Delay and reward choice in ADHD: An experimental test of the role of delay aversion.
Open accessAbstract
Children with attention deficit/hyperactivity disorder (ADHD) choose smaller sooner (SS) over larger later (LL) rewards more than controls. Here we assess the contributions of impulsive drive for immediate rewards (IDIR) and delay aversion (DAv) to this pattern. We also explore the characteristics of, and the degree of familiality in, ADHD SS responders. We had 360 ADHD probands; 349 siblings and 112 controls (aged between 6 to 17 years) chose between SS (1 point after 2 s) and LL reward (2 points after 30 s) outcomes on the Maudsley Index of Delay Aversion (Kuntsi, Oosterlaan, & Stevenson, 2001): Under one condition SS choice led to less overall trial delay under another it did not. ADHD participants chose SS more than controls under both conditions. This effect was larger when SS choice reduced trial delay. ADHD SS responders were younger, had lower IQ, more conduct disorder and had siblings who were more likely to be SS responders themselves. The results support a dual component model in which both IDIR and DAv contribute to SS choice in ADHD. SS choice may be a marker of an ADHD motivational subtype.
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Two studies have reported oversensitivity to reward and abnormal preference for immediate reward in unaffected siblings of participants with ADHD.
“These studies have reported oversensitivity to reward and abnormal preference for immediate reward in unaffected siblings 6,9.”
From Increased neural responses to reward in adolescents and young adults with attention-deficit/hyperactivity disorder and their unaffected siblings (2015) · cites this paper as [9]
The Analytical Strategy section says the sibling analysis excluded siblings with ADHD, and the sibling-performance results report that unaffected siblings of ADHD probands who preferred smaller, sooner rewards were more likely to show that preference themselves. The paper does not separately establish oversensitivity to reward in those siblings; it describes impulsive drive for immediate rewards and delay aversion as possible processes underlying the choice pattern. Page numbers are not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe notion that the choice of smaller sooner over larger later rewards in ADHD results from two processes-impaired signaling of delayed rewards and acquired aversion to delay-is supported by a recent large-scale study examining the effects of pre- and post-reward delay on choice for delayed rewards.
“Furthermore, the notion that the choice of SS over LL rewards in ADHD is the result of two processes (i.e., impairment in signaling of delayed rewards and acquired aversion to delay) is supported by a recent large scale study examining the effects of pre-and post-reward delay on choice for delayed rewards (Marco et al., 2009).”
From Context-dependent Dynamic Processes in Attention Deficit/Hyperactivity Disorder: Differentiating Common and Unique Effects of State Regulation Deficits and Delay Aversion (2010) · cites this paper as Marco et al., 2009
In the Marco et al. (2009) study, ADHD children chose smaller sooner over larger later rewards more than controls under both conditions, but this preference was greater when there was no post-reward delay and overall delay could be avoided.
“In this study ADHD children chose SS over LL more than controls under both conditions -but this preference was greater when there was no post-reward delay and overall delay could be avoided.”
From Context-dependent Dynamic Processes in Attention Deficit/Hyperactivity Disorder: Differentiating Common and Unique Effects of State Regulation Deficits and Delay Aversion (2010) · cites this paper as Marco et al., 2009
The effect of choosing SS over LL is especially pronounced where choice of the SS allows the child to reduce trial/session length and seems to be normalised where patients are allowed access to additional stimulation during delay.
“It is especially pronounced where choice of the SS allows the child to reduce trial/session length (Marco et al., 2009) and seems to be normalised where patients are allowed access to additional stimulation during delay (Antrop et al., 2006).”
From Context-dependent Dynamic Processes in Attention Deficit/Hyperactivity Disorder: Differentiating Common and Unique Effects of State Regulation Deficits and Delay Aversion (2010) · cites this paper as Marco et al., 2009
Delay aversion plays a role in human impulsive choice, especially in children diagnosed with ADHD.
“This is of interest in light of the observation that delay aversion plays a role in human impulsive choice, particularly in children diagnosed with attention-deficit hyperactivity disorder (ADHD; Marco et al., 2009; Sonuga-Barke, Taylor, Sembi, & Smith, 1992).”
From Changing Delay Discounting and Impulsive Choice: Implications for Addictions, Prevention, and Human Health (2019) · cites this paper as Marco et al., 2009
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- Authors
- Marco, R., Miranda, A., Schlotz, W., Melia, A., Mulligan, A., Müller, U., Andreou, P., Butler, L., Christiansen, H., Gabriels, I., Medad, S., Albrecht, B., Uebel, H., Asherson, P., Banaschewski, T., Gill, M., Kuntsi, J., Mulas, F., Oades, R., Roeyers, H., Steinhausen, H.-C., Rothenberger, A., Faraone, S. V., & Sonuga-Barke, E. J. S.
- Affiliations
- Universitat de València (ES)
- University of Southampton (GB)
- St. James's Hospital (IE)
- University of Zurich (CH)
- University of Duisburg-Essen (DE)
- Geha Mental Health Center (IL)
- University of Göttingen (DE)
- Central Institute of Mental Health (DE)
- Hospital Universitari i Politècnic La Fe (ES)
- Ghent University (BE)
- SUNY Upstate Medical University (US)
- ORCID
- Venue
- Neuropsychology
- Published
- 2009
- Volume
- 23
- Issue
- 3
- Pages
- 367-380
- ISSN
- 0894-4105 (ISSN-L)
- 1931-1559
- OpenAlex
- W2080248245
- Cited by
- 214
- References
- 87
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 10 · 2023: 11 · 2022: 6 · 2021: 9 · 2020: 4 · 2019: 13 · 2018: 16 · 2017: 9 · 2016: 16 · 2015: 15 · 2014: 21 · 2013: 15 · 2012: 23
- FWCI
- 12.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.zora.uzh.ch
- Licence
- other-oa
- Locations
- Neuropsychology (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- DuEPublico (University of Duisburg-Essen) (submittedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- GRO (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Institute of Mental Health (R01062873)
- Medical Research Council (G03001896)
- 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, delay aversion, reward delay, impulsivity, familiality, siblings, conduct disorder, IQ, children
- MeSH terms
- Adolescent, Analysis of Variance, Attention Deficit Disorder with Hyperactivity, Child, Choice Behavior, Female, Humans, Impulsive Behavior, Male, Neuropsychological Tests, Psychomotor Performance, Reaction Time, Reward, Time Factors, Logistic Models, Case-Control Studies, Siblings
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