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Cited by 127Attention Deficit Hyperactivity DisorderNeural and Behavioral Psychology StudiesGambling Behavior and Treatments

Risky behavior in gambling tasks in individuals with ADHD–a systematic literature review

Open access
Groen, Yvonne, Gaastra, Geraldina F., Lewis-Evans, Ben, Tucha, Oliver·2013·PLoS ONE
DOI 10.1371/journal.pone.0074909PMC PMC3772864
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Abstract

OBJECTIVE: The aim of this review was to gain insight into the relationship between Attention deficit hyperactivity disorder (ADHD) and risky performance in gambling tasks and to identify any potential alternate explanatory factors. METHODS: PsycINFO, PubMed, and Web of Knowledge were searched for relevant literature comparing individuals with ADHD to normal controls (NCs) in relation to their risky performance on a gambling task. In total, fourteen studies in children/adolescents and eleven studies in adults were included in the review. RESULTS: Half of the studies looking at children/adolescents with ADHD found evidence that they run more risks on gambling tasks when compared to NCs. Only a minority of the studies on adults with ADHD reported aberrant risky behavior. The effect sizes ranged from small to large for both age groups and the outcome pattern did not differ between studies that applied an implicit or explicit gambling task. Two studies demonstrated that comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) increased risky behavior in ADHD. Limited and/or inconsistent evidence was found that comorbid internalizing disorders (IDs), ADHD subtype, methylphenidate use, and different forms of reward influenced the outcomes. CONCLUSION: The evidence for increased risky performance of individuals with ADHD on gambling tasks is mixed, but is stronger for children/adolescents with ADHD than for adults with ADHD, which may point to developmental changes in reward and/or penalty sensitivity or a publication bias for positive findings in children/adolescents. The literature suggests that comorbid ODD/CD is a risk factor in ADHD for increased risky behavior. Comorbid IDs, ADHD subtype, methylphenidate use, and the form of reward received may affect risky performance in gambling tasks; however, these factors need further examination. Finally, the implications of the findings for ADHD models and the ecological validity of gambling tasks are discussed.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review found mixed evidence that individuals with ADHD show more risky performance than normal controls on gambling tasks, with stronger evidence in children/adolescents than adults. Comorbid ODD/CD appears to increase risky behavior, while other explanatory factors were limited or inconsistent.

Key findings

  • Across 25 studies, 10 (40%) reported more risky behavior in ADHD versus normal controls; this was 7/14 (50%) in children/adolescents and 3/11 (27%) in adults.
  • Effect sizes ranged from small to large: children/adolescents Cohen’s d = 0.04–1.32; adults Cohen’s d = 0.01–2.04, with no clear age-related pattern in magnitude.
  • The outcome pattern did not differ between implicit and explicit gambling tasks: positive findings included 7/10 implicit and 3/10 explicit studies; null findings included 11/15 implicit and 4/15 explicit studies.
  • Comorbid ODD/CD consistently increased risky behavior in ADHD; evidence for comorbid internalizing disorders, ADHD subtype, methylphenidate use, and reward form was limited and/or inconsistent.

Methods

  • Systematic literature review following PRISMA guidelines, searching PsycINFO, PubMed, and Web of Knowledge up to June 1, 2012, for studies comparing ADHD samples with normal controls on cognitive gambling tasks measuring risky performance.
  • Included 25 studies published between 1991 and 2012: 14 in children/adolescents and 11 in adults.
  • Results were structured by age and by implicit versus explicit gambling task; Cohen’s d effect sizes were reported where possible, but missing statistics and varied outcome measures prevented reliable average effect sizes, so ranges were provided instead.

Limitations

  • The paper states that no protocol exists for the review; insufficient reporting of statistics and large variation in outcome measures prevented calculation of reliable average effect sizes.
  • The paper states that publication bias may explain the stronger positive findings in children/adolescents, and that limited power may have contributed to null findings, with 17/25 studies (68%) using ADHD samples smaller than n = 30.
  • The paper states that ecological validity of gambling tasks is limited, especially in children/adolescents; evident from the text, only two placebo-controlled studies examined methylphenidate effects, and many alternate explanatory factors were inconsistently reported or controlled.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0074909

Cites

79 of 79 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 190 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The outcome pattern did not differ between studies that applied an implicit or explicit gambling task.

    “The effect sizes ranged from small to large for both age groups and the outcome pattern did not differ between studies that applied an implicit or explicit gambling task.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Half of the studies looking at children/adolescents with ADHD found evidence that they run more risks on gambling tasks when compared to normal controls.

    “Half of the studies looking at children/adolescents with ADHD found evidence that they run more risks on gambling tasks when compared to NCs.”
    Quote in the paperSubstantial claim
  • Findingown data

    Only a minority of the studies on adults with ADHD reported aberrant risky behavior.

    “Only a minority of the studies on adults with ADHD reported aberrant risky behavior.”
    Quote in the paperSubstantial claim
  • Findingown data

    The effect sizes ranged from small to large for both age groups.

    “The effect sizes ranged from small to large for both age groups and the outcome pattern did not differ between studies that applied an implicit or explicit gambling task.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Two studies demonstrated that comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) increased risky behavior in ADHD.

    “Two studies demonstrated that comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) increased risky behavior in ADHD.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 72
  • Classified as probably not a substantial claim. 30
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Limited and/or inconsistent evidence was found that comorbid internalizing disorders (IDs), ADHD subtype, methylphenidate use, and different forms of reward influenced the outcomes.

    “Limited and/or inconsistent evidence was found that comorbid internalizing disorders (IDs), ADHD subtype, methylphenidate use, and different forms of reward influenced the outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Ten studies investigated the performance of children/adolescents with ADHD on an implicit gambling task; six used the IGT or an IGT variant, three used the DOT, and one used the BART.

    “Ten studies investigated the performance of children/adolescents with ADHD on an implicit gambling task. Six studies used the IGT or a IGT variant [47]–[52], three studies used the DOT [35], [53], [54], and one study used the BART [55].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Six studies investigated the performance of children/adolescents with ADHD on the IGT or a variant of the IGT, of which two studies reported that children/adolescents clearly displayed more risky behavior than NCs.

    “Six studies investigated the performance of children/adolescents with ADHD on the IGT or a variant of the IGT [47]–[52], of which two studies reported that children/adolescents clearly displayed more risky behavior than NCs [47], [49].”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After the completion of the search 25 studies published between 1991 and 2012 were included in the review.

    “After the completion of the search 25 studies published between 1991 and 2012 were included in the review (see Table S2 for an overview of these studies).”
    Quote in the paperNot a substantial claim

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    Findingcitation

    Children with ADHD scored lower on post explosion reactivity on the BART than NCs, whereas children with ADHD with comorbid ODD scored higher on this measure than NCs.

    “Another study reported that children with ADHD scored lower on post explosion reactivity on the BART than NCs, whereas children with ADHD with comorbid ODD scored higher on this measure than the NCs [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] KL Humphreys, 2011, Risk taking and sensitivity to punishment in children with ADHD, ODD, ADHD+ODD, and controls, J Psychopathol Behav Assess source

      Not checked in the free run.

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    Findingcitation

    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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] R Drechsler, 2010, Decision making with uncertain reinforcement in children with attention deficit/hyperactivity disorder (ADHD), Child Neuropsychol source

      Not checked in the free run.

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    Findingcitation

    In two of three DOT studies, children with ADHD and comorbid ODD/CD played the task longer and ran more risks than NCs (Cohen's d = 0.97 and 1.32).

    “Two out of the three studies reported that children with ADHD and comorbid ODD/CD played the task longer and therefore ran more risks than the NCs [35], [53] (Cohen’s d respectively = 0.97 and 1.32).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [35] TK Daugherty, 1991, Response perseveration and delayed responding in childhood behavior disorders, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [53] W Matthys, 1998, The dominance of behavioural activation over behavioural inhibition in conduct disordered boys with or without attention deficit hyperactivity disorder, J Child Psychol Psychiatry source

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    Findingcitation

    On the PD, there was neither an age effect nor an interaction effect of age and diagnosis, and all groups made choices that maximized total gain.

    “Also, there was neither an age effect nor an interaction effect of age and diagnosis, and all groups made choices that maximized the total gain.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] A Scheres, 2006, Temporal and probabilistic discounting of rewards in children and adolescents: Effects of age and ADHD symptoms, Neuropsychologia source

      Not checked in the free run.

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    Findingcitation

    MPH reduced the number of points bet in the CGT, indicating that fewer risks were run by children/adolescents with ADHD treated with MPH.

    “Finally, another study demonstrated that MPH reduced the number of points bet in the CGT, which indicates that fewer risks were run by children/adolescents with ADHD who were treated with MPH [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] EE DeVito, 2008, The effects of methylphenidate on decision making in attention-deficit/hyperactivity disorder, Biol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Ten studies used an implicit gambling task, of which five (50%) found clear evidence that children/adolescents with ADHD displayed more risky behavior than NCs.

    “Ten studies used an implicit gambling task, of which five studies (5/10 = 50%) found clear evidence that children/adolescents with ADHD displayed more risky behavior than NCs [35], [47], [49], [53], [55].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [35] TK Daugherty, 1991, Response perseveration and delayed responding in childhood behavior disorders, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [47] N Garon, 2006, Decision making in children with ADHD only, ADHD-anxious/depressed, and control children using a child version of the iowa gambling task, J Atten Disord source

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    • cites [49] CW Hobson, 2011, Investigation of cool and hot executive function in ODD/CD independently of ADHD, J Child Psychol Psychiatry source

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  • The quote only partly states this claim.

    Findingcitation

    As the child IGT progressed, children with ADHD and anxiety/depression made more advantageous choices.

    “and as the task progressed they made more advantageous choices.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] N Garon, 2006, Decision making in children with ADHD only, ADHD-anxious/depressed, and control children using a child version of the iowa gambling task, J Atten Disord source

      Not checked in the free run.

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    Findingcitation

    On the BART, children with ADHD and comorbid ODD were most sensitive to punishment, pumping the balloon less in trials after a balloon pop, followed by NCs, and then children with ADHD without ODD, who were least sensitive.

    “Contrary to expectations, the children with ADHD and comorbid ODD were most sensitive to punishment, in that they pumped the balloon less in trials after having just been penalized with a balloon pop, followed by the NCs, and then the children with ADHD without ODD, who were the least sensitive to punishment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] KL Humphreys, 2011, Risk taking and sensitivity to punishment in children with ADHD, ODD, ADHD+ODD, and controls, J Psychopathol Behav Assess source

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    Findingcitation

    On the CGT, children with ADHD made less rational choices and scored lower on risk adjustment than NCs.

    “However, children with ADHD made less rational choices and scored lower on risk adjustment than the NCs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] EE DeVito, 2008, The effects of methylphenidate on decision making in attention-deficit/hyperactivity disorder, Biol Psychiatry source

      Not checked in the free run.

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    Findingcitation

    In the MPH condition of the CGT, children with ADHD bet fewer points, lowering their risk, but did not differ from the placebo condition in number of rational choices or risk adjustment.

    “In the MPH condition, the children with ADHD bet fewer points, thereby lowering their risk, but did not differ from the placebo condition in their number of rational choices or risk adjustment.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] EE DeVito, 2008, The effects of methylphenidate on decision making in attention-deficit/hyperactivity disorder, Biol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    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].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [40] R Drechsler, 2010, Decision making with uncertain reinforcement in children with attention deficit/hyperactivity disorder (ADHD), Child Neuropsychol source

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    • cites [58] R Drechsler, 2008, Decision-making on an explicit risk-taking task in preadolescents with attention-deficit/hyperactivity disorder, J Neural Transm source

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  • May combine two claims.

    Findingcitation

    Two of fourteen studies investigated effects of comorbid conditions and found that children with ADHD and comorbid ODD/CD performed in a more risky fashion than children with ADHD without comorbidity.

    “Two of the fourteen studies investigated the effects of comorbid conditions, and found that children with ADHD and comorbid ODD/CD performed in a more risky fashion than children with ADHD without comorbidity [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] KL Humphreys, 2011, Risk taking and sensitivity to punishment in children with ADHD, ODD, ADHD+ODD, and controls, J Psychopathol Behav Assess source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Children with ADHD and a comorbid ID (anxiety/depression) performed in a less risky fashion than children with ADHD without comorbidity, who could not be differentiated from NCs.

    “However, children with ADHD and a comorbid ID (anxiety/depression) performed in a less risky fashion than the children with ADHD without comorbidity, who could not be differentiated from the NCs [47].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] N Garon, 2006, Decision making in children with ADHD only, ADHD-anxious/depressed, and control children using a child version of the iowa gambling task, J Atten Disord source

      Not checked in the free run.

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    Findingcitation

    Mäntylä et al. found that adults with ADHD earned less money on a standard IGT than NCs (Cohen's d = 0.56), but this group effect appears to have been mediated by the educational level of the participants.

    “The study of Mäntylä et al. [64] initially appears different from those described above in that they found that adults with ADHD earned less money on a standard IGT than NCs (Cohen’s d = 0.56). This group effect, however, appears to have been mediated by the educational level of the participants.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] T Mäntylä, 2012, Decision making in adults with ADHD, J Atten Disord source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the first Matthies et al. study, adults with ADHD compared to NCs stayed less often with a safe option after positive feedback and stayed more often with a risky option after negative feedback.

    “In their first study, Matthies et al. [67)] (study 1 found that adults with ADHD compared to NCs stayed less often with a safe option after positive feedback and stayed more often with a risky option after negative feedback.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] S Matthies, 2012, Risky decision making in adults with ADHD, J Behav Ther Exp Psychiatry source

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    Findingcitation

    In Mäntylä et al., adults with ADHD pumped the balloons more up than NCs during the first of 10 trials, but there were no group differences in the remaining 50 trials, resulting in no overall group difference on the BART.

    “Specifically, while in the study of Mäntyla et al. [64] the adults with ADHD pumped the balloons more up than NCs during the first of 10 trials, there were no group differences in the remaining 50 trials, resulting in no overall group difference on this task.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] T Mäntylä, 2012, Decision making in adults with ADHD, J Atten Disord source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Two studies investigated the performance of adults with ADHD on the BART and neither revealed significant differences in risky performance between adults with ADHD and NCs.

    “Two studies investigated the performance of adults with ADHD on the BART and neither study revealed significant differences in risky performance between adults with ADHD and NCs [64], [65].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [64] T Mäntylä, 2012, Decision making in adults with ADHD, J Atten Disord source

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    • cites [65] J Weafer, 2011, Behavioral components of impulsivity predict alcohol consumption in adults with ADHD and healthy controls, Drug Alcohol Depend source

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    Findingcitation

    Only one study out of eight that examined implicit gambling tasks investigated the effects of MPH on gambling task performance in adults with ADHD and found no evidence for an effect of MPH.

    “Only one study out of these eight that examined implicit gambling tasks investigated the effects of MPH on gambling task performance in adults with ADHD and found no evidence for an effect of MPH [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] N Agay, 2010, Non-specific effects of methylphenidate (ritalin) on cognitive ability and decision-making of ADHD and healthy adults, Psychopharmacology (Berl ) source

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    Findingcitation

    In the second GDT study with boredom induction, there was no difference between adults with ADHD and NCs in net score (Cohen's d = 0.70) or feedback use.

    “In contrast to the first study [67] (study 1), this study did not find any difference between adults with ADHD and the NCs in net score (Cohen’s d = 0.70) or feedback use.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] S Matthies, 2012, Risky decision making in adults with ADHD, J Behav Ther Exp Psychiatry source

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    Findingcitation

    A direct comparison between the two GDT studies reveals that NCs in the boredom condition more often selected risky options than NCs in the condition without boredom, while the ADHD groups performed in a similar fashion in both conditions.

    “A direct comparison between these two studies reveals that the NCs in the boredom condition more often selected the risky options than the NCs in the condition without boredom, while the ADHD groups performed in a similar fashion in both conditions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] S Matthies, 2012, Risky decision making in adults with ADHD, J Behav Ther Exp Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the positive GDT study, adults with ADHD stayed less often with a safe option after positive feedback, and stayed more often with a risky option after negative feedback in comparison to NCs.

    “In that the adults with ADHD stayed less often with a safe option after positive feedback, and stayed more often with a risky option after negative feedback in comparison to the NCs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] S Matthies, 2012, Risky decision making in adults with ADHD, J Behav Ther Exp Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Eight studies used implicit gambling tasks, of which two (25%) provided clear evidence that adults with ADHD performed in a more risky fashion than NCs.

    “Eight studies used implicit gambling tasks, of which two studies (2/8 = 25%) provided clear evidence that adults with ADHD performed in a more risky fashion than NCs [62], [63].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [62] L Malloy-Diniz, 2007, Impulsive behavior in adults with attention deficit/hyperactivity disorder: Characterization of attentional, motor and cognitive impulsiveness, J Int Neuropsychol Soc source

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    • cites [63] L Malloy-Diniz, 2008, Brazilian portuguese version of the iowa gambling task: Transcultural adaptation and discriminant validity, Rev Bras Psiquiatr source

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    Findingcitation

    In the positive GDT study, adults with ADHD gained a lower net score than NCs (Cohen's d = 0.93) by tending to choose the option with two dice more often and the option with four dice less often than NCs.

    “Specifically, the adults with ADHD gained a lower net score than the NCs (Cohen’s d = 0.93) by tending to choose the option with two dice more often and the option with four dice less often than the NCs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] S Matthies, 2012, Risky decision making in adults with ADHD, J Behav Ther Exp Psychiatry source

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    Findingcitation

    Two other studies reported no greater levels of risky performance in adults with ADHD on the standard IGT compared to NCs, and one other study only revealed aberrant performance on the standard IGT in a subgroup of adults with ADHD with both hard drug dependence and working memory problems.

    “Much like Agay et al. [59], two other studies have also reported no greater levels of risky performance in adults with ADHD on the standard IGT when compared to NCs [61], [64], and one other study only revealed aberrant performance on the standard IGT in a subgroup of adults with ADHD with both hard drug dependence and working memory problems [60].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [61] M Ernst, 2003, Neural substrates of decision making in adults with attention deficit hyperactivity disorder, Am J Psychiatry source

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    • cites [64] T Mäntylä, 2012, Decision making in adults with ADHD, J Atten Disord source

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    • cites [60] NA Duarte, 2012, Working memory deficits affect risky decision-making in methamphetamine users with attention-deficit/hyperactivity disorder, J Psychiatr Res source

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    Findingcitation

    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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] G Wilbertz, 2012, Orbitofrontal reward sensitivity and impulsivity in adult attention deficit hyperactivity disorder, Neuroimage source

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    Findingcitation

    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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] G Wilbertz, 2012, Orbitofrontal reward sensitivity and impulsivity in adult attention deficit hyperactivity disorder, Neuroimage source

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  • May combine two claims.

    Findingcitation

    Malloy-Diniz et al. examined two different samples of adults with ADHD and found that in comparison to NCs, adults with ADHD obtained a lower net score on the standard IGT (Cohen's d = 0.79 and 0.70).

    “Specifically, Malloy-Diniz et al. [62], [63] examined two different samples of adults with ADHD and found that in comparison to NCs, adults with ADHD obtained a lower net score on the standard IGT (Cohen’s d respectively = 0.79 and 0.70).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [62] L Malloy-Diniz, 2007, Impulsive behavior in adults with attention deficit/hyperactivity disorder: Characterization of attentional, motor and cognitive impulsiveness, J Int Neuropsychol Soc source

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    • cites [63] L Malloy-Diniz, 2008, Brazilian portuguese version of the iowa gambling task: Transcultural adaptation and discriminant validity, Rev Bras Psiquiatr source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    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.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [67] S Matthies, 2012, Risky decision making in adults with ADHD, J Behav Ther Exp Psychiatry source

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    • cites [68] G Wilbertz, 2012, Orbitofrontal reward sensitivity and impulsivity in adult attention deficit hyperactivity disorder, Neuroimage source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Adolescents with ADHD-C more often chose the options with infrequent penalties and less often chose the options with frequent penalties when compared to adolescents with ADHD-I.

    “However, the adolescents with ADHD-C more often chose the options with infrequent penalties and less often chose the options with frequent penalties when compared to the adolescents with ADHD-I.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] ME Toplak, 2005, Executive and motivational processes in adolescents with attention-deficit-hyperactivity disorder (ADHD), Behav Brain Funct source

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    Findingnone given

    Only a few studies investigated the use of feedback and the findings were mixed.

    “Only a few studies investigated the use of feedback and the findings were mixed.”
    Quote in the paperNot a substantial claim

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    Findingnone given

    The other placebo-controlled study was carried out on adults and found no effects of MPH on performance on the IGT and FPGT in adults with ADHD or in NCs.

    “The other placebo-controlled study was carried out on adults and found no effects of MPH on performance on the IGT and FPGT in adults with ADHD or in NCs.”
    Quote in the paperSubstantial claim

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    Findingreasoning

    The evidence for a substantial influence of comorbid IDs, ADHD subtype, MPH use, and form of reward on the relationship between ADHD and risky decision-making was limited and/or inconsistent.

    “The evidence for a substantial influence of these variables was limited and/or inconsistent.”
    Quote in the paperSubstantial claim

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    Findingown data

    The results of fictive reward studies were inconsistent; 4/12 (33%) had positive findings.

    “The results of these, fictive reward, studies were also inconsistent (4/12 = 33% of the studies using fictive rewards had positive findings).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Across the studies with children/adolescents and adults, effect sizes ranged from small to large, with no clear pattern related to age.

    “Across the studies with children/adolescents and adults effect sizes ranged from small to large, with no clear pattern related to age.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The mixed evidence may point to developmental changes in reward and/or penalty sensitivity or a publication bias for positive findings in children/adolescents.

    “The evidence for increased risky performance of individuals with ADHD on gambling tasks is mixed, but is stronger for children/adolescents with ADHD than for adults with ADHD, which may point to developmental changes in reward and/or penalty sensitivity or a publication bias for positive findings in children/adolescents.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The evidence for increased risky performance of individuals with ADHD on gambling tasks is mixed, but is stronger for children/adolescents with ADHD than for adults with ADHD.

    “The evidence for increased risky performance of individuals with ADHD on gambling tasks is mixed, but is stronger for children/adolescents with ADHD than for adults with ADHD, which may point to developmental changes in reward and/or penalty sensitivity or a publication bias for positive findings in children/adolescents.”
    Quote in the paperSubstantial claim

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    Premisecitation

    In Luman et al.'s variant of the IGT, in the frequency condition both children with ADHD and NCs showed a preference for the advantageous deck, whereas in the magnitude condition only the NCs had a preference for the advantageous deck and the children with ADHD did not.

    “The results demonstrated that in the frequency condition, both the children with ADHD and the NCs showed a preference for the advantageous deck. However, in the magnitude condition, only the NCs had a preference for the advantageous deck, whereas the children with ADHD did not.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] M Luman, 2008, Decision-making in ADHD: Sensitive to frequency but blind to the magnitude of penalty?, J Child Psychol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Toplak et al., adolescents with ADHD-C chose the decks with infrequent penalties more often and the decks with frequent penalties less often compared to those with ADHD-I.

    “However, the adolescents with ADHD-C chose the decks with infrequent penalties more often and the decks with frequent penalties less often compared to those with ADHD-I.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] ME Toplak, 2005, Executive and motivational processes in adolescents with attention-deficit-hyperactivity disorder (ADHD), Behav Brain Funct source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Studies on the gambling task performance of individuals with ADHD show mixed results, which may be caused by the use of different task paradigms and/or by sample characteristics.

    “Studies on the gambling task performance of individuals with ADHD show mixed results, which may be caused by the use of different task paradigms and/or by sample characteristics.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This systematic literature review was carried out according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

    “This systematic literature review was carried out according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (see Table S1 for a completed checklist of the PRISMA guidelines for this study).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Some models of ADHD have incorporated motivational deficits as the core problem in ADHD, characterized by an aberrant level of sensitivity to rewards and penalties.

    “More recently, some models of ADHD have also incorporated motivational deficits as the core problem in ADHD [22]–[24], which are characterized by an aberrant level of sensitivity to rewards and penalties [25].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [22]–[24]

      Not checked in the free run.

    • cites [25] M Luman, 2005, The impact of reinforcement contingencies on AD/HD: A review and theoretical appraisal, Clin Psychol Rev source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The inconsistency in research findings on reward/penalty sensitivity in ADHD is presumably caused by many factors that influence decision-making in ADHD, such as characteristics of the individuals and the adopted task paradigm.

    “This inconsistency in research findings is presumably caused by the many factors that influence decision-making in ADHD, such as characteristics of the individuals and the adopted task paradigm.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Toplak et al., there were no group differences in the choices for the two decks with frequent penalties, with both ADHD individuals and NCs more often selecting the advantageous deck in this case.

    “There were no group differences in the choices for the two decks with frequent penalties, with both ADHD individuals and NC’s more often selecting the advantageous deck in this case.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] ME Toplak, 2005, Executive and motivational processes in adolescents with attention-deficit-hyperactivity disorder (ADHD), Behav Brain Funct source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Studies that only found group differences for specific aspects or parts of a gambling task were allocated to the null findings category.

    “As such, studies that only found group differences for specific aspects or parts of a gambling task were allocated to the null findings category.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Childhood ADHD is a risk factor for the dependence on, and abuse of, nicotine, alcohol, marihuana, and cocaine later in life.

    “In addition, in their meta-analytic review, Lee, Humphreys, Flory, Liu, & Glass [16] concluded that childhood ADHD was a risk factor for the dependence on, and abuse of, nicotine, alcohol, marihuana, and cocaine later in life.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lee, Humphreys, Flory, Liu, & Glass [16]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with ADHD have an increased chance to develop problem or pathological gambling, especially individuals with ADHD-C, individuals with severe ADHD symptoms, or individuals with persistent ADHD.

    “Individuals with ADHD also have an increased chance to develop problem or pathological gambling, especially individuals with ADHD-C [17], individuals with severe ADHD symptoms [18], or individuals with persistent ADHD [19].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [17] N Faregh, 2011, Gambling behavior among adolescents with attention deficit/hyperactivity disorder, J Gambl Stud source

      Not checked in the free run.

    • cites [18] JL Derevensky, 2007, Gambling problems and features of attention deficit hyperactivity disorder among children and adolescents, J Addict Med source

      Not checked in the free run.

    • cites [19] JL Breyer, 2009, Young adult gambling behaviors and their relationship with the persistence of ADHD, J Gambl Stud source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Toplak et al., in the second, risky, phase adolescents with ADHD chose the disadvantageous deck with infrequent penalties more often and chose the advantageous deck with infrequent penalties less often when compared to NCs.

    “However, in the second, risky, phase adolescents with ADHD chose the disadvantageous deck with infrequent penalties more often and chose the advantageous deck with infrequent penalties less often when compared to NCs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] ME Toplak, 2005, Executive and motivational processes in adolescents with attention-deficit-hyperactivity disorder (ADHD), Behav Brain Funct source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Comorbid IDs, ADHD subtype, methylphenidate use, and the form of reward received may affect risky performance in gambling tasks; however, these factors need further examination.

    “Comorbid IDs, ADHD subtype, methylphenidate use, and the form of reward received may affect risky performance in gambling tasks; however, these factors need further examination.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Dual Pathway Model (DPM) proposes that disturbances in at least two independent neural circuits can lead to ADHD: the ventrolateral and dorsolateral cortico-striatal circuitry, which subserves executive processes, and the mesolimbic ventral striatal circuitry, which subserves motivational processes.

    “The DPM proposes that disturbances in at least two independent neural circuits can lead to ADHD. Specifically the ventrolateral and dorsolateral cortico-striatal circuitry, which subserves executive processes, and the mesolimbic (medial-prefrontal and orbitofrontal) ventral striatal circuitry, which subserves motivational processes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22], [26]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    In cases where more than one ADHD group was compared to NCs only the results of the ADHD group with the least comorbidity were used for the classification.

    “In cases where more than one ADHD group was compared to NCs only the results of the ADHD group with the least comorbidity were used for the classification.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Luman et al. presumed that children with ADHD are sensitive to the frequency, but blind to the magnitude of a punishment.

    “The authors, therefore, presumed that children with ADHD are sensitive to the frequency, but blind to the magnitude of a punishment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] M Luman, 2008, Decision-making in ADHD: Sensitive to frequency but blind to the magnitude of penalty?, J Child Psychol Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Implicit gambling tasks are thought to depend on 'hot' decision-making involving emotional and affective responses to the options of choice as well as on 'cold' decision-making involving the rational and cognitive determinations of risks and benefits associated with the options in the later stages of the task.

    “Implicit gambling tasks are thought to depend on ‘hot’ decision-making involving emotional and affective responses to the options of choice as well as on ‘cold’ decision-making involving the rational and cognitive determinations of risks and benefits associated with the options in the later stages of the task [42], [43].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42], [43]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Garon et al., the NCs made more advantageous decisions as the task progressed, whereas the children with ADHD (without a comorbid ID) did not show this pattern, and did not choose the advantageous decks more often than predicted by chance.

    “The NCs also made more advantageous decisions as the task progressed, whereas the children with ADHD (without a comorbid ID) did not show this pattern, and did not choose the advantageous decks more often than predicted by chance.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] N Garon, 2006, Decision making in children with ADHD only, ADHD-anxious/depressed, and control children using a child version of the iowa gambling task, J Atten Disord source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is evidence for reduced psychophysiological sensitivity to rewards and penalty in individuals with ADHD, but these results are inconsistent.

    “However, there is also evidence for reduced psychophysiological sensitivity to rewards and penalty in individuals with ADHD [30]–[32], but according to the literature review by Luman and colleagues these results are inconsistent [25].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30]–[32]

      Not checked in the free run.

    • cites [25] M Luman, 2005, The impact of reinforcement contingencies on AD/HD: A review and theoretical appraisal, Clin Psychol Rev source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A rather conservative strategy was adopted for allocating studies to the positive findings category in order to maximize generalizability.

    “A rather conservative strategy was adopted for allocating studies to the positive findings category in order to maximize generalizability.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The DDT and DTD predict that children with ADHD need frequent reinforcement to learn optimally, show impaired learning in response to reinforcement, and show an impaired integration of earlier experiences of reinforcement when planning and carrying out behaviors.

    “and not only predict an increased preference for immediate over delayed rewards, but also predicts that children with ADHD need frequent reinforcement to learn optimally, show impaired learning in response to reinforcement, and show an impaired integration of earlier experiences of reinforcement when planning and carrying out behaviors.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [24] G Tripp, 2008, Research review: Dopamine transfer deficit: A neurobiological theory of altered reinforcement mechanisms in ADHD, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [23] T Sagvolden, 2005, A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes, Behav Brain Sci source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The relationship between ADHD and risky behavior may be explained by executive dysfunctioning, in particular inhibition deficits.

    “The relationship between ADHD and risky behavior may be explained by executive dysfunctioning, in particular inhibition deficits, that for many years have been the focus of ADHD models [20], [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20], [21]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No protocol exists for this review.

    “No protocol exists for this review.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Masunami et al. found significantly fewer T-patterns including penalties in children with ADHD compared to NCs, which indicates that children with ADHD paid less attention to penalties than the NCs.

    “The results showed that there were significantly less T-patterns including penalties in children with ADHD compared to NCs, which indicates that children with ADHD paid less attention to penalties than the NCs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] T Masunami, 2009, Decision-making patterns and sensitivity to reward and punishment in children with attention-deficit hyperactivity disorder, Int J Psychophysiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several other models predict that children with ADHD also suffer from a reduced sensitivity to punishment or non-reward, which makes them more focused on rewarding stimuli than children without ADHD.

    “Several other models predict that children with ADHD also suffer from a reduced sensitivity to punishment or non-reward, which makes them more focused on rewarding stimuli than children without ADHD [27]–[29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27]–[29]

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Individuals with ADHD-C appear therefore to be more sensitive to the frequency and less sensitive for the magnitude of penalties in comparison to individuals with ADHD-I.

    “Individuals with ADHD-C appear therefore to be more sensitive to the frequency and less sensitive for the magnitude of penalties in comparison to individuals with ADHD-I.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] ME Toplak, 2005, Executive and motivational processes in adolescents with attention-deficit-hyperactivity disorder (ADHD), Behav Brain Funct source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    It is unlikely that age contributed meaningfully to the outcomes of the studies, because all studies except one controlled for age by group matching or statistical correction (24/25 = 96%).

    “In terms of the effect of age within the individuals studies, it is unlikely that age contributed meaningfully to the outcomes of the studies, because all studies except one [65] controlled for age by group matching or statistical correction (24/25 = 96% of studies controlled for age as an alternate explanatory factor).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] J Weafer, 2011, Behavioral components of impulsivity predict alcohol consumption in adults with ADHD and healthy controls, Drug Alcohol Depend source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The evidence for more risky performance in gambling tasks in individuals with ADHD compared to NCs appears to be stronger for children/adolescents (7/14 = 50% of studies had positive findings) than for adults (3/11 = 27% of studies had positive findings).

    “Therefore, the evidence for more risky performance in gambling tasks in individuals with ADHD compared to NCs appears to be stronger for children/adolescents (7/14 = 50% of studies in children/adolescents had positive findings) than for adults (3/11 = 27% of studies in adults had positive findings).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    One study which included children with ADHD and comorbid IDs reported less risky performance, whereas the studies that included mixed samples and ADHD samples without comorbidity were inconsistent in their results.

    “In summary, one study which included children with ADHD and comorbid IDs reported less risky performance, whereas the studies that included mixed samples and ADHD samples without comorbidity were inconsistent in their results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The four studies that included participants with both ADHD and ODD/CD consistently showed increased risky performance compared with NCs, whereas the studies including mixed ADHD samples and ADHD samples without ODD/CD comorbidity were not consistent in their findings.

    “In summary, the four studies that included participants with both ADHD and ODD/CD consistently showed increased risky performance compared with NCs, whereas the studies including mixed ADHD samples and ADHD samples without ODD/CD comorbidity were not consistent in their findings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The studies with positive results reported in this review are more in line with ADHD models that predict cognitive deficits and with ADHD models that predict combined cognitive-motivational deficits (the DPM).

    “The studies with positive results reported in this review are, however, more in line with ADHD models that predict cognitive deficits [20], [21] and with ADHD models that predict combined cognitive-motivational deficits, i.e. the DPM [22], [26].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] RA Barkley, 1997, Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD, Psychol Bull source

      Not checked in the free run.

    • cites [21] B Pennington, 1996, Executive functions and developmental psychopathology, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [22] EJS Sonuga-Barke, 2002, Psychological heterogeneity in AD/HD - a dual pathway model of behaviour and cognition, Behav Brain Res source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The result that children/adolescents with ADHD may be more likely to perform in a more risky fashion on gambling tasks than NCs, irrespective of explicit or implicit tasks, implies both altered 'cold' and 'hot' decision-making strategies.

    “The result that children/adolescents with ADHD may be more likely to perform in a more risky fashion on gambling tasks than NCs, irrespective of the use of explicit or implicit tasks, implies both altered ‘cold’ and ‘hot’ decision-making strategies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    An important ability in the face of discontinuous reinforcement is the use of outcome feedback to subsequently adapt behavior or change strategy.

    “An important ability in the face of discontinuous reinforcement is the use of outcome feedback in order to subsequently adapt behavior or to change strategy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    More risky behavior on implicit gambling tasks implies impaired 'hot' and 'cold' decision-making strategies, which may be due to deficiencies in the cognitive control system as well as the affective-motivational system comprised of the subcortical and cortical midbrain dopamine systems.

    “On the other hand, more risky behavior on implicit gambling tasks implies impaired ‘hot’ and ‘cold’ decision-making strategies, which may be due to deficiencies in the cognitive control system as well as the affective-motivational system that is comprised of the subcortical and cortical midbrain dopamine systems.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Risky behavior on gambling tasks in children/adolescents with ADHD has been studied for roughly twenty years at the time of this review, and in those years findings indicating group differences may have been given preference for publication.

    “Risky behavior on gambling tasks in children/adolescents with ADHD has been studied for roughly twenty years at the time of this review, and in those years findings indicating group differences may have been given preference for publication.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The prefrontal recovery hypothesis postulates that the reduction of ADHD symptoms during adolescence is related to the degree in which prefrontal cognitive control functions ('cold' decision-making) compensate for primary and persistent subcortical deficits ('hot' decision-making).

    “The prefrontal recovery hypothesis [73] postulates that the reduction of ADHD symptoms during adolescence is related to the degree in which prefrontal cognitive control functions (‘cold’ decision-making) compensate for primary and persistent subcortical deficits (‘hot’ decision-making).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [73] JM Halperin, 2006, Revisiting the role of the prefrontal cortex in the pathophysiology of attention-deficit/hyperactivity disorder, Psychol Bull source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    MPH has been demonstrated to reduce the risk for drug abuse and risky driving behavior in individuals with ADHD.

    “MPH has for example been demonstrated to reduce the risk for drug abuse [74] and risky driving behavior [75] in individuals with ADHD.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [74] SV Faraone, 2003, Does stimulant treatment lead to substance use disorders?, J Clin Psychiatry

      Not checked in the free run.

    • cites [75] DJ Cox, 2012, Long-acting methylphenidate reduced collision rates of young adult drivers with attention-deficit/hyperactivity disorder, J Clin Psychopharmacol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The evidence for aberrant risk-taking performance on gambling tasks is stronger for children/adolescents with ADHD than for adults with ADHD, although it is still only present in around fifty percent of the reviewed studies in children/adolescents.

    “The evidence for aberrant risk-taking performance on gambling tasks is stronger for children/adolescents with ADHD than for adults with ADHD, although is it still only present in around fifty percent of the reviewed studies in children/adolescents.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Another explanation for the different outcomes in children/adolescents and adults may be that the study results in this review have been influenced by publication bias.

    “Another explanation for the different outcomes in children/adolescents and adults may, however, be that the study results in this review have been influenced by publication bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    This finding suggests that in cases where feedback is frequent individuals with ADHD react in a similar way to their NC peers, but in cases where feedback is infrequent there are likely to be more problems.

    “This finding suggests that while in cases where feedback is frequent individuals with ADHD react in a similar way to their NC peers, but in cases where feedback is infrequent there are likely to be more problems.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    A possible explanation for the higher proportion of positive studies in children/adolescents is the developmental trajectory of ADHD, characterized by a reduction of symptoms from childhood to adulthood.

    “A possible explanation for the higher proportion of positive studies in children/adolescents is the developmental trajectory of ADHD, which is characterized by a reduction of symptoms from childhood to adulthood (often accompanied with remission of ADHD).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ADHD symptoms reduce from childhood to adulthood, often with remission of ADHD.

  • May combine two claims.

    Interpretationcitation

    More risky behavior on explicit gambling tasks implies an impaired 'cold' decision-making strategy, which may be due to deficiencies in the cognitive control system comprised of the dorsal and ventral lateral prefrontal cortex and posterior parietal cortex.

    “On the one hand, more risky behavior on explicit gambling tasks implies an impaired ‘cold’ decision-making strategy, which may be due to deficiencies in the cognitive control system that is comprised of the dorsal and ventral lateral prefrontal cortex and posterior parietal cortex [44]–[46].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [44] BJ Casey, 2008, The adolescent brain, Dev Rev source

      Not checked in the free run.

    • cites [45] J Cohen, 2005, The vulcanization of the human brain: A neural perspective on interactions between cognition and emotion, J Econ Perspect source

      Not checked in the free run.

    • cites [46] L Steinberg, 2004, Risk taking in adolescence - what changes, and why?, Adolescent Brain Development: Vulnerabilities and Opportunities

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Important capabilities in the 'cold' decision-making strategy are understanding probabilities, updating this knowledge in working memory and storing it in long-term memory, and inhibiting responses to occasional feedback.

    “Important capabilities in this strategy are the understanding of probabilities, the ability to update this knowledge in working memory and store it in long-term memory, and to be able to inhibit responses to occasional feedback [69].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] ACK Van Duijvenvoorde, 2012, Age-related changes in decision making: Comparing informed and noninformed situations, Dev Psychol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The majority of studies overall did not report any impairment in ADHD participants, which is a challenge to both the cognitive and motivational models.

    “Although, it should be noted that the majority of studies overall did not report any impairment in ADHD participants, which is a challenge to both the cognitive and motivational models.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    This finding holds for both age groups irrespective of the use of an implicit or explicit gambling task.

    “This finding holds for both age groups irrespective of the use of an implicit or explicit gambling task.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The increased likelihood of children with ADHD to perform more risky on implicit gambling tasks found in the literature could point to an additional aspect of a dysfunctional reward (or punishment) system: children/adolescents with ADHD favor less probable large rewards over more probable smaller rewards, and risk higher penalties for those rewards.

    “The increased likelihood of children with ADHD to perform more risky on implicit gambling tasks found in the literature, however, could point to an additional aspect of a dysfunctional reward (or punishment) system, which is that children/adolescents with ADHD favor less probable large rewards over more probable smaller rewards, and risk higher penalties for those rewards.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Functions important for 'hot' decision-making are processing of reward and punishment and visceral responses to motivational cues.

    “Functions that are important for ‘hot’ decision-making are the processing of reward and punishment (which is also linked to inhibitory control) and the visceral responses to these motivational cues [42], [43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] JR Seguin, 2007, The contribution of “cool” and “hot” components of decision-making in adolescence: Implications for developmental psychopathology, Cogn Dev source

      Not checked in the free run.

    • cites [43] B Dunn, 2006, The somatic marker hypothesis: A critical evaluation, Neurosci Biobehav Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    This age related pattern might also reflect a publication bias for positive findings in children/adolescents in the past twenty years of research.

    “However, this age related pattern might also reflect a publication bias for positive findings in children/adolescents in the past twenty years of research.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Given variability in effect sizes and generally small sample sizes (n<30 in 68% of included studies), it is unclear whether limited power has contributed to the mixed findings.

    “Given this variability in effect sizes and the generally small sample sizes (n<30 in 68% of the included studies), it is unclear whether limited power has contributed to the mixed findings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    This finding cannot solely be explained by motivational models, because also 'cold' decision-making appears to be deficient, but is in line with the predictions of cognitive and combined motivational and cognitive models of ADHD.

    “This finding cannot solely be explained by motivational models, because also ‘cold’ decision-making appears to be deficient, but is in line with the predictions of cognitive and combined motivational and cognitive models of ADHD, such as the behavioral inhibition model [20], executive functioning model [21], and the Dual Pathway Model [22], [26].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] RA Barkley, 1997, Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD, Psychol Bull source

      Not checked in the free run.

    • cites [21] B Pennington, 1996, Executive functions and developmental psychopathology, J Child Psychol Psychiatry source

      Not checked in the free run.

    • cites [22] EJS Sonuga-Barke, 2002, Psychological heterogeneity in AD/HD - a dual pathway model of behaviour and cognition, Behav Brain Res source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The increased risky performance in some children/adolescents with ADHD in implicit gambling tasks provides some evidence that children/adolescents with ADHD prefer immediate over future rewards, prefer less probable large rewards over more probable smaller rewards, and risk higher penalties for these larger rewards.

    “The increased risky performance in some children/adolescents with ADHD in implicit gambling tasks provides some evidence that children/adolescents with ADHD do not only prefer immediate over future rewards, but also prefer less probable large rewards over more probable smaller rewards, and risk higher penalties for these larger rewards.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationnone given

    These models would still struggle to explain why there are many null findings in the literature.

    “Although, these models would still struggle to explain why there are many null findings in the literature.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Several other potential alternate explanatory factors have been reported in the literature, including comorbid IDs, ADHD subtype, use of MPH, and the form of reward used.

    “Several other potential alternate explanatory factors have been reported in the literature, including comorbid IDs, ADHD subtype, use of MPH, and the form of reward used.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    It is possible that the age related difference is due to developmental changes occurring during the transition from childhood to adulthood.

    “It is possible that the age related difference is due to developmental changes occurring during the transition from childhood to adulthood.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ADHD symptoms reduce from childhood to adulthood, often with remission of ADHD.

  • May combine two claims.

    Interpretationreasoning

    It remains unclear how increased risky behavior in gambling tasks relates to real-life decision-making, because of mixed findings and limited evidence for ecological validity of available gambling tasks, especially in children/adolescents.

    “It remains unclear, however, how increased risky behavior in gambling tasks relates to real-life decision-making, firstly because of the mixed findings in the area, but also because evidence for the ecological validity of the available gambling tasks is limited, especially in children/adolescents.”
    Quote in the paperSubstantial claim
94 of 94

  • The paper relies on this without support.

    Children with ADHD have a greater preference for immediate over delayed rewards compared to normal controls.

    “Both behavioral studies and animal-models have suggested that children with ADHD have a greater preference for immediate over delayed rewards compared to normal controls.”

  • The paper relies on this without support.

    ADHD symptoms reduce from childhood to adulthood, often with remission of ADHD.

    “which is characterized by a reduction of symptoms from childhood to adulthood (often accompanied with remission of ADHD)”

  • The paper relies on this without support.

    MPH is the most prescribed pharmacological treatment for ADHD.

    “Even though MPH is the most prescribed pharmacological treatment for ADHD”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Evidence for cognitive deficits is more consistent in children than adolescents or adults with ADHD.

    “Evidence for cognitive deficits is more consistent in children than adolescents or adults with ADHD (Groen et al., 2013; Pievsky and McGrath, 2018).”

    From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Groen et al., 2013

    The Results (Potential Alternate Explanatory Factors) find stronger evidence for risky gambling-task performance in children/adolescents with ADHD (7/14 studies) than in adults (3/11). The source groups children and adolescents together, so it does not establish that evidence is more consistent in children than in adolescents; it also addresses gambling-task performance rather than cognitive deficits generally. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Reports on behavioral measures of reward processing in ADHD are inconsistent and findings often remain unreplicated.

    “However, reports on behavioral measures of reward processing are inconsistent, and findings often remain unreplicated (e.g. 7,12,13).”

    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 [7]

    The Results (Potential Alternate Explanatory Factors; page unavailable) report inconsistent findings on risky decision-making in ADHD gambling tasks: 10 studies had positive findings and 15 had null findings, sometimes using the same tests. This supports inconsistency in one type of behavioral reward-related measure, but the paper does not establish that behavioral measures of reward processing generally often remain unreplicated. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Probabilistic-discounting risk direction is reversed

    Major

    The task description first says that less discounting of uncertain rewards is associated with risky choices, but then says that a smaller AUC, reflecting steeper discounting, indicates more risky performance.

  • Five of eight studies is not 71%

    Minor

    The stated fraction is 5/8, which is 62.5%, not 71%. The reported percentage corresponds approximately to 5/7.

    Reported 71 · recomputed 62.5

  • Study 2 of [67] is credited with a feedback difference it did not find

    Minor

    The discussion cites study 2 as evidence of aberrant adjustment after punishment. The results instead say that study 2 found no difference in feedback use between groups.

  • Study [52] is assigned inconsistent ADHD subtypes

    Minor

    The detailed account says [52] compared ADHD-C with ADHD-I, but the subtype analysis lists [52] among studies examining ADHD-C with ADHD-H.

  • ODD/CD comparison is assigned to the wrong task and age group

    Minor

    The cited studies [55] and [66] are described elsewhere as a BART study in children and a CT study in adults, respectively-not two DOT studies in children.

  • Study [48] is described as using the MMG rather than the IGT

    Minor

    The feedback summary attributes MMG findings to [48], whereas the detailed account identifies its task as a variant of the IGT.

  • Summary identifies the wrong group as similar to controls

    Minor

    The detailed results say that children with ADHD and anxiety/depression did not differ from controls. The summary instead assigns that description to the children with ADHD without the comorbidity.

7 of 7

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Groen, Y., Gaastra, G. F., Lewis-Evans, B., & Tucha, O.
Affiliations
University of Groningen (NL)
Corresponding author
Groen, Yvonne
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2013-09-13
Volume
8
Issue
9
Pages
e74909
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0074909
PMC
PMC3772864
OpenAlex
W2030744711
Cited by
127
References
78
Citations by year
2026: 8 · 2025: 7 · 2024: 12 · 2023: 12 · 2022: 5 · 2021: 13 · 2020: 8 · 2019: 6 · 2018: 9 · 2017: 9 · 2016: 19 · 2015: 13 · 2014: 6
FWCI
1.73
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
Funders
Rijksuniversiteit Groningen
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
Keywords
attention deficit hyperactivity disorder, risk-taking, gambling task, children and adolescents, adults, oppositional defiant disorder, conduct disorder, internalizing disorders, ADHD subtypes, methylphenidate, reward sensitivity, comorbidities
MeSH terms
Attention Deficit Disorder with Hyperactivity, Female, Gambling, Humans, Male, Risk-Taking, PubMed

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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