Study Finds No Difference Between Real Life, Experimental Risk Taking in Adults With ADHD

The link between attention-deficit/hyperactivity disorder (ADHD) and risk-taking behavior, including substance abuse, is a major public health issue. Studies estimate 30% of adults presenting with substance use disorder (SUD) have ADHD, and approximately 20% to 40% of adults with ADHD have histories of SUD.

In a recent study published in Psychiatry Research, researchers tested performance on a theoretically-based probabilistic decision-making video simulation in adults with and without ADHD. The study examined the relationship between experimental risk taking and history of real-life risk-taking behavior, defined as cigarette, alcohol, and street drug use.

University students with and without ADHD (n = 62, with 31 in each group), completed a modified version of the Cambridge Gambling Test (CGT), in which they had to choose between alternatives varied by level of risk. They also reported their history of substance use. Those who were on prescription medication for ADHD were asked not to take the medicine for 24 hours before the tests.

Both groups showed similar patterns of risk taking on the experimental decision-making task, suggesting that ADHD is not linked to low sensitivity to risk. Past and present substance use was more prevalent in adults with ADHD.

The researchers wrote that their finding questions the validity of the simulation as a valid model for ADHD-related risk-taking behavior.

The CGT or other risk-taking simulators have become more widely used in recent years as a way to provide a model of actual risk-taking behavior while controlling for key variables. The CGT uses pricing tasks, where participants are asked how much money (points) they wish to invest for the chance to gamble. Subjects are given explicit probabilistic information (eg, 20% chance that a token was hidden inside a blue box, 80% chance it was hidden inside a red box). The subjects are then asked to guess in which box the token is placed, and to determine the magnitude of bet they are willing to risk, given the probabilities.

The CGT separately taps several processes that are involved in decision making:

• Quality of gamble - the percent of trials in which the participant chooses the gamble with the higher probability to win.
• Sum of bet - the total number of points gambled indicating the overall tendency to take risks or the sensitivity to risk.
• Risk adjustment - the ability to adjust choices to the probability of winning.
• Deliberation time - the time it takes to make a decision.
• Delay aversion - the tendency to choose bets’ options that were presented earlier to the subject.

In this study, no significant differences between groups were observed regarding sum of bet, risk adjustment, and deliberation time. Adults with ADHD did not choose the riskier options more often than controls. These findings suggest that other characteristics of the task, such as the need to wait before choosing an option, account for previous findings showing greater risk taking by participants with ADHD on similar tasks.

Reference

Pollaka T, Shalita R, Aranb A. Risk taking and adult attention deficit/hyperactivity disorder: A gap between real life behavior and experimental decision making. Psychiatry Res. 2018; (259):56—62. dx.doi.org/10.1016/j.psychres.2017.10.012