Background
A growing number of studies have investigated delay discounting, a
behavioral economic index of impulsivity, and its relevance to attention
deficit hyperactivity disorder (ADHD), but with mixed findings. The current
meta-analysis synthesizes the literature on the relationship between
monetary delay discounting and ADHD in studies using case-control designs.
Specifically, the objectives were: 1) to characterize the aggregated
differences in monetary delay discounting between individuals with ADHD
(cases) and controls in studies using categorical case-control designs; 2)
to examine potential differences based on sample age (<18 vs.
>18), reward outcome (real vs. hypothetical), and prevalence of
conduct disorder and oppositional defiant disorder in the sample; and 3) to
evaluate potential small-study (publication) bias in the literature.
Methods
From 567 candidate articles, 21 independent investigations yielded 25
case-control comparisons (total N=3,913). Random effects
meta-analysis was conducted using Cohen's d as the common
effect size. Publication bias was evaluated using fail-safe N, Begg-Mazumdar
and Egger tests, and metaregression of publication year and effect size.
Results
Across studies, a statistically significant difference of medium
magnitude effect size was present for the case-control comparisons
(d=0.43; p <
10â15). No significant differences based on sample
age, reward outcome, or comorbid status was detected. Minimal heterogeneity
and evidence of publication bias was present.
Conclusions
These findings provide robust evidence that delay discounting is
significantly elevated among individuals with ADHD compared to controls.
Gaps in the literature and the importance of characterizing the neural and
genetic bases of this relationship are discussed.