Mediators of the Link between ADHD and Risk-Taking Behavior

Clinical evidence establishes the link between ADHD and increased engagement in risk-taking behaviors, including drug abuse, unsafe sexual behavior, reckless driving and other behaviors that may lead to detrimental outcomes. The current paper focuses on several potential mediators of this link, using decision theory as a conceptual framework.

Decision theory identifies variables that influence decision making, such as benefit and risk perceptions regarding the outcomes of the behavior, probability of outcomes, the delay between the decision and the outcome, as well as the history of outcomes that were delivered following past choices. We aimed to examine the sensitivity of individuals with and without ADHD to changes in these variables.

In a series of studies, adolescents and adults with and without ADHD were presented with decision problems. Levels of delay, probability, and serial feedback were manipulated. In other studies, benefit and risk perceptions were measured.

The findings of these studies demonstrated that individuals with ADHD were less sensitive than controls to information that may optimize decision making such as the expected value of each option, whereas they were more sensitive to information that is not relevant for utility maximization, such as the presence of feedback in explicit tasks. In result, subjects with ADHD were sometimes more risk seeking and present-biased, and sometimes more risk aversive and future-biased, compared to controls.

Together, these findings further support the idea that ADHD-related risk-taking behavior reflects suboptimal decision making, rather than a bias toward risky or immediate outcome per se.