Increased Delay Discounting on a Novel Real-Time Task among Girls, but not Boys, with ADHD

Abstract

The aim of this study was to examine delay discounting in girls and boys with ADHD-Combined type (ADHD-C) relative to typically developing (TD) children on two tasks that differ in the extent to which the rewards and delays were experienced by participants. Children ages 8–12 years with ADHD-C (n = 65; 19 girls) and TD controls (n = 55; 15 girls) completed two delay discounting tasks involving a series of choices between smaller, immediate and larger, delayed rewards. The classic delay discounting task involved choices about money at delays of 1–90 days and only some of the outcomes were actually experienced by the participants. The novel real-time discounting task involved choices about an immediately consumable reward (playing a preferred game) at delays of 25–100 s, all of which were actually experienced by participants. Participants also provided subjective ratings of how much they liked playing the game and waiting to play. Girls with ADHD-C displayed greater delay discounting compared to boys with ADHD-C and TD girls and boys on the real-time discounting task. Diagnostic group differences were not evident on the classic discounting task. In addition, children with ADHD-C reported wanting to play the game more and liking waiting to play the game less than TD children. This novel demonstration of greater delay discounting among girls with ADHD-C on a discounting task in which the rewards are immediately consumable and the delays are experienced in real-time informs our understanding of sex differences and motivational processes in children with ADHD.

Greater delay discounting among girls, but not boys, with ADHD correlates with cognitive control

“…Consequently, this study provides a unique contribution to the literature with regard to examining an understudied and therefore less understood question regarding the neuropsychological processes associated with variability in delay discounting task performance among girls and boys with ADHD. Furthermore, this study aimed to replicate gender-difference findings from previous work (Rosch & Mostofsky, 2016), which is essential given the relative dearth of literature explicating gender differences in reward-based decision-making in children with ADHD. It was hypothesized that (a) children with ADHD, relative to TD children, would exhibit greater delay discounting and weaker cognitive control as assessed using spatial span backwards, attention regulation, and inhibitory control tasks, (b) poor cognitive control would be related to greater delay discounting, and (c) the pattern of neuropsychological deficits and associations with delay discounting may differ for girls and boys with ADHD.…”

“…However, the majority of studies examining choice-impulsivity in children with ADHD have used choice-delay tasks (Patros et al, 2016) limiting our understanding of how children with ADHD perform on delay discounting tasks which tend to be more commonly used in the broader cognitive neuroscience literature and in studies of adult clinical populations (see reviews by Hamilton et al, 2015; Peters & Buchel, 2011). Furthermore, recent findings from a study involving two delay discounting tasks demonstrated that reward-based decision-making in children with ADHD may depend on characteristics of the task (e.g., type of reward, task duration) and/or the participant (e.g., sex; Rosch & Mostofsky, 2016), emphasizing the need for further research in this area.…”

“…Given potentially important differences between delay-related decision-making paradigms (Rosch & Mostofsky, 2016; Scheres, Lee, & Sumiya, 2008), findings from choice-delay task studies may not generalize to delay discounting tasks. Furthermore, previous studies have typically examined a single metric of cognitive control despite evidence of heterogeneity of cognitive deficits in ADHD (Nigg, Willcutt, Doyle, & Sonuga-Barke, 2005; Willcutt et al, 2005) thereby limiting our understanding of how various cognitive deficits relate to reward-based decision-making in ADHD.…”

“…In contrast, girls with ADHD tend to display equivalent or greater executive dysfunction both in terms of behavior (Rucklidge, 2010; Seymour et al, 2016) and the associated neural circuitry (Dirlikov et al, 2015; Jacobson et al, 2015). Moreover, recent evidence suggests that girls with ADHD show greater delay discounting relative to typically developing (TD) girls and to boys with ADHD (Rosch & Mostofsky, 2016). Collectively, while previous studies have demonstrated important relationships between variables leading to impulsive behavior, several limitations warrant hesitation with regard to generalizability of such findings.…”

What is the level of evidence for the use of currently available technologies in facilitating the self-management of difficulties associated with ADHD in children and young people? A systematic review

“…Reason for exclusion Barnett et al [86] Participants are teachers Benyakorn et al [87] Not interventional Bishop [88] Intervention not technology Bonarini et al [89] Population focus not ADHD Bul et al [90] Outcome measures do not assess ADHD-related difficulties Chan et al [91] Not interventional Chen et al [92] Not interventional Christiansen et al [93] Intervention reliant on others Dale and Grut [94] Not exclusively for ADHD Duffy [95] Population focus not ADHD Enebrink et al [96] Population focus not ADHD References Reason for exclusion Epstein et al [97] Intervention reliant on health care professionals Fiellin et al [98] Population focus not ADHD Frutos-Pascual et al [99] Population focus not ADHD Frutos-Pascual and GarciaZapirain [100] Participants typically developing, not ADHD Gray et al [72] ADHD not primary diagnosis of participants Halperin et al [101] Intervention not technology Janeslätt et al [102] Intervention not technology Kim et al [103] Intervention not technology Lim et al [104] Intervention reliant on health care professionals Mazurek and Engelhardt [105] Not interventional Myers et al [106] Participants ADHD diagnosis not confirmed Nie et al [107] Intervention not technology Pandria et al [108] Not interventional Rohani et al [109] Participants ADHD diagnosis not confirmed Rosch and Mostofsky [110] Not interventional Schafer et al [111] Participants not received ADHD diagnosis Schuck et al [112] Participants not received ADHD diagnosis Shah et al 2012 Not interventional Silva et al [113] Technology as outcome measure, not intervention Steeger et al 2016 Participants ADHD diagnosis not confirmed Stephenson [114] Population focus not ADHD Tse et al …”