Sex differences in physiological correlates of affectively driven decision-making behavior in adult ADHD.

BACKGROUND: Sex differences in the symptomatology of adults with attention-deficit/hyperactivity disorder (ADHD) have often been overlooked when studying behavioral abnormalities. However, it is known that women exhibit considerably more stronger symptoms related to emotional competence than men. Since affective functions significantly influence the processing of risky decision-making and risk-engagement, we assume that risky behavior in ADHD is affected by sex differences. Therefore, we specifically investigated sex-specific effects on the interaction between emotionally induced changes in physiology and behavioral performance on a decision-making task. METHODS: Skin conductance responses of twenty-nine adults with ADHD (n = 16 male; n = 13 female) and thirty-three adults in the control group (n = 14 male; n = 19 female) were recorded during the performance in a modified version of the Balloon Analogue Risk Task (BART). Additional questionnaires were used to reveal insights in the self-assessment of emotional competence, risk perception, and feedback sensitivity. Emotional arousal and decision-making behavior were analyzed using linear mixed-effects models. RESULTS: Results showed different effects of sex on risk behaviors in controls and ADHD. In contrast to healthy controls, female adults with ADHD showed a significantly greater risk engagement in the BART compared to males with ADHD. This contrary sex relation was not observed in skin conductance responses and revealed a significantly different sex-dependent correlation of body response and behavioral task performance in ADHD. Comparisons with results from self-assessments furthermore indicate a reduced behavioral self-perception in women with ADHD, but not in men. CONCLUSION: In summary, we found an altered interaction between physiological activity and risky behavior in women with ADHD. Thus, the present study indicates a reduced sensitivity towards the own bodily responses in women with ADHD, which could consequently cause increased risky DM behavior in daily life. The current results suggest that more consideration needs to be given to sex-specific effects on physiological processes and behavior in adults with ADHD.

Nothing to lose? Neural correlates of decision, anticipation, and feedback in the balloon analog risk task.

Understanding the subprocesses of risky decision making is a prerequisite for understanding (dys-)functional decisions. For the present fMRI study, we designed a novel variant of the balloon-analog-risk task (BART) that measures three phases: decision making, reward anticipation, and feedback processing. Twenty-nine healthy young adults completed the BART. We analyzed neural activity and functional connectivity. Parametric modulation allowed assessing changes in brain functioning depending on the riskiness of the decision. Our results confirm involvement of nucleus accumbens, insula, anterior cingulate cortex, and dorsolateral prefrontal cortex in all subprocesses of risky decision-making. In addition, subprocesses were differentiated by the strength of activation in these regions, as well as by changes in activity and nucleus accumbens-connectivity by the riskiness of the decision. The presented fMRI-BART variant allows distinguishing activity and connectivity during the subprocesses of risky decision making and shows how activation and connectivity patterns relate to the riskiness of the decision. Hence, it is a useful tool for unraveling impairments in subprocesses of risky decision making in people with high risk behavior.

Extreme weight conditions impact on the relationship between risky decision-making and interoception.

Anorexia nervosa (AN) and obesity (OB) lie on the two ends of the broad spectrum of extreme weight conditions (EWC). Both disorders entail the constant risk to one's body integrity. Importantly, risk-taking is supported by internal signals, the perception of which is typically distorted in EWC. In this study, we sought to characterize in EWC: (i) risky decision-making by contrasting situations in which people process bodies or neutral objects and (ii) the relationship between interoceptive ability and risky decision-making. In a between-subject design, participants with AN restricting type, participants with class 2 OB, and two groups of matched healthy controls (HC) (total N = 160) were administered either the Balloon Analogue Risk Task (BART) or a modified version of it by using a body-related stimulus as a cue in the place of the balloon. Moreover, we collected a measure of interoceptive sensibility and a measure of interoceptive accuracy. Results showed that, when analysing the global population as a continuum based on the BMI, the risk propensity decreased as a function of increased BMI, only for the task involving a body-related stimulus. Moreover, while HC risk propensity toward a body-related stimulus correlated with interoceptive sensibility, such correlation was absent in participants with AN. Individuals with OB, on the opposite pole, showed mixed interaction between interoception and risky decision-making in both tasks. These findings add one more tile to understanding these complex pathologies in the EWC spectrum, opening up future differential rehabilitation scenarios.

Combined Effects of Social Exclusion and Social Rank Feedback on Risky Decision-Making Across Adolescence.

Adolescents' need to belong and concerns about social status are thought to increase risk-taking, however, not much is known about how feedback about social rank and the effects of social exclusion moderate risky decision-making. To this end, the present study examined how social rank feedback moderates the effects of social exclusion on risky decisions during adolescence. The experimental study included a total of 122 participants (11-19 years; 44% female). Participants were randomly assigned to receive either individual or social rank feedback in the Columbia Card Task after social inclusion and exclusion via the Cyberball paradigm. Contrary to expectations, social exclusion led to more cautious decision-making. Mid-adolescents were most influenced by the combination of social exclusion and social rank feedback, while late adolescents became more cautious with individual feedback. These findings suggest that peer influences also have adaptive effects, increasing sensitivity to risk information, with developmental differences in the role of social rank.

Blunted sensitivity to expected value during risky decision making in individuals with problematic pornography use.

Background and aims: Neurobiological models of addiction posit that addiction manifests through an amplified salience towards addiction-associated stimuli and a diminished responsiveness to non-addiction-related incentives. However, existing research on reward processing in individuals with problematic pornography use (PPU) has primarily been limited to sexual cue reactivity. Methods: In this event-related potential (ERP) study, we employed a risky decision-making task involving 30 individuals with PPU and 33 healthy controls (HCs) to examine the effects of PPU on non-pornographic (money) reward valuation. Results: Compared to HCs, individuals with PPU exhibited compromised sensitivity to monetary rewards. Specifically, while the HC group demonstrated a differential response in late positive potential (LPP) amplitude to various expected value (EV) levels, this pattern was absent in the PPU group. This impairment was associated with poorer adaptive decision-making, as evidenced by PPU participants' inability to adjust risk choices based on changes in EV, leading to a propensity for riskier decisions in disadvantageous situations. Discussion and conclusions: The findings of impaired monetary evaluation in individuals with PPU may potentially explain why they continually pursue pornographic rewards while showing insensitivity to other rewards in daily life. Consequently, treatment development strategies may prioritize improving sensitivity to non-pornographic rewards within this population.

Neural mechanisms underlying competition-induced optimal decisions in individuals with high entrepreneurial intention.

In a rapidly changing and uncertain business environment, individuals with high entrepreneurial intention (HEI) inevitably need to compete or cooperate with others to maximize their gains. However, the effects of competition and cooperation on the risky decision-making and neural mechanisms of individuals with HEI are not clear. By combining the modified Devil Task and electroencephalogram (EEG) technology, the current study showed that a competition context is more likely to motivate optimal decisions and enhance the total decision gains for individuals with HEI than a cooperation context. A positive relationship between the frequency of optimal decisions and the total gains of decision-making for individuals with HEI was also found, and this relationship was mediated by the degree of entrepreneurial intention. The EEG results showed that individuals with HEI made decisions in the competition context with greater P2 amplitude of frontal regions than in the cooperation context, and source localization analyses revealed that this difference in brain activity was manifested in the medial prefrontal cortex. Finally, the results revealed a positive relationship between the P2 amplitude and the degree of entrepreneurial intention of individuals with HEI. Overall, the study suggests that competition is an effective way to motivate individuals with HEI to make optimal decisions and, thus, maximize their profits, providing new perspectives on ways to promote successful entrepreneurship.

Concurrent behavioral modeling and multimodal neuroimaging reveals how feedback affects the performance of decision making in internet gaming disorder.

Internet gaming disorder (IGD) prompts inquiry into how feedback from prior gaming rounds influences subsequent risk-taking behavior and potential neural mechanisms. Forty-two participants, including 15 with IGD and 27 health controls (HCs), underwent a sequential risk-taking task. Hierarchy Bayesian modeling was adopted to measure risky propensity, behavioral consistence, and affection by emotion ratings from last trial. Concurrent electroencephalogram and functional near-infrared spectroscopy (EEG-fNIRS) recordings were performed to demonstrate when, where and how the previous-round feedback affects the decision making to the next round. We discovered that the IGD illustrated heightened risk-taking propensity as compared to the HCs, indicating by the computational modeling (p = 0.028). EEG results also showed significant time window differences in univariate and multivariate pattern analysis between the IGD and HCs after the loss of the game. Further, reduced brain activation in the prefrontal cortex during the task was detected in IGD as compared to that of the control group. The findings underscore the importance of understanding the aberrant decision-making processes in IGD and suggest potential implications for future interventions and treatments aimed at addressing this behavioral addiction.

The effects of sleep deprivation on risky decision making.

Sleep deprivation stands as a major threat to both physical and mental well-being, disrupting normal work and life. Given the ubiquity of risky decision making, it is crucial to comprehend how individuals make risky decisions when sleep-deprived. Although research on the effects of sleep deprivation on risky decision making has increased in recent years, it remains limited and lacks a unified conclusion. The current review attempted to elucidate the effects of sleep deprivation on risky decision making in healthy adults and clarify the regulatory mechanisms. The review showed that sleep deprivation had complex effects on risky decision making; that is, whether sleep deprivation led to riskier or more conservative decision-making behavior depended on factors such as sex, gain-loss frame, use of psychotropic drugs, time interval of sleep elimination, duration of sleep deprivation, and others. Additionally, the complexity of these effects might partly arise from the use of different tasks to measure risk-taking behavior. The review also discussed some limitations of existing research and put forth practical recommendations for future studies, aiming to resolve inconsistencies in the effects of sleep deprivation on risky decision making and enhance the ecological validity of conclusions.

Fast & slow decisions under risk: Intuition rather than deliberation drives advantageous choices.

Would you take a gamble with a 10% chance to gain $100 and a 90% chance to lose $10? Even though this gamble has a positive expected value, most people would avoid taking it given the high chance of losing money. Popular "fast-and-slow" dual process theories of risky decision making assume that to take expected value into account and avoid a loss aversion bias, people need to deliberate. In this paper we directly test whether reasoners can also consider expected value benefit intuitively, in the absence of deliberation. To do so, we presented participants with bets and lotteries in which they could choose between a risky expected-value-based choice and a safe loss averse option. We used a two-response paradigm where participants made two choices in every trial: an initial intuitive choice under time-pressure and cognitive load and a final choice without constraints where they could freely deliberate. Results showed that in most trials participants were loss averse, both in the intuitive and deliberate stages. However, when people opted for the expected-value-based choice after deliberating, they had predominantly already arrived at this choice intuitively. Additionally, loss averse participants often showed an intuitive sensitivity to expected value (as reflected in decreased confidence). Overall, these results suggest that deliberation is not the primary route for expected-value-based responding in risky decision making. Risky decisions may be better conceptualized as an interplay between different types of "fast" intuitions rather than between two different types of "fast" and "slow" thinking per se.

Cognitive Correlates of Risky Decision-Making in Individuals with and without ADHD: A Meta-analysis.

This meta-analytic study aims to investigate the cognitive correlates of risky decision-making in individuals with attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) individuals. A systematic analysis of existing literature was conducted, encompassing 38 studies (496 ADHD and 1493 TD). Findings revealed a consistent propensity for riskier decision-making in individuals with ADHD, supported by significant correlations with attention, cognitive flexibility, inhibitory control, time perception, and working memory. The study underscores the relevance of these cognitive functions in shaping decision-making tendencies, with nuanced patterns observed within the ADHD and TD subgroups. Individuals with ADHD often demonstrate altered patterns of correlation, reflecting the specific cognitive challenges characteristic of the disorder.

Reining in regret: emotion regulation modulates regret in decision making.

Whereas the influence of regret on decision making is well-established, it remains unclear whether emotion regulation may modulate both the affective experience of regret and its influence on decisions. To examine this question, participants made decisions about options involving uncertainty using two different, instructed emotion regulation strategies. In one case, they were instructed to treat each choice individually, while in the other they were encouraged to treat a series of decisions as a portfolio. The present experiment demonstrates that approaching a series of decisions as a portfolio led to less extreme affective reactions to outcomes and lowered physiological arousal levels compared to focusing on each decision in isolation. However, the different emotion regulation strategies did not alter the influence of anticipatory regret on choices. The results indicate that these different emotion regulation strategies can be used to alter the experience of regret. These findings support a role for cognitive strategies in mitigating the affective experience of regret and suggest a means to encourage consumer welfare.

Associations of Impulsivity and Risky Decision-Making with E-Cigarette-Related Outcomes Among Adolescents with Congenital Heart Disease: Variable- and Person-Oriented Approaches.

Adolescents with congenital heart disease (CHD) have elevated risk for acquired cardiovascular complications, increasing their vulnerability to e-cigarette-related health harms. Impulsivity and risky decision-making have been associated with adolescent substance use, but the relationships between these factors and e-cigarette-related outcomes among cardiovascular at-risk adolescents with CHD are unknown. This cross-sectional study aimed to (a) determine the associations of impulsivity and risky decision-making with e-cigarette-related outcomes (i.e. susceptibility, ever use, perceptions of harm and addictiveness) via variable-oriented analysis (logistic regression), (b) identify groups of adolescents with similar profiles of impulsivity and risky decision-making via exploratory person-oriented analysis (latent profile analysis; LPA), and (c) examine differences on e-cigarette-related outcomes between profile groups. Adolescents aged 12 to 18 years with CHD (N = 98) completed a survey assessing impulsivity facets (Short UPPS-P) and e-cigarette-related outcomes and were administered a risky decision-making task (Iowa Gambling Task, Version 2; IGT2). In variable-oriented analyses, impulsivity facets (negative urgency, positive urgency, lack of premeditation) but not risky decision-making were associated with e-cigarette susceptibility and ever use. The exploratory LPA identified two groups with similar patterns of responding on the Short UPPS-P and IGT2 labeled "Low Impulsivity" and "High Impulsivity," which were primarily characterized by significant differences in negative and positive urgency. Adolescents in the High Impulsivity group had increased odds of e-cigarette susceptibility but not ever use compared to the Low Impulsivity group. This work indicates that strategies to prevent e-cigarette use among adolescents with CHD may be enhanced by addressing impulsivity, particularly negative and positive urgency.

Do incidental positive emotions induce more optimistic expectations of decision outcomes? An empirical study from the perspective of event-related potential.

INTRODUCTION: Previous research has found that incidental emotions of different valences (positive/negative/neutral) influence risky decision-making. However, the mechanism of their influence on psychological expectations of decision outcomes remains unclear. METHODS: We explored the effects of different incidental emotions on the behavioral, psychological, and electrophysiological responses of individuals in risky decision-making through a money gambling task using a one-way (emotion type: positive, negative, neutral emotions) between-subjects experimental design. RESULTS: Individuals with positive emotions had significantly greater risk-seeking rates than those with negative emotions during the decision selection phase (p < .01). In the feedback stage of decision outcomes, individuals showed stronger perceptions of uncertainty in the decision environment under gain and loss feedback compared with neutral feedback, as evidenced by a more positive P2 component (i.e., the second positive component of an event-related potential). Positive emotions produced greater than expected outcome bias than neutral emotions, as evidenced by a more negative FRN component (i.e., the feedback-related negativity component). CONCLUSION: Our results suggest that positive emotions increase individuals' psychological expectations of decision outcomes. This study provides new empirical insights to understand the influence of incidental emotions on risky decision outcome expectations.

Risky decision-making in major depressive disorder: A three-level meta-analysis / Toma de decisiones arriesgadas en el trastorno depresivo mayor: un metanálisis de tres niveles

Background: Individuals with major depressive disorder (MDD) are usually observed making inappropriate risky decisions. However, whether and to what extent MDD is associated with impairments in risky decision-making remains unclear. We performed a three-level meta-analysis to explore the relationship between risky decision-making and MDD. Method: We searched the Web of Science, PubMed, Scopus, and PsycINFO databases up to February 7, 2023, and calculated Hedges' g to demonstrate the difference in risky decision-making between MDD patients and healthy controls (HCs). The moderating effect of sample and task characteristics were also revealed. Results: Across 73 effect sizes in 39 cross-sectional studies, MDD patients exhibited greater risk-seeking than HCs (Hedges' g = 0.187, p = .030). Furthermore, age (p = .068), region (p = .005), and task type (p < .001) were found to have moderating effects. Specifically, patients preferred risk-seeking over HCs as age increased. European patients showed significantly increased risk-seeking compared to American and Asian patients. Patients in the Iowa Gambling Task (IGT) exhibited a notable rise in risk-seeking compared to other tasks, along with an increased risk aversion in the Balloon Analogue Risk Task (BART). The multiple-moderator analysis showed that only task type had significant effects, which may be explained by a tentative framework of "operationalization-mechanism-measure" specificity. Conclusions: MDD patients generally exhibit higher risk-seeking than HCs. It implies that impaired risky decision-making might be a noteworthy symptom of depression, which should be placed more emphasis for clinical management and psycho-education.(AU)

Development of the triadic neural systems involved in risky decision-making during childhood.

Risk-taking often occurs in childhood as a compex outcome influenced by individual, family, and social factors. The ability to govern risky decision-making in a balanced manner is a hallmark of the integrity of cognitive and affective development from childhood to adulthood. The Triadic Neural Systems Model posits that the nuanced coordination of motivational approach, avoidance and prefrontal control systems is crucial to regulate adaptive risk-taking and related behaviors. Although widely studied in adolescence and adulthood, how these systems develop in childhood remains elusive. Here, we show heterogenous age-related differences in the triadic neural systems involved in risky decision-making in 218 school-age children relative to 80 young adults. Children were generally less reward-seeking and less risk-taking than adults, and exhibited gradual increases in risk-taking behaviors from 6 to 12 years-old, which are associated with age-related differences in brain activation patterns underlying reward and risk processing. In comparison to adults, children exhibited weaker activation in control-related prefrontal systems, but stronger activation in reward-related striatal systems. Network analyses revealed that children showed greater reward-related functional connectivity within and between the triadic systems. Our findings support an immature and unbalanced developmental view of the core neurocognitive systems involved in risky decision-making and related behaviors in middle to late childhood.

Dorsal and ventral fronto-amygdala networks underlie risky decision-making in age-related cognitive decline.

Older adults often have difficulty in making decisions under uncertainty, increasing the risk of financial exploitation. However, it is still under investigation about the extent to which cognitive decline influences risky decision-making and the underlying neural correlates. We hypothesized that the individual differences of risk-taking behavior depend on cognitive integrity, in which the dorsal and ventral fronto-amygdala connectivity would play dissociable roles. In the current study, thirty-six young and 51 older adults were tested with the Iowa gambling task combing resting-state and task-related functional magnetic resonance imaging. The results showed significant changes in behaviors and the fronto-amygdala network in older adults relative to young adults. More importantly, age-effect on risk-taking behaviors was remarkably different in cognitively normal and impaired older adults. In resting-state analysis, task performance was positively correlated with the ventral fronto-amygdala connectivity and negatively correlated with the dorsal fronto-amygdala connectivity in cognitively impaired older adults, compared with cognitively normal individuals. Furthermore, task-related analysis confirmed the relationships between dorsal/ventral fronto-amygdala network and risk-taking behaviors depending on cognitive integrity. These findings indicate that the fronto-amygdala network is crucial for understanding altered risky decision-making in aging, suggesting dissociable contributions of the dorsal and ventral pathways in the context of cognitive decline.

Sleep deprivation attenuates neural responses to outcomes from risky decision-making.

Sleep loss impacts a broad range of brain and cognitive functions. However, how sleep deprivation affects risky decision-making remains inconclusive. This study used functional MRI to examine the impact of one night of total sleep deprivation (TSD) on risky decision-making behavior and the underlying brain responses in healthy adults. In this study, we analyzed data from N = 56 participants in a strictly controlled 5-day and 4-night in-laboratory study using a modified Balloon Analogue Risk Task. Participants completed two scan sessions in counter-balanced order, including one scan during rested wakefulness (RW) and another scan after one night of TSD. Results showed no differences in participants' risk-taking propensity and risk-induced activation between RW and TSD. However, participants showed significantly reduced neural activity in the anterior cingulate cortex and bilateral insula for loss outcomes, and in bilateral putamen for win outcomes during TSD compared with RW. Moreover, risk-induced activation in the insula negatively correlated with participants' risk-taking propensity during RW, while no such correlations were observed after TSD. These findings suggest that sleep loss may impact risky decision-making by attenuating neural responses to decision outcomes and impairing brain-behavior associations.

Attention biases the process of risky decision-making: Evidence from eye-tracking.

Attention determines what kind of option information is processed during risky choices owing to the limitation of visual attention. This paper reviews research on the relationship between higher-complexity risky decision-making and attention as illustrated by eye-tracking to explain the process of risky decision-making by the effect of attention. We demonstrate this process from three stages: the pre-phase guidance of options on attention, the process of attention being biased, and the impact of attention on final risk preference. We conclude that exogenous information can capture attention directly to salient options, thereby altering evidence accumulation. In particular, for multi-attribute risky decision-making, attentional advantages increase the weight of specific attributes, thus biasing risk preference in different directions. We highlight the significance of understanding how people use available information to weigh risks from an information-processing perspective via process data.

Neural mechanisms of intertemporal and risky decision-making in individuals with internet use disorder: A perspective from directed functional connectivity.

Background and aims: The intertemporal and risk decision-making impairments are vital cognitive mechanisms in internet use disorder (IUD). However, the underlying neural mechanisms for these two decision-making dysfunctions in individuals with IUD remain unclear. Methods: This study employed Functional Near-Infrared Spectroscopy (fNIRS) to record changes in blood oxygen concentration in the prefrontal cortex of individuals with IUD during intertemporal and risk decision-making tasks. Results: The findings revealed that the intertemporal decision-making deficits in IUD group were primarily associated with reduced activation in the left dorsolateral prefrontal cortex (dlPFC) and orbitofrontal cortex (OFC) and FC from the left dlPFC to the right dlPFC. On the other hand, risk decision-making impairments were linked to decreased OFC activation and weakened functional connectivity from the left dlPFC to the right dlPFC and OFC. Discussions and Conslusions: These results suggested that while there were common neural mechanisms underlying intertemporal and risk decision-making impairments in individuals with IUD, specific neural foundations existed for each type of dysfunction.

Neural symphony of risky decision making in children with ADHD: Insights from transcranial alternating current stimulation and cognitive modeling.

BACKGROUND: The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are key brain regions involved in risky decision making, affected in individuals with attention deficit hyperactivity disorder (ADHD). This study aims to examine how entrainment of these areas impacts the process and outcome of risky decision making in children with ADHD. METHODS: Eighteen children with ADHD performed the balloon analogue risk-taking task (BART) during five different sessions of tACS (1.5 mA, 6 Hz), separated by one-week intervals, via (1) two channels with synchronized stimulation over the left dlPFC and right vmPFC, (2) the same electrode placement with anti-phase stimulation, (3) stimulation over the left dlPFC only, (4) stimulation over right vmPFC only, and (5) sham stimulation. Four-parameter and constant-sensitivity models were used to model the data. RESULTS: The study showed that synchronized stimulation was associated with a reduction in positive prior belief, risk propensity, and deterministic selection. Desynchronized stimulation was associated with accelerated learning from initial selections. Isolated stimulation of the dlPFC leads to riskier decision enhanced learning updates and risk propensity, whereas isolated stimulation of the vmPFC facilitated faster learning and increased probabilistic selection. CONCLUSION: The results highlight the important roles of the dlPFC and vmPFC and their communication in decision making, showcasing their impact on various aspects of the decision-making process. The findings provide valuable insights into the complex interplay between cognitive and emotional factors in shaping our choices.