Role of the medial prefrontal cortex in impaired decision making in juvenile attention-deficit/hyperactivity disorder
Open accessAbstract
IMPORTANCE: Attention-deficit/hyperactivity disorder (ADHD) has been associated with deficient decision making and learning. Models of ADHD have suggested that these deficits could be caused by impaired reward prediction errors (RPEs). Reward prediction errors are signals that indicate violations of expectations and are known to be encoded by the dopaminergic system. However, the precise learning and decision-making deficits and their neurobiological correlates in ADHD are not well known. OBJECTIVE: To determine the impaired decision-making and learning mechanisms in juvenile ADHD using advanced computational models, as well as the related neural RPE processes using multimodal neuroimaging. DESIGN, SETTING, AND PARTICIPANTS: Twenty adolescents with ADHD and 20 healthy adolescents serving as controls (aged 12-16 years) were examined using a probabilistic reversal learning task while simultaneous functional magnetic resonance imaging and electroencephalogram were recorded. MAIN OUTCOMES AND MEASURES: Learning and decision making were investigated by contrasting a hierarchical Bayesian model with an advanced reinforcement learning model and by comparing the model parameters. The neural correlates of RPEs were studied in functional magnetic resonance imaging and electroencephalogram. RESULTS: Adolescents with ADHD showed more simplistic learning as reflected by the reinforcement learning model (exceedance probability, Px = .92) and had increased exploratory behavior compared with healthy controls (mean [SD] decision steepness parameter β: ADHD, 4.83 [2.97]; controls, 6.04 [2.53]; P = .02). The functional magnetic resonance imaging analysis revealed impaired RPE processing in the medial prefrontal cortex during cue as well as during outcome presentation (P < .05, family-wise error correction). The outcome-related impairment in the medial prefrontal cortex could be attributed to deficient processing at 200 to 400 milliseconds after feedback presentation as reflected by reduced feedback-related negativity (ADHD, 0.61 [3.90] μV; controls, -1.68 [2.52] μV; P = .04). CONCLUSIONS AND RELEVANCE: The combination of computational modeling of behavior and multimodal neuroimaging revealed that impaired decision making and learning mechanisms in adolescents with ADHD are driven by impaired RPE processing in the medial prefrontal cortex. This novel, combined approach furthers the understanding of the pathomechanisms in ADHD and may advance treatment strategies.
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The Hauser et al. study did not separate positive from negative reward prediction errors.
“but the study did not separate positive from negative reward prediction errors.”
From Are prediction error modifications domain specific in autism but domain general in ADHD? (2025) · cites this paper as Hauser et al., 2014
Adolescents with ADHD showed reduced reward prediction error processing in the medial prefrontal cortex during a reversal learning paradigm compared with adolescents without ADHD.
“Indeed, adolescents with ADHD showed reduced reward prediction error processing in the medial prefrontal cortex during a reversal learning paradigm compared with adolescents without ADHD (Hauser et al., 2014)”
From Are prediction error modifications domain specific in autism but domain general in ADHD? (2025) · cites this paper as Hauser et al., 2014
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- Authors
- Hauser, T. U., Iannaccone, R., Ball, J., Mathys, C., Brandeis, D., Walitza, S., & Brem, S.
- Affiliations
- University of Zurich (CH)
- Wellcome Centre for Human Neuroimaging (GB)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2014-10-01
- Volume
- 71
- Issue
- 10
- Pages
- 1165
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2065928720
- Cited by
- 168
- References
- 64
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 18 · 2023: 15 · 2022: 16 · 2021: 11 · 2020: 16 · 2019: 11 · 2018: 13 · 2017: 6 · 2016: 29 · 2015: 12 · 2014: 2
- FWCI
- 12.46
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- SDL (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- attention deficit hyperactivity disorder, decision-making, reward prediction error, medial prefrontal cortex, reinforcement learning, probabilistic reversal learning, feedback-related negativity, dopaminergic system, computational modeling, adolescents
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Brain, Child, Decision Making, Electroencephalography, Female, Humans, Learning, Magnetic Resonance Imaging, Male, Case-Control Studies, Prefrontal Cortex, Functional Neuroimaging
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