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

Differential neurocognitive profiles in adult attention-deficit/hyperactivity disorder subtypes revealed by the Cambridge Neuropsychological Test Automated Battery

Adult attention-deficit/hyperactivity disorder (aADHD) represents a heterogeneous entity incorporating different subgroups in terms of symptomatology, course, and neurocognition. Although neurocognitive dysfunction is generally associated with aADHD, its severity, association with self-reported symptoms, and differences between subtypes remain unclear. We investigated 61 outpatients (65.6% male, mean age 31.5 ± 9.5) diagnosed using DSM-5 criteria together with age-, sex-, and education-matched healthy controls (HC) (n = 58, 63.8% male, mean age 32.3 ± 9.6). Neurocognitive alterations were assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and compared between groups using the generalized linear model (GLM) method. Multivariate effects were tested by principal component analysis combined with multivariate pattern analysis. Self-reported symptom severity was tested for correlations with neurocognitive performance. GLM analyses revealed nominally significant differences between the aADHD and HC groups in several domains, however, only the Rapid Visual Information Processing measures survived correction, indicating impaired sustained attention and response inhibition in the aADHD group. Comparison of the predominantly inattentive and the hyperactive-impulsive/combined subtypes yielded nominally significant differences with higher levels of dysfunction in the inattentive group. In the stepwise discriminant analysis aADHD and HC groups were best separated with 2 factors representing sustained attention and reaction time. We found only weak correlations between symptom severity and CANTAB factors. aADHD patients are neuropsychologically heterogeneous and subtypes show different neurocognitive profiles. Differences between the aADHD and HC groups were driven primarily by the inattentive subtype. Sustained attention and its factor derivative showed the most significant alterations in aADHD patients.

Polygenic contributions to performance on the Balloon Analogue Risk Task

Risky decision-making is a common, heritable endophenotype seen across many psychiatric disorders. Its underlying genetic architecture is incompletely explored. We examined behavior in the Balloon Analogue Risk Task (BART), which tests risky decision-making, in two independent samples of European ancestry. One sample (n = 1138) comprised healthy participants and some psychiatric patients (53 schizophrenia, 42 bipolar disorder, 47 ADHD); the other (n = 911) excluded for recent treatment of various psychiatric disorders but not ADHD. Participants provided DNA and performed the BART, indexed by mean adjusted pumps. We constructed a polygenic risk score (PRS) for discovery in each dataset and tested it in the other as replication. Subsequently, a genome-wide MEGA-analysis, combining both samples, tested genetic correlation with risk-taking self-report in the UK Biobank sample and psychiatric phenotypes characterized by risk-taking (ADHD, Bipolar Disorder, Alcohol Use Disorder, prior cannabis use) in the Psychiatric Genomics Consortium. The PRS for BART performance in one dataset predicted task performance in the replication sample (r = 0.13, p = 0.000012, pFDR = 0.000052), as did the reciprocal analysis (r = 0.09, p = 0.0083, pFDR=0.04). Excluding participants with psychiatric diagnoses produced similar results. The MEGA-GWAS identified a single SNP (rs12023073; p = 3.24 × 10-8) near IGSF21, a protein involved in inhibitory brain synapses; replication samples are needed to validate this result. A PRS for self-reported cannabis use (p = 0.00047, pFDR = 0.0053), but not self-reported risk-taking or psychiatric disorder status, predicted behavior on the BART in our MEGA-GWAS sample. The findings reveal polygenic architecture of risky decision-making as measured by the BART and highlight its overlap with cannabis use.

Risky Decision-Making in Adults with Alcohol Use Disorder-A Systematic and Meta-Analytic Review

Alcohol use disorder (AUD) forms a major health concern and is the most common substance use disorder worldwide. The behavioural and cognitive deficits associated with AUD have often been related to impairments in risky decision-making. The aim of this study was to examine the magnitude and type of risky decision-making deficits of adults with AUD, as well as to explore the potential mechanisms behind these deficits. To this end, existing literature comparing risky decision-making task performance of an AUD group to a control group (CG) was systematically searched and analysed. A meta-analysis was performed to address overall effects. In total, 56 studies were included. In the majority of studies (i.e., 68%), the performance of the AUD group(s) deviated from the CG(s) on one or more of the adopted tasks, which was confirmed by a small to medium pooled effect size (Hedges' g = 0.45). This review therefore provides evidence of increased risk taking in adults with AUD as compared to CGs. The increased risk taking may be due to deficits in affective and deliberative decision-making. Making use of ecologically valid tasks, future research should investigate whether risky decision-making deficits predate and/or are consequential to the addiction of adults with AUD.

ADHD co-morbidities: A review of implication of gene × environment effects with dopamine-related genes

ADHD is a major burden in adulthood, where co-morbid conditions such as depression, substance use disorder and obesity often dominate the clinical picture. ADHD has substantial shared heritability with other mental disorders, contributing to comorbidity. However, environmental risk factors exist but their interaction with genetic makeup, especially in relation to comorbid disorders, remains elusive. This review for the first time summarizes present knowledge on gene x environment (GxE) interactions regarding the dopamine system. Hitherto, mainly candidate (GxE) studies were performed, focusing on the genes DRD4, DAT1 and MAOA. Some evidence suggest that the variable number tandem repeats in DRD4 and MAOA may mediate GxE interactions in ADHD generally, and comorbid conditions specifically. Nevertheless, even for these genes, common variants are bound to suggest risk only in the context of gender and specific environments. For other polymorphisms, evidence is contradictory and less convincing. Particularly lacking are longitudinal studies testing the interaction of well-defined environmental with polygenic risk scores reflecting the dopamine system in its entirety.

Decision-making and Risky Behavior in Individuals with Attention-Deficit/Hyperactivity Disorder: A 10-year Longitudinal Study

We assessed 85 children with Attention-Deficit/Hyperactivity Disorder (ADHD) and 50 typically developing children (TD) (M_age = 11.59, 57.8% boys) with the Hungry Donkey Task (HDT) at baseline and 2-year follow-up, and the Iowa Gambling Task at 10-year follow-up (75% retention). Improvement in the proportion of advantageous choices was observed from two- to 10-year follow-up, but the ADHD group improved less and was outperformed by the TD group at the 10-year follow-up. More advantageous choices on the HDT at baseline predicted less risky behavior at 10-year follow-up. Male sex and more inattentive or externalizing symptoms at baseline predicted more risky behavior.

Risk Behaviors in Youth With and Without Tourette Syndrome

BACKGROUND

Specific health-risk behaviors are present in older adolescents and young adults wtih Tourette syndrome (TS), but little is known about health-risk behaviors in youth with TS.

METHODS

We compared responses on the Youth Risk Behavior Surveillance System (YRBS) in youth with TS with those in a concurrent community control group. The YRBS evaluates risk behaviors most closely associated with morbidity and mortality in young people. Tic severity, presence of comorbid attention-deficit/hyperactivity disorder (ADHD), measures of ADHD symptom severity, and whether or not the individual had been bullied in school were also compared between the groups.

RESULTS

Data from 52 youth with TS and 48 control youth were included. We did not detect any differences between control youth and youth with TS in the reporting of risky behaviors. Tic severity was not significantly associated with high-risk behavior. However, ADHD was significantly more common in youth with TS (P < 0.0002), and youth with TS who identified themselves as victims of bullying had significantly higher ADHD symptom severity scores (P = 0.04) compared with those who were not bullied.

CONCLUSIONS

Risk behaviors are not reliably or clinically different in youth with TS compared with control youth. ADHD severity, but not tic severity, was associated with being bullied in youth with TS.

Decision-Making Deficits in Adolescent Boys with and without Attention-Deficit/Hyperactivity Disorder (ADHD): an Experimental Assessment of Associated Mechanisms

Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrate increased levels of real-life risk-taking behavior like substance abuse and reckless behavior in traffic, which potentially originates in decision-making deficits. Using experimental gambling tasks, the current study investigated three potential underlying mechanisms: (1) risky vs. suboptimal decision making, (2) the complexity of decision-making strategies and (3) the influence of feedback. Participants were 181 male adolescents (81 ADHD, 100 Typically Developing (TD); M_age = 15.1 years). First, we addressed a common confound in many gambling tasks by disentangling risk seeking from suboptimal decision making, and found that ADHD-related decision-making deficits do not originate in increased risk seeking but in suboptimal decision making. Second, we assessed decision-making strategies with a Bayesian latent mixture analysis and found that ADHD-related decision-making deficits are characterized by the use of less complex strategies. That is, adolescent boys with ADHD, relative to TD adolescent boys, less often adopted strategies in which all characteristics relevant to make an optimal decision were integrated. Third, we administered two gambling task conditions with feedback in which adolescents experience the outcomes of their decisions and found that adolescents with ADHD performed worse relative to TD adolescents on both conditions. Altogether, this set of studies demonstrated consistent decision-making deficits in adolescent boys with ADHD: The use of less complex decision-making strategies may cause suboptimal decision making, both in situations with and without direct feedback on performance.

Attention-deficit/hyperactivity disorder and risk-taking: A three-level meta-analytic review of behavioral, self-report, and virtual reality metrics

Meta-analytic methods were used to examine ADHD-related risk-taking in children and adults, and to compare the magnitude of risk taking across behavioral, self-report, and virtual reality metrics. Potential moderators of effect size heterogeneity were also examined via a three-level multi-level approach and a hybrid meta-analytic/systematic review approach. Aggregated effect sizes obtained from 56 behavioral-task studies (82 effect sizes; ADHD_N = 2577; TD_N = 2606), 51 self-report studies (130 effect sizes; ADHD_N = 18,641; TD_N = 113,163), and 8 virtual reality studies (16 effect sizes; ADHD_N = 382; TD_N = 436) suggest that children and adults with ADHD exhibit moderately more risk-taking compared to children and adults without the disorder. Notably, the aggregated effect size obtained from virtual reality simulations (Hedges', g = 0.43) was 30-40% larger than effect sizes obtained from self-report and behavioral task metrics (Hedges' g = 0.31 and 0.27), respectively. Suboptimal Decision Making was the only significant moderator identified via multi-level modeling; however, comparison of subgroup effect sizes revealed potential moderating effects of ADHD presentation and trial-by-trial feedback on behavioral tasks. Collectively, findings suggest that ADHD is reliably associated with small to moderate magnitude greater risk-taking behavior and virtual reality simulations appear be the most sensitive currently available metric.

Decision-Making Deficits in ADHD Are Not Related to Risk Seeking But to Suboptimal Decision-Making: Meta-Analytical and Novel Experimental Evidence

Objective: ADHD is related to decision-making deficits in real-life (e.g., substance abuse) and on experimental tasks (increased preference for risky options). In most tasks, risk and expected value are confounded (risky options have lowest expected value), making it impossible to disentangle risky from suboptimal (i.e., not choosing highest expected value) decision-making. We differentiated between risky and suboptimal decision-making in ADHD in two studies. Method and Results: First, on a multilevel meta-regression analysis (k = 48, n_ADHD = 1,144, n_Control = 1,108), ADHD and controls differed if the risky option was suboptimal (ADHD choosing more risky/suboptimal), whereas groups performed similar if the risky option was not suboptimal. Second, an empirical study showed that adults with ADHD (n = 40) made more suboptimal, but not more risky choices than controls (n = 40). Conclusion: These results contribute to a growing body of evidence that decision-making deficits in ADHD are driven by suboptimal decision-making and not by risk seeking.

Risk Taking by Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): a Behavioral and Psychophysiological Investigation of Peer Influence

Adolescents with ADHD demonstrate increased risk-taking behavior (RTB) like substance abuse and dangerous traffic conduct. RTB in adolescence is more likely under peer influence. The current investigation (1) tests the hypothesis that adolescents with ADHD are particularly susceptible to such influence and (2) tests whether groups differed in autonomic reactivity to peer influence. Adolescent boys between 12 and 19 years with (n = 81) and without (n = 99) ADHD performed the Balloon Analogue Risk Task twice. In the peer condition, a highly credible virtual peer manipulation that encouraged risk taking was added, in the solo condition this was absent. Autonomic reactivity was indexed by heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA). All adolescents engaged in more risk taking in the peer condition relative to solo condition. Autonomic differences between groups were only found on PEP: a stronger sympathetic response to peer influence was observed in typically developing adolescents relative to adolescents with ADHD. Increased physiological stress (as indexed by PEP) in the peer relative to the solo condition predicted peer-induced risk taking in all adolescents. We conclude that susceptibility to peer influence is not exaggerated in ADHD but rather reflects a general tendency of adolescents. As adolescents experiencing peer influence as stressful are most susceptible to peer influence, we suggest that increasing resistance to peer influence may be an important treatment aim for these adolescents specifically.

Early Attentional Modulation by Working Memory Training in Young Adult ADHD Patients during a Risky Decision-Making Task

Background: Working memory (WM) deficits and impaired decision making are among the characteristic symptoms of patients affected by attention deficit/hyperactivity disorder (ADHD). The inattention associated with the disorder is likely to be due to functional deficits of the neural networks inhibiting irrelevant sensory input. In the presence of unnecessary information, a good decisional process is impaired and ADHD patients tend to take risky decisions. This study is aimed to test the hypothesis that the level of difficulty of a WM training (WMT) is affecting the top-down modulation of the attentional processes in a probabilistic gambling task. Methods: Event-related potentials (ERP) triggered by the choice of the amount wagered in the gambling task were recorded, before and after WMT with a the dual n-back task, in young ADHD adults and matched controls. For each group of participants, randomly assigned individuals were requested to perform WMT with a fixed baseline level of difficulty. The remaining participants were trained with a performance-dependent adaptive n-level of difficulty. Results: We compared the ERP recordings before and after 20 days of WMT in each subgroup. The analysis was focused on the time windows with at least three recording sites showing differences before and after training, after Bonferroni correction ( p < 0.05 ). In ADHD, the P1 wave component was selectively affected at frontal sites and its shape was recovered close to controls' only after adaptive training. In controls, the strongest contrast was observed at parietal level with a left hemispheric dominance at latencies near 900 ms, more after baseline than after adaptive training. Conclusion: Partial restoration of early selective attentional processes in ADHD patients might occur after WMT with a high cognitive load. Modified frontal sites' activities might constitute a neural marker of this effect in a gambling task. In controls, conversely, an increase in late parietal negativity might rather be a marker of an increase in transfer effects to fluid intelligence.

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.

Risk taking behaviors in relation to Attention Deficit and Hyperactivity Disorder in Iranian male workers: a latent class analysis

BACKGROUND

Risk taking behaviors are a serious risk to the health and safety of workers. The aims of this study were to identify the subgroups of workers on the basis of risk taking behaviors and assess the independent role of ADHD on the membership of participants in each latent class.

METHODS

This cross sectional study was performed on 2434 workers. The sample was selected through random cluster sampling from Kaveh Industrial City. All workers completed five sets of checklists and questionnaires. Data analysis was performed using chi-square, Fisher's exact test, and latent class analysis.

RESULTS

Four latent classes were identified; namely, 1) very low risk (65.6%), 2) low risk (27.8%), moderate risk (4.1%) and, high risk (2.5%). After adjusting for other studied covariates, having ADHD significantly increased the odds of membership in moderate risk class (OR=3.42, 95% CI: 2.21 -5.29) and high risk class (OR=3.10, 95% CI: 1.80 -5.34) compared to very low risk class. Also, having anxiety increased the odds of membership in latent class 2 (OR=1.28, 95% CI: 1.02-1.62), 3(OR=2.15, 95% CI: 1.51-3.10) and 4 (OR=2.06, 95% CI: 1.32-3.22) in comparison to class 1. Among all participants, 187 (7.7%) had ADHD and among studied variables, ADHD has the strongest role in the membership of subjects in different classes.

CONCLUSION

Results from the present study indicate that 6.6% of the workers fell under moderate or high risk class. Focusing on the treatment of ADHD with considering other comorbid factors such as anxiety may be helpful in designing and executing effective programs to reduce risk taking behaviors among workers.