A neurocomputational account of reward and novelty processing and effects of psychostimulants in attention deficit hyperactivity disorder
Open accessAbstract
Computational models of reinforcement learning have helped dissect discrete components of reward-related function and characterize neurocognitive deficits in psychiatric illnesses. Stimulus novelty biases decision-making, even when unrelated to choice outcome, acting as if possessing intrinsic reward value to guide decisions toward uncertain options. Heightened novelty seeking is characteristic of attention deficit hyperactivity disorder, yet how this influences reward-related decision-making is computationally encoded, or is altered by stimulant medication, is currently uncertain. Here we used an established reinforcement-learning task to model effects of novelty on reward-related behaviour during functional MRI in 30 adults with attention deficit hyperactivity disorder and 30 age-, sex- and IQ-matched control subjects. Each participant was tested on two separate occasions, once ON and once OFF stimulant medication. OFF medication, patients with attention deficit hyperactivity disorder showed significantly impaired task performance (P = 0.027), and greater selection of novel options (P = 0.004). Moreover, persistence in selecting novel options predicted impaired task performance (P = 0.025). These behavioural deficits were accompanied by a significantly lower learning rate (P = 0.011) and heightened novelty signalling within the substantia nigra/ventral tegmental area (family-wise error corrected P < 0.05). Compared to effects in controls, stimulant medication improved attention deficit hyperactivity disorder participants' overall task performance (P = 0.011), increased reward-learning rates (P = 0.046) and enhanced their ability to differentiate optimal from non-optimal novel choices (P = 0.032). It also reduced substantia nigra/ventral tegmental area responses to novelty. Preliminary cross-sectional evidence additionally suggested an association between long-term stimulant treatment and a reduction in the rewarding value of novelty. These data suggest that aberrant substantia nigra/ventral tegmental area novelty processing plays an important role in the suboptimal reward-related decision-making characteristic of attention deficit hyperactivity disorder. Compared to effects in controls, abnormalities in novelty processing and reward-related learning were improved by stimulant medication, suggesting that they may be disorder-specific targets for the pharmacological management of attention deficit hyperactivity disorder symptoms.
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Stimulant medications can improve task performance and reward-learning rates in ADHD patients by modulating dopaminergic activity.
“This is further validated by the findings that stimulant medications can improve task performance and reward-learning rates in ADHD patients by specifically modulating dopaminergic activity in the brain [20].”
From The Impact of Social Media & Technology on Child and Adolescent Mental Health (2025) · cites this paper as [20]
The Results (Behavioural responses) report improved task performance in ADHD participants relative to controls, and the Discussion describes a tendency for stimulant medication to improve reward-learning rates, with statistical qualifications. But the Discussion says the learning-rate effects may be mediated through noradrenergic mechanisms; it does not establish that the improvements occur specifically through dopaminergic modulation. (LLM, conf=0.88)
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- Authors
- Sethi, A., Voon, V., Critchley, H. D., Cercignani, M., & Harrison, N. A.
- Affiliations
- Brighton and Sussex Medical School (GB)
- University of Cambridge (GB)
- Corresponding author
- Sethi, Arjun
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-03-13
- Volume
- 141
- Issue
- 5
- Pages
- 1545-1557
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC5917772
- OpenAlex
- W2792577143
- Cited by
- 36
- References
- 83
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 1 · 2023: 3 · 2022: 4 · 2021: 6 · 2020: 6 · 2019: 3
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Brain (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- Wellcome Trust (093881, 093881/Z/10/Z)
- Sussex Partnership NHS Foundation Trust
- Dr Mortimer and Theresa Sackler Foundation
- Medical Research Council (MR/P008747/1)
- 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, novelty seeking, reward processing, stimulus novelty, reinforcement learning, psychostimulants, stimulant medication, substantia nigra/ventral tegmental area, learning rate, decision-making, computational modelling, neurocognitive impairment
- MeSH terms
- Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Choice Behavior, Cross-Sectional Studies, Double-Blind Method, Exploratory Behavior, Female, Humans, Magnetic Resonance Imaging, Male, Methylphenidate, Models, Neurological, Photic Stimulation, Surveys and Questionnaires, Reward, Task Performance and Analysis, Case-Control Studies, Imaging, Three-Dimensional, Recognition, Psychology
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