Abstract
ObjectiveThe aim of this review was to gain insight into the relationship between Attention deficit hyperactivity disorder (ADHD) and risky performance in gambling tasks and to identify any potential alternate explanatory factors.MethodsPsycINFO, PubMed, and Web of Knowledge were searched for relevant literature comparing individuals with ADHD to normal controls (NCs) in relation to their risky performance on a gambling task. In total, fourteen studies in children/adolescents and eleven studies in adults were included in the review.ResultsHalf of the studies looking at children/adolescents with ADHD found evidence that they run more risks on gambling tasks when compared to NCs. Only a minority of the studies on adults with ADHD reported aberrant risky behavior. The effect sizes ranged from small to large for both age groups and the outcome pattern did not differ between studies that applied an implicit or explicit gambling task. Two studies demonstrated that comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) increased risky behavior in ADHD. Limited and/or inconsistent evidence was found that comorbid internalizing disorders (IDs), ADHD subtype, methylphenidate use, and different forms of reward influenced the outcomes.ConclusionThe evidence for increased risky performance of individuals with ADHD on gambling tasks is mixed, but is stronger for children/adolescents with ADHD than for adults with ADHD, which may point to developmental changes in reward and/or penalty sensitivity or a publication bias for positive findings in children/adolescents. The literature suggests that comorbid ODD/CD is a risk factor in ADHD for increased risky behavior. Comorbid IDs, ADHD subtype, methylphenidate use, and the form of reward received may affect risky performance in gambling tasks; however, these factors need further examination. Finally, the implications of the findings for ADHD models and the ecological validity of gambling tasks are discussed.
Highlights
Attention deficit hyperactivity disorder (ADHD) is characterized by attentional problems, hyperactivity, and impulsivity [1]
The following selection criteria were used for the inclusion of studies: (a) the study was written in English; (b) the inclusion of both an ADHD sample and a sample of normal controls (NCs); (c) a cognitive task with a gambling component was used; (d) the performance on the applied gambling task was measured in terms of risky performance
Six studies investigated the performance of children/adolescents with ADHD on the Iowa Gambling Task (IGT) or a variant of the IGT [47,48,49,50,51,52], of which two studies reported that children/adolescents clearly displayed more risky behavior than NCs [47,49]
Summary
Attention deficit hyperactivity disorder (ADHD) is characterized by attentional problems, hyperactivity, and impulsivity [1]. Based on these symptoms, three ADHD subtypes can be distinguished: the ADHD combined type (ADHD-C), the ADHD inattentive type (ADHD-I), and the ADHD hyperactive-impulsive type (ADHD-H). Those with ADHD tend to demonstrate more dangerous driving behavior [6,7,8], increased involvement in traffic accidents [9,10], increased criminality [11,12], more risky sexual behavior [13,14], and increased drug abuse [15]. Individuals with ADHD have an increased chance to develop problem or pathological gambling, especially individuals with ADHD-C [17], individuals with severe ADHD symptoms [18], or individuals with persistent ADHD [19]
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