Reward anticipation and outcomes in adult males with attention-deficit/hyperactivity disorder
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has been suggested to involve deficits in reward processing. We used functional magnetic resonance imaging (fMRI) to compare the neural responses to reward anticipation and outcomes in 10 adults with ADHD and 10 controls as they played a monetary incentive delay task. Adults with ADHD were unmedicated, and groups were matched for age, verbal IQ and smoking habits. Adults with ADHD showed decreased activation in the ventral striatum during the anticipation of gain, but increased activation of the orbitofrontal cortex in response to gain outcomes. Ventral striatal activation in adults with ADHD during gain anticipation was negatively correlated with self-rated symptoms of hyperactivity and impulsivity. These findings suggest that male adults with ADHD show neural signs of abnormal reward processing. Future studies will have to investigate whether these dysfunctional patterns might be normalized by treatment.
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Amygdala hyperactivation has also been reported in ADHD during the processing of delayed rewards.
“Amygdala hyperactivation has also been reported in ADHD during the processing of delayed rewards, perhaps consistent with the delay aversion found in some behavioral studies (38, 99-101).”
From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [99]
Some studies have found a stronger response to reward outcome either in striatum or in OFC in ADHD patients versus controls.
“At the same time, some studies have found a stronger response to reward outcome either in striatum (Furukawa et al., 2014; von Rhein et al., 2015) or in the OFC (Strohle et al., 2008) in ADHD patients vs. controls.”
From Top-Down Dysregulation—From ADHD to Emotional Instability (2016) · cites this paper as Strohle et al., 2008
fMRI studies in ADHD have shown decreased ventral striatum activation during monetary-reward anticipation, atypical orbitofrontal activation during monetary-reward outcome, and decreased DCN and amygdala activation during delayed reward outcome.
“These studies have shown decreased ventral striatum activation during monetary-reward anticipation [484-487], atypical orbitofrontal activation during monetary-reward outcome [487,488], and decreased DCN and amygdala activation during delayed reward outcome [485,489].”
From Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings (2012) · cites this paper as [487]
Children with ADHD have reduced NAc activity when anticipating monetary rewards, seen particularly in drug-naive children, carriers of the DAT nine-repeat allele, and in response to seeking gains rather than avoiding losses.
“Children with ADHD have reduced NAc activity when anticipating monetary rewards [18,486,487], which is seen particularly in drug-naive children [490], in carriers of the DAT nine-repeat allele [491], and in response to seeking gains rather than avoiding losses [492].”
From Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings (2012) · cites this paper as [487]
This finding is consistent with fMRI data showing ventrostriatal hyporesponsiveness during immediate and delayed reward processing in adults with ADHD.
“This finding is consistent with recent fMRI data showing ventrostriatal hyporesponsiveness during immediate and delayed reward processing in adults with ADHD (Plichta et al, 2009;Strohle et al, 2008).”
From Understanding the Effects of Stimulant Medications on Cognition in Individuals with Attention-Deficit Hyperactivity Disorder: A Decade of Progress (2011) · cites this paper as Strohle et al, 2008
Recent studies have indicated deficits in the dopamine reward circuitry in ADHD, as predicted by developmental neurobiological models of the disorder.
“Recent studies have further indicated deficits in the dopamine reward circuitry,3–5 as predicted by developmental neurobiological models of the disorder.6–8”
From Striatal sensitivity during reward processing in attention-deficit/hyperactivity disorder (2012) · cites this paper as [4]
The caudate nucleus is a core region of the dopamine reward-circuit, implicated in ADHD-control differences, and genetic variation in DAT1 is reported to affect its function and structure.
“The caudate nucleus is a core region of the dopamine reward-circuit,42 implicated in ADHD-control differences,4 and genetic variation in DAT1 is reported to affect its function and structure 26,43”
From Striatal sensitivity during reward processing in attention-deficit/hyperactivity disorder (2012) · cites this paper as [4]
In adults with ADHD, most studies report reduced activation in the ventral striatum during anticipation of monetary gains compared to controls.
“In adults with ADHD most studies report reduced activation in the ventral striatum (VS) during anticipation of monetary gains compared to controls,4,21,22 with one exception.23”
From Striatal sensitivity during reward processing in attention-deficit/hyperactivity disorder (2012) · cites this paper as [4]
Studies that investigated activation in the outcome phase reported increased activation in adults with ADHD compared to controls in the caudate nucleus and orbitofrontal cortex.
“Studies that investigated activation in the outcome phase reported increased activation in adults with ADHD (compared to controls) in the caudate nucleus and the orbitofrontal cortex4 or no differences.23”
From Striatal sensitivity during reward processing in attention-deficit/hyperactivity disorder (2012) · cites this paper as [4]
The single previous study that examined outcome-related activation in adolescents with ADHD focused solely on the VS and did not find group differences.
“Although in agreement with previous evidence from adults with ADHD,4 the single previous study that examined outcome-related activation in adolescents with ADHD had focused solely on the VS and did not find group differences.3”
From Striatal sensitivity during reward processing in attention-deficit/hyperactivity disorder (2012) · cites this paper as [4]
MILT differed from MID-type paradigms in that conditioned cues predicted successful outcomes with greater certainty (~80% vs ~66%).
“MILT differed from MID-type paradigms used in earlier ADHD research in two ways: first, the conditioned cues predicted successful outcomes with greater certainty (∼80%, compared to ∼66%3,4).”
From Striatal sensitivity during reward processing in attention-deficit/hyperactivity disorder (2012) · cites this paper as [4]
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“Most of the neuroimaging studies have rather focused on reward anticipation and reward processing (e.g., Ströhle et al., 2008; Stoy et al., 2011; Carmona et al., 2012; Wilbertz et al., 2012; Edel et al., 2013; Furukawa et al., 2014; Plichta and Scheres, 2014).”
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- Authors
- Ströhle, A., Stoy, M., Wrase, J., Schwarzer, S., Schlagenhauf, F., Huss, M., Hein, J., Nedderhut, A., Neumann, B., Gregor, A., Juckel, G., Knutson, B., Lehmkuhl, U., Bauer, M., & Heinz, A.
- Affiliations
- Stiftung Charité (DE)
- Charité – Universitätsmedizin Berlin (DE)
- Stanford University (US)
- Corresponding author
- Ströhle, Andreas
- ORCID
- Venue
- NeuroImage
- Publisher
- Elsevier BV
- Published
- 2008-02
- Volume
- 39
- Issue
- 3
- Pages
- 966-972
- ISSN
- 1053-8119 (ISSN-L)
- OpenAlex
- W2130141507
- Cited by
- 323
- References
- 36
- Citations by year
- 2026: 9 · 2025: 5 · 2024: 6 · 2023: 12 · 2022: 7 · 2021: 8 · 2020: 12 · 2019: 17 · 2018: 13 · 2017: 16 · 2016: 23 · 2015: 18 · 2014: 26 · 2013: 31 · 2012: 29
- FWCI
- 12.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- NeuroImage (publishedVersion)
- PubMed (publishedVersion)
- 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, reward processing, reward anticipation, reward outcome, ventral striatum, orbitofrontal cortex, monetary incentive delay task, hyperactivity, impulsivity
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Data Interpretation, Statistical, Humans, Male, Motivation, Neuropsychological Tests, Psychiatric Status Rating Scales, Reward, Neostriatum, Prefrontal Cortex
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