Skip to main content
SpringerLink
Log in

The effect of methylphenidate and mixed amphetamine salts on cognitive reflection: a field study

  • Original Investigation
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

Rationale

Methylphenidate (MPH) and mixed D,L-amphetamine salts (MASs; Adderall) were previously found to have unreliable effects on judgment and decision processes.

Objective

We predicted that MPH and MASs have a specific effect of reducing heuristic responses, which should lead to increased performance on the cognitive reflection test (CRT). The CRT is considered to be a testbed for heuristic versus deliberative response modes.

Methods

We recruited a sample of 15,361 individuals using the Prolific Academic crowdsourcing platform. From this initial pool, our final sample consisted of 294 participants (125 MPH users and 169 MASs users) who conformed to the study criteria and completed the experimental tasks. Tasks were performed on days where participants were either medicated or not, allowing to assess the effect of medication status.

Results

There was a strong positive effect of taking MPH on CRT scores (Cohen’s d = 0.40) which was not qualified by frequency of MPH usage, ADHD symptoms, and demographic factors. There was also a somewhat weaker effect for MASs (Cohen’s d = 0.07). No effects of MPH and MASs were recorded for risk-taking and numeracy.

Conclusions

The results indicate that MPH enhances decision-making in tasks where heuristic responses typically bias it.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. Notice though that focused attention has its drawbacks: Certain cognitive aspects such as task switching are potentially impaired by the usage of methylphenidate (Rajala et al. 2020).

  2. We aimed for 15,000 individuals, and the stopping point was based on the resources available for the study.

  3. Since recommended dosages of Ritalin and Concerta vary slightly, in the analysis of dosage, we compared the effect of medication type (Ritalin, Concerta, Adderall) rather than drug type (MPH vs. MASs).

  4. It might be that participants who reported symptoms in these tests did so based on their behavior while being medicated.

  5. We also re-ran this analysis without five individuals who had high response times (three standard deviations above the average of 99.1 s). The results replicated the main effect of medication status (F(1,285) = 6.84, p = .009).

  6. This notion may also explain the negative effect of MPH on performance in reversal learning tasks which are highly intuitive (e.g., van der Schaaf et al. 2013). As noted at the outset, in some tasks, extensive deliberation may even interrupt decision performance.

References

  • Agay N, Yechiam E, Carmel Z, Levkovitz Y (2010) Non-specific effects of methylphenidate (Ritalin) on cognitive ability and decision-making of ADHD and healthy adults. Psychopharmacology 210:511–509

    CAS  PubMed  Google Scholar 

  • Agay N, Yechiam E, Carmel Z, Levkovitz Y (2014) Methylphenidate enhances cognitive performance in adults with poor baseline capacities regardless of Attention-Deficit/Hyperactivity Disorder diagnosis. J Clin Psychopharm 34:261–265

    CAS  Google Scholar 

  • Aron AR, Dowson JH, Sahakian BJ, Robbins TW (2003) Methylphenidate improves response inhibition in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry 54:1465–1468

    CAS  PubMed  Google Scholar 

  • Ayal S, Rusou Z, Zakay D, Hochman G (2015) Determinants of judgment and decision making quality: the interplay between information processing style and situational factors. Front Psychol 6:1088

    PubMed  PubMed Central  Google Scholar 

  • Bago B, De Neys W (2019) The Smart System 1: evidence for the intuitive nature of correct responding on the bat-and-ball problem. Think Reasoning 25:257–299

    Google Scholar 

  • Bar-Hillel M, Neter E (1993) How alike is it versus how likely is it: a disjunction fallacy in probability judgments. J Person Soc Psychol 65:1119–1131

    Google Scholar 

  • Bechara A, Damasio AR, Damasio H, Anderson SW (1994) Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50:7–15

    CAS  PubMed  Google Scholar 

  • Chai G, Governale L, McMahon AW, Trinidad JP, Staffa J, Murphy D (2012) Trends of outpatient prescription drug utilization in US children, 2002–2010. Pediatrics 130:23–31

    PubMed  Google Scholar 

  • Campitelli G, Gerrans P (2014) Does the cognitive reflection test measure cognitive reflection? A mathematical modeling approach. Mem Cognition 42:434–447

    Google Scholar 

  • Chater N (2018) Is the type 1/type 2 distinction important for behavioral policy? Trends Cogn Sci 22:369–371

    PubMed  Google Scholar 

  • Conners CK, Erhardt D, Sparrow E (1999) Conners’ Adult ADHD Rating Scales Multi-Health Systems Inc., New York.

  • Denes-Raj V, Epstein S (1994) Conflict between intuitive and rational processing: when people behave against their better judgment. J Person Soc Psychol 66:819–829

    CAS  Google Scholar 

  • Dijksterhuis A, Nordgren LF (2006) A theory of unconscious thought. Perspect Psychol Sci 1:95–109

    PubMed  Google Scholar 

  • Faraone SV (2018) The pharmacology of amphetamine and methylphenidate: relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav R 87:255–270

    CAS  Google Scholar 

  • Frederick S (2005) Cognitive reflection and decision making. J Econ Perspect 19:25–42

    Google Scholar 

  • Grimmsmann T, Himmel W (2021) The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. Eur J Clin Pharmacol 77:107–115

    PubMed  Google Scholar 

  • Kahneman D (2011) Thinking, fast and slow. Farrar, Straus and Giroux, New York

    Google Scholar 

  • Keren G, Schul Y (2009) Two is not always better than one: a critical evaluation of two-system theories. Perspect Psychol Sci 4:533–550

    PubMed  Google Scholar 

  • Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE (2005) The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 35:245–256

    PubMed  Google Scholar 

  • Kroyzer N, Gross-Tsur V, Pollak Y (2014) Risk taking in adolescents with attention deficit hyperactivity disorder on a probabilistic choice task. J Nerv Ment Dis 202:247–252

    PubMed  Google Scholar 

  • Kurscheidt JC, Peiler P, Behnken A, Abel S, Pedersen A, Suslow T, Deckert J (2008) Acute effects of methylphenidate on neuropsychological parameters in adults with ADHD: possible relevance for therapy. J Neural Transm 115:357–362

    CAS  PubMed  Google Scholar 

  • Liberali JM, Reyna VF, Furlan S, Stein LM, Pardo ST (2012) Individual differences in numeracy and cognitive reflection, with implications for biases and fallacies in probability judgment. J Behav Dec Making 25:361–381

    Google Scholar 

  • Lindley RH, Smith WI, Thomas TJ (1988) The relationship between speed of information processing as measured by timed paper-and-pencil tests and psychometric intelligence. Intelligence 12:17–25

    Google Scholar 

  • Lipkus IM, Samsa G, Rimer BK (2001) General performance on a numeracy scale among highly educated samples. Med Dec Making 21:37–44

    CAS  Google Scholar 

  • Linssen AMW, Sambeth A, Vuurman EFPM, Riedel WJ (2014) Cognitive effects of methylphenidate in healthy volunteers: a review of single dose studies. Int J Neuropsychoph 17:961–977

    CAS  Google Scholar 

  • Looby A, Zimmerman L, Livingston NR (2021) Expectation for stimulant type modifies caffeine’s effects on mood and cognition among college students. Exp Clin Psychopharmacology. https://doi.org/10.1037/pha0000448

    Article  Google Scholar 

  • Lopez F, Silva R, Pestreich L, Muniz R (2003) Comparative efficacy of two once daily methylphenidate formulations (Ritalin LA and Concerta) and placebo in children with attention deficit hyperactivity disorder across the school day. Paediatr Drugs 5:545–555

    PubMed  Google Scholar 

  • Maher B (2008) Look who‘s doping. Nature 452:674–675

    CAS  PubMed  Google Scholar 

  • Markowitz JS, Straughn AB, Patrick KS (2003) Advances in the pharmacotherapy of attention-deficit-hyperactivity disorder: focus on methylphenidate formulations. Pharmacotherapy 23:1281–1299

    CAS  PubMed  Google Scholar 

  • Marraccini ME, Weyandt LL, Rossi JS, Gudmundsdottir BG (2016) Neurocognitive enhancement or impairment? A systematic meta-analysis of prescription stimulant effects on processing speed, decision-making, planning, and cognitive perseveration. Exp Clin Psychopharm 24:269–284

    Google Scholar 

  • Menkhoff L, Sakha S (2017) Estimating risky behavior with multiple-item risk measures. J Econ Psychol 59:59–86

    Google Scholar 

  • Nunnally JC (1978) Psychometric theory. McGraw-Hill, New York

    Google Scholar 

  • Patel N, Baker G, Scherer LD (2019) Evaluating the cognitive reflection test as a measure of intuition/reflection, numeracy, and insight problem solving, and the implications for understanding real-world judgments and beliefs. J Exp Psychol Gen 148:2129–2153

    PubMed  Google Scholar 

  • Pietrzak RH, Mollica CM, Maruff P, Snyder PJ (2006) Cognitive effects of immediate-release methylphenidate in children with attention-deficit/hyperactivity disorder. Neurosci Biobehav R 30:1225–1245

    CAS  Google Scholar 

  • Pievsky MA, McGrath RE (2018) Neurocognitive effects of methylphenidate in adults with attention-deficit/hyperactivity disorder: a meta-analysis. Neurosci Biobehav R 90:447–455

    CAS  Google Scholar 

  • Rajala AZ, Populin LC, Jenison RL (2020) Methylphenidate affects task-switching and neural signaling in non-human primates. Psychopharmacology 237:1533–1543

    CAS  PubMed  PubMed Central  Google Scholar 

  • Riddle EL, Hanson GR, Fleckenstein AE (2007) Therapeutic doses of amphetamine and methylphenidate selectively redistribute the vesicular monoamine transporter-2. Eur J Pharmacol 571:25–28

    CAS  PubMed  PubMed Central  Google Scholar 

  • Roberts CA, Jones A, Sumnall H, Gage SH, Montgomery C (2020) How effective are pharmaceuticals for cognitive enhancement in healthy adults? A series of meta-analyses of cognitive performance during acute administration of modafinil, methylphenidate and D-amphetamine. Eur Neuropsychopharmacol 38:40–62

    CAS  PubMed  Google Scholar 

  • Robinson JB (1985) Stereoselectivity and isoenzyme selectivity of monoamine oxidase inhibitors. Enantiomers of amphetamine. N-Methylamphetamine and Deprenyl Biochem Pharmacol 34:4105–4108

    CAS  PubMed  Google Scholar 

  • Sjastad H, Baumeister RF (2021) Fast optimism, slow realism? Causal evidence for a two-step model of future thinking. Working paper, available at https://psyarxiv.com/v6ksu/. Accessed 1 Oct 2021

  • Stuhec M, Lukić P, Locatelli I (2019) Efficacy, acceptability, and tolerability of lisdexamfetamine, mixed amphetamine salts, methylphenidate, and modafinil in the treatment of attention-deficit hyperactivity disorder in adults: a systematic review and meta-analysis. Ann Pharmacother 53:121–133

    CAS  PubMed  Google Scholar 

  • Szollosi A, Bago B, Szaszi B, Aczel B (2017) Exploring the determinants of confidence in the bat-and-ball problem. Acta Physiol (oxf) 180:1–7

    Google Scholar 

  • Travers E, Rolison JJ, Feeney A (2016) The time course of conflict on the cognitive reflection test. Cognition 150:109–118

    PubMed  Google Scholar 

  • Tulloch SJ, Zhang Y, McLean A, Wolf KN (2002) SLI381 (Adderall XR), a two-component extended-release formulation of mixed amphetamine salts: bioavailability of three test formulations and comparisons of fasted, fed, and sprinkled administration. Pharmacotherapy 22:1404–1415

    Google Scholar 

  • Turner DC, Blackwell AD, Dowson JH, McLean A, Sahakian BJ (2005) Neurocognitive effects of methylphenidate in adult attention-deficit/hyperactivity disorder. Psychopharmacology 178:286–295

    CAS  PubMed  Google Scholar 

  • Tversky A, Kahneman D (1983) Extensional versus intuitive reasoning: the conjunction fallacy in probability judgment. Psychol Rev 90:293–315

    Google Scholar 

  • Vaidya CJ, Austin G, Kirkorian G, Ridlehuber HW, Desmond JE, Glover GH, Gabrieli JDE (1998) Selective effects of methylphenidate in attention deficit hyperactivity disorder: a functional magnetic resonance study. P Natl Acad of Sci USA 95:14494–14499

    CAS  Google Scholar 

  • van der Schaaf ME, Fallon SJ, ter Huurne N, Buitelaar J, Cools R (2013) Working memory capacity predicts effects of methylphenidate on reversal learning. Neuropsychopharmacology 38:2011–2018

    PubMed  PubMed Central  Google Scholar 

  • Weller JA, Dieckmann NF, Tusler M, Mertz CK, Burns WJ, Peters E (2013) Development and testing of an abbreviated numeracy scale: a Rasch analysis approach. J Behav Dec Making 26:198–212

    Google Scholar 

  • Wobbrock JO, Findlater L, Gergle D, Higgins J (2011) The aligned rank transform for nonparametric factorial analyses using only ANOVA procedures. In Tan D, Fitzpatrick G, Gutwin C, Begole B, Kellogg WA (eds) Proceedings of the ACM conference on human factors in computing systems (CHI ’11), Association for Computing Machinery. New York, NY, pp. 143–146

Download references

Funding

This study was funded in part by the Max Wertheimer Minerva Center for Cognitive Studies.

Author information

Authors and Affiliations

  1. Max Wertheimer Minerva Center for Cognitive Studies, Technion–Israel Institute of Technology, 3200003, Haifa, Israel

    Eldad Yechiam & Dana Zeif

Authors
  1. Eldad Yechiam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dana Zeif
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eldad Yechiam.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 90 KB)

Appendix

Appendix

Cognitive reflection test

  1. 1.

    In part of the ocean, there is a field of plankton. In a certain time of the year, the field doubles in size every hour. If it takes 38 h for the patch to cover 1 square kilometer, how long would it take for the patch to cover half a square kilometer? ___ hours

  2. 2.

    If it takes 5 machines 5 min to make 5 lottery tickets, how long would it take 100 machines to make 100 lottery tickets? ____ min

  3. 3.

    I bought a set of shoes and sport socks for 110 pesos in total. The shoes were 100 pesos more than the socks. How much did the shoes cost? ____ pesos

Hypothetical investment test

  1. 1.

    Imagine that you are an investor in an option market and your goal is to make as much money for a client over the next 3 months. You can choose to invest in one out of two stocks. In each stock you predict the outcome is as follows

    Stock 1. Every day, there is a 1 in 2 chance (50%) for a 1% profit from the invested amount, and otherwise no profit and no loss in the same given day.

    Stock 2. Every day, there is a 1 in 2 chance (50%) for a 3% profit from the invested amount, and otherwise a loss of 1% in the same given day.

    The draw on each day is independent of the previous day. In this particular market you cannot change your choice during the 3 months. Which stock would you invest in? ____

  2. 2.

    Now a third stock has been added to the market:

Stock 3. Every day, there is a 0.5% profit from the invested amount.

Which of the three stocks (1, 2, or 3) would you now prefer? _____

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yechiam, E., Zeif, D. The effect of methylphenidate and mixed amphetamine salts on cognitive reflection: a field study. Psychopharmacology 239, 455–463 (2022). https://doi.org/10.1007/s00213-021-06016-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00213-021-06016-1

Keywords

Search

Navigation