Risk Taking and Sensitivity to Punishment in Children with ADHD, ODD, ADHD+ODD, and Controls

Abstract

We used the Balloon Analog Risk Task (BART) to examine risk taking and sensitivity to punishment, two relevant aspects of behavioral inhibition, in 203 school-age children with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), ADHD+ODD, and controls. Participants earned points on the BART by pumping 30 separate balloons that exploded at variable intervals. No points were earned on a trial when a balloon exploded. The number of pumps across all balloons estimated risk taking and the reduction in pumps following balloon explosions was interpreted as an indicator of sensitivity to negative punishment. We found that all groups significantly differed from one another on risk taking. The ADHD+ODD group pumped the most, followed by the ODD, ADHD, and the control group, respectively. For sensitivity to negative punishment, all groups performed differently, with the ODD group showing the least sensitivity to an exploded balloon, followed by the ADHD, control, and ADHD+ODD groups, respectively. Children with ADHD+ODD demonstrated significantly different patterns of risk taking and sensitivity to negative punishment than children with either ADHD-only or ODD-only. ADHD youth with comorbid ODD had the greatest levels of risk taking, but they were also the most sensitive to negative punishment. The relationship between ADHD and ODD, as well as the nature of comorbidity in constructs related to risk taking and related behaviors, are discussed.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Alderson, R. M., Rapport, M. D., & Kofler, M. J. (2007). Attention-deficit/hyperactivity disorder and behavioral inhibition: A meta-analytic review of the stop-signal paradigm. Journal of Abnormal Child Psychology, 35, 745–758.

    PubMed  Article  Google Scholar 

  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  3. Antrop, I., Stock, P., Verté, S., Wiersema, J. R., Baeyens, D., & Roeyers, H. (2006). ADHD and delay aversion: The influence of non-temporal stimulation on choice for delayed rewards. Journal of Child Psychology and Psychiatry, 47, 1152–1158.

    PubMed  Article  Google Scholar 

  4. Arnett, J. J. (1992). Reckless behavior in adolescence: a developmental perspective. Developmental Review, 12, 339–373.

    Article  Google Scholar 

  5. Arnett, P. A., Fischer, M., & Newby, R. F. (1996). The effect of Ritalin on response to reward and punishment in children with ADHD. Child Study Journal, 26, 51–70.

    Google Scholar 

  6. Aron, A. R., & Poldrack, R. A. (2005). The cognitive neuroscience of response inhibition: Relevance for genetic research in attention-deficit/hyperactivity disorder. Biological Psychiatry, 57, 1285–1292.

    PubMed  Article  Google Scholar 

  7. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.

    PubMed  Article  Google Scholar 

  8. Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). New York: Guilford.

    Google Scholar 

  9. Barkley, R. A., Fischer, M., Edelbrock, C. S., & Smallish, L. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546–557.

    PubMed  Article  Google Scholar 

  10. Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 7–15.

    PubMed  Article  Google Scholar 

  11. Boyer, T. W. (2006). The development of risk-taking: A multi-perspective review. Developmental Review, 26, 291–345.

    Article  Google Scholar 

  12. Breyer, J. L., Botzet, A. M., Winters, K. C., Stinchfield, R. D., August, G., & Realmuto, G. (2009). Young adult gambling behaviors and their relationship with the persistence of ADHD. Journal of Gambling Studies, 2, 227–238.

    Article  Google Scholar 

  13. Burt, R. D., Dinh, K. T., Peterson, A. V., & Sarason, I. G. (2000). Predicting adolescent smoking: A prospective study of personality variables. Preventive Medicine, 30, 115–125.

    PubMed  Article  Google Scholar 

  14. Carlson, C. L., & Tamm, L. (2000). Responsiveness of children with attention deficit–hyperactivity disorder to reward and response cost: Differential impact on performance and motivation. Journal of Consulting and Clinical Psychology, 68, 73–83.

    PubMed  Article  Google Scholar 

  15. Carlson, C. L., Mann, M., & Alexander, D. K. (2000). Effects of reward and response cost on the performance and motivation of children with ADHD. Cognitive Therapy and Research, 24, 87–98.

    Article  Google Scholar 

  16. Castel, A. D., Lee, S. S., Humphreys, K. L., & Moore, A. N. (2011). Memory capacity, selective control and value-directed remembering in children with and without attention-deficit/hyperactivity Disorder (ADHD). Neuropsychology, 25, 15–24.

    PubMed  Article  Google Scholar 

  17. Charach, A., Yeung, E., Climans, T., & Lillie, E. (2011). Childhood attention-deficit/hyperactivity disorder and future substance use disorders: Comparative meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 9–21.

    PubMed  Article  Google Scholar 

  18. Cicchetti, D., & Rogosch, F. A. (1996). Equifinality and multifinality in developmental psychopathology. Development and Psychopathology, 8, 597–600.

    Article  Google Scholar 

  19. Congdon, E., & Canli, T. (2005). The endophenotype of impulsivity: Reaching consilience through behavioral, genetic, and neuroimaging approaches. Behavioral and Cognitive Neuroscience Reviews, 4, 262–281.

    PubMed  Article  Google Scholar 

  20. de Zeeuw, P., Aarnoudse-Moens, C., Bijlhout, J., König, C., Uiterweer, A. P., Papanikolau, A., et al. (2008). Inhibitory performance, response speed, IIV, and response accuracy in ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 808–816.

    PubMed  Article  Google Scholar 

  21. DeVito, E. E., Blackwell, A. D., Kent, L., Ersche, K. D., Clark, L., Salmond, C. H., et al. (2008). The effects of methylphenidate on decision making in attention-deficit/hyperactivity disorder. Biological Psychiatry, 64, 636–639.

    PubMed  Article  Google Scholar 

  22. Everitt, B. J., & Robbins, T. W. (2005). Neural systems of reinforcement for drug addiction: From actions to habits to compulsion. Nature Neuroscience, 8(11), 1481–1489.

    PubMed  Article  Google Scholar 

  23. Faraone, S. V. (2000). Genetics of childhood disorders: XX. ADHD, part 4: Is ADHD genetically heterogeneous? Journal of the American Academy of Child & Adolescent Psychiatry, 39, 1455–1457.

    Article  Google Scholar 

  24. Flory, K., & Lynam, D. R. (2003). The relation between attention deficit hyperactivity disorder and substance abuse: What role does conduct disorder play? Clinical Child and Family Psychology Review, 6, 1–16.

    PubMed  Article  Google Scholar 

  25. Flory, K., Molina, B. S. G., Pelham, W. E., Gnagy, E., & Smith, B. (2006). Childhood ADHD predicts risky sexual behavior in young adulthood. Journal of Clinical Child and Adolescent Psychology, 35, 571–577.

    PubMed  Article  Google Scholar 

  26. Gadow, K. D., & Nolan, E. E. (2002). Differences between preschool children with ODD, ADHD, and ODD + ADHD symptoms. Journal of Child Psychology and Psychiatry, 43, 191–201.

    PubMed  Article  Google Scholar 

  27. Garon, N., & Moore, C. (2004). Complex decision-making in early childhood. Brain and Cognition, 55, 158–170.

    PubMed  Article  Google Scholar 

  28. Garzon, D. L., Huang, H., & Todd, R. D. (2008). Do attention deficit/hyperactivity disorder and oppositional defiant disorder influence preschool unintentional injury risk? Archives of Psychiatric Nursing, 22, 288–296.

    PubMed  Article  Google Scholar 

  29. Geurts, H. M., van der Oord, S., & Crone, E. A. (2006). Hot and cool aspects of cognitive control in children with ADHD: Decision-making and inhibition. Journal of Abnormal Child Psychology, 34, 813–824.

    PubMed  Article  Google Scholar 

  30. Gomez, R. (2003). Underlying processes in the poor response inhibition of children with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 6, 111–122.

    PubMed  Article  Google Scholar 

  31. Hinshaw, S. P. (2003). Impulsivity, emotion regulation, and developmental psychopathology: Specificity versus generality of linkages. In J. A. King, C. F. Ferris, & I. I. Lederhendler (Eds.), Roots of mental illness in children (pp. 149–159). New York: New York Academy of Sciences.

    Google Scholar 

  32. Hinshaw, S. P., & Lee, S. S. (2003). Conduct and oppositional defiant disorders. In E. J. Mash & R. A. Barkley (Eds.), Child psychopathology (2nd ed., pp. 144–198). New York: Guilford.

    Google Scholar 

  33. Hinshaw, S. P., Lahey, B. B., & Hart, E. L. (1993). Issues of taxonomy and comorbidity in the development of conduct disorder. Development and Psychopathology, 5, 31–49.

    Article  Google Scholar 

  34. Hinshaw, S. P., March, J. S., Abikoff, H., Arnold, L. E., Cantwell, D. P., Conners, C. K., et al. (1997). Comprehensive assessment of childhood Attention-Deficit Hyperactivity Disorder in the context of a multisite, multimodal clinical trial. Journal of Attention Disorders, 1, 217–234.

    Article  Google Scholar 

  35. Humphreys, K. L., Mehta, N., & Lee, S. S. (2011). Association of parental ADHD and depression with externalizing and internalizing dimensions of child psychopathology. Journal of Attention Disorders, (in press). http://jad.sagepub.com/content/early/2010/10/31/1087054710387264.long.

  36. Jessor, R. (1998). New perspectives on adolescent risk behavior. Cambridge, England: Cambridge University Press.

    Book  Google Scholar 

  37. Kochanska, G., & Aksan, N. (2006). Children’s conscience and self-regulation. Journal of Personality, 74, 1587–1617.

    PubMed  Article  Google Scholar 

  38. Kroes, G., Veerman, J. W., & De Bruyn, E. E. J. (2003). Bias in parental reports? Maternal psychopathology and the reporting of problem behavior in clinic-referred children. European Journal of Psychological Assessment, 19, 195–203.

    Article  Google Scholar 

  39. Kuhne, M., Schachar, R., & Tannock, R. (1997). Impact of comorbid oppositional or conduct problems on attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1715–1725.

    PubMed  Article  Google Scholar 

  40. Kuntsi, J., Oosterlaan, J., & Stevenson, J. (2001). Psychological mechanisms in hyperactivity: I response inhibition deficit, working memory impairment, delay aversion, or something else? Journal of Child Psychology and Psychiatry, 42, 199–210.

    PubMed  Article  Google Scholar 

  41. Lahey, B. B., Applegate, B., Barkley, R. A., Garfinkel, B., McBurnett, K., Kerdyk, L., et al. (1994a). DSM-IV Field Trials for oppositional defiant disorder and conduct disorder in children and adolescents. The American Journal of Psychiatry, 151, 1163–1171.

    Google Scholar 

  42. Lahey, B. B., Applegate, B., McBurnett, K., Biederman, J., Greenhill, L., Hynd, G. W., et al. (1994b). DSM-IV Field Trials for attention deficit hyperactivity disorder in children and adolescents. The American Journal of Psychiatry, 151, 1673–1685.

    Google Scholar 

  43. Lahey, B. B., Waldman, I. D., & McBurnett, K. (1999). Annotation: The development of antisocial behavior: An integrative causal model. Journal of Child Psychology and Psychiatry, 40, 669–682.

    PubMed  Article  Google Scholar 

  44. Lee, S. S., Lahey, B. B., Owens, E. B., & Hinshaw, S. P. (2008). Few preschool boys and girls with ADHD are well-adjusted during adolescence. Journal of Abnormal Child Psychology, 36, 373–383.

    PubMed  Article  Google Scholar 

  45. Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. 31, 328–341.

  46. Lejuez, C. W., Read, J. P., Kahler, C. W., Richards, J. B., Ramsey, S. E., Stuart, G. L., et al. (2002). Evaluation of a behavioral measure of risk-taking: The Balloon Analogue Risk Task (BART). Journal of Experimental Psychology. Applied, 6, 75–84.

    Article  Google Scholar 

  47. Lejuez, C. W., Aklin, W. M., Jones, H. A., Richards, J. B., Strong, D. R., Kahler, C. W., et al. (2003). The Balloon Analogue Risk Task (BART) differentiates smokers and nonsmokers. Experimental and Clinical Psychopharmacology, 11, 26–33.

    PubMed  Article  Google Scholar 

  48. Lejuez, C. W., Bornovalova, M., Daughters, S. B., & Curtin, J. J. (2005). Differences in impulsivity and sexual risk-taking behavior among inner-city crack/cocaine and heroin users. Drug and Alcohol Dependence, 77, 169–175.

    PubMed  Article  Google Scholar 

  49. Lejuez, C. W., Aklin, W., Daughters, S., Zvolensky, M., Kahler, C., & Gwadz, M. (2007). Reliability and validity of the youth version of the balloon analogue risk task (BART-Y) in the assessment of risk taking behavior among inner-city adolescents. Journal of Clinical Child and Adolescent Psychology, 36, 106–111.

    PubMed  Google Scholar 

  50. Lilienfeld, S. O., & Waldman, I. D. (1990). The relation between childhood attention-deficit hyperactivity disorder and adult antisocial behavior reexamined: The problem of heterogeneity. Clinical Psychology Review, 10, 699–725.

    Article  Google Scholar 

  51. Loeber, R., Burke, J. D., Lahey, B. B., Winters, A., & Zera, M. (2000). Oppositional defiant and conduct disorder: A review of the past 10 years, part I. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1468–1484.

    PubMed  Article  Google Scholar 

  52. Loeber, R., Burke, J., & Pardini, D. A. (2009). Perspectives on oppositional defiant disorder, conduct disorder, and psychopathic features. Journal of Child Psychology and Psychiatry, 50, 133–142.

    PubMed  Article  Google Scholar 

  53. MacPherson, L., Magidson, J. F., Reynolds, E. K., Kahler, C. W., & Lejuez, C. W. (2010). Changes in sensation seeking and risk taking propensity predict increases in alcohol use among early adolescents. Alcoholism, Clinical and Experimental Research, 34, 1400–1408.

    PubMed  Google Scholar 

  54. Mann, L., Harmoni, R., & Power, C. (1989). Adolescent decision-making: the development of competence. Journal of Adolescence, 12, 265–278.

    PubMed  Article  Google Scholar 

  55. Masunami, T., Okazaki, S., & Maekawa, H. (2009). Decision-making patterns and sensitivity to reward and punishment in children with attention-deficit hyperactivity disorder. International Journal of Psychophysiology, 72, 283–288.

    PubMed  Article  Google Scholar 

  56. Matthys, W., Van Goozen, S. H. M., Snoek, H., & Van Engeland, H. (2004). Response perseveration and sensitivity to reward and punishment in boys with oppositional defiant disorder. European Child & Adolescent Psychiatry, 13, 362–364.

    Article  Google Scholar 

  57. Newcorn, J. H., Halperin, J. M., Jensen, P. S., Abikoff, H. B., Arnold, L. E., Cantwell, D. P., et al. (2001). Symptom profiles in children with ADHD: Effects of comorbidity and gender. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 137–146.

    PubMed  Article  Google Scholar 

  58. Newman, J. P. (1987). Reaction to punishment in extraverts and psychopaths: Implications for the impulsive behavior of disinhibited individuals. Journal of Research in Personality, 21, 464–480.

    Article  Google Scholar 

  59. Nigg, J. T. (2003). Response inhibition and disruptive behaviors: Toward a multiprocess conception of etiological heterogeneity for ADHD combined type and conduct disorder early-onset type. In J. A. King, C. F. Ferris, & I. I. Lederhendler (Eds.), Roots of mental illness in children (pp. 170–182). New York: New York Academy of Sciences.

    Google Scholar 

  60. Nigg, J. T., Hinshaw, S. P., Carte, E. T., & Treuting, J. J. (1998). Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: Explainable by comorbid disruptive behavior or reading problems? Journal of Abnormal Psychology, 107, 468–480.

    PubMed  Article  Google Scholar 

  61. Nigg, J. T., Goldsmith, H. H., & Sachek, J. (2004). Temperament and attention deficit hyperactivity disorder: The development of a multiple pathway model. Journal of Clinical Child and Adolescent Psychology, 33, 42–53.

    PubMed  Article  Google Scholar 

  62. Ostrov, J. M. (2006). Deception and subtypes of aggression in early childhood. Journal of Experimental Child Psychology, 93, 322–336.

    PubMed  Article  Google Scholar 

  63. Owens, E. B., Hinshaw, S. P., Lee, S. S., & Lahey, B. B. (2009). Few girls with childhood attention-deficit/hyperactivity disorder show positive adjustment during adolescence. Journal of Clinical Child and Adolescent Psychology, 38, 132–143.

    PubMed  Article  Google Scholar 

  64. Paloyelis, Y., Asherson, P., & Kuntsi, J. (2009). Are ADHD symptoms associated with delay aversion or choice impulsivity? A general population study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 837–846.

    PubMed  Article  Google Scholar 

  65. Pelham, W. E., Foster, E. M., & Robb, J. A. (2007). The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. Journal of Pediatric Psychology, 32, 711–727.

    PubMed  Article  Google Scholar 

  66. Pleskac, T. J. (2008). Decision making and learning while taking sequential risks. Journal of Experimental Psychology. Learning, Memory, and Cognition, 34, 167–185.

    PubMed  Article  Google Scholar 

  67. Polanczyk, G., Silva de Lima, M., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. The American Journal of Psychiatry, 164, 942–948.

    PubMed  Article  Google Scholar 

  68. Reynolds, B., Ortengren, A., Richards, J. B., & de Wit, W. (2006). Dimensions of impulsive behavior: Personality and behavioral measures. Personality and Individual Differences, 40, 305–315.

    Article  Google Scholar 

  69. Schaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.

    Article  Google Scholar 

  70. Schwebel, D. C., Speltz, M. L., Jones, K., & Bardina, P. (2002). Unintentional injury in preschool boys with and without early onset of disruptive behavior. Journal of Pediatric Psychology, 27, 727–737.

    PubMed  Article  Google Scholar 

  71. Steinberg, L. (2007). Risk taking in adolescence: New perspectives from brain and behavioral science. Current Directions in Psychological Science, 16, 55–59.

    Article  Google Scholar 

  72. Steinberg, L., & Scott, E. S. (2003). Less guilty by reason of adolescence: Developmental immaturity, diminished responsibility, and the juvenile death penalty. American Psychologist, 58, 1009–1018.

    PubMed  Article  Google Scholar 

  73. Thompson, A. L., Molina, B. S. G., Pelham, W., & Gnagy, E. M. (2007). Risky driving in adolescents and young adults with childhood ADHD. Journal of Pediatric Psychology, 32, 745–759.

    PubMed  Article  Google Scholar 

  74. Tom, S. M., Fox, C. R., Trepel, C., & Poldrack, R. A. (2007). The neural basis of loss aversion in decision-making under risk. Science, 315, 515–518.

    PubMed  Article  Google Scholar 

  75. van Bokhoven, I., Matthys, W., van Goozen, S. H. M., & van Engeland, H. (2005). Prediction of adolescent outcome in children with disruptive behaviour disorders: A study of neurobiological, psychological and family factors. European Child & Adolescent Psychiatry, 14, 153–163.

    Article  Google Scholar 

  76. Wåhlstedt, C., Thorell, L. B., & Bohlin, G. (2009). Heterogeneity in ADHD: Neuropsychological pathways, comorbidity and symptom domains. Journal of Abnormal Child Psychology, 37, 551–564.

    PubMed  Article  Google Scholar 

  77. Wrase, J., Kahnt, T., Schlagenhauf, F., Beck, A., Cohen, M. X., et al. (2007). Different neural systems adjust motor behavior in response to reward and punishment. NeuroImage, 36, 1253–1262.

    PubMed  Article  Google Scholar 

  78. Youngstrom, E., Izard, C., & Ackerman, B. (1999). Dysphoria-related bias in maternal ratings of children. Journal of Consulting and Clinical Psychology, 67, 905–916.

    PubMed  Article  Google Scholar 

Download references

Acknowledgements

We wish to thank Dr. Lara Ray for her comments and revisions on earlier versions of this manuscript. We also thank the families for participation in the study and the research staff for their help with data collection and management. This work was partially supported by the Consortium for Neuropsychiatric Phenomics (CNP) (NIH Roadmap for Medical Research grant UL1-DE019580, RL1DA024853) and NIH grant 1R03AA020186-01 to Steve S. Lee. This work was also supported by a National Science Foundation (NSF) Graduate Research Fellowship to the first author.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Steve S. Lee.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Humphreys, K.L., Lee, S.S. Risk Taking and Sensitivity to Punishment in Children with ADHD, ODD, ADHD+ODD, and Controls. J Psychopathol Behav Assess 33, 299–307 (2011). https://doi.org/10.1007/s10862-011-9237-6

Download citation

Keywords

  • ADHD
  • Oppositional defiant disorder
  • Risk taking
  • Punishment
  • Comorbidity