Abstract
Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrate increased levels of real-life risk-taking behavior like substance abuse and reckless behavior in traffic, which potentially originates in decision-making deficits. Using experimental gambling tasks, the current study investigated three potential underlying mechanisms: (1) risky vs. suboptimal decision making, (2) the complexity of decision-making strategies and (3) the influence of feedback. Participants were 181 male adolescents (81 ADHD, 100 Typically Developing (TD); Mage = 15.1 years). First, we addressed a common confound in many gambling tasks by disentangling risk seeking from suboptimal decision making, and found that ADHD-related decision-making deficits do not originate in increased risk seeking but in suboptimal decision making. Second, we assessed decision-making strategies with a Bayesian latent mixture analysis and found that ADHD-related decision-making deficits are characterized by the use of less complex strategies. That is, adolescent boys with ADHD, relative to TD adolescent boys, less often adopted strategies in which all characteristics relevant to make an optimal decision were integrated. Third, we administered two gambling task conditions with feedback in which adolescents experience the outcomes of their decisions and found that adolescents with ADHD performed worse relative to TD adolescents on both conditions. Altogether, this set of studies demonstrated consistent decision-making deficits in adolescent boys with ADHD: The use of less complex decision-making strategies may cause suboptimal decision making, both in situations with and without direct feedback on performance.
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Notes
Expected Value (EV) = (gain probability × gain amount) – (loss probability × loss amount). Risk = √(gain probability × (gain amount - EV)2 + loss probability × (loss amount - EV)2). Note: loss amount is an absolute value.
Throughout this study, “optimal” describes the decision for the option with the highest EV.
Adolescents took part in a multi-experiment study. For another, yet unpublished part of this study, we measured salivary hormone levels (among which testosterone), and recruiting girls would have required a substantially larger sample size.
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Acknowledgements
We would like to thank all adolescents, parents, schools and mental healthcare institutions that participated. Furthermore, we are very grateful to Alec Schouten, Anna Kastelein, Annel Koomen, Anouk Fieten, Carlijn Vrijhoef, Carlotta Vroon, Charlotte Meire, Charlotte Smink, Claudia Meijer, Esther Baars, Hanne van der Veen, Iza Leeuwin, Jesse Schouw, Joukje Poelmann, Julia Vink, Laura Stol, Lily Menco, Lisa Nokkert, Liza Klouwers, Maartje Wierda, Marene Hardonk, Margarita Arabadzhieva, Mathilde Looman, Mees Jongema, Meike van den Bongaardt, Minke Bosma, Nina Admiraal, Noor Galesloot, Odette van Rongen, Priscilla Veen, Puk Visser, Risa Witschge, Robin van der Reep, Roxanne Bongers, Sabine Hollmann, Sam Stuijver, Sanne Schouten, Scarlett Slagter, Serena Brandenburg, Seyda Günay, Shanna Fransen, Viktor Hortmann and Wikke van der Putten for assistance in the collection of the data. We thank Jasper Wijnen for programming the tasks.
Funding
TJD is supported by a Prins Bernhard Cultuurfonds grant (no. 40021352) and TJD, JNZ, and HMH are supported by a VICI grant (453–12-005) from the Netherlands Organization for Scientific Research (NWO). The funding sources had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, nor the decision to submit the paper for publication.
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Dekkers, T.J., Huizenga, H.M., Popma, A. et al. Decision-Making Deficits in Adolescent Boys with and without Attention-Deficit/Hyperactivity Disorder (ADHD): an Experimental Assessment of Associated Mechanisms. J Abnorm Child Psychol 48, 495–510 (2020). https://doi.org/10.1007/s10802-019-00613-7
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DOI: https://doi.org/10.1007/s10802-019-00613-7