Decision Making with Uncertain Reinforcement in Children with Attention Deficit/Hyperactivity Disorder (ADHD)
Abstract
Reward-related processes are impaired in children with ADHD. Whether these deficits can be ascribed to an aversion to delay or to an altered responsiveness to magnitude, frequency, valence, or the probability of rewards still needs to be explored. In the present study, children with ADHD and normal controls aged 7 to 10 years performed a simple probabilistic discounting task. They had to choose between alternatives where the magnitude of rewards was inversely related to the probability of outcomes. As a result, children with ADHD opted more frequently for less likely but larger rewards than normal controls. Shifts of the response category after positive or negative feedback, however, occurred as often in children with ADHD as in control children. In children with ADHD, the frequency of risky choices was correlated with neuropsychological measures of response time variability but unrelated to measures of inhibitory control. It is concluded that the tendency to select less likely but larger rewards possibly represents a separate facet of dysfunctional reward processing, independent of delay aversion or altered responsiveness to feedback.
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Behaviorally, individuals with ADHD display a range of motivational deficits, including impaired behavioral modification in response to rewards, enhanced motivation for larger but riskier rewards, and decreased motivation for social rewards.
“behaviorally, individuals with ADHD display a range of motivational deficits, including impaired behavioral modification in response to rewards [468], enhanced motivation for larger but riskier rewards [479], and decreased motivation for social rewards [480].”
From Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings (2012) · cites this paper as [479]
On the MMG, both children with ADHD and NCs did not change their strategy during task progression and switched set equally often following positive or negative feedback.
“Both groups did not change their strategy during task progression and switched set equally often following positive or negative feedback.”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [40]
Two studies found no differences in the number of switches after negative or positive feedback in the MMG between children with ADHD and NCs.
“Lastly, two other studies found no differences in the number of switches after negative or positive feedback in the MMG between children with ADHD and NCs [40], [48].”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [40]
Four of fourteen studies with children/adolescents used an explicit gambling task and two (50%) found that children/adolescents with ADHD performed in a more risky fashion than NCs.
“Four of the fourteen studies with children/adolescents used an explicit gambling task and two studies (2/4 = 50%) found that children/adolescents with ADHD performed in a more risky fashion than NCs [40], [58].”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [40]
On the MMG, children with ADHD had a greater preference for conditions with a low probability large reward than NCs (four-card selections; Cohen's d = 1.20).
“Drechsler et al. [40] developed the MMG and demonstrated that children with ADHD had a greater preference for conditions with a low probability large reward, than NCs (four-card selections; Cohen’s d = 1.20).”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [40]
Higher levels of risky performance were found in mixed samples of individuals with ADHD compared to NCs, which included studies that examined participants of all three ADHD subtypes or participants with ADHD-C and ADHD-I.
“If findings are compared across studies, higher levels of risky performance were found in mixed samples of individuals with ADHD compared to NCs, which included studies that examined participants of all three ADHD subtypes [40], [58] (2/10 = 20% of studies with positive findings) or participants with ADHD-C and ADHD-I [62] (1/10 = 10% of studies with positive findings).”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [40]
Group differences between ADHD participants and NCs were present in 5/10 (50%) of studies with positive findings in which participants discontinued MPH 8 to 48 hours before the experiment.
“Group differences between ADHD participants and NCs were present in studies in which participants discontinued medication treatment with MPH 8 to 48 hours before the experiment [40], [49], [53], [58], [67] (5/10 = 50% of studies with positive findings; reference 67 refers to study 1)”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [40]
Of the 13 studies using tangible rewards, 6 (46%) found a group effect.
“of which six studies found a group effect [35], [40], [47], [49], [53], [55] and seven studies had null findings [41], [50], [52], [59], [61], [65], [68] (6/13 = 46% of the studies using tangible rewards had positive findings)”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [40]
Other studies failed to find any deviations in feedback use in individuals with ADHD.
“Other studies failed to find any deviations in feedback use in individuals with ADHD [40], [48], [67].”
From Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review (2013) · cites this paper as [40]
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- Authors
- Drechsler, R., Rizzo, P., & Steinhausen, H.-C.
- Affiliations
- University of Zurich (CH)
- Corresponding author
- Drechsler, Renate
- ORCID
- Drechsler, Renate
- Venue
- Child Neuropsychology
- Publisher
- Informa UK Limited
- Published
- 2009-10-09
- Volume
- 16
- Issue
- 2
- Pages
- 145-161
- ISSN
- 0929-7049 (ISSN-L)
- 1744-4136
- OpenAlex
- W1995156059
- Cited by
- 56
- References
- 72
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 1 · 2023: 2 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 1 · 2017: 4 · 2016: 4 · 2015: 4 · 2014: 4 · 2013: 8 · 2012: 4
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Child Neuropsychology (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- 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, decision-making, reward processing, probabilistic discounting, decision making under risk, delay aversion, reaction time variability, inhibitory control, feedback, children
- MeSH terms
- Analysis of Variance, Attention, Attention Deficit Disorder with Hyperactivity, Child, Cognition, Decision Making, Female, Games, Experimental, Humans, Impulsive Behavior, Inhibition, Psychological, Male, Neuropsychological Tests, Reaction Time, Reinforcement Schedule, Reward, Risk-Taking, Uncertainty
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