Planning to make economic decisions in the future, but choosing impulsively now: are preference reversals related to symptoms of ADHD and depression?

Delay discounting of monetary gains and losses in adolescents with ADHD: Contribution of delay aversion to choice

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are known to have stronger preferences for smaller immediate rewards over larger delayed rewards in delay discounting tasks than their peers, which has been argued to reflect delay aversion. Here, participants performed a delay discounting task with gains and losses. In this latter condition, participants were asked whether they were willing to wait in order to lose less money. Following the core assumption of the delay aversion model that individuals with ADHD have a general aversion to delay, one would predict adolescents with ADHD to avoid waiting in both conditions. Adolescents (12-17 years) with ADHD (n = 29) and controls (n = 28) made choices between smaller immediate and larger delayed gains, and between larger immediate and smaller delayed losses. All delays (5-25 s) and gains/losses (2-10 cents) were experienced. In addition to an area under the curve approach, a mixed-model analysis was conducted to disentangle the contributions of delay duration and immediate gain/delayed loss amount to choice. The ADHD group chose the immediate option more often than controls in the gain condition, but not in the loss condition. The contribution of delay duration to immediate choices was stronger for the ADHD group than the control group in the gain condition only. In addition, the ADHD group scored higher on self-reported delay aversion, and delay aversion was associated with delay sensitivity in the gain condition, but not in the loss condition. In sum, we found no clear evidence for a general aversion to delay in adolescents with ADHD.

Waiting and working for rewards: Attention-Deficit/Hyperactivity Disorder is associated with steeper delay discounting linked to amygdala activation, but not with steeper effort discounting

OBJECTIVE

Children and adolescents with ADHD have a relatively strong preference for smaller immediate rewards over larger delayed rewards (steep delay discounting). It is unknown whether such steep discounting of rewards is specific for delayed rewards, i.e., supporting the delay aversion account of ADHD, or whether it is also present for effortful rewards, i.e., representing general reward insensitivity. Therefore, this study examined behavioral and BOLD responses during delay discounting (DD) and effort discounting (ED) in ADHD.

METHOD

Thirty adolescents with ADHD and 28 controls (12-17 years) were scanned while performing a DD-ED task (fMRI findings were based on 21 and 25 participants, respectively). During DD, participants were presented with a series of choices between a small reward delivered immediately and a larger reward delivered after 5-25s. During ED, participants were presented with choices between a small reward that was delivered after exerting 15% of their maximal hand grip strength and a larger reward delivered after exerting 30-90% of their strength.

RESULTS

Analyses on the subjective values of delayed and effortful rewards and on the Area Under the discounting Curves (AUCs) indicated that adolescents with ADHD showed steeper discounting than controls for DD, but not for ED. This was accompanied by a slightly stronger delay dose-response relationship in the amygdala for adolescents with ADHD who reported to be more delay averse in daily life.

CONCLUSION

Together, these results-steeper DD in the ADHD group and a stronger delay dose-response relationship in the amygdala, while no evidence for group differences in ED was found-support the delay aversion account of ADHD.

Planning to make economic decisions in the future, but choosing impulsively now: are preference reversals related to symptoms of ADHD and depression?

A preference for smaller immediate rewards over larger delayed rewards (delay discounting, DD) is common in attention deficit hyperactivity disorder (ADHD), but rarely investigated in depression. Whether this preference is due to sensitivity to reward immediacy or delay aversion remains unclear. To investigate this, we examined whether ADHD and depressive symptoms are associated with preference reversals: a switch from smaller immediate rewards to larger delayed rewards when smaller rewards are also delayed. We also examined whether these symptoms differentially affect DD of losses. In Study 1 undergraduates completed a questionnaire about ADHD symptoms, and performed a hypothetical DD task. In the NOW condition, participants were presented with choices between a small reward available today and a large reward available after one year. In the FUTURE condition both rewards were delayed with +1 year. In Study 2 undergraduates completed questionnaires about ADHD and depressive symptoms and performed a DD task with gains and losses. Participants showed preference reversals in both studies and tasks. Losses were less steeply discounted than gains. ADHD and depressive symptoms did not influence these effects. Depressive symptoms, but not ADHD symptoms, were associated with less economic choices in general. These findings suggest that impulsive choice in depression is not explained by sensitivity to reward immediacy. Copyright © 2016 John Wiley & Sons, Ltd.