Cited by 122Attention Deficit Hyperactivity DisorderNeural and Behavioral Psychology StudiesDecision-Making and Behavioral Economics

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

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Drechsler, R., Rizzo, P., Steinhausen, H.-C.·2008·Journal of Neural Transmission

DOI 10.1007/s00702-007-0814-5

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Abstract

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

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Pollak, Y., Shalit, R., & Aran, A. A. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.10.012 · Cited by 27
adgrl3.1-deficient zebrafish show noradrenaline-mediated externalizing behaviors, and altered expression of externalizing disorder-candidate genes, suggesting functional targets for treatment
Fontana, B. D., Reichmann, F., Tilley, C. A., Lavlou, P., Shkumatava, A., Alnassar, N., Hillman, C., Karlsson, K. Æ., Norton, W., & Parker, M. O. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02601-4 · Cited by 21
“Risk-taking behavior Novel object test: Increased risk-taking behavior is common in ADHD patients [41], and can be assessed in zebrafish using the novel object test [42, 43].”
Method
Risk Taking in Adolescents With Attention Deficit Hyperactivity Disorder on a Probabilistic Choice Task
Kroyzer, N., Gross‐Tsur, V., & Pollak, Y. (2014) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000100 · Cited by 21
“Drechsler et al. (2008) used the Game of Dice Task (GDT), in which subjects carry out decisions on a computerized dice game, choosing between four possible outcomes: two high-risk choices, associated with high gains and a low probability to win, and two low-risk choices, associated with small gains…”
Method
Risky decision-making in children with and without ADHD: A prospective study
Humphreys, K. L., Tottenham, N., & Lee, S. S. (2016) · Child Neuropsychology · doi:10.1080/09297049.2016.1264578 · Cited by 19
Does Gender Matter in the Relationship between Anxiety and Decision-Making?
Zhang, F., Xiao, L., & Gu, R. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.02231 · Cited by 19
“…the GDT, except for some notable clinical studies: Patients with attentiondeficit/hyperactivity disorder (ADHD) made more risky choices than the controls in the GDT (Drechsler et al., 2008), but those with obsessive–compulsive disorder (OCD) showed unimpaired GDT performance (Starcke et al., 2010).”
Recent Updates in Modeling Risky Decision Making in Rodents
Orsini, C. A., Blaes, S. L., Setlow, B., & Simon, N. W. (2019) · Methods in molecular biology · doi:10.1007/978-1-4939-9554-7_5 · Cited by 19
The Effectiveness of the Game of Dice Task in Predicting At-Risk and Problem Gambling Among Adolescents: The Contribution of the Neural Networks
Donati, M. A., Frosini, A., Izzo, V. A., & Primi, C. (2018) · Journal of Gambling Studies · doi:10.1007/s10899-018-9796-5 · Cited by 18
Risk attitudes and birth order
Krause, P., Heindl, J., Jung, A., Langguth, B., Hajak, G., & Sand, P. G. (2013) · Journal of Health Psychology · doi:10.1177/1359105313481075 · Cited by 17
“1) (Murphy and Adler, 2004) was used to screen for the presence of attention-deficit hyperactivity disorder (ADHD), an important confounder in the assessment of risk-taking (Drechsler et al., 2008).”
Method
Feedback May Harm: Role of Feedback in Probabilistic Decision Making of Adolescents with ADHD
Pollak, Y., & Shoham, R. (2015) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-015-0016-9 · Cited by 18
Relationship between Symptoms of Disruptive Behavior Disorders and Unsafe Internet Usage in Early Adolescence
Vural, P., Uncu, Y., & Kılıç, E. Z. (2015) · Nöro Psikiyatri Arşivi · doi:10.5152/npa.2015.7346 · Cited by 18
The Relations Between Temperament, Character, and Executive Functions in Children With ADHD and Clinical Controls
Drechsler, R., Logoz, M. Z., Walitza, S., & Steinhausen, H. (2015) · Journal of Attention Disorders · doi:10.1177/1087054715583356 · Cited by 18
“…MI and the Inhibit scale of the BRI differentiated between the groups, which is in line with the previous findings in children with predominantly combined ADHD subtype (DSM-IV; Drechsler et al., 2008; Drechsler & Steinhausen, 2013; Linder et al., 2010; Mahone et al., 2002; Shimoni et al., 2012).”
ResultSelf-citation
A Critical Look at the Relationship Between Impulsivity and Decision-Making in Adolescents: Are They Related or Separate Factors?
Leshem, R., & Glicksohn, J. (2012) · Developmental Neuropsychology · doi:10.1080/87565641.2012.718815 · Cited by 18
“In IGT performance, there are two different types of decision-making: the first type is ambiguous choice, in which the risk linked to the different options is still unknown; the second type is risky decision-making, in which the probability of outcomes has been learned (Brand, Recknor, Grabenhorst, & Bechara, 2007; Dr…”
BackgroundInfluential
Risky sexual behavior among adolescents: The role of decision-making, problems from cannabis use and externalizing disorder symptoms
Ross, J. M., Granja, K., Duperrouzel, J. C., Pacheco‐Colón, I., Lopez‐Quintero, C., Hawes, S. W., & González, R. (2018) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2018.1550192 · Cited by 20
A novel risk-based decision-making paradigm
Morgado, P. F., Marques, F., Silva, M. B., Sousa, N., & Cerqueira, J. (2014) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2014.00045 · Cited by 14
“…schizophrenia (Heerey et al., 2008), obsessive compulsive disorders (Starcke et al., 2010), depression (Smoski et al., 2008), attention deficit and hyperactive disorder (Ernst et al., 2003; Drechsler et al., 2008), addictive disorders (Bechara, 2003) and pathological gambling (Ochoa et al., 2013).”
BackgroundInfluential
The unique and combined effects of reinforcement and methylphenidate on temporal information processing in attention-deficit/hyperactivity disorder
Luman, M., Papanikolau, A., & Oosterlaan, J. (2015) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000349 · Cited by 14
Decision-Making as a Latent Construct and its Measurement Invariance in a Large Sample of Adolescent Cannabis Users
Pacheco‐Colón, I., Hawes, S. W., Duperrouzel, J. C., Lopez‐Quintero, C., & González, R. (2019) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617719000341 · Cited by 13
Disentangling ADHD's Presentation-Related Decision-Making—A Meta-Analytic Approach on Predominant Presentations
Schulze, M., Coghill, D., Lux, S., & Philipsen, A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.519840 · Cited by 13
“In our analysis, different paradigmswere used that rely on cool executive functions: game of dice task (35), make-a-match game (15), and probabilistic-game tasks (36).”
Method
Decision Making by People With Aphasia: A Comparison of Linguistic and Nonlinguistic Measures
Kim, E., Suleman, S., & Hopper, T. L. (2020) · Journal of Speech Language and Hearing Research · doi:10.1044/2020_jslhr-19-00182 · Cited by 13
Early-Onset Conduct Problems: Predictions from Daring Temperament and Risk Taking Behavior
Bai, S., & Lee, S. S. (2017) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-017-9612-z · Cited by 12
“Risk taking behavior in the laboratory was positively associated with ADHD symptoms in children (Drechsler et al. 2008), as well as real-world risk taking (e.g., substance use) in adolescents (Lejuez et al. 2002).”
Relationships Between Impulsivity, Anxiety, and Risk-Taking and the Neural Correlates of Attention in Adolescents
Elsey, J. W. B., Crowley, M. J., Mencl, W. E., Lacadie, C., Mayes, L. C., & Potenza, M. N. (2016) · Developmental Neuropsychology · doi:10.1080/87565641.2016.1167212 · Cited by 15
A rating measure of ADHD-related neuropsychological impairment in children and adolescents: Data from theCognition and Motivation in Everyday Life (CAMEL) Scalefrom population and clinical samples
Liefferinge, D. V., Sonuga-Barke, E. J. S., Broeck, N. V., der Oord, S. V., Lemiere, J., & Danckaerts, M. (2016) · Child Neuropsychology · doi:10.1080/09297049.2016.1170798 · Cited by 13
Monitoring supports performance in a dual-task paradigm involving a risky decision-making task and a working memory task
Gathmann, B., Schiebener, J., Wolf, O. T., & Brand, M. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00142 · Cited by 10
“Moreover, it was found that GDT performance is associated with working memory (Drechsler et al., 2007; Schiebener et al., 2013).”
Background
Early Attentional Modulation by Working Memory Training in Young Adult ADHD Patients during a Risky Decision-Making Task
Jaquerod, M. E., Mesrobian, S. K., Villa, A. E. P., Bader, M., & Lintas, A. (2020) · Brain Sciences · doi:10.3390/brainsci10010038 · Cited by 11
Investigating the predictive role of working memory in risky decision- making in children with attention deficit and hyperactivity disorder
Najarzadegan, M., Nejati, V., & Amiri, N. (2016) · KAUMS Journal · Cited by 9
Blunted neural response to gains versus losses associated with both risk‐prone and risk‐averse behavior in a clinically diverse sample
Huggins, A. A., Weinberg, A., Gorka, S. M., & Shankman, S. A. (2019) · Psychophysiology · doi:10.1111/psyp.13342 · Cited by 9
“My Brain Can Stop”: An ERP Study of Longitudinal Prediction of Inhibitory Control in Adolescence
Einziger, T., Ben‐Shachar, M. S., Devor, T., Shmueli, M., Auerbach, J. G., & Berger, A. (2021) · Brain Sciences · doi:10.3390/brainsci11010100 · Cited by 9
“The intensity of these behaviors may be substantially enhanced in adolescents with ADHD symptomatology [47,48], especially among those with impairments in the executive functioning domain and inhibitory control [47,49].”
Background
Reciprocal associations between affective decision-making and mental health in adolescence
Bentivegna, F., Flouri, E., & Papachristou, E. (2022) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-022-02096-2 · Cited by 10
Decision-making in patients with temporal lobe epilepsy: Delay gratification ability is not impaired in patients with hippocampal sclerosis
Rzezak, P., Lima, E. M., Pereira, F., Gárgaro, A. C., Coimbra, É. R., Vincentiis, S., Velasco, T. R., Leite, J. P., Busatto, G. F., & Valente, K. D. R. (2016) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2016.04.042 · Cited by 8
“Indeed, several studies demonstrated that patients with executive dysfunction (measured with similar tests as the ones used in the present study — WCST, Tower of London/Hanoi, Trail Making Test, Color Word Interference Test) choose more high-risk options with negative consequences in the GDT, the PAG task, and in the…”
Method
Effects of goals on decisions under risk conditions: Goals can help to make better choices, but relatively high goals increase risk-taking
Schiebener, J., Wegmann, E., Pawlikowski, M., & Brand, M. (2014) · Journal of Cognitive Psychology · doi:10.1080/20445911.2014.903254 · Cited by 12
Alterations of decision making and underlying neural correlates after resection of a mediofrontal cortical dysplasia: A single case study
Labudda, K., Brand, M., Mertens, M., Ebner, A., Markowitsch, H. J., & Woermann, F. G. (2010) · Neurocase · doi:10.1080/13554790903329125 · Cited by 8
Different roads to the same destination – The impact of impulsivity on decision-making processes under risk within a rewarding context in a healthy male sample
Dinu-Biringer, R., Nees, F., Falquez, R., Berger, M. C., & Barnow, S. (2016) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2016.01.012 · Cited by 7
“…conditions were found in pathological gamblers (PG; Brand et al., 2006, 2005), adolescents with attention-deficit/ hyperactivity disorder (ADHD; Drechsler et al., 2008), amphetamine abusers (Rogers et al., 1999), and patients with lesions in the ventrolateral and orbitofrontal regions (Floden…”
Background
From the Clinic to Schools: Iterative Development of a Depression Prevention Program for Adolescents With ADHD Within an Urban School System
Meinzer, M. C., Schwartz, K. T. G., Triece, P., Horn, S. R., & Chronis-Tuscano, A. M. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.10.008 · Cited by 6
Decision‐making impairments under ambiguous and risky situations in patients with prefrontal tumor: A neuropsychological study
Wang, Y., Wang, X., Wang, K., Zhao, B. T., & Chen, X. (2020) · Brain and Behavior · doi:10.1002/brb3.1951 · Cited by 7
Risk Taking in Hospitalized Patients with Acute and Severe Traumatic Brain Injury
Fecteau, S., Levasseur‐Moreau, J., García‐Molina, A., Kumru, H., Pelayo, R., Bernabeu, M., Roig-Rovira, T., Pascual‐Leone, Á., & Tormos, J. M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0083598 · Cited by 6
“It would also be interesting to test the impact on risk taking in patients with concurrent conditions such as attention deficit hyperactivity disorder (ADHD), as ADHD has been associated with impaired risk taking [56].”
Background
The Role of Probabilistic Reasoning Abilities on Adolescent Risk Taking
Donati, M. A., Chiesi, F., & Primi, C. (2015) · The Mathematics Enthusiast · doi:10.54870/1551-3440.1347 · Cited by 5
Further Insights on Decision-Making Abilities in Compulsive Sexual Behavior Disorder: Findings from the Sex@Brain-Study
Engel, J., Liebnau, J., Müller, S. M., Veit, M., Kneer, J., Sinke, C., & Kruger, T. H. C. (2025) · Sexual Health & Compulsivity · doi:10.1080/26929953.2025.2465778 · Cited by 4
“In fact, patients with Korsakoff syndrome (Brand et al., 2005), pathological gambling (Brand et al., 2005), Parkinson´s disease (Brand et al., 2004) or attention-deficit/hyperactive disorder (Drechsler et al., 2008) show deficits in GDT performance.”
Cognitive Correlates of Risky Decision-Making in Individuals with and without ADHD: A Meta-analysis
Nejati, V., Peyvandi, A., Nazari, N., & Dehghan, M. (2024) · Neuropsychology Review · doi:10.1007/s11065-024-09646-2 · Cited by 4
“…Antonini et al., 2015; Baker, 2011; Caprì et al., 2019; Coghill et al., 2014; Dekkers et al., 2020a; Dekkers et al., 2020a, b; DeVito et al., 2008; Drechsler et al., 2008; Farmer & Peterson, 1995; Gonzalez-Gadea et al., 2013; Humphreys et al., 2018; Humphreys & Lee, 2011; Ibanez et al., 2012;…”
Influential
The association between perinatal hypoxia exposure and externalizing symptoms and children’s decision making in conditions of uncertainty is moderated by DRD2 genotype
White, R., Gatzke‐Kopp, L. M., Ryan, P. J., & Lydon‐Staley, D. M. (2018) · Developmental Psychobiology · doi:10.1002/dev.21785 · Cited by 3
Proceso de toma de decisiones en niños y adolescentes con TDAH: Revisión sistemática
Rubiales, J., Urquijo, S., Said, A., & Macbeth, G. (2017) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.22.num.2.2017.17688 · Cited by 7
“Drechsler et al. (2008) Niños 11 a 13 23 (91.3”
BackgroundInfluential
Affective Decision-Making in School-Aged Children with Attention Deficit/Hyperactivity Disorder (ADHD)
Baker, J. (2011) · Cited by 3
Changes in decision‐making function in patients with subacute mild traumatic brain injury
Wang, Y., Chen, Q., Zhang, X., Wang, K., Cheng, H., & Chen, X. (2023) · European Journal of Neuroscience · doi:10.1111/ejn.16195 · Cited by 2
“…function indeed show impaired performance in risky decision-making tasks (e.g., as measured by the Wisconsin and Modified Card Sorting Test, Tower of Hanoi, London, Trail Making Test A/B and Color Word Interference Test) (Delazer et al., 2007; Drechsler et al., 2008; Euteneuer et al., 2009).”
Method
Sex differences in Cingulo-Opercular activation during risky decision-making in youth with externalizing disorders
Murray, O. K., Mattey-Mora, P. P., Aloi, J. M., Abu-Sultanah, M., Smoker, M. P., & Hulvershorn, L. A. (2025) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2025.111965 · Cited by 3

Authors: Drechsler, R., Rizzo, P., & Steinhausen, H.-C.
Affiliations: University of Zurich (CH)
Corresponding author: Drechsler, R.
ORCID: Drechsler, R.
Steinhausen, H.-C.
Venue: Journal of Neural Transmission
Publisher: Springer Science and Business Media LLC
Published: 2007-09-21
Volume: 115
Issue: 2
Pages: 201-209
ISSN: 0300-9564 (ISSN-L)
1435-1463
DOI: 10.1007/s00702-007-0814-5
OpenAlex: W2079702865
Cited by: 122
References: 44
Citations by year: 2026: 1 · 2025: 4 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 6 · 2019: 8 · 2018: 6 · 2017: 5 · 2016: 15 · 2015: 11 · 2014: 11 · 2013: 8 · 2012: 8
FWCI: 3.35
Type: journal article
Language: en
Open access: green
www.zora.uzh.ch
Licence: other-oa
www.springer.com/tdm (tdm)
Locations: Journal of Neural Transmission (publishedVersion)
PubMed (publishedVersion)
Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
reroDoc Digital Library (submittedVersion)
Zurich Open Repository and Archive (University of Zurich)
Funders: National Science Foundation
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
Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
Keywords: attention deficit hyperactivity disorder, risk-taking, decision-making, preadolescents, Game of Dice Task, hyperactivity, inhibitory control, working memory
MeSH terms: Attention Deficit Disorder with Hyperactivity, Child, Child Behavior, Decision Making, Female, Humans, Male, Neuropsychological Tests, Risk-Taking

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

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