Orbitofrontal reward sensitivity and impulsivity in adult attention deficit hyperactivity disorder
Abstract
Impulsivity symptoms of adult attention deficit hyperactivity disorder (ADHD) such as increased risk taking have been linked with impaired reward processing. Previous studies have focused on reward anticipation or on rewarded executive functioning tasks and have described a striatal hyporesponsiveness and orbitofrontal alterations in adult and adolescent ADHD. Passive reward delivery and its link to behavioral impulsivity are less well understood. To study this crucial aspect of reward processing we used functional magnetic resonance imaging (fMRI) combined with electrodermal assessment in male and female adult ADHD patients (N=28) and matched healthy control participants (N=28) during delivery of monetary and non-monetary rewards. Further, two behavioral tasks assessed risky decision making (game of dice task) and delay discounting. Results indicated that both groups activated ventral and dorsal striatum and the medial orbitofrontal cortex (mOFC) in response to high-incentive (i.e. monetary) rewards. A similar, albeit less strong activation pattern was found for low-incentive (i.e. non-monetary) rewards. Group differences emerged when comparing high and low incentive rewards directly: activation in the mOFC coded for the motivational change in reward delivery in healthy controls, but not ADHD patients. Additionally, this dysfunctional mOFC activity in patients correlated with risky decision making and delay discounting and was paralleled by physiological arousal. Together, these results suggest that the mOFC codes reward value and type in healthy individuals whereas this function is deficient in ADHD. The brain-behavior correlations suggest that this deficit might be related to behavioral impulsivity. Reward value processing difficulties in ADHD should be considered when assessing reward anticipation and emotional learning in research and applied settings.
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Wilbertz et al. found decreased differentiation between high-incentive and low-incentive rewards in the medial orbitofrontal cortex and in physiological arousal in patients with ADHD that correlated with risky decision-making and delay-discounting.
“Wilbertz and colleagues [493] found decreased differentiation between high-incentive and low-incentive rewards in the medial orbitofrontal cortex and in physiological arousal in patients with ADHD that correlated with risky decision-making and delay-discounting.”
From Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings (2012) · cites this paper as [493]
The finding of medial prefrontal overreactivity in response to social reward is in line with Wilbertz and colleagues who reported stronger orbitofrontal activity for non-monetary reward in adults with ADHD.
“Our finding of medial prefrontal overreactivity in response to social reward can be seen in line with Wilbertz and colleagues who reported stronger orbitofrontal activity for non-monetary reward (i.e., checkmark for accurate task performance) in adults with ADHD (Wilbertz et al., 2012).”
From Differentiating neural reward responsiveness in autism versus ADHD (2014) · cites this paper as Wilbertz et al., 2012
While one study observed (33%) increased risky behavior in adults with ADHD on the GDT, the other two studies failed to find any overall group differences between adults with ADHD and NCs.
“While one study observed (1/3 = 33%) increased risky behavior in adults with ADHD [67] (study 1), the other two studies failed to find any overall group differences between adults with ADHD and NCs.”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [68]
In Wilbertz et al., the ADHD and NC group differed in their fMRI and electrodermal responsiveness to reward value; whereas in NCs the reward value was differentially coded in the medial orbitofrontal cortex, this was not the case in the ADHD group.
“However, the ADHD and NC group did differ in their fMRI and electrodermal responsiveness to reward value. Whereas in the NCs the reward value (high versus low incentive) was differentially coded in the medial orbitofrontal cortex, this was not the case in the ADHD group.”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [68]
Wilbertz et al. did not find any differences between adults with ADHD and NCs with regard to their performance on the GDT (Cohen's d block 1 & 2 respectively = 0.23 and 0.04).
“In a separate study, Wilbertz and colleagues [68] did not find any differences between adults with ADHD and NCs with regard to their performance on the GDT (Cohen’s d block 1 & 2 respectively = 0.23 and 0.04).”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [68]
In Wilbertz et al., dysfunctional coding in patients correlated with risky performance in the GDT and was paralleled by physiological arousal.
“This dysfunctional coding in patients correlated with risky performance in the GDT and was paralleled by physiological arousal.”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [68]
The reviewed studies with mixed ADHD subtype samples included studies examining participants with ADHD-C and ADHD-I (3/15 = 20% of studies with null findings).
“participants with ADHD-C and ADHD-I [51], [61], [68] (3/15 = 20% of studies with null findings)”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [68]
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References 94 · Cited by 125
- Authors
- Wilbertz, G., Tebartz van Elst, L., Delgado, M. R., Maier, S., Feige, B., Philipsen, A., & Blechert, J.
- Affiliations
- University of Freiburg (DE)
- Rutgers, The State University of New Jersey (US)
- University Medical Center Freiburg (DE)
- Venue
- NeuroImage
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 60
- Issue
- 1
- Pages
- 353-361
- ISSN
- 1053-8119 (ISSN-L)
- OpenAlex
- W2139169982
- Cited by
- 125
- References
- 94
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 4 · 2023: 8 · 2022: 1 · 2021: 5 · 2020: 12 · 2019: 10 · 2018: 8 · 2017: 6 · 2016: 17 · 2015: 13 · 2014: 12 · 2013: 14 · 2012: 9
- FWCI
- 7.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- NeuroImage (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft (BL 1009/2-1)
- Bundesministerium für Bildung und Forschung (01GV0606)
- 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
- adult ADHD, impulsivity, reward processing, medial orbitofrontal cortex, risky decision making, delay discounting, ventral striatum, dorsal striatum, monetary rewards, physiological arousal, electrodermal activity, brain-behavior relationship
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Cerebral Cortex, Female, Humans, Impulsive Behavior, Male, Reward
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