Delay aversion in attention deficit/hyperactivity disorder is mediated by amygdala and prefrontal cortex hyper‐activation
Open accessAbstract
Background: Experimental research supports delay aversion as a motivational feature of attention deficit/hyperactivity disorder ( ADHD ). To investigate the neurobiology of delay aversion in ADHD , this study examined whether adolescents with ADHD display an unusually strong activation in affective brain regions in response to cues predicting forthcoming delay and whether these effects are (a) delay‐dose dependent and (b) statistically mediate the association between ADHD and self‐reported delay aversion. Methods: Twenty‐nine right‐handed male adolescents with combined type ADHD and 32 typically developing controls (ages 10–18 years) performed a reaction time task in an MRI scanner. Pretarget cues indicated delay‐related response consequences. One indicated that delay would follow the response irrespective of response speed ( CERTAIN DELAY ), a second that delay would only follow if the response was too slow ( CONDITIONAL DELAY ), and a third that no delay would follow the response whatever its speed ( NO DELAY ). Delay levels were 2, 6, or 14 s. Participants also rated their own delay aversion in everyday life. Results: Individuals with ADHD rated themselves as more delay averse than controls. Significantly greater activation to CERTAIN DELAY cues relative to NO DELAY cues was found in participants with ADHD compared to controls (bilaterally) in amygdala, anterior insula, temporal pole, dorsolateral prefrontal cortex ( DLPFC ), and ventromedial prefrontal cortex. Amygdala and DLPFC activation strength were strongly and delay‐dose dependently correlated with delay aversion ratings, and statistically mediated the relationship between ADHD status and delay aversion. Conclusions: When presented with cues predicting impending delay, adolescents with ADHD , relative to controls, displayed a delay‐related increase in activation in amygdala and DLPFC , regions known to be implicated in the processing of aversive events. Future studies should examine the specificity of these effects to delay aversion compared to aversive events in general.
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Dysregulation in the mesolimbic pathway is linked to altered reward processing and delay aversion characteristic of ADHD.
“dysregulation in the mesolimbic pathway is linked to altered reward processing and the “delay aversion” characteristic of ADHD”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [68]
The Introduction (page unavailable) describes a theoretical account linking altered reward circuits and ventral-striatal responses to an immediate-reward preference that can lead to delay aversion in ADHD. It does not identify this as dysregulation of the mesolimbic pathway. The study’s reported findings instead concern amygdala and prefrontal activation in response to delay cues. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIndividuals with ADHD experience relatively strong negative emotions during waiting times, resulting in a preference to escape delay.
“it has been shown that individuals with ADHD experience relatively strong negative emotions during waiting times, resulting in a preference to escape delay”
From Behavioral trainings and manipulations to reduce delay discounting: A systematic review (2019) · cites this paper as Van Dessel et al., 2018
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“Concurrently, dysregulation in the mesolimbic pathway is linked to altered reward processing and the “delay aversion” characteristic of ADHD [68].”
- Authors
- Van Dessel, J., Sonuga‐Barke, E., Mies, G., Lemiere, J., Van der Oord, S., Morsink, S., & Danckaerts, M.
- Affiliations
- Center for Developmental Psychiatry UPC ‐ KU Leuven Leuven Belgium
- Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology and Neuroscience Kings College London London UK
- Radboud University Nijmegen (NL)
- KU Leuven (BE)
- Clinical Psychology KU Leuven Leuven Belgium
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2018-02-10
- Volume
- 59
- Issue
- 8
- Pages
- 888-899
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2793343101
- Cited by
- 61
- References
- 56
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 11 · 2023: 6 · 2022: 6 · 2021: 9 · 2020: 10 · 2019: 6 · 2018: 3
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (acceptedVersion, cc-by-nc)
- UvA-DARE (University of Amsterdam) (submittedVersion, cc-by-nc)
- Research Portal (King's College London) (submittedVersion, cc-by-nc)
- Lirias (KU Leuven) (submittedVersion, cc-by-nc)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Fonds Wetenschappelijk Onderzoek (11.ZU.117N, G.0821.11N)
- KU Leuven (OT/12/096)
- 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, delay aversion, amygdala, dorsolateral prefrontal cortex, ventromedial prefrontal cortex, adolescents, motivation, reaction time task
- MeSH terms
- Adolescent, Amygdala, Attention Deficit Disorder with Hyperactivity, Child, Humans, Magnetic Resonance Imaging, Male, Nerve Net, Reaction Time, Prefrontal Cortex, Delay Discounting
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