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Bado PP, Salum GA, Rohde LA, Gadelha A, Pan PM, Miguel EC, Tripp G, Furukawa E. Is waiting for rewards good for you? No association between impulsive choice, psychopathology, and functional outcomes in a large cohort sample. JCPP ADVANCES 2024; 4:e12231. [PMID: 38827985 PMCID: PMC11143955 DOI: 10.1002/jcv2.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/19/2024] [Indexed: 06/05/2024] Open
Abstract
Background A stronger preference for immediate rewards has been reported in individuals with ADHD and other disorders. However, the consistency of the associations between this preference and psychiatric conditions as well as functional outcomes have been questioned. Research on its association with longitudinal outcomes is scarce. Methods The current study used data on a choice delay task (CDT) from a school-based cohort of Brazilian children with those at higher risk for psychiatric disorders over-sampled (n = 1917). The sample included typically developing children (n = 1379), those with ADHD (n = 213), and other disorders. The frequency of the trials where children chose a larger later reward versus a smaller sooner reward was compared for those with ADHD and typically developing children. Cross-sectionally and longitudinally, the study also evaluated whether children's preference for larger delayed rewards at baseline predicted the presence of psychiatric disorders and functional life outcomes (academic performance, alcohol use, early pregnancy, criminal conviction, BMI). Results Children with ADHD and their typically developing peers performed similarly on the CDT. Their baseline task performance was not related to psychiatric conditions or life outcomes. Conclusions The current results raise questions regarding the use of the CDT with diverse populations and whether a preference for larger delayed rewards is predictive of positive long-term outcomes as widely assumed.
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Affiliation(s)
- Patricia P. Bado
- Hospital de Clínicas de Porto Alegre (HCPA)Universidade Federal Do Rio Grande Do Sul (UFRGS)Porto AlegreBrazil
- Pontifícia Universidade Católica do Rio de Janeiro (PUC‐Rio)Rio de JaneiroBrazil
| | - Giovanni A. Salum
- Hospital de Clínicas de Porto Alegre (HCPA)Universidade Federal Do Rio Grande Do Sul (UFRGS)Porto AlegreBrazil
- National Institute of Developmental Psychiatry for Children and Adolescents & National Center for Innovation and Research in Mental HealthSão PauloBrazil
| | - Luis A. Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents & National Center for Innovation and Research in Mental HealthSão PauloBrazil
- ADHD Outpatient Program & Developmental Psychiatry ProgramHospital de Clínicas de Porto AlegreFederal University of Rio Grande Do SulPorto AlegreBrazil
- Medical Council UniEduKSão PauloBrazil
| | - Ary Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents & National Center for Innovation and Research in Mental HealthSão PauloBrazil
- Universidade Federal de São Paulo (UNIFESP)São PauloBrazil
- Laboratório de Neurociências Integrativas (Linc)Universidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Pedro M. Pan
- National Institute of Developmental Psychiatry for Children and Adolescents & National Center for Innovation and Research in Mental HealthSão PauloBrazil
- Laboratório de Neurociências Integrativas (Linc)Universidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Eurípedes C. Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents & National Center for Innovation and Research in Mental HealthSão PauloBrazil
- Universidade de São Paulo (USP)São PauloBrazil
| | - Gail Tripp
- Okinawa Institute of Science and Technology (OIST) Graduate UniversityOnna‐sonOkinawaJapan
| | - Emi Furukawa
- Okinawa Institute of Science and Technology (OIST) Graduate UniversityOnna‐sonOkinawaJapan
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Chen C, Zhang S, Hong H, Qiu S, Zhou Y, Zhao M, Pan M, Si F, Dong M, Li H, Wang Y, Liu L, Sonuga-Barke EJS, Qian Q. Psychometric properties of the Chinese version of the Quick Delay Questionnaire (C-QDQ) and ecological characteristics of reward-delay impulsivity of adults with ADHD. BMC Psychiatry 2024; 24:251. [PMID: 38566048 PMCID: PMC10988885 DOI: 10.1186/s12888-024-05706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The Quick Delay Questionnaire (QDQ) is a short questionnaire designed to assess delay-related difficulties in adults. This study aimed to examine the reliability and validity of the Chinese version of the QDQ (C-QDQ) in Chinese adults, and explore the ecological characteristics of delay-related impulsivity in Chinese adults with attention-deficit/hyperactivity disorder (ADHD). METHODS Data was collected from 302 adults, including ADHD (n = 209) and healthy controls (HCs) (n = 93). All participants completed the C-QDQ. The convergent validity, internal consistency, retest reliability and confirmatory factor analysis (CFA) of the C-QDQ were analyzed. The correlations between C-QDQ and two laboratory measures of delay-related difficulties and Barratt Impulsiveness Scale-11 (BIS-11), the comparison of C-QDQ scores between ADHD subgroups and HCs were also analyzed. RESULTS The Cronbach's α of C-QDQ was between 0.83 and 0.89. The intraclass correlation coefficient of C-QDQ was between 0.80 and 0.83. The results of CFA of C-QDQ favoured the original two-factor model (delay aversion and delay discounting). Significant positive associations were found between C-QDQ scores and BIS-11 total score and performance on the laboratory measure of delay-related difficulties. Participants with ADHD had higher C-QDQ scores than HCs, and female ADHD reported higher scores on delay discounting subscale than male. ADHD-combined type (ADHD-C) reported higher scores on delay aversion subscale than ADHD-inattention type (ADHD-I). CONCLUSION The C-QDQ is a valid and reliable tool to measure delay-related responses that appears to have clinical utility. It can present the delay-related impulsivity of patients with ADHD. Compared to HCs, the level of reward-delay impulsivity was higher in ADHD.
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Affiliation(s)
- Caili Chen
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Shiyu Zhang
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Haiheng Hong
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Sunwei Qiu
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Yi Zhou
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Mengjie Zhao
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Meirong Pan
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Feifei Si
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Min Dong
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Haimei Li
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China
| | - Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China.
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China.
| | | | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, 100191, Beijing, China.
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 100191, Beijing, China.
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Marx I, Hacker T, Yu X, Cortese S, Sonuga-Barke E. ADHD and the Choice of Small Immediate Over Larger Delayed Rewards: A Comparative Meta-Analysis of Performance on Simple Choice-Delay and Temporal Discounting Paradigms. J Atten Disord 2021; 25:171-187. [PMID: 29806533 DOI: 10.1177/1087054718772138] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Impulsive choices can lead to suboptimal decision making, a tendency which is especially marked in individuals with ADHD. We compared two different paradigms assessing impulsive choice: the simple choice paradigm (SCP) and the temporal discounting paradigm (TDP). Method: Random effects meta-analyses on 37 group comparisons (22 SCP; 15 TDP) consisting of 3.763 participants (53% ADHD). Results: Small-to-medium effect sizes emerged for both paradigms, confirming that participants with ADHD choose small immediate over large delayed rewards more frequently than controls. Moderation analyses show that offering real rewards in the SCP almost doubled the odds ratio for participants with ADHD. Conclusion: We suggest that a stronger than normal aversion toward delay interacts with a demotivating effect of hypothetical rewards, both factors promoting impulsive choice in participants with ADHD. Furthermore, we suggest the SCP as the paradigm of choice due to its larger ecological validity, contextual sensitivity, and reliability.
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Affiliation(s)
- Ivo Marx
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Thomas Hacker
- Department of Psychiatry and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Xue Yu
- School of Education, Chongqing Normal University, Chongqing, China
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, Southampton, UK.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK.,Solent NHS Trust, Southampton, UK.,New York University Child Study Center, New York, USA.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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Schulze M, Coghill D, Lux S, Philipsen A. Disentangling ADHD's Presentation-Related Decision-Making-A Meta-Analytic Approach on Predominant Presentations. Front Psychiatry 2021; 12:519840. [PMID: 33679462 PMCID: PMC7930744 DOI: 10.3389/fpsyt.2021.519840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Deficient decision-making (DM) in attention deficit/hyperactivity disorder (ADHD) is marked by altered reward sensitivity, higher risk taking, and aberrant reinforcement learning. Previous meta-analysis aggregate findings for the ADHD combined presentation (ADHD-C) mostly, while the ADHD predominantly inattentive presentation (ADHD-I) and the predominantly hyperactive/impulsive presentation (ADHD-H) were not disentangled. The objectives of the current meta-analysis were to aggregate findings from DM for each presentation separately. Methods: A comprehensive literature search of the PubMed (Medline) and Web of Science Database took place using the keywords "ADHD," "attention-deficit/hyperactivity disorder," "decision-making," "risk-taking," "reinforcement learning," and "risky." Random-effects models based on correlational effect-sizes were conducted. Heterogeneity analysis and sensitivity/outlier analysis were performed, and publication biases were assessed with funnel-plots and the egger intercept. Results: Of 1,240 candidate articles, seven fulfilled criteria for analysis of ADHD-C (N = 193), seven for ADHD-I (N = 256), and eight for ADHD-H (N = 231). Moderate effect-size were found for ADHD-C (r = 0.34; p = 0.0001; 95% CI = [0.19, 0.49]). Small effect-sizes were found for ADHD-I (r = 0.09; p = 0.0001; 95% CI = [0.008, 0.25]) and for ADHD-H (r = 0.1; p = 0.0001; 95% CI = [-0.012, 0.32]). Heterogeneity was moderate for ADHD-H. Sensitivity analyses show robustness of the analysis, and no outliers were detected. No publication bias was evident. Conclusion: This is the first study that uses a meta-analytic approach to investigate the relationship between the different presentations of ADHD separately. These findings provide first evidence of lesser pronounced impairment in DM for ADHD-I and ADHD-I compared to ADHD-C. While the exact factors remain elusive, the current study can be considered as a starting point to reveal the relationship of ADHD presentations and DM more detailed.
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Affiliation(s)
- Marcel Schulze
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - David Coghill
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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5
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Mphahlele RM, Pillay BJ, Meyer A. Delay aversion in school-aged children with attention-deficit hyperactivity disorder. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1177/0081246320964350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study considered whether children with attention-deficit hyperactivity disorder displayed a stronger preference for smaller, more immediate rewards over larger, but delayed rewards (delay aversion) when compared to typically developing controls and, furthermore, whether age and gender influenced their preference in any way. Children, between 6 and 15 years of age, living in Limpopo province of South Africa, participated in the study. Two hundred sixteen children in total (108 with attention-deficit hyperactivity disorder and 108 matched controls without attention-deficit hyperactivity disorder symptoms) were assessed, on a task of delay aversion. The Two Choice Impulsivity Paradigm, which assesses immediate and delayed responses, was administered to both the attention-deficit hyperactivity disorder and control groups. The performance of both groups was compared on the Two Choice Impulsivity Paradigm, and the scores were analysed as a function of gender and age. The attention-deficit hyperactivity disorder group chose significantly more immediate, smaller responses than the neurotypical control group, which preferred significantly more delayed but larger responses. Gender and age did not affect the response choices for both immediate and delayed measurements. Children with attention-deficit hyperactivity disorder show a greater need for more immediate gratification, even if the reward is smaller, than the neurotypical control group who could delay gratification to receive a larger reward. Gender and age did not influence their preferences.
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Affiliation(s)
- Ramatladi Meriam Mphahlele
- Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Basil Joseph Pillay
- Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Anneke Meyer
- Department of Behavioural Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
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Bayard F, Abé C, Wrobel N, Ingvar M, Henje E, Petrovic P. Emotional Instability Relates to Ventral Striatum Activity During Reward Anticipation in Females. Front Behav Neurosci 2020; 14:76. [PMID: 32547375 PMCID: PMC7274270 DOI: 10.3389/fnbeh.2020.00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Both non-emotional symptoms, such as inattention, and symptoms of emotional instability (EI) are partially co-varying and normally distributed in the general population. Attention Deficit Hyperactivity Disorder (ADHD), which is associated with both inattention and emotional instability, has been related to lower reward anticipation activation in the ventral striatum. However, it is not known whether non-emotional dysregulation, such as inattention, or EI—or both—are associated with this effect. We hypothesized that altered reward processing relates specifically to EI. To test this, 29 healthy participants were recruited to this functional MRI study (n = 15 females). Reward processing was studied using a modified version of the Monetary Incentive Delay (MID) task. Brown Attention-Deficit Disorder Scales questionnaire was used to assess EI and inattention symptoms on a trait level. We observed less ventral striatal activation during reward anticipation related to the EI trait in females, also when controlling for the inattention trait, but not in the whole sample or males only. Our study suggests the existence of sex differences in the relationship between reward processing and EI/inattention traits.
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Affiliation(s)
- Frida Bayard
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christoph Abé
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Wrobel
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Henje
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Predrag Petrovic
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Yu X, Sonuga-Barke E. Childhood ADHD and Delayed Reinforcement: A Direct Comparison of Performance on Hypothetical and Real-Time Delay Tasks. J Atten Disord 2020; 24:810-818. [PMID: 27469395 DOI: 10.1177/1087054716661231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: Individuals with ADHD have been shown to prefer smaller sooner over larger later rewards. This has been explained in terms of abnormally steeper discounting of the value of delayed reinforcers. Evidence for this comes from different experimental paradigms. In some, participants experience delay in the laboratory (real-time delay tasks; R-TD), in others they imagine the delay to reinforcers (hypothetical delay tasks; HD). Method: We directly contrasted the performance of 7- to 12-year-old children with ADHD (n = 23) and matched controls (n = 23) on R-TD and HD tasks with monetary rewards. Results: Children with ADHD displayed steeper temporal discounting on the R-TD, but not the HD tasks. Conclusion: These findings suggest that the experience of waiting prior to the delivery of rewards is an important determinant of heightened temporal discounting in ADHD-a finding consistent with models that emphasize the aversive nature of delay for children.
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Affiliation(s)
- Xue Yu
- Beijing Normal University, China
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8
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To eat or not to eat: Reward delay impulsivity in children with loss of control eating, attention deficit / hyperactivity disorder, a double diagnosis, and healthy children. PLoS One 2019; 14:e0221814. [PMID: 31525207 PMCID: PMC6746378 DOI: 10.1371/journal.pone.0221814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/15/2019] [Indexed: 11/21/2022] Open
Abstract
Reward delay impulsivity is a feature of attention deficit/hyperactivity disorder (ADHD) and a likely feature of loss of control eating (LOC-E), which might explain the higher risk of children with ADHD or LOC-E to become obese. The goal of this study was to investigate reward delay impulsivity in children with LOC-E, ADHD, or a double diagnosis, in contrast to healthy children. Children (8 to 13 years) with LOC-E (n = 24), ADHD (n = 33), a double diagnosis (n = 9), and healthy children (n = 34) performed a computer game (door opening task [DOT]) and the delay of gratification task (DoGT) to assess food related facets of reward delay impulsivity. In addition, children reported whether they worried to lose control over eating during the DoGT. There were no group differences in the DOT. However, children with ADHD or a double diagnosis had a significantly higher risk to eat prematurely during the DoGT than children with LOC-E, who were not significantly different from healthy children. Children with a double diagnosis were most likely to worry about losing control over eating during the DoGT, followed by children with LOC-E, and both had a significantly higher probability to worry than healthy children. For children with a double diagnosis the probability to worry was significantly higher than for children with ADHD. If replicated, these findings point to a special relevance of reward delay impulsivity in children with ADHD or a double diagnosis, compared to children with LOC-E. ADHD should be regularly assessed in children with LOC-E.
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Burns P, Fay O, McCafferty M, McKeever V, Atance C, McCormack T. Examining children's ability to delay reward: Is the delay discounting task a suitable measure? JOURNAL OF BEHAVIORAL DECISION MAKING 2019. [DOI: 10.1002/bdm.2154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Patrick Burns
- School of PsychologyQueen's University Belfast Belfast UK
| | - Olivia Fay
- School of PsychologyQueen's University Belfast Belfast UK
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10
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Behavioral adjustment to asymmetric reward availability among children with and without ADHD: effects of past and current reinforcement contingencies. ACTA ACUST UNITED AC 2018; 11:149-158. [PMID: 30191501 DOI: 10.1007/s12402-018-0265-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Altered reinforcement sensitivity is hypothesized to underlie symptoms of attention deficit hyperactivity disorder (ADHD). Here we evaluate the behavioral sensitivity of Brazilian children with and without ADHD to a change in reward availability. Forty typically developing children and 32 diagnosed with DSM-IV ADHD completed a signal-detection task in which correct discriminations between two stimuli were associated with different frequencies of reinforcement. The response alternative associated with the higher rate of reinforcement switched, without warning, after 30 rewards were delivered. The task continued until another 30 rewards were delivered. Both groups of children developed a response bias toward the initially more frequently reinforced alternative. This effect was larger in the control group. The response allocation of the two groups changed following the shift in reward availability. Over time the ADHD group developed a significant response bias toward the now more frequently reinforced alternative. In contrast, the bias of the control group stayed near zero after an initial decline following the contingency change. The overall shift in bias was similar for the two groups. The behavior of both groups of children was sensitive to the asymmetric reward distribution and to the change in reward availability. Subtle group differences in response patterns emerged, possibly reflecting differences in the time frame of reward effects and sensitivity to reward exposure.
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11
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Chronaki G, Soltesz F, Benikos N, Sonuga-Barke EJS. An electrophysiological investigation of reinforcement effects in attention deficit/hyperactivity disorder: Dissociating cue sensitivity from down-stream effects on target engagement and performance. Dev Cogn Neurosci 2017; 28:12-20. [PMID: 29080475 PMCID: PMC6987869 DOI: 10.1016/j.dcn.2017.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 01/20/2023] Open
Abstract
Objective Neural hypo-sensitivity to cues predicting positive reinforcement has been observed in ADHD using the Monetary Incentive Delay (MID) task. Here we report the first study using an electrophysiological analogue of this task to distinguish between (i) cue related anticipation of reinforcement and downstream effects on (ii) target engagement and (iii) performance in a clinical sample of adolescents with ADHD and controls. Methods Thirty-one controls and 32 adolescents with ADHD aged 10–16 years performed the electrophysiological (e)-MID task − in which preparatory cues signal whether a response to an upcoming target will be reinforced or not − under three conditions; positive reinforcement, negative reinforcement (response cost) and no consequence (neutral). We extracted values for both cue-related potentials known to be, both, associated with response preparation and modulated by reinforcement (Cue P3 and Cue CNV) and target-related potentials (target P3) and compared these between ADHD and controls. Results ADHD and controls did not differ on cue-related components on neutral trials. Against expectation, adolescents with ADHD displayed Cue P3 and Cue CNV reinforcement-related enhancement (versus neutral trials) compared to controls. ADHD individuals displayed smaller target P3 amplitudes and slower and more variable performance − but effects were not modulated by reinforcement contingencies. When age, IQ and conduct problems were controlled effects were marginally significant but the pattern of results did not change. Discussion ADHD was associated with hypersensitivity to positive (and marginally negative) reinforcement reflected on components often thought to be associated with response preparation − however these did not translate into improved attention to targets. In the case of ADHD, upregulated CNV may be a specific marker of hyper-arousal rather than an enhancement of anticipatory attention to upcoming targets. Future studies should examine the effects of age, IQ and conduct problems on reinforcement sensitivity in ADHD.
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Affiliation(s)
- Georgia Chronaki
- Developmental Cognitive Neuroscience (DCN) Laboratory, School of Psychology, University of Central Lancashire, UK; Developmental Brain-Behaviour Laboratory, Psychology, University of Southampton, UK; Division of Neuroscience & Experimental Psychology, University of Manchester, UK
| | - Fruzsina Soltesz
- Developmental Brain-Behaviour Laboratory, Psychology, University of Southampton, UK
| | - Nicholas Benikos
- Department of Cognitive Science Australian Hearing Hub 16 University Avenue Macquarie University, NSW, 2109, UK
| | - Edmund J S Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK; Department of Experimental Clinical and Health Psychology, Ghent University, Belgium.
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12
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Behavioral sensitivity of Japanese children with and without ADHD to changing reinforcer availability: an experimental study using signal detection methodology. Behav Brain Funct 2017; 13:13. [PMID: 28946880 PMCID: PMC5613339 DOI: 10.1186/s12993-017-0131-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/18/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Most research on motivational processes in attention deficit hyperactivity disorder (ADHD) has been undertaken in Western Europe and North America. The extent to which these findings apply to other cultural groups is unclear. The current study evaluated the behavioral sensitivity of Japanese children with and without ADHD to changing reward availability. Forty-one school-aged children, 19 diagnosed with DSM-IV ADHD, completed a signal-detection task in which correct discriminations between two stimuli were associated with different reinforcement frequencies. The response alternative associated with the higher rate of reinforcement switched twice during the task without warning. FINDINGS Both groups of children developed an initial bias toward the more frequently reinforced response alternative. When the reward contingencies switched the response allocation (bias) of the control group children followed suit. The response bias scores of the children with ADHD did not, suggesting impaired tracking of reward availability over time. CONCLUSIONS Japanese children with ADHD adjust their behavioral responses to changing reinforcer availability less than their typically developing peers. This is not explained by poor attention to task or a lack of sensitivity to reward. The current results are consistent with altered sensitivity to changing reward contingencies identified in non-Japanese samples of children with ADHD. Irrespective of their country of origin, children with ADHD will likely benefit from behavioral expectations and reinforcement contingencies being made explicit together with high rates of reinforcement for appropriate behaviors.
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Leibenluft E. Pediatric Irritability: A Systems Neuroscience Approach. Trends Cogn Sci 2017; 21:277-289. [PMID: 28274677 PMCID: PMC5366079 DOI: 10.1016/j.tics.2017.02.002] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
Irritability, defined as an increased propensity to exhibit increased anger relative to one's peers, is a common clinical problem in youth. Irritability can be conceptualized as aberrant responses to frustration (where frustration is the emotional response to blocked goal attainment) and/or aberrant 'approach' responses to threat. Irritable youth show hyper-reactivity to threat mediated by dysfunction in amygdala, medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, and association cortex. Irritable youth also show abnormalities in reward learning, cognitive control, and responses to frustration. These abnormalities are mediated by circuitry that includes the inferior frontal gyrus (iFG), striatum, ACC, and parietal cortex. Effective treatments for irritability are lacking, but pathophysiological research could lead to more precisely targeted interventions.
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Affiliation(s)
- Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
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Jackson JNS, MacKillop J. Attention-Deficit/Hyperactivity Disorder and Monetary Delay Discounting: A Meta-Analysis of Case-Control Studies. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:316-325. [PMID: 27722208 PMCID: PMC5049699 DOI: 10.1016/j.bpsc.2016.01.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A growing number of studies have investigated delay discounting, a behavioral economic index of impulsivity, and its relevance to attention deficit hyperactivity disorder (ADHD), but with mixed findings. The current meta-analysis synthesizes the literature on the relationship between monetary delay discounting and ADHD in studies using case-control designs. Specifically, the objectives were: 1) to characterize the aggregated differences in monetary delay discounting between individuals with ADHD (cases) and controls in studies using categorical case-control designs; 2) to examine potential differences based on sample age (<18 vs. >18), reward outcome (real vs. hypothetical), and prevalence of conduct disorder and oppositional defiant disorder in the sample; and 3) to evaluate potential small-study (publication) bias in the literature. METHODS From 567 candidate articles, 21 independent investigations yielded 25 case-control comparisons (total N=3,913). Random effects meta-analysis was conducted using Cohen's d as the common effect size. Publication bias was evaluated using fail-safe N, Begg-Mazumdar and Egger tests, and metaregression of publication year and effect size. RESULTS Across studies, a statistically significant difference of medium magnitude effect size was present for the case-control comparisons (d=0.43; p < 10-15). No significant differences based on sample age, reward outcome, or comorbid status was detected. Minimal heterogeneity and evidence of publication bias was present. CONCLUSIONS These findings provide robust evidence that delay discounting is significantly elevated among individuals with ADHD compared to controls. Gaps in the literature and the importance of characterizing the neural and genetic bases of this relationship are discussed.
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Affiliation(s)
- Jacob N S Jackson
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Homewood Research Institute, Homewood Health Centre, Guelph, Ontario, Canada
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Petrovic P, Castellanos FX. Top-Down Dysregulation-From ADHD to Emotional Instability. Front Behav Neurosci 2016; 10:70. [PMID: 27242456 PMCID: PMC4876334 DOI: 10.3389/fnbeh.2016.00070] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/29/2016] [Indexed: 12/31/2022] Open
Abstract
Deficient cognitive top-down executive control has long been hypothesized to underlie inattention and impulsivity in attention-deficit/hyperactivity disorder (ADHD). However, top-down cognitive dysfunction explains a modest proportion of the ADHD phenotype whereas the salience of emotional dysregulation is being noted increasingly. Together, these two types of dysfunction have the potential to account for more of the phenotypic variance in patients diagnosed with ADHD. We develop this idea and suggest that top-down dysregulation constitutes a gradient extending from mostly non-emotional top-down control processes (i.e., “cool” executive functions) to mainly emotional regulatory processes (including “hot” executive functions). While ADHD has been classically linked primarily to the former, conditions involving emotional instability such as borderline and antisocial personality disorder are closer to the other. In this model, emotional subtypes of ADHD are located at intermediate levels of this gradient. Neuroanatomically, gradations in “cool” processing appear to be related to prefrontal dysfunction involving dorsolateral prefrontal cortex (dlPFC) and caudal anterior cingulate cortex (cACC), while “hot” processing entails orbitofrontal cortex and rostral anterior cingulate cortex (rACC). A similar distinction between systems related to non-emotional and emotional processing appears to hold for the basal ganglia (BG) and the neuromodulatory effects of the dopamine system. Overall we suggest that these two systems could be divided according to whether they process non-emotional information related to the exteroceptive environment (associated with “cool” regulatory circuits) or emotional information related to the interoceptive environment (associated with “hot” regulatory circuits). We propose that this framework can integrate ADHD, emotional traits in ADHD, borderline and antisocial personality disorder into a related cluster of mental conditions.
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Affiliation(s)
- Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
| | - F Xavier Castellanos
- Department of Child and Adolescent Psychiatry, The Child Study Center at NYU Langone Medical CenterNew York, NY, USA; Nathan Kline Institute for Psychiatric ResearchOrangeburg, NY, USA
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Sonuga-Barke EJS, Cortese S, Fairchild G, Stringaris A. Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders--differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety. J Child Psychol Psychiatry 2016; 57:321-49. [PMID: 26705858 PMCID: PMC4762324 DOI: 10.1111/jcpp.12496] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review. SCOPE AND METHODOLOGY We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes. FINDINGS AND CONCLUSION Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- Developmental Brain-Behaviour Laboratory, Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Developmental Brain-Behaviour Laboratory, Academic Unit of Psychology, University of Southampton, Southampton, UK
- Child Study Center at NYU Langone Medical Center, New York, NY, USA
| | - Graeme Fairchild
- Developmental Brain-Behaviour Laboratory, Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Argyris Stringaris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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