Characterization of Goal-Directed and Habitual Behavior in Children with Attention-Deficit/Hyperactivity Disorder

Abstract

Background: Children with attention-deficit/hyperactivity disorder (ADHD) exhibit cognitive impairments that affect their daily life functioning. These impairments may reflect a deficit in action-control, i.e., an inability to flexibly adapt behavior to changing consequences. Action-control is modulated by balancing goal-directed (reflective) and habitual (reflexive) behaviors. Studying action-control as a cognitive mechanism will further our understanding of the nature of ADHD in terms of varying degrees of dysfunction at the individual level. Here, we aimed to characterize action-control patterns in children with ADHD as an endophenotype with diagnostic value. Our central hypothesis was that children with ADHD have a higher dominance of habitual response compared to healthy children (HC). Methods: We tested 18 medication-free children with ADHD and 12 HC. Participants were 6-10 years old and were group matched for age and gender. We tested action-control using a computer-based task of the outcome-devaluation paradigm. We used a Q-learning computational model to fit cognitive data and examine individual mechanisms of response. Findings: Compared to HC, children with ADHD demonstrated a predominance of habitual behavior, and a higher level of random choice exploration regardless of feedback. Habitual behavior scores differentiated HC from children with ADHD with a 90% specificity and sensitivity, and correlated with different ADHD symptoms. Interpretation: These findings suggest that studying goal-directed/habitual behavior in children with ADHD can serve as a cognitive endophenotype with a potential diagnostic value. Funding: Hikma Pharmaceuticals LLC., Mr. Saad Mouasher, and Mr. Fadi Ghandour. Declaration of Interest: All authors report no financial disclosures or conflict of interests. Ethical Approval: All research was conducted according to the Declaration of Helsinki and approved by Al-Quds University Research Ethics Committee.