Decision Making in Adolescents with ADHD: Waiting for, Working for, and Sharing Rewards

ADHD has been associated with unique decision making styles. Decision making in the context of ADHD may be viewed as the result of interactions between cognitive control and motivational states: reward-related decision making. Research on reward-related decision making in ADHD has primarily employed risk tasks, and temporal discounting tasks (choosing between small immediate and large delayed rewards). In this talk, I will focus on (1) temporal discounting tasks and what these can tell us about delay aversion; (2) reward-related decision making during social interactions. (1) We examined whether weak preferences for large delayed rewards in ADHD were specific for delayed rewards (supporting the delay aversion account), or whether these were present for large effortful rewards as well (representing general reward insensitivity). In support of the delay aversion model, adolescents with ADHD showed weaker preferences for large rewards than controls in the delay condition, but not in the effort condition. (2) In a second study, we examined reward-related decision- making in children and adolescents with ADHD in a social context, using economic games, specifically the Ultimatum and Dictator Games. The ADHD group had a larger discrepancy between ultimatum game and dictator game offers than controls, indicating strategic rather than fairness driven decisions. In conclusion, children and adolescents with ADHD were less motivated by fairness in these simple social situations during which they made reward-related decisions. Future research needs to broaden its approaches and contexts in order to increase our understanding of reward-related decision making in those with ADHD.