Temporal discounting in children and adolescents with and without attention-deficit/hyperactivity disorder: a comparison of four scoring methods.

Temporal discounting (TD) tasks measure the preference for immediate rewards over larger delayed rewards and have been widely used to study impulsivity in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Relatively impulsive individuals tend to show high inconsistency in their choices, which makes it difficult to determine commonly used TD outcome measures (e.g., area under the curve, AUC). In this study, we leveraged two published datasets to compare four methods to compute TD outcome measures in children and adolescents (8-17 years) with (n = 107) and without ADHD (n = 128): two predetermined rules methods, a proportion method, and logistic regression. In both datasets, when using the two predetermined rules methods and the proportion method, TD outcomes were highly correlated and group differences in TD were similar. When using logistic regression, a large proportion of AUCs (95% in dataset 1; 33% in dataset 2) could not be computed due to inconsistent choice patterns. These findings indicate that predetermined rules methods (for studies with small sample sizes and experienced raters) and a proportion method (for studies with larger sample sizes or less experienced raters) are recommended over logistic regression when determining subjective reward values for participants with inconsistent choice patterns.

Brain responses and approach bias to social alcohol cues and their association with drinking in a social setting in young adult males.

Alcohol is mainly consumed in social settings, in which people often adapt their drinking behaviour to that of others, also called imitation of drinking. Yet, it remains unclear what drives this drinking in a social setting. In this study, we expected to see stronger brain and behavioural responses to social compared to non-social alcohol cues, and these responses to be associated with drinking in a social setting. The sample consisted of 153 beer-drinking males, aged 18-25 years. Brain responses to social alcohol cues were measured during an alcohol cue-exposure task performed in an fMRI scanner. Behavioural responses to social alcohol cues were measured using a stimulus-response compatibility task, providing an index of approach bias towards these cues. Drinking in a social setting was measured in a laboratory mimicking a bar environment. Specific brain responses to social alcohol cues were observed in the bilateral superior temporal sulcus and the left inferior parietal lobe. There was no approach bias towards social alcohol cues specifically; however, we did find an approach bias towards alcohol (versus soda) cues in general. Brain responses and approach bias towards social alcohol cues were unrelated and not associated with actual drinking. Thus, we found no support for a relation between drinking in a social setting on the one hand, and brain cue-reactivity or behavioural approach biases to social alcohol cues on the other hand. This suggests that, in contrast to our hypothesis, drinking in a social setting may not be driven by brain or behavioural responses to social alcohol cues.

Delay discounting of monetary gains and losses in adolescents with ADHD: Contribution of delay aversion to choice.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are known to have stronger preferences for smaller immediate rewards over larger delayed rewards in delay discounting tasks than their peers, which has been argued to reflect delay aversion. Here, participants performed a delay discounting task with gains and losses. In this latter condition, participants were asked whether they were willing to wait in order to lose less money. Following the core assumption of the delay aversion model that individuals with ADHD have a general aversion to delay, one would predict adolescents with ADHD to avoid waiting in both conditions. Adolescents (12-17 years) with ADHD (n = 29) and controls (n = 28) made choices between smaller immediate and larger delayed gains, and between larger immediate and smaller delayed losses. All delays (5-25 s) and gains/losses (2-10 cents) were experienced. In addition to an area under the curve approach, a mixed-model analysis was conducted to disentangle the contributions of delay duration and immediate gain/delayed loss amount to choice. The ADHD group chose the immediate option more often than controls in the gain condition, but not in the loss condition. The contribution of delay duration to immediate choices was stronger for the ADHD group than the control group in the gain condition only. In addition, the ADHD group scored higher on self-reported delay aversion, and delay aversion was associated with delay sensitivity in the gain condition, but not in the loss condition. In sum, we found no clear evidence for a general aversion to delay in adolescents with ADHD.

Waiting and working for rewards: Attention-Deficit/Hyperactivity Disorder is associated with steeper delay discounting linked to amygdala activation, but not with steeper effort discounting.

OBJECTIVE: Children and adolescents with ADHD have a relatively strong preference for smaller immediate rewards over larger delayed rewards (steep delay discounting). It is unknown whether such steep discounting of rewards is specific for delayed rewards, i.e., supporting the delay aversion account of ADHD, or whether it is also present for effortful rewards, i.e., representing general reward insensitivity. Therefore, this study examined behavioral and BOLD responses during delay discounting (DD) and effort discounting (ED) in ADHD. METHOD: Thirty adolescents with ADHD and 28 controls (12-17 years) were scanned while performing a DD-ED task (fMRI findings were based on 21 and 25 participants, respectively). During DD, participants were presented with a series of choices between a small reward delivered immediately and a larger reward delivered after 5-25s. During ED, participants were presented with choices between a small reward that was delivered after exerting 15% of their maximal hand grip strength and a larger reward delivered after exerting 30-90% of their strength. RESULTS: Analyses on the subjective values of delayed and effortful rewards and on the Area Under the discounting Curves (AUCs) indicated that adolescents with ADHD showed steeper discounting than controls for DD, but not for ED. This was accompanied by a slightly stronger delay dose-response relationship in the amygdala for adolescents with ADHD who reported to be more delay averse in daily life. CONCLUSION: Together, these results-steeper DD in the ADHD group and a stronger delay dose-response relationship in the amygdala, while no evidence for group differences in ED was found-support the delay aversion account of ADHD.

A Pilot Study of Behavioral, Physiological, and Subjective Responses to Varying Mental Effort Requirements in Attention-Deficit/Hyperactivity Disorder.

Background: Attention-deficit/hyperactivity disorder (ADHD) is presumed to involve mental effort application difficulties. To test this assumption, we manipulated task difficulty and measured behavioral, as well as subjective and psychophysiological indices of effort. Methods: Fifteen adolescent ADHD boys and 16 controls performed two tasks. First, subjective estimates and behavioral and pupillary measures of effort were recorded across five levels of N-back task difficulties. Second, effort discounting was assessed. In the latter, participants made repeated choices between performing a difficult N-back task for a high reward versus an easier N-back task for a smaller reward. Results: Increasing task difficulty led to similar deteriorations in performance for both groups - although ADHD participants performed more poorly at all difficulty levels than controls. While ADHD and control participants rated the tasks equally difficult and discounted effort similarly, those with ADHD displayed slightly different pupil dilation patterns with increasing task difficulty. Conclusion: The behavioral results did not provide evidence for mental effort problems in adolescent boys with ADHD. The subtle physiological effects, however, suggest that adolescents with ADHD may allocate effort in a different way than controls.

Polygenic risk for alcohol consumption and its association with alcohol-related phenotypes: Do stress and life satisfaction moderate these relationships?

BACKGROUND: Genetic and environmental factors contribute about equally to alcohol-related phenotypes in adulthood. In the present study, we examined whether more stress at home or low satisfaction with life might be associated with heavier drinking or more alcohol-related problems in individuals with a high genetic susceptibility to alcohol use. METHODS: Information on polygenic scores and drinking behavior was available in 6705 adults (65% female; 18-83 years) registered with the Netherlands Twin Register. Polygenic risk scores (PRSs) were constructed for all subjects based on the summary statistics of a large genome-wide association meta-analysis on alcohol consumption (grams per day). Outcome measures were quantity of alcohol consumption and alcohol-related problems assessed with the Alcohol Use Disorders Identification Test (AUDIT). Stress at home and life satisfaction were moderating variables whose significance was tested by Generalized Estimating Equation analyses taking familial relatedness, age and sex into account. RESULTS: PRSs for alcohol were significantly associated with quantity of alcohol consumption and alcohol-related problems in the past year (R2=0.11% and 0.10% respectively). Participants who reported to have experienced more stress in the past year and lower life satisfaction, scored higher on alcohol-related problems (R2=0.27% and 0.29 respectively), but not on alcohol consumption. Stress and life satisfaction did not moderate the association between PRSs and the alcohol outcome measures. CONCLUSIONS: There were significant main effects of polygenic scores and of stress and life satisfaction on drinking behavior, but there was no support for PRS-by-stress or PRS-by-life satisfaction interactions on alcohol consumption and alcohol-related problems.

Does an attention bias to appetitive and aversive words modulate interference control in youth with ADHD?

Interference control refers to the ability to selectively attend to certain information while ignoring distracting information. This ability can vary as a function of distractor relevance. Distractors that are particularly relevant to an individual may attract more attention than less relevant distractors. This is referred to as attention bias. Weak interference control and altered reward sensitivity are both important features of attention deficit hyperactivity disorder (ADHD). However, interference control is typically studied in isolation. This study integrates both. Youths (aged 9 to 17 years) with ADHD (n = 37, 25 boys) and typically-developing controls (n = 38, 20 boys) completed a Stroop task using appetitive words and matched neutral words to assess whether appetitive distractors diminished interference control more in youths with ADHD than controls. In order to test for specificity, aversive words were also included. As expected, appetitive words disrupted interference control but this effect was not stronger for youths with ADHD than the controls. Aversive words, on the other hand, facilitated interference control. Dimensional analyses revealed that this facilitation effect increased substantially as a function of ADHD symptom severity. Possible mechanisms for this effect include up-regulation of interference control as a function of induced negative mood, or as a function of increased effort. In conclusion, appetitive words do not lead to worse interference control in youths with ADHD compared with controls. Interference control was modulated in a valence-specific manner, concurrent with mood-induced effects on cognitive control.

The prevalence of food addiction in a large sample of adolescents and its association with addictive substances.

The prevalence of overweight and obesity is increasing, due to, among other factors, increased availability of highly palatable food (food high in fat, salt and/or sugar). It has been proposed that certain foods and/or eating behaviours may be addictive, to a degree comparable to substances of abuse. The Yale Food Addiction Scale (YFAS) measures 'food addiction' by translating the diagnostic criteria for substance use disorder to eating behaviour. So far, only a few studies have examined the prevalence of food addiction in children with the YFAS for children (YFAS-C). Large-scale studies, especially among adolescents, are lacking. Adolescence is of particular interest because it is a period wherein unhealthy eating behaviours or addictive tendencies are likely to develop. The current study examines the prevalence of food addiction using the YFAS-C in a large group of Dutch adolescents (N = 2653) aged 14-21 years. With Generalized Estimation Equation (GEE) analysis we tested the relationship between food addiction symptoms and smoking, cannabis use, alcohol use, and sugar intake through drinks, while controlling for gender, age, educational level and weight class. In the total sample 2.6% met the criteria for a food addiction 'diagnosis', and the average symptom count was 1.0 (SD = 1.3, range 0-7). Symptoms of food addiction were positively associated with smoking, alcohol use, cannabis use and sugar intake. We propose that future studies focus on possible genetic/(neuro)biological mechanisms involved in both food addiction and substance use and that longitudinal designs are needed to examine possible causal pathways.

Neural responses to social exclusion in adolescents: Effects of peer status.

We examined whether adolescents' neural responses to social exclusion and inclusion are influenced by their own popularity and acceptance and by the popularity of their excluders and includers. Accepted adolescents are highly prosocial. In contrast, popular adolescents, who are central and influential, show prosocial as well as antisocial behaviors, such as peer exclusion. Fifty-two 12-16 year-old adolescents underwent an functional magnetic resonance imaging (fMRI) scan while playing the ball-tossing game Cyberball in which they received or did not receive the ball from other virtual players. The other virtual players were described as either highly popular or average in popularity. Participants' own popularity and acceptance were assessed with peer nominations at school (n = 31). Participants' acceptance was positively correlated with activity of the dorsal anterior cingulate cortex (ACC) during exclusion. Participants' popularity was positively associated with ventral striatum and medial prefrontal cortex activity during exclusion, but only when the excluders were popular virtual players. Participants showed increased rostral ACC activation to inclusion by players who were average in popularity. These findings indicate that peer status plays an important role in adolescents' neural processing of social exclusion and inclusion. Moreover, these findings underscore that popularity and acceptance are distinct types of high peer status in adolescence, with not only distinct behavioral correlates, but also distinct neural correlates.

Neural mechanisms of individual differences in temporal discounting of monetary and primary rewards in adolescents.

Adolescents are generally characterized as impulsive. However, impulsivity is a multi-dimensional construct that involves multiple component processes. Which of these components contribute to adolescent impulsivity is currently unclear. This study focused on the neural mechanisms underlying individual differences in distinct components of temporal discounting (TD), i.e., the preference for smaller immediate rewards over larger delayed rewards. Participants were 58 adolescents (12-16 years-old) who performed an fMRI TD task with both monetary and snack rewards. Using mixed-effects modeling, we determined participants' average impatience, and further decomposed TD choices into: 1) amount sensitivity (unique contribution of the magnitude of the immediate reward); and 2) delay sensitivity (unique contribution of delay duration). Adolescents' average impatience was positively correlated with frontoparietal and ventral striatal activity during delayed reward choices, and with ventromedial prefrontal cortex activity during immediate reward choices. Adolescents' amount sensitivity was positively associated with ventral striatal and dorsal anterior cingulate cortex activity during immediate reward choices. Delay sensitivity was positively correlated with inferior parietal cortex activity during delayed reward choices. As expected, snacks were discounted more steeply than money, and TD of both reward types was associated with overlapping activation in the inferior parietal cortex. Exploring whether testosterone or estradiol were associated with TD and its neural correlates revealed no significant associations. These findings indicate that distinct components contribute uniquely to TD choice and that individual differences in amount sensitivity are uniquely associated with activation of reward valuation areas, while individual differences in delay sensitivity are uniquely associated with activation of cognitive control areas.

Quick Delay Questionnaire: Reliability, validity, and relations to functional impairments in adults with attention-deficit/hyperactivity disorder (ADHD).

The Quick Delay Questionnaire (QDQ) is a self-report measure of delay-related behaviors in adults, and the present study aimed at investigating the psychometric properties of QDQ scores, how well they can discriminate between ADHD adults and both clinical and nonclinical controls, as well as their relations to measures of functional impairments. In the present study, QDQ ratings, a laboratory measure of delay discounting, and ratings of functional impairments were collected from adults diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 51), a clinical control group with other psychiatric disorders (n = 46), and a nonclinical control group (n = 105). Results showed that the QDQ scores showed adequate reliability. Adults with ADHD had higher scores compared with normal controls on both QDQ subscales, and they also reported higher levels of delay aversion than the clinical controls. Logistic regression analyses showed high specificity but low sensitivity when trying to discriminate between adults with ADHD and nonclinical controls. QDQ scores were not associated with a laboratory measure of delay discounting, but with functional impairments such as substance use, criminality, and money management. Our findings indicate that QDQ scores are reliable, but this instrument should be regarded as a complement rather than as a replacement for laboratory measures. The relatively low sensitivity of QDQ scores is in line with current models of heterogeneity stating that only a subgroup of individuals with ADHD has high levels of delay-related behaviors. Our findings further indicate that this subgroup may be at particularly high risk for problems in everyday life. (PsycINFO Database Record

Ventral striatal hyperconnectivity during rewarded interference control in adolescents with ADHD.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is characterized by cognitive deficits (e.g., interference control) and altered reward processing. Cognitive control is influenced by incentive motivation and according to current theoretical models, ADHD is associated with abnormal interactions between incentive motivation and cognitive control. However, the neural mechanisms by which reward modulates cognitive control in individuals with ADHD are unknown. METHOD: We used event-related functional resonance imaging (fMRI) to study neural responses during a rewarded Stroop color-word task in adolescents (14-17 years) with ADHD (n = 25; 19 boys) and healthy controls (n = 33; 22 boys). RESULTS: Adolescents with ADHD showed increased reward signaling within the superior frontal gyrus and ventral striatum (VS) relative to controls. Importantly, functional connectivity analyses revealed a hyperconnectivity between VS and motor control regions in the ADHD group, as a function of reward-cognitive control integration. Connectivity was associated with performance improvement in controls but not in the ADHD group, suggesting inefficient connectivity. CONCLUSION: Adolescents with ADHD show increased neural sensitivity to rewards and its interactions with interference control in VS and motor regions, respectively. The findings support theoretical models of altered reward-cognitive control integration in individuals with ADHD.

Planning to make economic decisions in the future, but choosing impulsively now: are preference reversals related to symptoms of ADHD and depression?

A preference for smaller immediate rewards over larger delayed rewards (delay discounting, DD) is common in attention deficit hyperactivity disorder (ADHD), but rarely investigated in depression. Whether this preference is due to sensitivity to reward immediacy or delay aversion remains unclear. To investigate this, we examined whether ADHD and depressive symptoms are associated with preference reversals: a switch from smaller immediate rewards to larger delayed rewards when smaller rewards are also delayed. We also examined whether these symptoms differentially affect DD of losses. In Study 1 undergraduates completed a questionnaire about ADHD symptoms, and performed a hypothetical DD task. In the NOW condition, participants were presented with choices between a small reward available today and a large reward available after one year. In the FUTURE condition both rewards were delayed with +1 year. In Study 2 undergraduates completed questionnaires about ADHD and depressive symptoms and performed a DD task with gains and losses. Participants showed preference reversals in both studies and tasks. Losses were less steeply discounted than gains. ADHD and depressive symptoms did not influence these effects. Depressive symptoms, but not ADHD symptoms, were associated with less economic choices in general. These findings suggest that impulsive choice in depression is not explained by sensitivity to reward immediacy. Copyright © 2016 John Wiley & Sons, Ltd.

Neurophysiological correlates of anhedonia in feedback processing.

Disturbances in feedback processing and a dysregulation of the neural circuit in which the cingulate cortex plays a key role have been frequently observed in depression. Since depression is a heterogeneous disease, instead of focusing on the depressive state in general, this study investigated the relations between the two core symptoms of depression, i.e., depressed mood and anhedonia, and the neural correlates of feedback processing using fMRI. The focus was on the different subdivisions of the anterior cingulate cortex (ACC). Undergraduates with varying levels of depressed mood and anhedonia performed a time-estimation task in which they received positive and negative feedback that was either valid or invalid (i.e., related vs. unrelated to actual performance). The rostral cingulate zone (RCZ), corresponding to the dorsal part of the ACC, was less active in response to feedback in more anhedonic individuals, after correcting for the influence of depressed mood, whereas the subgenual ACC was more active in these individuals. Task performance was not affected by anhedonia, however. No statistically significant effects were found for depressed mood above and beyond the effects of anhedonia. This study therefore implies that increasing levels of anhedonia involve changes in the neural circuitry underlying feedback processing.

The neural correlates of temporal reward discounting.

Temporal reward discounting (TD) refers to the decrease in subjective value of a reward when the delay to that reward increases. In recent years, a growing number of studies on the neural correlates of temporal reward discounting have been conducted. This article focuses on functional magnetic resonance imaging (fMRI) studies on TD in humans. First, we describe the different types of tasks (also from behavioral studies) and the dependent variables. Subsequently, we discuss the evidence for three neurobiological models of TD: the dual-systems model, the single-system model and the self-control model. Further, studies in which nontraditional tasks (e.g., with nonmonetary rewards) were used to study TD are reviewed. Finally, we discuss the neural correlates of individual differences in discounting, and its development across the lifespan. We conclude that the evidence for each of the three neurobiological models of TD is mixed, in that all models receive (partial) support, and several studies provide support for multiple models. Because of large differences between studies in task design and analytical approach, it is difficult to draw a firm conclusion regarding which model provides the best explanation of the neural correlates of temporal discounting. We propose that some components of these models can complement each other, and future studies should test the predictions offered by different models against each other. Several future research directions are suggested, including studying the connectivity between brain regions in relation to discounting, and directly comparing the neural mechanisms involved in discounting of monetary and primary rewards. WIREs Cogn Sci 2013, 4:523-545. doi: 10.1002/wcs.1246 CONFLICT OF INTEREST: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website.

The anterior cingulate cortex responds differently to the validity and valence of feedback in a time-estimation task.

This study examined the role of the medial frontal cortex in the processing of valence and validity of performance feedback using a time-estimation paradigm. Participants had to produce 1s intervals followed by positive and negative feedback that could be valid or invalid (i.e., related or unrelated to task performance). Performance results showed that participants used the validity information to adjust their time estimations to negative feedback. The rostral cingulate zone (RCZ) was more active after valid feedback than after invalid feedback, but was insensitive to the valence of the feedback. The rostral anterior cingulate cortex (rACC), posterior cingulate and right superior frontal gyrus, however, appeared to be primarily sensitive to the valence of the feedback; being more active after positive feedback. The results are discussed along the lines of the ACC's cognitive and affective subdivisions and their structural and functional connections.

Remedial action and feedback processing in a time-estimation task: evidence for a role of the rostral cingulate zone in behavioral adjustments without learning.

The present study examined the role of the rostral cingulate zone (RCZ) in feedback processing, and especially focused on effects of modality of the feedback stimulus and remedial action. Participants performed a time-estimation task in which they had to estimate a 1-second interval. After the estimation participants received verbal (correct/false) or facial (fearful face/happy face) feedback. Percentage of positive and negative feedback was kept at 50% by dynamically adjusting the interval in which estimations were labeled correct. Contrary to predictions of the reinforcement learning theory, which predicts more RCZ activation when the outcome of behavior is worse than expected, we found that the RCZ was more active after positive feedback than after negative feedback, independent of the modality of the feedback stimulus. More in line with the suggested role of the RCZ in reinforcement learning was the finding that the RCZ was more active after negative feedback that was followed by a correct adjustment as compared to negative feedback followed by an incorrect adjustment. Both findings can be explained in terms of the RCZ being involved in facilitating remedial action as opposed to the suggested signaling function (outcome is worse than expected) proposed by the reinforcement learning theory.

Acute tryptophan depletion in healthy males attenuates phasic cardiac slowing but does not affect electro-cortical response to negative feedback.

RATIONALE: Recent studies have shown that serotonin might be involved in performance monitoring, although the results have been inconclusive. Inconsistent results might be related to the type of pharmacological manipulation and the used behavioral and physiological measures. OBJECTIVES: The present study aimed at further specifying the role of serotonin in performance monitoring. MATERIALS AND METHODS: The effect of serotonin on performance monitoring was studied by using acute tryptophan depletion (ATD), a well-known method to transiently lower central serotonin levels. Twenty healthy male volunteers performed a time-estimation task and their event-related brain potential (ERP), behavioral, and cardiac responses to feedback stimuli were measured. Furthermore, subjective mood and amino-acid levels were determined. RESULTS: As expected, ATD did not affect mood and lowered tryptophan levels. ATD attenuated cardiac slowing to negative feedback but did not affect responses to positive feedback, ERPs, and performance measures. CONCLUSIONS: The data point in the direction of a dissociation between cardiac and electro-cortical responses. Cardiac responses appear to be more sensitive to changes in serotonin metabolism and appear to reflect different aspects of the feedback stimulus. The phasic cardiac response appears to be an important measure that provides additional information about the impact of feedback stimuli and serotonergic functioning.