current research suggests that people with attention deficit hyperactivity disorder (ADHD) are at higher risk of physical and mental health disorders. This study aimed to explore these health risks in ADHD from the perspectives of multiple stakeholders. METHODS This study forms part of the 'Managing young people with ADHD in Primary care (MAP) study'. A survey developed by the study team was distributed to over 16 year olds with ADHD, their supporters, primary healthcare professionals and health commissioners across England, via social media and through patient/clinical networks (September-October 2022). This survey contained two questions on health risks. Question one asked about views on health risks in ADHD (free text). Question two asked about advice given (options list and free text). Descriptive statistics summarised responses to questions one and two, and qualitative analysis (reflexive thematic analysis) was used to explore free text responses from question one. RESULTS 782 participants responded to the MAP survey. Of these, 206 healthcare professionals, 157 people with ADHD and 88 supporters answered question one. The most mentioned perceived risks were substance misuse, sleep disorders, weight management and smoking. More people with ADHD reported disordered eating as a health risk (n = 32) than healthcare professionals (n = 5). Generated themes included perceived health risks, impact of living with ADHD, lack of adequate healthcare, and need for ADHD awareness. In respect to advice given (question two), based on responses from 258 professionals, 162 people with ADHD and 100 supporters, the most common advice discussed in consultation was mental health (n = 149, n = 50 and n = 17 respectively). High numbers of respondents reported not giving/receiving advice on wider health (n = 38, n = 88 and n = 61 respectively). CONCLUSIONS Findings demonstrate that respondents perceived a range of physical and mental health risks posed by ADHD. These related to difficulties with activities of daily living, as well as healthcare interactions and the impact of core features of ADHD (e.g. impulsivity, emotional dysregulation). These risks are not currently explicitly addressed in United Kingdom national guidance on ADHD. More work is needed to examine and address the broader health outcomes of people with ADHD.
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Affiliation(s)
- John H Ward
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK.
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Royal Devon University Hospital NHS Foundation Trust, Devon, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Kieran Becker
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Jane Smith
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Anna Price
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Tamsin Newlove-Delgado
- University of Exeter Medical School, 2.05 South Cloisters, St Luke's Campus, Heavitree Road, Exeter, UK
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3
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Smith JN, Jusko ML, Fosco WD, Musser ED, Raiker JS. A critical review of hot executive functioning in youth attention-deficit/hyperactivity disorder: Methodological limitations, conceptual considerations, and future directions. Dev Psychopathol 2024; 36:601-615. [PMID: 36734223 DOI: 10.1017/s0954579422001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hot executive functioning (EF) - EF under emotionally or motivationally salient conditions - is a putative etiology of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems (DBPs), and their related impairments. Despite two decades of research, the present study is the first review of the construct in youth ADHD, with a particular focus on the role of task design, age, and DBPs, as well as relevant conceptual and methodological considerations. While certain hot EF tasks have been investigated extensively (e.g., choice impulsivity), substantial inconsistency in measurement of the broader construct remains, severely limiting conclusions. Future research should a) consider the extent to which various hot EF tasks relate to one another, a higher order factor, and other related constructs; b) further investigate task design, particularly the elicitation of emotion or motivation and its anticipated effect on EF; and c) incorporate multiple levels of analysis to validate similarities and differences among tasks with regard to the affective experiences and cognitive demands they elicit. With improved measurement and conceptual clarity, hot EF has potential to advance the literature on etiological pathways to ADHD, DBPs and associated impairments and, more broadly, may represent a useful tool for understanding the influence of emotion and motivation on cognition.
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Affiliation(s)
| | | | | | - Erica D Musser
- Florida International University (FIU), USA
- FIU Center for Children and Families, USA
- FIU Embrace, USA
| | - Joseph S Raiker
- Florida International University (FIU), USA
- FIU Center for Children and Families, USA
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4
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Sørensen L, Adolfsdottir S, Kvadsheim E, Eichele H, Plessen KJ, Sonuga-Barke E. Suboptimal decision making and interpersonal problems in ADHD: longitudinal evidence from a laboratory task. Sci Rep 2024; 14:6535. [PMID: 38503800 PMCID: PMC10951300 DOI: 10.1038/s41598-024-57041-x] [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: 05/24/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
Over half of children with Attention-Deficit/Hyperactivity Disorder (ADHD) display interpersonal and social problems. Several lines of research suggest that suboptimal decision making, the ability to adjust choices to different risk-varying options, influences poorer choices made in social interactions. We thus measured decision making and its prediction of social problems longitudinally with the Cambridge Gambling Task in children with ADHD over four years. Children with ADHD had shown suboptimal decision making driven mainly by delay aversion at baseline and we expected this to be a stabile trait which would predict greater parent-reported social problems. From the baseline assessment (n = 70), 67% participated at the follow-up assessment, 21 from the ADHD group and 26 from the typically developing group. The mean age at the follow-up was 14.5 years old. The results confirmed our expectations that suboptimal decision making was a stabile trait in children and adolescents with ADHD. Although delay aversion did not differ from controls at follow-up it still proved to be the main longitudinal predictor for greater social problems. Our findings indicate that impulsivity in social interactions may be due to a motivational deficit in youth with ADHD.
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Affiliation(s)
- L Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009, Bergen, Norway.
| | - S Adolfsdottir
- Department of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009, Bergen, Norway
- Division of Vision Impairments, Statped - National Service for Special Needs Education, Bergen, Norway
| | - E Kvadsheim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - H Eichele
- Regional Resource Centre for Autism, ADHD and Tourette Syndrome Western Norway, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - K J Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - E Sonuga-Barke
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Aarhus University, Aarhus, Denmark
- Department of Psychology, Hong Kong University, Hong Kong, China
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Barack DL, Ludwig VU, Parodi F, Ahmed N, Brannon EM, Ramakrishnan A, Platt ML. Attention deficits linked with proclivity to explore while foraging. Proc Biol Sci 2024; 291:20222584. [PMID: 38378153 PMCID: PMC10878810 DOI: 10.1098/rspb.2022.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024] Open
Abstract
All mobile organisms forage for resources, choosing how and when to search for new opportunities by comparing current returns with the average for the environment. In humans, nomadic lifestyles favouring exploration have been associated with genetic mutations implicated in attention deficit hyperactivity disorder (ADHD), inviting the hypothesis that this condition may impact foraging decisions in the general population. Here we tested this pre-registered hypothesis by examining how human participants collected resources in an online foraging task. On every trial, participants chose either to continue to collect rewards from a depleting patch of resources or to replenish the patch. Participants also completed a well-validated ADHD self-report screening assessment at the end of sessions. Participants departed resource patches sooner when travel times between patches were shorter than when they were longer, as predicted by optimal foraging theory. Participants whose scores on the ADHD scale crossed the threshold for a positive screen departed patches significantly sooner than participants who did not meet this criterion. Participants meeting this threshold for ADHD also achieved higher reward rates than individuals who did not. Our findings suggest that ADHD attributes may confer foraging advantages in some environments and invite the possibility that this condition may reflect an adaptation favouring exploration over exploitation.
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Affiliation(s)
- David L. Barack
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, PA 19104, USA
- Department of Philosophy, University of Pennsylvania, PA 19104, USA
| | - Vera U. Ludwig
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, PA 19104, USA
- University of Pennsylvania, PA 19104, USA
| | - Felipe Parodi
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, PA 19104, USA
| | - Nuwar Ahmed
- Department of Psychology, University of Pennsylvania, PA 19104, USA
| | | | - Arjun Ramakrishnan
- Department of Biological Sciences and Bioengineering and Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology, Kanpur 208016, India
| | - Michael L. Platt
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, PA 19104, USA
- Department of Psychology, University of Pennsylvania, PA 19104, USA
- Department of Marketing, Wharton School, University of Pennsylvania, PA 19104, USA
- University of Pennsylvania, PA 19104, USA
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Oguchi M, Furukawa E, Nagahama N, Perera KD, Tripp G. Relationships between experimental task and questionnaire measures of reward/punishment sensitivity in attention-deficit/hyperactivity disorder (ADHD): protocol for a scoping review. BMJ Open 2024; 14:e078026. [PMID: 38355179 PMCID: PMC10868308 DOI: 10.1136/bmjopen-2023-078026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION One of the purported underlying causal mechanisms of attention deficit hyperactivity disorder (ADHD) is altered motivational processes. Questionnaires have been used to identify the characteristics of reward and punishment sensitivity in individuals with ADHD. However, these questionnaires were initially developed to measure individual traits related to anxiety (inhibitory) and impulsivity (approach) tendencies or differences in pleasure-seeking. These reward and punishment sensitivity questionnaires are useful but might not capture all relevant aspects of altered motivational processes in ADHD. The proposed scoping review aims to: (1) examine which aspects of hypothesised altered reward and punishment sensitivity correspond to constructs measured by existing questionnaires, (2) characterise the relationships between ADHD symptomatology and reward and punishment sensitivity as measured by existing questionnaires and (3) evaluate the consistency between the altered reward and punishment sensitivity as measured by existing questionnaires and experimental task performance. METHODS AND ANALYSIS Reporting of the scoping review results will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the Joanna Briggs Methodology for Scoping Reviews. Published English-language literature was searched in three electronic databases (PubMed, Web of Science, APA PsycINFO) on 16 November 2023, with no restriction on the year of publication. Two researchers independently screened all identified titles/abstracts before proceeding to full-text review and additional handsearching of relevant studies. A narrative review and conclusions will be presented together with tables summarising the articles reviewed and the results organised by the three aims. ETHICS AND DISSEMINATION This study reviews existing publications with ethical approval in place. Therefore, ethical approval is not required. Review results will be disseminated through academic conferences and peer-reviewed manuscripts. Scoping review results will also inform future research to measure and identify altered motivational processes in ADHD.
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Affiliation(s)
- Mana Oguchi
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
- Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Emi Furukawa
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
| | - Naano Nagahama
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
- Laboratory of Behavioral Neuroendocrinology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kokila Dilhani Perera
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
| | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
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7
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Atkinson-Clement C, Lebreton M, Patsalides L, de Liege A, Klein Y, Roze E, Deniau E, Hartmann A, Palminteri S, Worbe Y. Decision-making under risk and ambiguity in adults with Tourette syndrome. Psychol Med 2023; 53:5256-5266. [PMID: 35899867 DOI: 10.1017/s0033291722002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tourette syndrome (TS) as well as its most common comorbidities are associated with a higher propensity for risky behaviour in everyday life. However, it is unclear whether this increased risk propensity in real-life contexts translates into a generally increased attitude towards risk. We aimed to assess decision-making under risk and ambiguity based on prospect theory by considering the effects of comorbidities and medication. METHODS Fifty-four individuals with TS and 32 healthy controls performed risk and ambiguity decision-making tasks under both gains and losses conditions. Behavioural and computational parameters were evaluated using (i) univariate analysis to determine parameters difference taking independently; (ii) supervised multivariate analysis to evaluate whether our parameters could jointly account for between-group differences (iii) unsupervised multivariate analysis to explore the potential presence of sub-groups. RESULTS Except for general 'noisier' (less consistent) decisions in TS, we showed no specific risk-taking behaviour in TS or any relation with tics severity or antipsychotic medication. However, the presence of comorbidities was associated with distortion of decision-making. Specifically, TS with obsessive-compulsive disorder comorbidity was associated with a higher risk-taking profile to increase gain and a higher risk-averse profile to decrease loss. TS with attention-deficit hyperactivity disorder comorbidity was associated with risk-seeking in the ambiguity context to reduce a potential loss. CONCLUSIONS Impaired valuation of risk and ambiguity was not related to TS per se. Our findings are important for clinical practice: the involvement of individuals with TS in real-life risky situations may actually rather result from other factors such as psychiatric comorbidities.
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Affiliation(s)
- Cyril Atkinson-Clement
- Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Sorbonne University, 75005 Paris, France
- Movement Investigation and Therapeutics Team, Paris, France
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Mael Lebreton
- Paris School of Economics, Paris, France
- Swiss Center for Affective Science, University of Geneva, Geneva, Switzerland
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Fundamental Neurosciences, University of Geneva, Geneva, Switzerland
| | - Leïla Patsalides
- Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Sorbonne University, 75005 Paris, France
- Movement Investigation and Therapeutics Team, Paris, France
| | - Astrid de Liege
- Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Sorbonne University, 75005 Paris, France
- Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France
| | - Yanica Klein
- Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Sorbonne University, 75005 Paris, France
- Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France
| | - Emmanuel Roze
- Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Sorbonne University, 75005 Paris, France
- Movement Investigation and Therapeutics Team, Paris, France
- Department of Neurology, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France
| | - Emmanuelle Deniau
- Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Sorbonne University, 75005 Paris, France
- Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France
| | - Andreas Hartmann
- Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Sorbonne University, 75005 Paris, France
- Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France
| | - Stefano Palminteri
- Laboratoire de Neurosciences Cognitives et Computationnelles, INSERM, Paris, France
- Département d'Etudes Cognitives, ENS, PSL Research University, Paris, France
- Institute for Cognitive Neuroscience, HSE, Moscow, Russian Federation
| | - Yulia Worbe
- Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Sorbonne University, 75005 Paris, France
- Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France
- Department of Neurophysiology, Saint Antoine Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
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Oguchi M, Takahashi T, Nitta Y, Kumano H. Moderating effect of attention deficit hyperactivity disorder tendency on the relationship between delay discounting and procrastination in young adulthood. Heliyon 2023; 9:e14834. [PMID: 37025860 PMCID: PMC10070913 DOI: 10.1016/j.heliyon.2023.e14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Among adults with ADHD, one of the most common problems in daily life is procrastination. ADHD is characterized by attention as well as suboptimal decision-making deficits, indicating difficulty in making long-term reward choices. However, little is known about the relationship between suboptimal decision-making or temporal discounting (TD) and procrastination among adults with ADHD. This study aimed to investigate whether ADHD symptoms enhance the relationship between TD and procrastination. Fifty-eight university participants completed questionnaires about procrastination and an experimental task which measured TD rates in reward and punishment conditions. Only the reward condition showed that ADHD symptoms significantly strengthened the association between the TD rate and procrastination. This study revealed that even when ADHD symptoms were high, higher TD rates were associated with more procrastination, while lower TD rates were associated with less procrastination. The results suggest that procrastination interventions for adult ADHD-prone individuals need to pay attention to reward responses.
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9
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Winter GN, Aran A, Pollak Y. Risk-Taking Behaviors in Children with ADHD Compared to Children with Primary Headaches. Neuropediatrics 2023. [PMID: 36442789 DOI: 10.1055/a-1988-2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The study examined the engagement in risk-taking behaviors and their onset in children with attention-deficit/hyperactivity disorder (ADHD) compared with children with primary headaches. Whether ADHD is associated with higher engagement in risk-taking behavior compared with other neurodevelopmental disorders (and not only typical development) has yet to be demonstrated. A sample of 189 children, 10 to 18 years old, undergoing neurological surveillance for ADHD (N = 144) or primary headaches (N = 45) participated in the study. The children and their parents reported the children's engagement in various risk-taking behaviors. The ADHD group reported a higher level of general risk-taking behavior relative to the headache group. The differences remained significant even after controlling for demographic and clinical variables. No differences in the age of onset of risk-taking behaviors were found. It is concluded that risk-taking behavior is more common in children with ADHD under active neurological surveillance than in children followed for primary headaches.
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Affiliation(s)
- Gidon Nathan Winter
- Department of Pediatric Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Adi Aran
- Department of Pediatric Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yehuda Pollak
- Department of Pediatric Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
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10
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Halbe E, Kolf F, Heger AS, Hüpen P, Bergmann M, Aslan B, Harrison BJ, Davey CG, Philipsen A, Lux S. Altered interaction of physiological activity and behavior affects risky decision-making in ADHD. Front Hum Neurosci 2023; 17:1147329. [PMID: 37151896 PMCID: PMC10157058 DOI: 10.3389/fnhum.2023.1147329] [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: 01/18/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Background Adult attention-deficit/hyperactivity disorder (ADHD) is often associated with risky decision-making behavior. However, current research studies are often limited by the ability to adequately reflect daily behavior in a laboratory setting. Over the lifespan impairments in cognitive functions appear to improve, whereas affective functions become more severe. We assume that risk behavior in ADHD arises predominantly from deficits in affective processes. This study will therefore aim to investigate whether a dysfunction in affective pathways causes an abnormal risky decision-making (DM) behavior in adult ADHD. Methods Twenty-eight participants with ADHD and twenty-eight healthy controls completed a battery of questionnaires regarding clinical symptoms, self-assessment of behavior and emotional competence. Furthermore, skin conductance responses were measured during the performance in a modified version of the Balloon Analogue Risk Task. A linear mixed-effects model analysis was used to analyze emotional arousal prior to a decision and after feedback display. Results Results showed higher emotional arousal in ADHD participants before decision-making (β = -0.12, SE = 0.05, t = -2.63, p < 0.001) and after feedback display (β = -0.14, SE = 0.05, t = -2.66, p = 0.008). Although risky behavior was greater in HC than in ADHD, we found a significant interaction effect of group and anticipatory skin conductance responses regarding the response behavior (β = 107.17, SE = 41.91, t = 2.56, p = 0.011). Post hoc analyses revealed a positive correlation between anticipatory skin conductance responses and reaction time in HC, whereas this correlation was negative in ADHD. Self-assessment results were in line with the objective measurements. Conclusion We found altered changes in physiological activity during a risky decision-making task. The results confirm the assumption of an aberrant relationship between bodily response and risky behavior in adult ADHD. However, further research is needed with respect to age and gender when considering physiological activities.
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Affiliation(s)
- Eva Halbe
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
- *Correspondence: Eva Halbe,
| | - Fabian Kolf
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alina Sophie Heger
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Philippa Hüpen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- JARA–Translational Brain Medicine, Aachen, Germany
| | - Moritz Bergmann
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Behrem Aslan
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Ben J. Harrison
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | | | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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Benwell CSY, Mohr G, Wallberg J, Kouadio A, Ince RAA. Psychiatrically relevant signatures of domain-general decision-making and metacognition in the general population. NPJ MENTAL HEALTH RESEARCH 2022; 1:10. [PMID: 38609460 PMCID: PMC10956036 DOI: 10.1038/s44184-022-00009-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/04/2022] [Indexed: 04/14/2024]
Abstract
Human behaviours are guided by how confident we feel in our abilities. When confidence does not reflect objective performance, this can impact critical adaptive functions and impair life quality. Distorted decision-making and confidence have been associated with mental health problems. Here, utilising advances in computational and transdiagnostic psychiatry, we sought to map relationships between psychopathology and both decision-making and confidence in the general population across two online studies (N's = 344 and 473, respectively). The results revealed dissociable decision-making and confidence signatures related to distinct symptom dimensions. A dimension characterised by compulsivity and intrusive thoughts was found to be associated with reduced objective accuracy but, paradoxically, increased absolute confidence, whereas a dimension characterized by anxiety and depression was associated with systematically low confidence in the absence of impairments in objective accuracy. These relationships replicated across both studies and distinct cognitive domains (perception and general knowledge), suggesting that they are reliable and domain general. Additionally, whereas Big-5 personality traits also predicted objective task performance, only symptom dimensions related to subjective confidence. Domain-general signatures of decision-making and metacognition characterise distinct psychological dispositions and psychopathology in the general population and implicate confidence as a central component of mental health.
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Affiliation(s)
- Christopher S Y Benwell
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK.
| | - Greta Mohr
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK
| | - Jana Wallberg
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
| | - Aya Kouadio
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
| | - Robin A A Ince
- School of Psychology and Neuroscience, University of Glasgow, Glasgow, UK
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12
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Orm S, Pollak Y, Fossum IN, Andersen PN, Øie MG, Skogli EW. Decision-making and Risky Behavior in Individuals with Attention-Deficit/Hyperactivity Disorder: A 10-year Longitudinal Study. Dev Neuropsychol 2022; 47:193-209. [PMID: 35642565 DOI: 10.1080/87565641.2022.2082430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We assessed 85 children with Attention-Deficit/Hyperactivity Disorder (ADHD) and 50 typically developing children (TD) (Mage = 11.59, 57.8% boys) with the Hungry Donkey Task (HDT) at baseline and 2-year follow-up, and the Iowa Gambling Task at 10-year follow-up (75% retention). Improvement in the proportion of advantageous choices was observed from two- to 10-year follow-up, but the ADHD group improved less and was outperformed by the TD group at the 10-year follow-up. More advantageous choices on the HDT at baseline predicted less risky behavior at 10-year follow-up. Male sex and more inattentive or externalizing symptoms at baseline predicted more risky behavior.
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Affiliation(s)
- Stian Orm
- Division Mental Health Care, Innlandet Hospital Trust, Brumunddal Norway.,Department of Psychology, University of Oslo, Oslo Norway
| | - Yehuda Pollak
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Israel
| | - Ingrid Nesdal Fossum
- Division Mental Health Care, Innlandet Hospital Trust, Brumunddal Norway.,Department of Psychology, University of Oslo, Oslo Norway
| | - Per Normann Andersen
- Department of Psychology, Inland Norway University of Applied Sciences, Elverum Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo Norway.,Research Department, Innlandet Hospital Trust, Brumunddal Norway
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13
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Development of decision making based on internal and external information: A hierarchical Bayesian approach. JUDGMENT AND DECISION MAKING 2021. [DOI: 10.1017/s1930297500008482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractIn decision making, people may rely on their own information as well as on information from external sources, such as family members, peers, or experts. The current study investigated how these types of information are used by comparing four decision strategies: 1) an internal strategy that relies solely on own information; 2) an external strategy that relies solely on the information from an external source; 3) a sequential strategy that relies on information from an external source only after own information is deemed inadequate; 4) an integrative strategy that relies on an integration of both types of information. Of specific interest were individual and developmental differences in strategy use. Strategy use was examined via Bayesian hierarchical mixture model analysis. A visual decision task was administered to children and young adolescents (N=305, ages 9–14). Individual differences but no age-related changes were observed in either decision accuracy or strategy use. The internal strategy was dominant across ages, followed by the integrative and sequential strategy, respectively, while the external strategy was extremely rare. This suggests a reluctance to rely entirely on information provided by external sources. We conclude that there are individual differences but not developmental changes in strategy use pertaining to perceptual decision-making in 9- through 14-year-olds. Generalizability of these findings is discussed with regard to different forms of social influence and varying perceptions of the external source. This study provides stepping stones in better understanding and modeling decision making processes in the presence of both internal and external information.
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14
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Dekkers TJ, Huizenga HM, Popma A, Bexkens A, Zadelaar JN, Jansen BRJ. Decision-Making Deficits in Adolescent Boys with and without Attention-Deficit/Hyperactivity Disorder (ADHD): an Experimental Assessment of Associated Mechanisms. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2021; 48:495-510. [PMID: 31883040 DOI: 10.1007/s10802-019-00613-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrate increased levels of real-life risk-taking behavior like substance abuse and reckless behavior in traffic, which potentially originates in decision-making deficits. Using experimental gambling tasks, the current study investigated three potential underlying mechanisms: (1) risky vs. suboptimal decision making, (2) the complexity of decision-making strategies and (3) the influence of feedback. Participants were 181 male adolescents (81 ADHD, 100 Typically Developing (TD); Mage = 15.1 years). First, we addressed a common confound in many gambling tasks by disentangling risk seeking from suboptimal decision making, and found that ADHD-related decision-making deficits do not originate in increased risk seeking but in suboptimal decision making. Second, we assessed decision-making strategies with a Bayesian latent mixture analysis and found that ADHD-related decision-making deficits are characterized by the use of less complex strategies. That is, adolescent boys with ADHD, relative to TD adolescent boys, less often adopted strategies in which all characteristics relevant to make an optimal decision were integrated. Third, we administered two gambling task conditions with feedback in which adolescents experience the outcomes of their decisions and found that adolescents with ADHD performed worse relative to TD adolescents on both conditions. Altogether, this set of studies demonstrated consistent decision-making deficits in adolescent boys with ADHD: The use of less complex decision-making strategies may cause suboptimal decision making, both in situations with and without direct feedback on performance.
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Affiliation(s)
- Tycho J Dekkers
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129b, 1018WS, Amsterdam, Netherlands. .,Department of Forensic Psychiatry and Complex Behavioral Disorders, De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, Netherlands. .,Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, VUmc, Amsterdam, Netherlands.
| | - Hilde M Huizenga
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129b, 1018WS, Amsterdam, Netherlands.,Amsterdam Brain and Cognition Center, University of Amsterdam, Amsterdam, Netherlands.,Research priority area Yield, University of Amsterdam, Amsterdam, Netherlands
| | - Arne Popma
- Department of Forensic Psychiatry and Complex Behavioral Disorders, De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, VUmc, Amsterdam, Netherlands
| | - Anika Bexkens
- Department of Developmental and Educational Psychology, Leiden University, Leiden, Netherlands.,Department of Child and Adolescent Psychiatry, GGZ Delfland, Center for Psychiatry, Amsterdam, Netherlands
| | - Jacqueline N Zadelaar
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129b, 1018WS, Amsterdam, Netherlands
| | - Brenda R J Jansen
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129b, 1018WS, Amsterdam, Netherlands
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15
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Roberts DK, Alderson RM, Betancourt JL, Bullard CC. Attention-deficit/hyperactivity disorder and risk-taking: A three-level meta-analytic review of behavioral, self-report, and virtual reality metrics. Clin Psychol Rev 2021; 87:102039. [PMID: 34004385 DOI: 10.1016/j.cpr.2021.102039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
Meta-analytic methods were used to examine ADHD-related risk-taking in children and adults, and to compare the magnitude of risk taking across behavioral, self-report, and virtual reality metrics. Potential moderators of effect size heterogeneity were also examined via a three-level multi-level approach and a hybrid meta-analytic/systematic review approach. Aggregated effect sizes obtained from 56 behavioral-task studies (82 effect sizes; ADHDN = 2577; TDN = 2606), 51 self-report studies (130 effect sizes; ADHDN = 18,641; TDN = 113,163), and 8 virtual reality studies (16 effect sizes; ADHDN = 382; TDN = 436) suggest that children and adults with ADHD exhibit moderately more risk-taking compared to children and adults without the disorder. Notably, the aggregated effect size obtained from virtual reality simulations (Hedges', g = 0.43) was 30-40% larger than effect sizes obtained from self-report and behavioral task metrics (Hedges' g = 0.31 and 0.27), respectively. Suboptimal Decision Making was the only significant moderator identified via multi-level modeling; however, comparison of subgroup effect sizes revealed potential moderating effects of ADHD presentation and trial-by-trial feedback on behavioral tasks. Collectively, findings suggest that ADHD is reliably associated with small to moderate magnitude greater risk-taking behavior and virtual reality simulations appear be the most sensitive currently available metric.
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Affiliation(s)
| | - R Matt Alderson
- Oklahoma State University, Stillwater, OK, United States of America.
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16
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Shoham R, Sonuga-Barke E, Yaniv I, Pollak Y. ADHD Is Associated With a Widespread Pattern of Risky Behavior Across Activity Domains. J Atten Disord 2021; 25:989-1000. [PMID: 31583930 DOI: 10.1177/1087054719875786] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: ADHD has been linked to higher engagement in risky behaviors in circumscribed domains such as dangerous driving, substance abuse, and gambling. This study tests whether ADHD is associated with a pervasive tendency to engage in risky behavior across a spectrum of activities and domains, and whether this tendency is driven by comorbid disorders. Method: A sample of 97 adults with ADHD and 103 typically developing controls completed a self-report questionnaire measuring the likelihood and frequency of engaging in a broad range of risky behaviors. ADHD, comorbid psychiatric disorders, and demographic variables were extensively assessed using standardized instruments. Results: Participants with ADHD reported a pervasive tendency to engage in risky behaviors across multiple activities. This tendency was associated with ADHD over and above the contribution of comorbid psychiatric disorders. Conclusion: These results suggest that ADHD is uniquely linked to a pervasive pattern of engagement in risky behaviors.
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Affiliation(s)
- Rachel Shoham
- The Hebrew University of Jerusalem, Israel.,Talpiot College of Education, Holon, Israel
| | | | - Ilan Yaniv
- The Hebrew University of Jerusalem, Israel
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17
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Villanueva‐Moya L, Expósito F. Gender differences in decision‐making: The effects of gender stereotype threat moderated by sensitivity to punishment and fear of negative evaluation. JOURNAL OF BEHAVIORAL DECISION MAKING 2021. [DOI: 10.1002/bdm.2239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Laura Villanueva‐Moya
- Mind, Brain, and Behavior Research Center (CIMCYC), Department of Social Psychology University of Granada Granada Spain
| | - Francisca Expósito
- Mind, Brain, and Behavior Research Center (CIMCYC), Department of Social Psychology University of Granada Granada Spain
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18
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Persson E, Heilig M, Tinghög G, Capusan AJ. Using quantitative trait in adults with ADHD to test predictions of dual-process theory. Sci Rep 2020; 10:20076. [PMID: 33208789 PMCID: PMC7674480 DOI: 10.1038/s41598-020-76923-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/04/2020] [Indexed: 12/28/2022] Open
Abstract
Dual-process theory is a widely utilized modelling tool in the behavioral sciences. It conceptualizes decision-making as an interaction between two types of cognitive processes, some of them fast and intuitive, others slow and reflective. We make a novel contribution to this literature by exploring differences between adults with clinically diagnosed ADHD and healthy controls for a wide range of behaviors. Given the clinical picture and nature of ADHD symptoms, we had a strong a priori reason to expect differences in intuitive vs reflective processing; and thus an unusually strong case for testing the predictions of dual-process theory. We found mixed results, with overall weaker effects than expected, except for risk taking, where individuals with ADHD showed increased domain sensitivity for gains vs losses. Some of our predictions were supported by the data but other patterns are more difficult to reconcile with theory. On balance, our results provide only limited empirical support for using dual-process theory to understand basic social and economic decision-making.
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Affiliation(s)
- Emil Persson
- Department of Management and Engineering, Division of Economics, Linköping University, 581 83, Linköping, Sweden.
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Gustav Tinghög
- Department of Management and Engineering, Division of Economics, Linköping University, 581 83, Linköping, Sweden
- The National Center for Priority Setting in Health Care, The Department of Health, Medicine and Caring Sciences (HMV), Linköping University, 581 83, Linköping, Sweden
| | - Andrea J Capusan
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
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19
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Takahashi F, Ishizu K, Matsubara K, Ohtsuki T, Shimoda Y. Acceptance and commitment therapy as a school-based group intervention for adolescents: An open-label trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Zadelaar JN, Dekkers TJ, Huizenga HM. The association between risky decision making and attention‐deficit/hyperactivity disorder symptoms: A preregistered assessment of need for cognition as underlying mechanism. JOURNAL OF BEHAVIORAL DECISION MAKING 2020. [DOI: 10.1002/bdm.2177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | - Tycho J. Dekkers
- Department of Psychology University of Amsterdam Amsterdam The Netherlands
- Department of Forensic Psychiatry and Complex Behavioral Disorders De Bascule, Academic Center for Child‐ and Adolescent Psychiatry Amsterdam The Netherlands
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Free University Medical Center (VUmc) Amsterdam The Netherlands
- Department of Psychology University of Central Florida Orlando Florida
| | - Hilde M. Huizenga
- Department of Psychology University of Amsterdam Amsterdam The Netherlands
- Amsterdam Brain and Cognition Center University of Amsterdam Amsterdam The Netherlands
- Research Priority Area Yield University of Amsterdam Amsterdam The Netherlands
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21
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Pollak Y, Dekkers TJ, Shoham R, Huizenga HM. Risk-Taking Behavior in Attention Deficit/Hyperactivity Disorder (ADHD): a Review of Potential Underlying Mechanisms and of Interventions. Curr Psychiatry Rep 2019; 21:33. [PMID: 30903380 DOI: 10.1007/s11920-019-1019-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Attention deficit/hyperactivity disorder (ADHD) is associated with several forms of risk-taking behavior (RTB). This paper aims to examine the scope of ADHD-related RTB, to highlight potential underlying mechanisms of this association, and to review initial evidence for interventions aimed to treat ADHD-related RTB. RECENT FINDINGS Multiple lines of evidence indicate that ADHD is associated with real-life RTB across several domains (e.g., reckless driving, substance use, and unprotected sex), which is corroborated by evidence on laboratory risk-taking tasks. Several individual differences, some of them informed by decision theory, e.g., comorbid disorders, parental monitoring, and perceived enlarged benefits of RTB, may explain the link between ADHD and RTB. A number of studies showed that interventions designed for ADHD may reduce RTB. ADHD is linked to RTB across several domains. Decision theory may serve as a conceptual framework for understanding the underlying mechanisms, and thus may inform future research.
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Affiliation(s)
- Yehuda Pollak
- The Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Tycho J Dekkers
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Forensic Youth Psychiatry and Complex Behavioral Disorders, De Bascule, Academic Center for Child and Adolescent Psychiatry, Duivendrecht, The Netherlands
| | - Rachel Shoham
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.,Special Education Department, Talpiot College, Holon, Israel
| | - Hilde M Huizenga
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition Center, University of Amsterdam, Amsterdam, The Netherlands.,Research Priority Area Yield, University of Amsterdam, Amsterdam, The Netherlands
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