dekkers-et-al-2018-decision-making-deficits-in-adhd-are-not-related-to-risk-seeking-but-to-suboptimal-decision-making

Introduction

• ADHD is associated with a variety of negative health outcomes.

  • Examples: decision-making deficits including substance abuse, reckless driving, sexual risk-taking, and gambling (Barkley et al., 2002; Faregh & Derevensky, 2011).

  • Real-life decision-making deficits in ADHD can have significant negative impacts on individuals and society (Nigg, 2013).

  • Prevalence in prison populations: between 26% to 45% diagnosed with ADHD (Eyestone & Howell, 1994; Rösler et al., 2004).

  • 30% of adults with substance use disorder have comorbid ADHD (Schubiner, 2005).

Decision-Making Deficits in ADHD

• Decision-making deficits can manifest in both experimental tasks (risk preference in gambling tasks) and real-life contexts (delinquency, substance use) (Sonuga-Barke et al., 2016; Parker & Fischhoff, 2005).

• A meta-analysis revealed that ADHD is associated with small to medium effect sizes for riskier choices in gambling tasks (Dekkers et al., 2016).

• Risky vs. Suboptimal Decision-Making:

  • Risky Decision-Making: Defined as options with high variance outcomes.

  • Suboptimal Decision-Making: Choosing the option with the lowest expected value (EV).

  • Common tasks confound risk and EV, making it hard to separately analyze risk seeking and suboptimal choices.

• Understanding the origin of decision-making deficits in ADHD is imperative for developing intervention strategies.

Method and Results of Study

Meta-Analytical Evidence

• Conducted a multilevel meta-regression analysis (k=48, n_ADHD=1,144, n_Control=1,108).

  • Results suggested differences in decision-making based on whether the risky option was suboptimal.

  • ADHD groups made more risky/suboptimal choices when risky options were not advantageous.

Empirical Evidence

• An additional empirical study examined adults with and without ADHD (n=40 each) on gambling tasks designed to discriminate between risky and suboptimal decision-making.

  • Results showed adults with ADHD made more suboptimal choices but did not necessarily prefer risky choices more than the control group.

Conclusions

• ADHD-related decision-making deficits primarily arise from suboptimal decision-making rather than outright risk-seeking behavior.

• Implications for future research include:

  • Better separating risk-taking and suboptimal choices in experimental designs.

Definition of Key Terms

• Risk Seeking: Preference for options yielding uncertain outcomes with potential high rewards.

• Suboptimal Decision-Making: Preferential choice of options that do not yield the best expected outcomes.

Further Research Directions

• Investigate how ADHD affects decision-making during real-life scenarios compared to experimental settings.

• Develop more ecologically valid assessments of decision-making that consider emotional and social influences (e.g., peer influence).

Limitations of Study

• The current study's conclusions rely on assumptions about the applicability of experimental tasks to real-world decision-making.

• Future studies should address potential comorbid conditions like disruptive behavior disorders that may influence decision-making dynamics.

Practical Implications

• Improving decision-making quality in individuals with ADHD should focus on enhancing their evaluation of expected values (EV).

• Understanding that ADHD is linked to underperformance in advantageous risk situations challenges existing assumptions about ADHD behavior.