Decision-making patterns and sensitivity to reward and punishment in children with attention-deficit hyperactivity disorder
Introduction
Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in children and adolescents, characterized by inattentive, hyperactive, and impulsive behaviors (American Psychiatric Association, 1994).
Earlier studies have attempted to investigate the decision-making ability of children with ADHD using the Iowa gambling task, which simulates real-life decisions in the manner it factors uncertainty of rewards and punishments (Ernst et al., 2003a, Ernst et al., 2003b, Garon et al., 2006, Geurts et al., 2006, Toplak et al., 2005). The gambling task was specifically designed to detect the decision-making deficit in patients with ventromedial prefrontal damage, who generally demonstrate a strong preference for immediate prospects combined with reduced sensitivity to future consequences, positive or negative (Bechara et al., 1994, Bechara et al., 1996, Bechara et al., 1997, Bechara et al., 2000). Although differences have been noted between ADHD patients and normal controls in performing the gambling task, some studies have failed to show a clear difference in the number of good deck choices, which is an index of decision-making ability in the task (Ernst et al., 2003b, Geurts et al., 2006).
On the other hand, Geurts et al. (2006) suggested that ADHD children may not change their decision-making strategies in response to losses in the same manner as normal individuals, although their result showed only a marginally significant difference. Therefore, children with ADHD and normal children may demonstrate different decision-making strategies or choice patterns derived from such strategies, which are hardly detectable by the number of good deck choices. Moreover, because several theories have proposed that ADHD is associated with an aberrant sensitivity to reinforcement (Luman et al., 2005), the differences in decision-making strategies may result from different sensitivity to rewards and punishments. However, to my knowledge, the study by Geurts et al. (2006) is the only study to examine decision-making strategies depending on rewards and punishments, and they only examined whether such feedbacks influence decision-making that occurs immediately afterward. There are no studies to examine whether feedbacks influence decision-making after several trials on the gambling task.
In order to detect such patterns between temporally distant events and elucidate the differences in decision-making strategies between ADHD and normal children more precisely, we employed the heuristic bottom-up pattern detection method developed by Magnusson, 1996, Magnusson, 2000. This method can detect a complex time pattern called a T-pattern in a bottom-up manner while considering the time interval between events. If pairs of events recur in the same order (and/or concurrently) with a significantly similar time interval between them even if their interval is distant, they are regarded as components of a T-pattern. Moreover, the bottom-up manner allows to detect not only simple patterns which consist of only two events but also more complex and complete patterns. Because of focusing on patterns relevant to rewards and punishments, the detected T-patterns were categorized into those with rewards, with punishments, and without rewards and punishments.
Moreover, in order to examine their sensitivity to rewards and punishments, we measured skin conductance responses (SCRs). We analyzed not only SCRs to rewards and punishments but also anticipatory SCRs, which normal subjects generate before choosing from a bad deck in the gambling task, because choosing from good decks is a correlate of the development of anticipatory SCRs (Bechara et al., 1996, Bechara et al., 1997, Bechara et al., 1999, Crone et al., 2004).
Our primary hypothesis for the present study was that ADHD and normal children use different decision-making strategies depending on their sensitivity to rewards and punishments in the gambling task. Based on theories of reinforcement contingencies, it is possible to establish four hypotheses regarding the differences in T-patterns and sensitivity to rewards and punishments between ADHD and normal children. First, as explained by many theories (Douglas, 1989, Douglas, 1999, Douglas and Parry, 1994, Sagvolden et al., 1998, Sagvolden et al., 2005, Sonuga-Barke, 2002, Sonuga-Barke, 2003), if ADHD children have high sensitivity to rewards or immediate rewards, they would pay more attention to rewards. As a result, they would demonstrate large reward SCRs and many T-patterns depending on rewards (i.e., T-patterns with rewards). Second, as explained by Quay, 1988a, Quay, 1988b, Quay, 1988c, if ADHD children have low sensitivity to punishments, they would pay less attention to punishments. As a result, they would demonstrate small punishment SCRs and few T-patterns depending on punishments (i.e., T-patterns with punishments). Third, as explained by Haenlein and Caul (1987), if ADHD children have an elevated reward threshold, they would have low sensitivity to rewards. As a result, they would demonstrate small reward SCRs and few T-patterns with rewards. Fourth, according to the cognitive-energetic model (CEM) of Sergeant (2005) and Sergeant et al. (1999), ADHD children have a deficit in the effort pool which is related to motivation. Since effort pool is activated by a system which monitors rewards and punishments, the dysfunction of the pool seems to cause low sensitivity to both rewards and punishments. That is why, based on the CEM, ADHD children would demonstrate small reward and punishment SCRs and few T-patterns with rewards and punishments.
Section snippets
Participants
Participants consisted of 14 children (1 girl, 13 boys) referred by a pediatrician, in whom the diagnosis of ADHD was confirmed using a semi-structured interview based on DSM-IV (American Psychiatric Association, 1994) criteria for ADHD, and 11 normal children (5 girls, 6 boys) between the ages of 7 and 14 years. The children with ADHD, comprising 13 children with a combined type diagnosis and 1 with the inattentive type of the disorder, had a full-scale IQ score of 85 or higher (WISC-III or
Number of good deck choices
To examine whether the children with ADHD differed from the normal children in decision-making ability, the number of good deck choices for each block of 20 cards was compared between the two groups using the Wilcoxon rank sum test. The result indicated no differences between the groups in all blocks, but small effect sizes were found in the first three blocks (the first block, Cohen's r = 0.11, power value = 0.08; the second block, Cohen's r = 0.14, power value = 0.10; the third block, Cohen's r = 0.17,
Discussion
In order to examine whether the children with ADHD and the normal children use different decision-making strategies depending on their sensitivity to rewards and punishments in the gambling task, we analyzed T-patterns with rewards, with punishments, and without rewards and punishments, and SCRs for rewards, punishments, and anticipation in both groups. The ADHD children had fewer T-patterns with punishments, which indicated that they paid less attention to punishments. Moreover, they showed a
Acknowledgments
We would like to thank all the children and parents who participated in this study. We would also like to thank the director, Noriko Sato, the late Dr. Satoshi Futakami, and Ms. Kazuko Kozone of Izu Medical and Welfare Center for their generous support for conducting this study.
References (34)
- et al.
Insensitivity to future consequences following damage to human prefrontal cortex
Cognition
(1994) Can Skinnerian theory explain attention deficit disorder. A reply to Barkley
- et al.
Attention deficit disorder with hyperactivity: a specific hypothesis of reward dysfunction
J. Am. Acad. Child Adolesc. Psych.
(1987) - et al.
The impact of reinforcement contingencies on AD/HD: a review and theoretical appraisal
Clin. Psychol. Rev
(2005) Reward, inhibition, and attention deficit hyperactivity disorder
J. Am. Acad. Child Adolesc. Psych.
(1988)- et al.
Altered reinforcement mechanisms in attention-deficit/hyperactivity disorder
Behav. Brain Res
(1998) Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model
Biol. Psychiatry
(2005)Psychological heterogeneity in AD/HD-A dual pathway model of behaviour and cognition
Behav. Brain Res
(2002)The dual pathway model of AD/HD: an elaboration of neuro-developmental characteristics
Neurosci. Biobehav. Rev
(2003)Diagnostic and Statistical Manual of Mental Disorders
(1994)
Failure to respond autonomically to anticipated future outcomes following damage to prefrontal cortex
Cereb. Cortex
Deciding advantageously before knowing the advantageous strategy
Science
Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making
J. Neurosci.
Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions
Brain
Statistical Power Analysis for the Behavioral Sciences
Sensitivity to interference and response contingencies in attention-deficit/hyperactivity disorder
J. Child Psychol. Psychiatry
Heart rate and skin conductance analysis of antecedents and consequences of decision making
Psychophysiology
Cited by (45)
Towards a computational psychiatry of juvenile obsessive-compulsive disorder
2020, Neuroscience and Biobehavioral ReviewsCitation Excerpt :However, overall studies in adult OCD patients show more subtle biases, such as a reduced reward sensitivity (Aranovich et al., 2017), or increased randomness for gains (i.e. a violation of subjective-value maximization resulting from choosing an uncertain over a certain option; Pushkarskaya et al., 2017), with some of them replicating in juvenile OCD patients (Norman et al., 2018). This is in contrast to other disorders such as attention-deficit/hyperactivity disorder (ADHD) and depression that have shown a clearer imbalance in reward and punishment sensitivity (Gotlib et al., 2010; Masunami et al., 2009; Tripp and Alsop, 1999). Many OCD-related clinical behaviours, such as heightened threat perception that induces compulsions, are often based on experienced, rather than explicitly stated stimulus-outcome associations (e.g. compulsions relieving distress).
Atypical Cortical Activation During Risky Decision Making in Disruptive Behavior Disordered Youths With Histories of Suicidal Ideation
2020, Biological Psychiatry: Cognitive Neuroscience and NeuroimagingT-patterns in the study of movement and behavioral disorders
2020, Physiology and BehaviorCitation Excerpt :TPA has been fruitfully employed to study specific pathological conditions such as autism spectrum disorders (ASD) or attention-deficit hyperactivity disorder (ADHD). On the basis of previous studies showing that children affected by ADHD are affected by an abnormal sensitivity to punishments and/or rewards [20-23], Masunami and Colleagues [24] hypothesized that ADHD children and normal children present a completely different decision-making strategy and that this strategy is highly dependent on the sensitivity to rewards and punishments in the gambling task. Results revealed that ADHD children had fewer T-patterns with punishments and have an important tendency to have many T-patterns with rewards.
Comparison of cognitive flexibility, appropriate risk-taking and reaction time in individuals with and without adult ADHD
2020, Psychiatry ResearchCitation Excerpt :The results are in line with prior studies (Mowinckel et al., 2015; Drechsler et al., 2008; Ernst et al., 2003; Mäntylä et al., 2012; Matthies et al., 2012). Moreover, our findings are also in line with the results of Masunami et al. (2009), Garon et al. (2006) and Toplak et al. (2005) who showed the same results in ADHD children and adolescents. However, Geurts et al. (2006), found no significant differences in inappropriate risk-taking in children with and without ADHD (Geurts et al., 2006).
Valence, arousal or both? Shared emotional deficits associated with Attention Deficit and Hyperactivity Disorder and Oppositional/Defiant-Conduct Disorder symptoms in school-aged youth
2019, Biological PsychologyCitation Excerpt :Low HR reactivity in ODD/CD or ADHD has not been supported (de Wied, van Boxtel, Zaalberg, Goudena, & Matthys, 2006; Lorber, 2004), though de Wied, Boxtel, Posthumus, Goudena, and Matthys (2009) noted less HR deceleration to sadness in ODD/CD (some cases with ADHD), which they explained as low empathy. Indirect support for hyporeactivity in children with ADHD comes from their relative insensitivity to punishment and reward (Crone et al., 2003; Iaboni, Douglas, & Ditto, 1997; Luman, Oosterlaan, & Sergeant, 2005; Masunami, Okazaki, & Maekawa, 2009; Meel, van Heslenfeld, Oosterlaan, Luman, & Sergeant, 2011), but relevant physiological data are lacking. Studies using facial EMG at the corrugator and zygomaticus muscles during emotional stimulation in children with ODD, CD or ADHD have yielded mixed results.
The research domain criteria framework: The case for anterior cingulate cortex
2016, Neuroscience and Biobehavioral ReviewsCitation Excerpt :Relative to typically developing children, they also exhibit stronger preferences for immediate rewards (Tripp and Alsop, 2001), elevated temporal discounting of rewards (Scheres et al., 2010), and progressive increases in risky decision-making (Drechsler et al., 2008). The heart rate (Crone et al., 2003) and skin conductance response (Masunami et al., 2009) of children with ADHD are also relatively less sensitive to differences between reward and penalty feedback. These behaviors appear to be propelled by an exaggerated sensitivity to the salience of rewards (Carlson and Tamm, 2000; Luman et al., 2005; McInerney and Kerns, 2003; Scheres et al., 2008), such that simply providing external motivators like money, tokens, and social rewards tends to normalize differences in cognitive control (Dovis et al., 2012; Kohls et al., 2009; Konrad et al., 2000; Shiels et al., 2008).