Risky decision making in Attention-Deficit/Hyperactivity Disorder: A meta-regression analysis

Diving and attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a psychiatric condition that affects attention, concentration, impulse control and awareness. Not only these symptoms, but also the medications used to treat ADHD (psychostimulants) pose a risk to both the diver and his or her buddy. This article presents guidelines for recreational diving in combination with ADHD and psychostimulants. These guidelines are based solely on 'expert' opinion and were adopted at a meeting of the Dutch Association for Diving Medicine in 2017.

Attention Deficit/Hyperactivity Disorder and Increased Engagement in Sexual Risk-Taking Behavior: The Role of Benefit Perception

Attention deficit/hyperactivity disorder (ADHD) has been linked to higher engagement in sexual risk-taking behavior (SRTB). The current study aims to establish the link between ADHD symptoms and SRTB in the general population and to examine whether an exaggerated perceived benefit of the positive outcomes of SRTB explains that link. A scale for measuring the frequency, likelihood, perceived benefit, and perceived risk of SRTB was developed. Young adult sexually active participants who did not have a stable partnership completed the above scale, as well as a scale of ADHD symptoms. The level of ADHD symptoms positively correlated with the frequency and likelihood of SRTB, even when the overall level of sexual behavior was controlled for. ADHD symptoms also correlated with the perceived benefit of SRTB, but not with the perceived risk of SRTB. Mediation analysis confirmed an indirect pathway: ADHD symptoms predicted perceived benefit of SRTB, which in turn predicted increased likelihood to engage in SRTB. These findings suggest a positive link between ADHD symptoms and SRTB in the general population, which is accounted for by an exaggerated perceived benefit of SRTB.

Impulsivity Moderates Skin Conductance Activity During Decision Making in a Modified Version of the Balloon Analog Risk Task

Individual differences in traits such as impulsivity and processing of risk and reward have been linked to decision making and may underlie divergent decision making strategies. It is, however, unclear whether and how far individual differences in these characteristics jointly influence decision making. Here, we aimed to investigate the roles of skin conductance responses, a psychophysiological marker of risk processing and impulsivity, as assessed by the Barratt Impulsiveness Scale 11 on decision making. Forty-six healthy participants performed a modified version of the Balloon Analog Risk Task (BART), where reward and explosion risk are manipulated separately. Participants are informed about whether they play a high versus low reward and high versus low explosion risk condition. The exact risk and reward contingencies are, however, unknown to participants. Participants were less risk-taking under high, compared to low explosion risk and under high reward, compared to low reward on the modified BART, which served as a validation of the paradigm. Risk-taking was negatively related to skin conductance responses under high explosion risk. This relationship was primarily driven by individuals with relatively high levels of impulsivity. However, impulsivity alone was not found to be related to decision making on the modified BART. These results extend evidence that skin conductance responses may guide decision making in situations, where participants are informed about risk level (high vs. low), which might be differentially moderated by different levels of impulsivity.

Examining the neurochemical underpinnings of animal models of risky choice: Methodological and analytic considerations

Because risky choice is associated with several psychiatric conditions, recent research has focused on examining the underlying neurochemical processes that control risk-based decision-making. Not surprisingly, several tasks have been developed to study the neural mechanisms involved in risky choice. The current review will briefly discuss the major tasks used to measure risky choice and will summarize the contribution of several major neurotransmitter systems to this behavior. To date, the most common measures of risky choice are the probability discounting task, the risky decision task, and the rat gambling task. Across these three tasks, the contribution of the dopaminergic system has been most studied, although the effects of serotonergic, adrenergic, cholinergic, and glutamatergic ligands will be discussed. Drug effects across these tasks have been inconsistent, which makes determining the precise role of neurotransmitter systems in risky choice somewhat difficult. Furthermore, procedural differences can modulate drug effects in these procedures, and the way data are analyzed can alter the interpretations one makes concerning pharmacological manipulations. By taking these methodological/analytic considerations into account, we may better elucidate the neurochemistry of risky decision-making. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Pubertal influences on neural activation during risky decision-making in youth with ADHD and disruptive behavior disorders

OBJECTIVE

Risk-taking during adolescence is a leading cause of mortality; Neuroscience research examining pubertal effects on decision-making is needed to better inform interventions, particularly among youth with attention-deficit/hyperactivity (ADHD) and disruptive behavior disorders (DBD), who are particularly prone to risky decision-making. We examined effects of pubertal development on risky decision-making and neural activation during decision-making among youth with ADHD/DBDs.

METHOD

Forty-six 11-12-year-olds (29.4% girls; 54.9% white; Tanner M(SD) = 2.08(1.32)) who met DSM-5 criteria for ADHD/DBD completed the Balloon Analog Risk Task (BART) during fMRI scanning. We examined effects of Tanner stage, sex, and age on risky decision-making (mean wager at which individuals stopped balloon inflation) and neural activation in the middle frontal gyrus and the ventral striatum during the choice and outcome phases of decision-making.

RESULTS

Those in earlier pubertal stages made riskier decisions during the BART compared to those in later Tanner stages (β=-0.62, p =  .02). Later pubertal stage was associated with greater activation in the left middle frontal gyrus (β=0.61, p = .03) during the choice phase and in the right ventral striatum in response to rewards (β=0.59, p = .03).

CONCLUSION

Youth with ADHD/DBD in later stages of puberty, regardless of age, show greater ventral striatal activation in response to rewards.

Risk-Taking Behavior in Attention Deficit/Hyperactivity Disorder (ADHD): a Review of Potential Underlying Mechanisms and of Interventions

PURPOSE OF REVIEW

Attention deficit/hyperactivity disorder (ADHD) is associated with several forms of risk-taking behavior (RTB). This paper aims to examine the scope of ADHD-related RTB, to highlight potential underlying mechanisms of this association, and to review initial evidence for interventions aimed to treat ADHD-related RTB.

RECENT FINDINGS

Multiple lines of evidence indicate that ADHD is associated with real-life RTB across several domains (e.g., reckless driving, substance use, and unprotected sex), which is corroborated by evidence on laboratory risk-taking tasks. Several individual differences, some of them informed by decision theory, e.g., comorbid disorders, parental monitoring, and perceived enlarged benefits of RTB, may explain the link between ADHD and RTB. A number of studies showed that interventions designed for ADHD may reduce RTB. ADHD is linked to RTB across several domains. Decision theory may serve as a conceptual framework for understanding the underlying mechanisms, and thus may inform future research.

Peer-Influence on Risk-Taking in Male Adolescents with Mild to Borderline Intellectual Disabilities and/or Behavior Disorders

This study aimed to disentangle the effects of Mild-to-Borderline Intellectual Disability (MBID) and Behavior Disorders (BD)on risk taking in circumstances where peer influence was absent or present. We studied 319 adolescents in four groups: MBID-only, MBID+BD, BD-only, and typically developing controls. The Balloon Analogue Risk-Task (BART), in a solo or peer condition, was used as a proxy of real-life risk-taking. Results show a significant main effect of BART condition. Post-hoc tests indicated higher risk-taking in the peer compared to the solo condition in all groups except BD-only. Moreover, risk taking was increased in adolescents with MBID compared to adolescents without MBID, but only under peer-influence. No main or interaction effects with BD were observed. Model based decomposition of BART performance in underlying processes showed that the MBID related increase in risk-taking under peer-influence was mainly related to increased risk-taking propensity, and in the MBID-only group also to increased safety estimates and increased confidence in these safety estimates. The present study shows that risk-taking in MBID may be better explained by low intellectual functioning than by comorbid BD, and may not originate in increased risk taking per se, but may rather be related to risk-taking under peer-influence, which is a complex, multifaceted risk-taking context. Therefore, interventions to decrease risk-taking by adolescents with MBID that specifically target peer-influence may be successful.

Simulated Driving Performance, Self-Reported Driving Behaviors, and Mental Health Symptoms in Adolescent Novice Drivers

BACKGROUND

Risky driving behaviors contribute to adolescent injury, disability, and death, yet little is known about how mental health factors are associated with adolescent driving behaviors.

OBJECTIVES

The purpose of the research was to determine the association of risky driving behaviors and mental health symptoms in novice adolescent drivers.

METHODS

We recruited a convenience sample (n = 60) of adolescents to complete an assessment of driving performance errors in a high-fidelity simulator (Simulated Driving Assessment [SDA] Error Score) and a self-report measure of risky driving (Behavior of Young Novice Drivers Survey [BYNDS]). Participants also completed a mental health assessment of self-reported symptoms of depression (Center for Epidemiologic Studies-Depression Scale) and attention-deficit/hyperactivity disorder (ADHD; inattention and hyperactivity-impulsivity), conduct disorder, and oppositional defiant disorder (Conners-3 self-report and parent report). We evaluated the cross-sectional relationships between SDA Error Score, BYNDS, and mental health survey data with descriptive statistics, bivariate correlations, and linear regression.

RESULTS

In linear regression models, higher self-reported inattentive ADHD T-scores were associated with higher SDA Error Score (model adjusted R = .20). Higher self-reported T-scores of hyperactive-impulsive ADHD and conduct disorder were associated with higher BYNDS total scores (model adjusted R = .32). Parent report measures were not associated with adolescent BYNDS total score or SDA Error Score.

DISCUSSION

These data highlight the association of risky driving with adolescent symptoms of inattention, hyperactivity, and conduct disorder. The early stage of independent driving is an important time for addressing the relationship between driving performance and mental health conditions.

Risky sexual behavior among adolescents: The role of decision-making, problems from cannabis use and externalizing disorder symptoms

INTRODUCTION

Previous research has demonstrated that externalizing symptoms, cannabis use problems, and poor decision-making abilities are each independently related to risky sexual behavior (RSB). However, few studies have examined the joint effect of these factors on RSB among a sample of adolescents.

METHODS

The current study addresses this gap in the literature by examining how externalizing disorder symptoms, cannabis use, and decision-making abilities interact to predict RSB among a sample of adolescents (n = 204; M_age = 15.5) at-risk for escalation in cannabis use. Poisson regression was used for all analyses, and simple slope difference tests were used for all post-hoc analyses.

RESULTS

A greater number of externalizing symptoms, more problems from cannabis use, and more risk disadvantageous choices on the Cups Task (CT) total trials and more risk disadvantageous choices on the CT-gain trials predicted greater RSB endorsement. Findings also highlight significant interactions between cannabis use problems and CT-total and -gain trial performance, as well as between cannabis use problems and externalizing symptoms in predicting RSB.

CONCLUSION

Current treatment and prevention approaches to reduce RSB among adolescents may benefit from incorporating techniques that improve decision-making skills.

The Neurocognitive Profile of Attention-Deficit/Hyperactivity Disorder: A Review of Meta-Analyses

Objective

Numerous meta-analyses have summarized studies comparing the neurocognitive performance of individuals with attention-deficit/hyperactivity disorder (ADHD) to that of healthy controls.

Method

The present study is a systematic review and quantitative summary of those meta-analyses that aimed to determine the extent to which individuals with ADHD differ cognitively from typically developing controls.

Results

Of 253 standardized mean differences (SMDs) drawn from 34 meta-analyses, 244 (96%) were positive, indicating better neurocognitive performance in the control group than the ADHD group. The mean effect size was .45 (SD = .27). Unweighted means of SMDs for neurocognitive domains ranged from .35 (set shifting) to .54 (working memory). When weighted by the number of studies aggregated, they ranged from .35 (set shifting) to .66 (reaction time variability). Neurocognitive domains with mean effects over .50 included working memory (.54), reaction time variability (.53), response inhibition (.52), intelligence/achievement (.51), and planning/organization (.51). When weighted by number of aggregated studies, the domains with mean effects over .50 were reaction time variability (.66), intelligence/achievement (.60), vigilance (.56), working memory (.54), and response inhibition (.52). Age moderated the relationship between ADHD diagnosis and neurocognitive functioning, with greater between-groups differences among children and adults than among adolescents. Funding also moderated this relationship: meta-analyses that received drug funding found larger effect sizes than those without drug funding.

Conclusions

The evidence suggests that ADHD is associated with substantial deficits across a variety of neurocognitive domains. This is the most in-depth review of the neurocognitive functioning of people with ADHD to date.

Attention-deficit hyperactivity disorder and addictions (substance and behavioral): Prevalence and characteristics in a multicenter study in France

AIM

The aim of this study is to determine the possible links between attention-deficit hyperactivity disorder (ADHD) and the presence of concomitant addictions with or without substance use in a French student population.

MEASURES

A battery of questionnaire measuring socioeconomic characteristics, university curriculum, ADHD (Wender Utah Rating Scale and Adult ADHD Self-Report Scale), substance consumptions (alcohol, tobacco, and cannabis), and behavioral addictions [(eating disorders (SCOFF)], Internet addiction (Internet Addiction Test), food addiction (Yale Food Addiction Scale), compulsive buying (Echeburua's), and problem gambling (The Canadian Problem Gambling Index)] and measures of physical activity (Godin's Leisure Time Exercise Questionnaire) was filled up by university students in Rouen and Nanterre in France.

RESULTS

A total of 1,517 students were included (472 from Paris Nanterre and 1,042 from Rouen). The mean age was 20.6 years (SD = 3.6) and the sex ratio male to female was 0.46. The prevalence of ADHD among the students (current ADHD with a history of ADHD in childhood) was 5.6%. A quarter (25.7%) of students had already repeated their university curriculum, compared to 42.2% among the students with ADHD. Students with possible ADHD had repeated classes more often and believed to have a lower academic level than the students without ADHD. Significant differences were found as students with ADHD were less likely to succeed in their studies (repeated classes more often) than non-ADHD students, and considered their academic level to be lower. They also had significantly higher scores on substance (alcohol, cannabis, and tobacco) as well as behavioral addictions (gambling, compulsive buying disorder, eating disorders, and Internet addiction).

CONCLUSION

It seems essential to determine students' problems and propose interventions adapted to students' needs, in order to reduce the negative impact on their future academic and global successes.

Species-conserved SYNGAP1 phenotypes associated with neurodevelopmental disorders

SYNGAP1 loss-of-function variants are causally associated with intellectual disability, severe epilepsy, autism spectrum disorder and schizophrenia. While there are hundreds of genetic risk factors for neurodevelopmental disorders (NDDs), this gene is somewhat unique because of the frequency and penetrance of loss-of-function variants found in patients combined with the range of brain disorders associated with SYNGAP1 pathogenicity. These clinical findings indicate that SYNGAP1 regulates fundamental neurodevelopmental processes that are necessary for brain development. Here, we describe four phenotypic domains that are controlled by Syngap1 expression across vertebrate species. Two domains, the maturation of cognitive functions and maintenance of excitatory-inhibitory balance, are defined exclusively through a review of the current literature. Two additional domains are defined by integrating the current literature with new data indicating that SYNGAP1/Syngap1 regulates innate survival behaviors and brain structure. These four phenotypic domains are commonly disrupted in NDDs, suggesting that a deeper understanding of developmental Syngap1 functions will be generalizable to other NDDs of known or unknown etiology. Therefore, we discuss the known molecular and cellular functions of Syngap1 and consider how these functions may contribute to the emergence of disease-relevant phenotypes. Finally, we identify major unexplored areas of Syngap1 neurobiology and discuss how a deeper understanding of this gene may uncover general principles of NDD pathobiology.

Sexually Transmitted Infection Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder: A Nationwide Longitudinal Study

OBJECTIVE

Previous studies have suggested that attention-deficit/hyperactivity disorder (ADHD) is related to risky sexual behaviors, which have been regarded as a major risk factor of sexually transmitted infection (STI). However, the association between ADHD and subsequent STIs remains unknown.

METHOD

Using the Taiwan National Health Insurance Research Database, 17,898 adolescents and young adults who were diagnosed with ADHD by psychiatrists and 71,592 age- and sex-matched comparisons without ADHD were enrolled from 2001 through 2009 and followed to the end of 2011. Participants who developed any STI during the follow-up period were identified. Cox regression analysis was performed to examine the risk of STIs between patients with ADHD and those without ADHD.

RESULTS

Patients with ADHD were prone to developing any STI (hazard ratio [HR] 3.36, 95% CI 2.69∼4.21) after adjusting for demographic data, psychiatric comorbidities, and ADHD medications compared with the comparison group. Substance use disorders (HR 1.94, 95% CI 1.27∼2.98) also were associated with STI risk. Short-term use (HR 0.70, 95% CI 0.53∼0.94) and long-term use (HR 0.59, 95% CI 0.37∼0.93) of ADHD medications were related to a lower risk of subsequent STIs. However, an association between substance use disorders and STIs was observed only in women. By contrast, the effect of ADHD medications on the decrease of STI risk was observed only in men.

CONCLUSION

Adolescents and young adults with ADHD had an increased risk of developing any STI later in life compared with the non-ADHD comparisons. Patients with ADHD who also had substance use disorders were at the highest risk of subsequent STIs. Treatment with ADHD medications was associated with a lower risk of subsequent STIs.

Risk taking and adult attention deficit/hyperactivity disorder: A gap between real life behavior and experimental decision making

Adults with attention deficit/hyperactivity disorder (ADHD) are prone to suboptimal decision making and risk taking. The aim of this study was to test performance on a theoretically-based probabilistic decision making task in well-characterized adults with and without ADHD, and examine the relation between experimental risk taking and history of real-life risk-taking behavior, defined as cigarette, alcohol, and street drug use. University students with and without ADHD completed a modified version of the Cambridge Gambling Test, in which they had to choose between alternatives varied by level of risk, and reported their history of substance use. Both groups showed similar patterns of risk taking on the experimental decision making task, suggesting that ADHD is not linked to low sensitivity to risk. Past and present substance use was more prevalent in adults with ADHD. These finding question the validity of experimental probabilistic decision making task as a valid model for ADHD-related risk-taking behavior.

Optogenetic Inhibition Reveals Distinct Roles for Basolateral Amygdala Activity at Discrete Time Points during Risky Decision Making

Decision making is a multifaceted process, consisting of several distinct phases that likely require different cognitive operations. Previous work showed that the basolateral amygdala (BLA) is a critical substrate for decision making involving risk of punishment; however, it is unclear how the BLA is recruited at different stages of the decision process. To this end, the current study used optogenetics to inhibit the BLA during specific task phases in a model of risky decision making (risky decision-making task) in which rats choose between a small, "safe" reward and a large reward accompanied by varying probabilities of footshock punishment. Male Long-Evans rats received intra-BLA microinjections of viral vectors carrying either halorhodopsin (eNpHR3.0-mCherry) or mCherry alone (control) followed by optic fiber implants and were trained in the risky decision-making task. Laser delivery during the task occurred during intertrial interval, deliberation, or reward outcome phases, the latter of which was further divided into the three possible outcomes (small, safe; large, unpunished; large, punished). Inhibition of the BLA selectively during the deliberation phase decreased choice of the large, risky outcome (decreased risky choice). In contrast, BLA inhibition selectively during delivery of the large, punished outcome increased risky choice. Inhibition had no effect during the other phases, nor did laser delivery affect performance in control rats. Collectively, these data indicate that the BLA can either inhibit or promote choice of risky options, depending on the phase of the decision process in which it is active.SIGNIFICANCE STATEMENT To date, most behavioral neuroscience research on neural mechanisms of decision making has used techniques that preclude assessment of distinct phases of the decision process. Here we show that optogenetic inhibition of the BLA has opposite effects on choice behavior in a rat model of risky decision making, depending on the phase in which inhibition occurs. BLA inhibition during a period of deliberation between small, safe and large, risky outcomes decreased risky choice. In contrast, BLA inhibition during receipt of the large, punished outcome increased risky choice. These findings highlight the importance of temporally targeted approaches to understand neural substrates underlying complex cognitive processes. More importantly, they reveal novel information about dynamic BLA modulation of risky choice.

Psychotherapy for Adolescents With Attention-Deficit Hyperactivity Disorder: A Pediatrician's Guide

Attention-deficit hyperactivity disorder (ADHD) presents with high levels of inattention, impulsiveness, and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. ADHD symptoms lead to decreased functionality in various life domains and result in poor academics, behavioral challenges, delayed independence, and strained relationships. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. This article aims to provide a review of the psychotherapeutic interventions available for teens that receive pharmacotherapy but continue to struggle with the residual symptoms of ADHD that interfere with academic function, relationship formation, and psychological development.

Is decision-making ability related to food choice and facets of eating behaviour in adolescents?

PURPOSE

To test the prediction that poor decision-making would predict poor eating-related behaviours, which in turn would relate to elevated body mass index (BMI) percentile.

METHODS

Associations among decision-making ability, eating behaviours, and BMI percentile were examined in a sample of 311 healthy male and female adolescents, aged 14-18 years. Structural equation modelling was used to test the proposed relationships.

RESULTS

The predicted model was a good fit to the data and all paths between latent and indicator variables were significant. Impulsive responding significantly predicted poor food choice and overeating. No significant relationships emerged between eating-related variables and BMI percentile.

CONCLUSIONS

Findings from this study extend the existing research in adults and offer a more comprehensive understanding of factors that may contribute to eating behaviours and weight status in teenagers.

Annual Research Review: On the relations among self-regulation, self-control, executive functioning, effortful control, cognitive control, impulsivity, risk-taking, and inhibition for developmental psychopathology

BACKGROUND

Self-regulation (SR) is central to developmental psychopathology, but progress has been impeded by varying terminology and meanings across fields and literatures.

METHODS

The present review attempts to move that discussion forward by noting key sources of prior confusion such as measurement-concept confounding, and then arguing the following major points.

RESULTS

First, the field needs a domain-general construct of SR that encompasses SR of action, emotion, and cognition and involves both top-down and bottom-up regulatory processes. This does not assume a shared core process across emotion, action, and cognition, but is intended to provide clarity on the extent of various claims about kinds of SR. Second, top-down aspects of SR need to be integrated. These include (a) basic processes that develop early and address immediate conflict signals, such as cognitive control and effortful control (EC), and (b) complex cognition and strategies for addressing future conflict, represented by the regulatory application of complex aspects of executive functioning. Executive function (EF) and cognitive control are not identical to SR because they can be used for other activities, but account for top-down aspects of SR at the cognitive level. Third, impulsivity, risk-taking, and disinhibition are distinct although overlapping; a taxonomy of the kinds of breakdowns of SR associated with psychopathology requires their differentiation. Fourth, different aspects of the SR universe can be organized hierarchically in relation to granularity, development, and time. Low-level components assemble into high-level components. This hierarchical perspective is consistent across literatures.

CONCLUSIONS

It is hoped that the framework outlined here will facilitate integration and cross-talk among investigators working from different perspectives, and facilitate individual differences research on how SR relates to developmental psychopathology.

Effects of NMDA receptor antagonists on probability discounting depend on the order of probability presentation

Risky decision making can be measured using a probability-discounting procedure, in which animals choose between a small, certain reinforcer and a large, uncertain reinforcer. Recent evidence has identified glutamate as a mediator of risky decision making, as blocking the N-methyl-d-aspartate (NMDA) receptor with MK-801 increases preference for a large, uncertain reinforcer. Because the order in which probabilities associated with the large reinforcer can modulate the effects of drugs on choice, the current study determined if NMDA receptor ligands alter probability discounting using ascending and descending schedules. Sixteen rats were trained in a probability-discounting procedure in which the odds against obtaining the large reinforcer increased (n=8) or decreased (n=8) across blocks of trials. Following behavioral training, rats received treatments of the NMDA receptor ligands MK-801 (uncompetitive antagonist; 0, 0.003, 0.01, or 0.03mg/kg), ketamine (uncompetitive antagonist; 0, 1.0, 5.0, or 10.0mg/kg), and ifenprodil (NR2B-selective non-competitive antagonist; 0, 1.0, 3.0, or 10.0mg/kg). Results showed discounting was steeper (indicating increased risk aversion) for rats on an ascending schedule relative to rats on the descending schedule. Furthermore, the effects of MK-801, ketamine, and ifenprodil on discounting were dependent on the schedule used. Specifically, the highest dose of each drug decreased risk taking in rats in the descending schedule, but only MK-801 (0.03mg/kg) increased risk taking in rats on an ascending schedule. These results show that probability presentation order modulates the effects of NMDA receptor ligands on risky decision making.