Decision-making in social contexts in youth with ADHD

Ili Ma,Antonius H N Cillessen,Nanda N J Lambregts-Rommelse,Anouk P J Scheres,Jan K Buitelaar

doi:10.1007/s00787-016-0895-5

Abstract

This study examined reward-related decision-making in children and adolescents with ADHD in a social context, using economic games. We furthermore examined the role of individual differences in reward-related decision-making, specifically, the roles of reward sensitivity and prosocial skills. Children and adolescents (9–17 years) with ADHD-combined subtype (n = 29; 20 boys) and healthy controls (n = 38; 20 boys) completed the ultimatum game and dictator game as measures of reward-related decision-making in social contexts. Prosocial skills were measured with the Interpersonal Reactivity Index. The ADHD group had a larger discrepancy between ultimatum game and dictator game offers than controls, indicating strategic rather than fairness driven decisions. This finding was supported by self-reports showing fewer individuals with ADHD than controls who considered fairness as motive for the decisions. Perspective taking or empathic concern did not differ between groups and was not significantly associated with offers. In conclusion, the results suggest that rather than a failure to understand the perspective of others, children and adolescents with ADHD were less motivated by fairness than controls in simple social situations. Results encourage the use of economic games in ADHD research.

Highlights

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood-onset disorder characterized by ageinappropriate levels of inattention and/or hyperactivity– impulsivity that are present in multiple settings [3, 4]
The effects remained the same when excluding individuals with comorbid oppositional defiant disorder (ODD) (n = 9; there were no participants who met criteria for comorbid CD or other comorbidities): Children with ADHD made lower offers on the dictator game (DG) compared with controls (U = 258.50, p = .03, r = −.28) and there was no significant group difference in the ultimatum game (UG) (U = 361.00, p = .57, r = −.06)
This study investigated reward-related decision-making in social contexts in children and adolescents with ADHD compared with controls by employing the well-established ultimatum game UG [24] and dictator game DG [33]

Summary

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood-onset disorder characterized by ageinappropriate levels of inattention and/or hyperactivity– impulsivity that are present in multiple settings [3, 4]. In line with growing awareness of ADHD heterogeneity e.g., [9], [60], decisionmaking in the context of ADHD may be best viewed as the result of interactions between cognitive control and motivational states, e.g., [8, 61]. This relates to decision-making contexts in which the motivational significance of stimuli needs to be appraised, referred to as reward-related decision-making, when the motivational component pertains to monetary outcome, e.g., [36, 43, 68]. Children and adolescents with ADHD show increased risky performance and a stronger preference for small immediate rewards compared with controls [21, 32]

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