Impulsivity and Sustained Attention in Pathological Gamblers: Influence of Childhood ADHD History

Do attention-deficit/hyperactivity symptoms influence treatment outcome in gambling disorder?

BACKGROUND AND AIMS

Numerous studies point to the comorbidity between gambling disorder (GD) and attention deficit hyperactivity disorder (ADHD). However, there is a lack of research exploring how ADHD symptoms might influence psychological treatment outcomes for GD. Therefore, we aimed to explore differences between patients with GD with and without self-reported ADHD symptoms regarding psychopathology, personality, sociodemographic and treatment outcome measures.

METHOD

This longitudinal study included 170 patients with GD receiving cognitive behavioral therapy. Multiple self-reported instruments were used to assess clinical variables and sociodemographic measures prior to treatment.

RESULTS

A clinical profile characterized by greater GD severity, higher psychopathology and impulsivity, and less adaptive personality features was observed in patients with self-reported ADHD symptoms compared to those without. No significant differences in treatment response (measured by dropout and relapse rates) were observed between the two groups. However, patients with self-reported ADHD symptoms experienced more severe relapses (i.e., gambled more money) and GD patients who relapsed scored higher on measures of ADHD, particularly inattention.

CONCLUSION

Individuals with GD and self-reported symptoms of ADHD may experience more severe relapses following treatment, suggesting a need for more vigilant follow-up and interventions for patients with this comorbidity.

Interval timing relative to response inhibition in the differential reinforcement of low-rate responding in normally developing young adults

With recent proposal suggesting the multifaceted nature of impulsivity, researchers have been intrigued by the question of whether the impulsive behaviour measured in the traditionally psychological paradigms is unitary. One such paradigm, the differential reinforcement of low-rate responding (DRL), has been used to assess response inhibition, but its underlying mechanism has still been debated. In present research, we examined and differentiated the effects of both response inhibition and interval timing on a multisession DRL-10 s (DRL-10 s) in a large sample of normally developing young adults, as well as with three other measures including the stop-signal reaction task (SSRT), time production task-10 s (TPT-10 s), and the Barrett impulsivity scale-11 (BIS-11). The results showed that behavioural changes existed in DRL. As the task sessions progressed, there was an increase in both reinforcement probability and peak time, but a decrease in burst responses. Most importantly, both principal component analysis and generalized multilevel modeling yielded consistent results that as the task progressed, there was an increasing involvement of the TPT in the late sessions of DRL. However, none of the effect of SSRT was found. In sum, the differential degrees of involvement of the timing process, relative to response inhibition, were observed in DRL.

Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles

Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.

Research on Gambling in Young People: A Co-Occurrence Analysis

Gambling as a risk factor in youth development, particularly its causes and consequences, has been the subject of a growing number of studies. However, the literature relating to young people has yet to be compiled in a systematic form. The present study adopts a descriptive bibliometric approach to map global research on gambling in young people using metadata from the Web of Science database. The results show that research on gambling in young people at a country level has increased in recent years, though some regions are underrepresented. Co-occurrence analysis revealed the frequent use of several terms. It is hoped that these findings will assist in future research on the subject.

Alfa band power increases in posterior brain regions in attention deficit hyperactivity disorder after digital cognitive stimulation treatment

The changes triggered by pharmacological treatments in resting-state alpha-band (8–14 Hz) oscillations have been widely studied in attention deficit hyperactivity disorder. However, to date, there has been no evidence regarding the possible changes in cognitive stimulation treatments on these oscillations. This paper sets out to verify whether cognitive stimulation treatments based on progressive increases in cognitive load can be effective in triggering changes in alpha-band power in attention deficit hyperactivity disorder. With this objective, we compared a cognitive stimulation treatment (n = 13) to placebo treatment (n = 13) for 12 weeks (36 sessions of 15 min) in child patients (8–11 years old) with attention deficit hyperactivity disorder. Two magnetoencephalographic recordings were acquired for all the participants. In order to extract the areas with changes in alpha power between both magnetoencephalographic recordings, the differences in the power ratio (pre/post-condition) were calculated using an Analysis of Covariance test adjusted for the age variable. The results show an increase in the post-treatment power ratio in the experimental group versus the placebo group (P < 0.01) in posterior regions and the default mode network. In addition, these alpha changes were related to measures of attention, working memory and cognitive flexibility. The results seem to indicate that cognitive stimulation treatment based on progressive increases in cognitive load triggers alpha-band power changes in child attention deficit hyperactivity disorder patients in the direction of their peers without this disorder.

Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial

BACKGROUND

Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder.

OBJECTIVE

Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients.

METHODS

In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians.

RESULTS

In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship.

CONCLUSIONS

The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318.

Considering Motor Excitability During Action Preparation in Gambling Disorder: A Transcranial Magnetic Stimulation Study

A lack of inhibitory control appears to contribute to the development and maintenance of addictive disorders. Among the mechanisms thought to assist inhibitory control, an increasing focus has been drawn on the so-called preparatory suppression, which refers to the drastic suppression observed in the motor system during action preparation. Interestingly, deficient preparatory suppression has been reported in alcohol use disorders. However, it is currently unknown whether this deficit also concerns behavioral, substance-free, addictions, and thus whether it might represent a vulnerability factor common to both substance and behavioral addictive disorders. To address this question, neural measures of preparatory suppression were obtained in gambling disorder patients (GDPs) and matched healthy control subjects. To do so, single-pulse transcranial magnetic stimulation was applied over the left and the right motor cortex to elicit motor-evoked potentials (MEPs) in both hands when participants were performing a choice reaction time task. In addition, choice and rapid response impulsivity were evaluated in all participants, using self-report measures and neuropsychological tasks. Consistent with a large body of literature, the MEP data revealed that the activity of the motor system was drastically reduced during action preparation in healthy subjects. Surprisingly, though, a similar MEP suppression was observed in GDPs, indicating that those subjects do not globally suffer from a deficit in preparatory suppression. By contrast, choice impulsivity was higher in GDPs than healthy subjects, and a higher rapid response impulsivity was found in the more severe forms of GD. Altogether, those results demonstrated that although some aspects of inhibitory control are impaired in GDPs, these alterations do not seem to concern preparatory suppression. Yet, the profile of individuals suffering of a GD is very heterogeneous, with only part of them presenting an impulsive disposition, such as in patients with alcohol use disorders. Hence, a lack of preparatory suppression may be only shared by this sub-type of addicts, an interesting issue for future investigation.

Uncovering Underlying Processes Before Illusion of Control Begins in Gambling Disorder: A Pilot Study

Gambling Disorder (GD) is characterized by persistent betting even in face of accruing debts and psychosocial hardship. Gambling Disorder behavior has been linked to conditioning, cognitive distortions and superstitious behavior. Previous studies have demonstrated that during response-outcome analytical tests (ROAT), non-gambling individuals are precluded from response extinction when failure feedback is suppressed, and develop superstitious behaviors and illusion of control instead. Gambling can be regarded as a ROAT paradigm in which disordered gamblers (DGs) fail to compute failure feedback; hence they do not perceive the independence between response and outcome. In order to investigate early phenomena on response and outcome processing in DGs, we developed two short ROAT versions, one with a controllable outcome and one with an uncontrollable outcome, both with explicit failure feedback. Twenty DGs and twenty healthy controls were assessed using this novel paradigm. Compared to controls, DGs reported higher distress during the controllable ROAT, less self-confidence in the uncontrollable ROAT, and more random responses and less use of analytical strategies in both tests, evidencing potential deficits in cognitive control. In contrast to previous findings, DGs did not demonstrate more superstitious beliefs, or illusion of control, and were generally more skeptical than controls regarding the controllability of both ROAT versions. Taken together, our findings provide some support for deficits in cognitive control in GD that precede illusion of control and superstitious behaviors.

Self-reported rates of impulsivity in Parkinson's Disease

OBJECTIVE

Impulsive decision-making is characterized by actions taken without considering consequences. Patients with Parkinson's disease (PD) who receive dopaminergic treatment, especially dopamine agonists, are at risk of developing impulsive-compulsive behaviors (ICBs). We assessed impulse-related changes across a large heterogeneous PD population using the Barratt impulsivity scale (BIS-11) by evaluating BIS-11 first- and second-order factors.

METHODS

We assessed a total of 204 subjects: 93 healthy controls (HCs), and 68 ICB- and 43 ICB + PD patients who completed the BIS-11. Using a general linear model and a least absolute shrinkage and selection operation regression, we compared BIS-11 scores between the HC, ICB- PD, and ICB + PD groups.

RESULTS

Patients with PD rated themselves as more impulsive than HCs in the BIS-11 total score, second-order attention domain, and first-order attention and self-control domains. ICB + patients recorded higher total scores as well as higher scores in the second-order non-planning domain and in self-control and cognitive complexity than ICB- patients.

INTERPRETATION

These results indicate that the patients with PD show particular problems with attentional control, whereas ICB + patients show a distinct problem in cognitive control and complexity. Additionally, it appears that all patients with PD are more impulsive than their age- and sex-matched healthy peers. Increased impulsivity may be a result of the disease course, or attributed to dopaminergic medication use, but these results emphasize the importance of the cognitive components of impulsivity in patients with PD.

Adult ADHD Is Associated With Gambling Severity and Psychiatric Comorbidity Among Treatment-Seeking Problem Gamblers

Objective: The aim of this study is as follows: (a) exploring retrospective childhood and adult ADHD symptomatology in treatment-seeking gamblers, (b) providing detailed characteristics of the association between pathological gambling (PG) and ADHD, and (c) identifying risk factors for a history of ADHD. Method: Eighty problem gamblers (20% female) were examined using a standardized interview (PG: Diagnostic and Statistical Manual of Mental Disorders [4th ed.; DSM-IV] criteria, Gambling Attitudes and Beliefs Survey; ADHD: Wender Utah Rating Scale-deutsche Kurzform, Adult ADHD Self-Report Scale; comorbidities: Mini International Neuropsychiatric Interview). Results: Forty-three percentage of patients screened positive for childhood ADHD, and in 11%, ADHD persisted in adulthood. Patients with adult ADHD had more severe gambling problems (p = .009, d = 1.03) and a higher number of psychiatric comorbidities (p < .001, d = 1.62) compared with those without ADHD. Substance abuse/dependence constituted a predictor for having a history of ADHD (odds ratio [OR] = 4.07, p = .025). Conclusion: ADHD-PG comorbidity is linked to factors that worsen the prognosis. Thus, screening for ADHD and verifying persistence in adulthood should be an integral component in the interdisciplinary treatment of problem/pathological gamblers.

Exploring the Relationships Between Problem Gambling and ADHD: A Meta-Analysis

Objective: At present, there are inconsistencies in the literature pertaining to the association between ADHD and problem gambling. This study utilized meta-analytic techniques to clarify the association between symptoms of problem gambling and symptoms of ADHD. Method: Several meta-analyses were conducted using a random effects model. PsycINFO, PubMed, ProQuest Dissertations & Theses, and Google Scholar were searched for relevant studies. Results: The weighted mean correlation between ADHD symptomology and gambling severity was r = .17, 95% confidence interval (CI) = [0.12, 0.22], p < .001. Mean age of the sample was the only moderator to approach significance, with greater age being linked to a stronger relationship between symptoms of ADHD and gambling severity. Conclusion: Clinicians needs to be cognizant of the greater risk of ADHD symptoms when working with problem gamblers and vice versa.

Allelic variation in dopamine D2 receptor gene is associated with attentional impulsiveness on the Barratt Impulsiveness Scale (BIS-11)

OBJECTIVES

Previous studies have postulated that noradrenergic and/or dopaminergic gene variations are likely to underlie individual differences in impulsiveness, however, few have shown this. The current study examined the relationship between catecholamine gene variants and self-reported impulsivity, as measured by the Barratt Impulsiveness Scale (Version 11; BIS-11) Methods: Six hundred and seventy-seven non-clinical adults completed the Barratt Impulsiveness Scale (BIS-11). DNA was analysed for a set of 142 single-nucleotide polymorphisms (SNPs) across 20 autosomal catecholamine genes. Association was tested using an additive regression model with permutation testing used to control for the influence of multiple comparison.

RESULTS

Analysis revealed an influence of rs4245146 of the dopamine D2 receptor (DRD2) gene on the BIS-11 attention first-order factor, such that self-reported attentional impulsiveness increased in an additive fashion with each copy of the T allele.

CONCLUSIONS

These findings provide preliminary evidence that allelic variation in DRD2 may influence impulsiveness by increasing the propensity for attentional lapses.

Relationship between attention-deficit hyperactivity disorder symptoms and problem gambling: A mediation analysis of influential factors among 7,403 individuals from the UK

BACKGROUND AND AIMS

Our goal was to examine the association between attention-deficit hyperactivity disorder (ADHD) symptoms and gambling problems, and to identify potential mediating factors of this association.

METHODS

This study used cross-sectional, community-based data from 7,403 people aged ≥16 years who participated in the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS) Screener. Problem gambling was assessed using a questionnaire based on the 10 DSM-IV diagnostic criteria for pathological gambling. Respondents were classified as having no problem, at-risk, or problem gambling. Logistic regression and mediation analyses were conducted to analyze the association between ADHD symptoms (i.e., ASRS score ≥14) and problem gambling and the role of several variables in this association.

RESULTS

The prevalence of at-risk (5.3% vs. 2.4%) and problem gambling (2.4% vs. 0.6%) was higher in individuals with ADHD symptoms than in those without ADHD symptoms. ADHD symptoms were significantly associated with both at-risk (OR = 2.15; 95% CI = 1.22-3.79) and problem gambling (OR = 3.57; 95% CI = 1.53-8.31) when adjusted for age, sex, and ethnicity. Common mental disorders (CMDs; i.e., depression and anxiety disorders) (mediated percentage = 22.4%), borderline personality disorder (BPD) traits (22.1%), stressful life events (13.2%), stress at work or home (12.6%), alcohol dependence (11.8%), and impulsivity (11.2%) were significant mediators in the ADHD-gambling association.

DISCUSSION AND CONCLUSIONS

Overall, ADHD symptoms were positively associated with problem gambling. CMDs, BPD traits, and stressful life events were important mediators in this relationship.

Distinct Response Inhibition Patterns in Obsessive Compulsive Disorder Patients and Pathological Gamblers

Background: Obsessive-compulsive disorder (OCD) and pathological gambling (PG) are common disorders. The cognitive models of OCD and PG focus on abnormalities in response inhibition. Although, these functions have been studied in different PG and OCD samples, no study has compared the response inhibition in both. Methods: Medication-naïve OCD (n = 61) and PG subjects (n = 109) and healthy controls (n = 131) performed CPT and Go/NoGo tasks. Results: Compared to healthy controls (HC), PG and OCD groups underperformed on speed and exhibited larger time variability on the CPT and Go/NoGo task. Only in OCD patients, a positive correlation between omission errors and response time (RT) was observed in the CPT. At the Go/NoGo task, a negative correlation between false alarms and RT (a fast-errors trade-off) was significant only in the PG group. The HC group had greater sensitivity values (d') than the OCD and PG groups in the Go/NoGo task. The PG group displayed lower d' values and more conservative response criterion in the CPT. In addition, only the OCD group expressed a high switching cost compared to both the PG and HC groups in terms of the RT and d' values. Conclusions: Both the PG and OCD groups demonstrated impaired response inhibition compared to the HC group. On several measures, the OCD and PG groups showed comparable impairments, and in others these were distinct. Thus, it appears that distinct neurocognitive patterns are involved in performance of the CPT and the Go/NoGo tasks among OCD and PG subjects whose cognitive status is currently under intensive investigation.

Cognitive Remediation Interventions for Gambling Disorder: A Systematic Review

Various therapeutic approaches are available for the treatment of gambling disorder (GD), especially cognitive behavioral therapy (CBT; the most widely used treatment). However, CBT has high dropout and relapse rates as well as non-compliance issues, which may be partly due to resistance to changing core characteristics, such as executive functioning, attention, and emotional regulation abnormalities. Finding new therapeutic approaches to treat GD is thus a key challenge. Cognitive remediation (CR) interventions represent a promising approach to GD management, which has recently been demonstrated to have efficacy for treating other addictive disorders. The objective of this review is to describe the possible benefits of CR interventions for GD management. Two systematic searches in MEDLINE and ScienceDirect databases were conducted up until January 2017. Potential neurocognitive targets of CR interventions for GD were reviewed, as is the use and efficacy of such interventions for GD. While there is evidence of several neurocognitive deficits in individuals with GD in terms of impulsive, reflective, and interoceptive processes, the literature on CR interventions is virtually absent. No clinical studies were found in the literature, apart from a trial of a very specific program using Playmancer, a serious videogame, which was tested in cases of bulimia nervosa and GD. However, neurocognitive impairments in individuals with addictive disorders are highly significant, not only affecting quality of life, but also making abstinence and recovery more difficult. Given that CR interventions represent a relatively novel therapeutic approach to addiction and that there is currently a scarcity of studies on clinical populations suffering from GD, further research is needed to examine the potential targets of such interventions and the effectiveness of different training approaches. So far, no consensus has been reached on the optimal parameters of CR interventions (duration, intensity, frequency, group vs. individual, pencil-and-paper vs. computerized delivery, etc.). Although no firm conclusions can be drawn, CR interventions represent a promising adjunct treatment for GD. Such a novel therapy could be associated with common interventions, such as CBT and educational and motivational interventions, in order to make therapies more effective and longer-lasting and to decrease the risk of relapse.

Gambling disorder: an integrative review of animal and human studies

Gambling disorder (GD), previously called pathological gambling and classified as an impulse control disorder in DSM-III and DSM-IV, has recently been reclassified as an addictive disorder in the DSM-5. It is widely recognized as an important public health problem associated with substantial personal and social costs, high rates of psychiatric comorbidity, poor physical health, and elevated suicide rates. A number of risk factors have been identified, including some genetic polymorphisms. Animal models have been developed in order to study the underlying neural basis of GD. Here, we discuss recent advances in our understanding of the risk factors, disease course, and pathophysiology. A focus on a phenotype-based dissection of the disorder is included in which known neural correlates from animal and human studies are reviewed. Finally, current treatment approaches are discussed, as well as future directions for GD research.

Comparison of impulsivity in non-problem, at-risk and problem gamblers

As a non-substance addiction, gambling disorder represents the model for studying the neurobiology of addiction without toxic consequences of chronic drug use. From a neuropsychological perspective, impulsivity is deemed as a potential construct responsible in the onset and development of drug addiction. The objective of this study was to investigate the associations between impulsivity and gambling status in young adults with varying severity of gambling. A sample of 1120 college students, equally divided into non-problem, at-risk and problem gamblers, were administered multiple measures of impulsivity including the UPPSP Impulsive Behaviors Scale (UPPSP), the Barratt Impulsiveness Scale-11 (BIS-11), and the Delay-discounting Test (DDT). Compared with non-problem gamblers, both at-risk gamblers and problem gamblers displayed elevated scores on Negative Urgency, Positive Urgency, Motor Impulsiveness, and Attentional Impulsiveness. Problem gamblers showed higher scores than at-risk gamblers on Positive Urgency. Logistic regression models revealed that only Negative Urgency positively predicted both at-risk gambling and problem gambling compared to non-problem gambling. These results suggest that dimensions of impulsivity may be differentially linked to gambling behavior in young adults, with Negative Urgency putatively identified as an important impulsivity-related marker for the development of gambling disorder, which may provide a better understanding of the pathogenesis.

Gambling, Delay, and Probability Discounting in Adults With and Without ADHD

OBJECTIVE

We investigated the relationship between impulsivity, as measured by delay and probability discounting, and gambling-related cognitions and behavior in adults with and without ADHD.

METHOD

Adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnostic criteria for ADHD (n = 31) and controls (n = 29) were recruited from the community. All completed an interview that included an assessment of psychiatric disorders, gambling questionnaires, and simulated gambling, delay, and probability discounting tasks.

RESULTS

The ADHD group was more likely to meet the criteria for problem gambling and was more impulsive than controls based on a composite discounting measure. ADHD symptoms were correlated with gambling-related cognitions and behavior. Probability, but not delay discounting, explained significant variance in gambling-related measures after controlling for ADHD symptoms.

DISCUSSION

Results confirm an association between adult ADHD and gambling, and suggest that the facets of impulsivity related to risk proneness may be an independent risk factor for problem gambling in this population.

Personality traits in adults with attention-deficit hyperactivity disorder and their unaffected first-degree relatives

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) shows clear, albeit heterogeneous, cognitive dysfunctions. However, personality traits are not well understood in adults with ADHD, and it is unclear whether they are predisposing factors or phenotypical facets of the condition.

AIMS

To assess whether personality traits of impulsivity, sensation seeking and sensitivity to punishment and reward are predisposing factors for ADHD or aspects of the clinical phenotype.

METHOD

Twenty adults with ADHD, 20 unaffected first-degree relatives and 20 controls completed rating scales assessing traits of impulsivity, sensation seeking and sensitivity to punishment/reward.

RESULTS

Compared with relatives and controls, individuals with ADHD showed increased impulsive personality traits, were more susceptible to boredom and presented hypersensitivity to reward but normal sensitivity to punishment.

CONCLUSIONS

High impulsivity traits, heightened sensitivity to reward and boredom are associated with the phenotype of ADHD, rather than being predisposing factors, as these traits were not shared between ADHD probands and their relatives.

DECLARATION OF INTEREST

E.T.B. is employed part-time by GSK and part-time by the University of Cambridge; he holds stock in GSK. B.J.S. consults for Cambridge Cognition, Servier and Lundbeck; she holds a grant from Janssen/J&J. U.M. has received honoraria for consultancy and speaking at conferences and travel expenses from Bristol-Myers Squibb, Eli Lilly, Janssen-Cilag, Lundbeck, Pharmacia-Upjohn and UCB Pharma.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Gambling and Attention Deficit Hyperactivity Disorders (ADHD) in a Population of French Students

Attention deficit disorder with or without hyperactivity (ADD/ADHD) is a neurodevelopmental disorder that can be exacerbated by psychosocial factors. Various studies confirm that the severity of a psychiatric disorder, particularly when it comes to ADHD, is strongly correlated with the amount of use. This study (1) evaluated the association between ADHD and gambling among young students; (2) determined which symptom among ADHD's three symptoms (attention deficit, hyperactivity, or impulsivity) had the strongest association with video game addiction and gambling; and (3) determined the impact of the association between ADHD and video game addiction and gambling on self-esteem and academic performance of students. A total of 720 students (445 males and 274 females) were recruited from eight higher educational institutions of Ile de France. They all completed a battery of questionnaire consisting of Canadian Problem Gambling Index, UPPS Impulsive Behavior Scale, Wender Utah Rating Scale (WURS), Adult ADHD Self-Report Scale (ASRS) and Rosenberg scales, and socio-demographic data. 13.33% of the participants had symptoms of ADHD during childhood (WURS scale score) and 40.41% of them have symptoms of ADHD in adulthood (ASRS score). Finally, among the participants, 37.5% had excessive gambling addiction, have positive results on WURS and ASRS scales, thus having a probable ADHD, whereas 14.55% had no gambling addiction. The results demonstrated that adult ADHD was associated with gambling addiction. Significant associations were observed between ADHD and impulsivity, academic difficulties and gambling addiction. The association between ADHD and gambling seems to be common among vulnerable populations such as adolescents and could be related to variables such as self-esteem, which appears to potentially worsen the prognosis. Further research on this relationship is needed to optimize prevention strategies and effective treatment.

Gambling behaviors and psychopathology related to Attention-Deficit/Hyperactivity Disorder (ADHD) in problem and non-problem adult gamblers

Previous studies showed that Pathological Gambling and Attention Deficit/Hyperactivity Disorder (ADHD) often co-occur. The aim of this study was to examine whether ADHD is associated with specific severity patterns in terms of gambling behavior, psychopathology and personality traits. 599 problem and non-problem-gamblers were recruited in addiction clinics and gambling places in France. Subjects were assessed with the Wender-Utah Rating Scale-Child, the Adult ADHD Self-Report Scale, the Mini International Neuropsychiatric Interview, the Temperament and Character Inventory, the South Oaks Gambling Screen and questionnaires assessing gambling related cognitive distortions and gambling habits. 20.7% (n=124) of gamblers were screened positive for lifetime or current ADHD. Results from the multivariate analysis showed that ADHD was associated with a higher severity of gambling-related problems and with more psychiatric comorbidity. Among problem gamblers, subjects with history of ADHD were also at higher risk for unemployment, psychiatric comorbidity and specific dysfunctional personality traits. This study supports the link between gambling related problems and ADHD in a large sample of problem and non-problem gamblers, including problem-gamblers not seeking treatment. This points out the necessity to consider this disorder in the prevention and in the treatment of pathological gambling.

Ability to use the wait-and-see strategy in pathological gamblers

Pathological gamblers (PGs) perform differently on neurocognitive tests than do healthy controls (HC). The aim of this study was to assess "waiting ability" - a major components of inhibition control-using a modified Stop Signal Task (SST) in a population of male PGs (N=55), and HCs (N=53). Results indicated no differences between PGs and HCs in reaction times, intra-individual response variability, or number of false alarms and misses. In conclusion, PGs were not impaired in their ability to manipulate their on-line response strategy during the experimental task and were instead able to change their strategy to decrease the number of false alarms. However, much more empirical and theoretical work needs to be carried out in order to understand the key neural basis of impulsivity among PGs.

Beta-adrenoreceptor blockade abolishes atomoxetine-induced risk taking

RATIONALE

Clinical studies have shown that patients with exaggerated risk-taking tendencies have high baseline levels of norepinephrine. In this work, we systemically manipulated norepinephrine levels in rats and studied their behavioral changes in a probabilistic discounting task, which is a paradigm for gauging risk taking.

METHODS

This study aims to explore the effects of the selective norepinephrine reuptake inhibitor (atomoxetine at doses of 0.6, 1.0 and 1.8 mg/kg), and receptor selective antagonists (propranolol at a single dose of 1.0/kg, and prazosin at a single dose of 0.1 mg/kg), on risk taking using a probabilistic discounting task. In this task, there were two levers available to rats: pressing the 'small/certain' lever guaranteed a single food pellet, and pressing the 'large/risky' lever yielded either four pellets or none. The probability of receiving four food pellets decreased across the four experimental blocks from 100% to 12.5%.

RESULTS

Atomoxetine increased the tendency to choose the large/risky lever. It significantly reduced the lose-shift effect (i.e. pressing a different lever after losing a trial), but did not affect the win-stay effect (i.e. pressing the same lever after winning a trial). Furthermore, co-administration of beta-adrenoreceptor antagonist, propranolol, eliminated the effects of atomoxetine on risk taking and the lose-shift effect; but co-administration of alpha1-adrenoreceptor antagonist, prazosin, did not.

CONCLUSIONS

Atomoxetine boosted NE levels and increased risk taking. This was because atomoxetine decreased rats' sensitivity to losses. These effects were likely mediated by beta-adrenoreceptor.

Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder

Objectives. (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. Method. A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. Results. Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18–35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. Conclusion. The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.

Guanfacine enhances inhibitory control and attentional shifting in early abstinent cocaine-dependent individuals

OBJECTIVES

Attenuation of adrenergic drive and cognitive enhancement, via stimulation of alpha2 pre- and post-synaptic receptors, may selectively enhance executive performance in early abstinent cocaine-dependent individuals. As these cognitive processes underpin important treatment-related behaviors, the alpha2 agonist, guanfacine HCl, may represent an effective pharmaco-therapeutic intervention.

METHODS

Twenty-five early abstinent cocaine-dependent individuals were administered a battery of neurocognitive tasks on entry into treatment (baseline) and again following 3 weeks of either placebo or guanfacine treatment (up to 3 mg). Tasks included: Stop Signal, Stroop, 3-Dimentional Intra-dimensional/Extra-dimensional (IDED) task, Spatial Working Memory (SWM), Paired Associates Learning (PAL), Verbal Fluency and the Rey Auditory Verbal Learning Test (RAVLT).

RESULTS

Compared with placebo, the guanfacine group demonstrated attenuated anxiety and negative affect as well as improved performance on selective executive tests. This included fewer directional errors on the stop signal task, fewer errors on the extra-dimensional shift component of the IDED task and better attentional switching during verbal fluency. Guanfacine did not improve strategic working memory or peripheral memory.

CONCLUSION

Guanfacine improves selective cognitive processes which may underlie salient treatment-related regulatory behaviors. Alpha2 agonists may therefore represent important agents for cocaine dependence.

Impact of ADHD symptoms on clinical and cognitive aspects of problem gambling

BACKGROUND

Problem gambling is common across cultures, and has been conceptualized in terms of impulsivity. While elevated rates of attention deficit hyperactivity disorder (ADHD) have been observed in problem gamblers, the relationship between these two conditions, and other dissociable forms of impulsivity, has received little research attention.

METHODS

N=126 non-treatment seeking young adults with problem gambling were recruited from the community, and were grouped according to the presence or absence of probable current ADHD. Clinical and cognitive measures pertaining to impulsivity were collected via detailed psychiatric assessment, questionnaires, and computerized neuropsychological tests. These variables were compared between groups.

RESULTS

Probable current ADHD was identified in 21.4% of the sample, and was associated with earlier age at onset of gambling behaviors, higher Barratt impulsivity scores (all three subscales), greater caffeine intake, worse response inhibition (Stop-Signal Test), and impaired decision-making (greater proportion of points gambled, Cambridge Gamble Test). Problem gamblers with and without ADHD did not differ on demographic characteristics or the rate of other psychiatric disorders, depression scores, nicotine and alcohol consumption, and body mass index. No significant group differences were found for general response speed, working memory, or executive planning.

CONCLUSIONS

ADHD is common in young adults with dysfunctional gambling behaviors and is associated with elevated questionnaire and cognitive based measures of impulsivity, along with heightened caffeine use. Future work should study the causal nature between these factors and the treatment implications of these findings.

Deficits in behavioural inhibition in substance abuse and addiction: a meta-analysis

AIMS

Deficits in behavioural inhibitory control are attracting increasing attention as a factor behind the development and maintenance of substance dependence. However, evidence for such a deficit is varied in the literature. Here, we synthesised published results to determine whether inhibitory ability is reliably impaired in substance users compared to controls.

METHODS

The meta-analysis used fixed-effects models to integrate results from 97 studies that compared groups with heavy substance use or addiction-like behaviours with healthy control participants on two experimental paradigms commonly used to assess response inhibition: the Go/NoGo task, and the Stop-Signal Task (SST). The primary measures of interest were commission errors to NoGo stimuli and stop-signal reaction time in the SST. Additionally, we examined omission errors to Go stimuli, and reaction time in both tasks. Because inhibition is more difficult when inhibition is required infrequently, we considered papers with rare and equiprobable NoGo stimuli separately.

RESULTS

Inhibitory deficits were apparent for heavy use/dependence on cocaine, MDMA, methamphetamine, tobacco, and alcohol (and, to a lesser extent, non-dependent heavy drinkers), and in pathological gamblers. On the other hand, no evidence for an inhibitory deficit was observed for opioids or cannabis, and contradictory evidence was observed for internet addiction.

CONCLUSIONS

The results are generally consistent with the view that substance use disorders and addiction-like behavioural disorders are associated with impairments in inhibitory control. Implications for treatment of substance use are discussed, along with suggestions for future research arising from the limitations of the extant literature.

Impaired Decision Making is Associated with Poor Inhibition Control in Nonpathological Lottery Gamblers

Previous studies by questionnaires have demonstrated that lottery gamblers who have not meet the criteria of pathological gambler show greater gambling acceptability. However, few empirical evidence of whether such nonpathological lottery gamblers (NPLGs) display the same impairments of decision making with pathological gamblers has been found so far. In present study, NPLGs and matched controls (MCs) were asked to perform the Iowa Gambling Task (IGT) and inter-temporal choice task (ICT). We found that compared to MCs, NPLGs displayed much lower IGT scores, net gains and proportions of advantageous decks in the IGT task and much higher percentages of trials during which smaller-but-sooner rewards were chosen in the ICT. These findings indicate that NPLGs display much more risky and impulsive decision makings, just like pathological gamblers in the previous studies. Next, the Go/NoGo task was employed to explore the role of response inhibition in the impairment of decision making in NPLGs. We found that NPLGs did show much higher commission errors compared to MCs. Moreover, IGT scores, net gain and proportions of advantageous decks were significantly negatively correlated with commission errors, which indicates that poor response inhibition might be involved in the impairments of decision making in NPLGs. To our knowledge, we provided the first empirical evidence of impairment of decision making and its cognitive mechanisms in NPLGs.

A model-based analysis of impulsivity using a slot-machine gambling paradigm

Impulsivity plays a key role in decision-making under uncertainty. It is a significant contributor to problem and pathological gambling (PG). Standard assessments of impulsivity by questionnaires, however, have various limitations, partly because impulsivity is a broad, multi-faceted concept. What remains unclear is which of these facets contribute to shaping gambling behavior. In the present study, we investigated impulsivity as expressed in a gambling setting by applying computational modeling to data from 47 healthy male volunteers who played a realistic, virtual slot-machine gambling task. Behaviorally, we found that impulsivity, as measured independently by the 11th revision of the Barratt Impulsiveness Scale (BIS-11), correlated significantly with an aggregate read-out of the following gambling responses: bet increases (BIs), machines switches (MS), casino switches (CS), and double-ups (DUs). Using model comparison, we compared a set of hierarchical Bayesian belief-updating models, i.e., the Hierarchical Gaussian Filter (HGF) and Rescorla-Wagner reinforcement learning (RL) models, with regard to how well they explained different aspects of the behavioral data. We then examined the construct validity of our winning models with multiple regression, relating subject-specific model parameter estimates to the individual BIS-11 total scores. In the most predictive model (a three-level HGF), the two free parameters encoded uncertainty-dependent mechanisms of belief updates and significantly explained BIS-11 variance across subjects. Furthermore, in this model, decision noise was a function of trial-wise uncertainty about winning probability. Collectively, our results provide a proof of concept that hierarchical Bayesian models can characterize the decision-making mechanisms linked to the impulsive traits of an individual. These novel indices of gambling mechanisms unmasked during actual play may be useful for online prevention measures for at-risk players and future assessments of PG.

Are executive function and impulsivity antipodes? A conceptual reconstruction with special reference to addiction

RATIONALE

Although there is considerable interest in how either executive function (EF) or impulsivity relate to addiction, there is little apparent overlap between these research areas.

OBJECTIVES

The present paper aims to determine if components of these two constructs are conceptual antipodes--widely separated on a shared continuum.

METHODS

EFs and impulsivities were compared and contrasted. Specifically, the definitions of the components of EF and impulsivity, the methods used to measure the various components, the populations of drug users that show deficits in these components, and the neural substrates of these components were compared and contrasted.

RESULTS

Each component of impulsivity had an antipode in EF. EF, however, covered a wider range of phenomena, including compulsivity.

CONCLUSIONS

Impulsivity functions as an antipode of certain components of EF. Recognition of the relationship between EF and impulsivity may inform the scientific inquiry of behavioral problems such as addiction. Other theoretical implications are discussed.

Investigating facets of personality in adult pathological gamblers with ADHD

The present study explored facets of personality in a sample of pathological gamblers with ADHD (n = 52) and without ADHD (n = 43). Participants were assessed for psychopathology and gambling disorders using the Mini International Neuropsychiatric Interview, the National Opinion Research Center DSM Screen for Gambling Problems, and the Adult ADHD Self-Report Scale. Facets of personality were assessed using the NEO Personality Inventory-Revised. Group differences emerged across several facets of personality when analyzed using multivariate statistics. Although both groups experienced difficulties in several areas compared with norming data (e.g., greater depression, higher impulsivity, lower self-esteem and lower self-discipline), these facets of personality were more pronounced in pathological gamblers with ADHD. Most notable among these differences are tendencies for gamblers with ADHD to experience greater levels of emotional instability, interpersonal sensitivity and stress proneness. Pathological gamblers with ADHD also appear to experience lower self-esteem, greater difficulty being assertive and lower levels of self-discipline. Surprisingly, both groups were comparable on facets of impulsivity. These findings suggest that pathological gamblers diagnosed with adult ADHD may experience additional challenges compared with pathological gamblers without ADHD.

Response inhibition during cue reactivity in problem gamblers: an fMRI study

Disinhibition over drug use, enhanced salience of drug use and decreased salience of natural reinforcers are thought to play an important role substance dependence. Whether this is also true for pathological gambling is unclear. To understand the effects of affective stimuli on response inhibition in problem gamblers (PRGs), we designed an affective Go/Nogo to examine the interaction between response inhibition and salience attribution in 16 PRGs and 15 healthy controls (HCs).

Four affective blocks were presented with Go trials containing neutral, gamble, positive or negative affective pictures. The No-Go trials in these blocks contained neutral pictures. Outcomes of interest included percentage of impulsive errors and mean reaction times in the different blocks. Brain activity related to No-Go trials was assessed to measure response inhibition in the various affective conditions and brain activity related to Go trials was assessed to measure salience attribution.

PRGs made fewer errors during gamble and positive trials than HCs, but were slower during all trials types. Compared to HCs, PRGs activated the dorsolateral prefrontal cortex, anterior cingulate and ventral striatum to a greater extent while viewing gamble pictures. The dorsal lateral and inferior frontal cortex were more activated in PRGs than in HCs while viewing positive and negative pictures. During neutral inhibition, PRGs were slower but similar in accuracy to HCs, and showed more dorsolateral prefrontal and anterior cingulate cortex activity. In contrast, during gamble and positive pictures PRGs performed better than HCs, and showed lower activation of the dorsolateral and anterior cingulate cortex.

This study shows that gambling-related stimuli are more salient for PRGs than for HCs. PRGs seem to rely on compensatory brain activity to achieve similar performance during neutral response inhibition. A gambling-related or positive context appears to facilitate response inhibition as indicated by lower brain activity and fewer behavioural errors in PRGs.

Similar hyporesponsiveness of the dorsomedial prefrontal cortex in problem gamblers and heavy smokers during an inhibitory control task

BACKGROUND

Behavioral addictions like pathological gambling share many clinical characteristics with substance dependence. In addition, both types of disorders are associated with impairments in inhibitory control. Studies in patients with substance use disorders point to hyporesponsiveness of the dorsomedial prefrontal cortex. However, no such data exist on behavioral addictions.

METHODS

Using functional magnetic resonance imaging, we investigated the neural circuitry associated with impaired response inhibition in a group of male problem gamblers (n=17) using a stop signal task. We included control conditions tailored to specifically isolate neural correlates of inhibitory control. To investigate the specificity of effects, a group of heavy smokers (n=18) and a group of healthy controls (n=17) were also included.

RESULTS

Groups did not differ in behavioral performance on the stop signal task. However, both problem gamblers and heavy smokers showed hyporesponsiveness of the dorsomedial prefrontal cortex compared to healthy controls, during successful as well as failed response inhibition. These effects were robust against adjustments for depression and adult attention deficit scores.

CONCLUSIONS

These findings suggest that hypoactivation of the inhibition circuit is a shared neural mechanism in substance use disorders and behavioral addictions. As such, they support the reclassification of pathological gambling as a behavioral addiction in DSM-V.

Similarities and differences between pathological gambling and substance use disorders: a focus on impulsivity and compulsivity

RATIONALE

Pathological gambling (PG) has recently been considered as a "behavioral" or nonsubstance addiction. A comparison of the characteristics of PG and substance use disorders (SUDs) has clinical ramifications and could help advance future research on these conditions. Specific relationships with impulsivity and compulsivity may be central to understanding PG and SUDs.

OBJECTIVES

This review was conducted to compare and contrast research findings in PG and SUDs pertaining to neurocognitive tasks, brain function, and neurochemistry, with a focus on impulsivity and compulsivity.

RESULTS

Multiple similarities were found between PG and SUDs, including poor performance on neurocognitive tasks, specifically with respect to impulsive choice and response tendencies and compulsive features (e.g., response perseveration and action with diminished relationship to goals or reward). Findings suggest dysfunction involving similar brain regions, including the ventromedial prefrontal cortex and striatum and similar neurotransmitter systems, including dopaminergic and serotonergic. Unique features exist which may in part reflect influences of acute or chronic exposures to specific substances.

CONCLUSIONS

Both similarities and differences exist between PG and SUDs. Understanding these similarities more precisely may facilitate treatment development across addictions, whereas understanding differences may provide insight into treatment development for specific disorders. Individual differences in features of impulsivity and compulsivity may represent important endophenotypic targets for prevention and treatment strategies.

A neurocognitive comparison of cognitive flexibility and response inhibition in gamblers with varying degrees of clinical severity

BACKGROUND

As a behavioral addiction with clinical and phenomenological similarities to substance addiction, recreational and pathological gambling represent models for studying the neurobiology of addiction, without the confounding deleterious brain effects which may occur from chronic substance abuse.

METHOD

A community sample of individuals aged 18-65 years who gamble was solicited through newspaper advertising. Subjects were grouped a priori into three groups (no-risk, at-risk, and pathological gamblers) based on a diagnostic interview. All subjects underwent a psychiatric clinical interview and neurocognitive tests assessing motor impulsivity and cognitive flexibility. Subjects with a current axis I disorder, history of brain injury/trauma, or implementation or dose changes of psychoactive medication within 6 weeks of study enrollment were excluded.

RESULTS

A total of 135 no-risk, 69 at-risk and 46 pathological gambling subjects were assessed. Pathological gamblers were significantly older, and exhibited significant deficiencies in motor impulse control (stop-signal reaction times), response speed (median 'go' trial response latency) and cognitive flexibility [total intra-dimensional/extra-dimensional (IDED) errors] versus controls. The finding of impaired impulse control and cognitive flexibility was robust in an age-matched subgroup analysis of pathological gamblers. The no-risk and at-risk gambling groups did not significantly differ from each other on task performance.

CONCLUSIONS

Impaired response inhibition and cognitive flexibility exist in people with pathological gambling compared with no-risk and at-risk gamblers. The early identification of such illness in adolescence or young adulthood may aid in the prevention of addiction onset of such disabling disorders.

Glücksspiel im Gehirn: Neurobiologische Grundlagen pathologischen Glücksspielens

Hintergrund: Pathologisches Glücksspielen (PG) wird in den internationalen Klassifikationssystemen bislang als Impulskontrollstörung klassifiziert. Erst in jüngster Zeit wird aufgrund der Ähnlichkeiten in Phänomenologie, Ätiologie, Verlauf sowie genetischen und neurobiologischen Faktoren mit der Substanzabhängigkeit eine Einordnung des PGs als Verhaltenssucht diskutiert. Insbesondere neurobiologische und neuropsychologische Befunde haben zu dieser veränderten Sichtweise beigetragen. Methode: Im vorliegenden Beitrag werden Befunde zu neurobiologischen Grundlagen PGs vorgestellt. Der Schwerpunkt liegt auf neurokognitiven Prozessen wie Belohnungs- und Bestrafungsverarbeitung, Cue-Reaktivität, Impulsivität und Entscheidungsfindung. Die Befunde werden im Hinblick auf Ähnlichkeiten und Unterschiede PGs zur Substanzabhängigkeit diskutiert. Ergebnisse: Ähnlich wie bei der Substanzabhängigkeit zeigt sich auch bei pathologischen Spielern Veränderungen mesolimbischer-präfrontaler Netzwerke, die sich in einer verminderten Belohnungs- und Bestrafungssensitivität, Impulshemmung und einer erhöhten Cue-Reaktivität auf glücksspielassoziierte Reize äußern können. Jedoch sind die Befunde teilweise nicht eindeutig und eine Vielzahl der Studien unterliegt methodischen Einschränkungen. Schlussfolgerungen: Bisherige Befunde stützen die Einordnung pathologischen Spielverhaltens als Verhaltenssucht.

Inhibitory control and psychopathology: a meta-analysis of studies using the stop signal task

The Stop Signal Task (SST) is a measure that has been used widely to assess response inhibition. We conducted a meta-analysis of studies that examined SST performance in patients with various psychiatric disorders to determine the magnitude and generality of deficient inhibition. A five-item instrument was used to assess the methodological quality of studies. We found medium deficits in stop signal reaction time (SSRT), reflecting the speed of the inhibitory process, for attention-deficit hyperactivity disorder (ADHD) (g = 0.62), obsessive compulsive disorder (OCD) (g = 0.77) and schizophrenia (SCZ) (g = 0.69). SSRT was less impaired or normal for anxiety disorder (ANX), autism, major depressive disorder (MDD), oppositional defiant disorder/conduct disorder (ODD/CD), pathological gambling, reading disability (RD), substance dependence, and Tourette syndrome. We observed a large SSRT deficit for comorbid ADHD + RD (g = 0.82). SSRT was less than moderately impaired for ADHD + ANX and ADHD + ODD/CD. Study quality did not significantly affect SSRT across ADHD studies. This confirms an inhibition deficit in ADHD, and suggests that comorbid ADHD has different effects on inhibition in patients with ANX, ODD/CD, and RD. Further studies are needed to firmly establish an inhibition deficit in OCD and SCZ.

Does early emotional distress predict later child involvement in gambling?

OBJECTIVE

Younger people are engaging in gambling, with some showing excessive involvement. Although a consequence of gambling could be anxiety and depression, emotional distress could be a precursor to gambling involvement. This could reflect developmental proneness toward problem behaviour. We assessed whether early emotional distress directly influences later gambling or if it operates through an indirect pathway.

METHODS

Using a prospective longitudinal design, an intentional subsample of children from the 1999 kindergarten cohort of the Montreal Longitudinal Preschool Study (Quebec) from intact families were retraced in 2005 for follow-up in Grade 6. Consenting parents and children were separately interviewed. Key child variables and sources included kindergarten teacher ratings of emotional distress and impulsivity and self-reported parent and child gambling.

RESULTS

Higher levels of teacher-rated emotional distress in kindergarten significantly predicted a higher propensity toward later gambling behaviour. Impulsivity, a factor often comorbidly present with emotional distress, completely explained this predictive relation above and beyond potential child- and family-related confounds, including parental gambling.

CONCLUSIONS

Children with higher levels of emotional distress at kindergarten were more inclined toward child gambling behaviour in Grade 6. The influence of early emotional distress completely vanished when behaviours reflecting impulsivity were considered when predicting later child gambling behaviour. The relation between emotional distress and child gambling involvement in children was thus explained by its comorbidity with early impulsivity. This study does not rule out the possibility that emotional distress could become a correlate or consequence of excessive involvement in gambling activities at a later developmental period.