How Do Adults with ADHD Process Decision-Making Differently?

What you need to know

• Adults with ADHD showed different brain activity patterns when making value-based decisions compared to adults without ADHD
• The brain differences were seen even when the task did not require learning or inhibiting impulses
• Adults with ADHD had less brain activity distinguishing between different choice values, which may contribute to riskier decision-making
• The findings suggest adults with ADHD process the value of choices differently, beyond just having difficulty with impulse control or learning

Understanding Decision-Making in Adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) is typically associated with children, but it often continues into adulthood. Adults with ADHD can face challenges in many areas of life, including making sound financial decisions and avoiding risky behaviors. While impulsivity and learning difficulties play a role, researchers wanted to understand if there are more fundamental differences in how adults with ADHD process information when making decisions.

This study used brain imaging to examine neural activity in adults with and without ADHD as they completed a decision-making task. The goal was to identify differences in how the brains of adults with ADHD respond to and process information about the value of different choices.

The Lottery Choice Task

Participants completed a “lottery choice task” while their brains were scanned using functional magnetic resonance imaging (fMRI). In each trial, they saw information about a potential win or loss, including:

• The probability of winning (ranging from very low to very high)
• The magnitude of the potential win or loss (small or large amount of points)

Participants then decided whether to accept or reject each “stake.” Importantly, the outcomes were random on each trial, so there was no pattern to learn over time. The task was designed to focus on how participants processed the value information when making decisions, rather than their ability to learn or control impulses.

Key Findings

Behavioral Differences

Adults with ADHD showed a trend toward accepting more “stakes” with a middle-to-low probability of winning, especially for larger potential gains. This suggests a tendency toward slightly riskier decision-making. They also took longer to make their choices compared to the control group.

Brain Activity Differences

Several key brain areas showed different patterns of activity in adults with ADHD compared to the control group:

Dorsolateral prefrontal cortex (DLPFC): This area, involved in reasoning and decision-making, showed lower overall activity in adults with ADHD across all types of choices.

Ventromedial prefrontal cortex (VMPFC): In the control group, activity in this region changed in a linear pattern as the probability of winning increased. Adults with ADHD did not show this same pattern, suggesting less sensitivity to differences in probability.

Putamen and hippocampus: These areas showed higher activity in adults with ADHD when they experienced an unexpected loss.

Connections Between Brain Regions

In the control group, lower activity in the left DLPFC was associated with greater sensitivity to probability in the VMPFC. This relationship was not seen in adults with ADHD. Additionally, DLPFC activity was linked to less risky choices in the control group, but not in adults with ADHD.

Implications for Understanding Adult ADHD

These findings provide new insight into how adults with ADHD process information when making value-based decisions. The key takeaway is that there appear to be differences in how the brain represents and computes the value of different options, beyond just issues with impulsivity or learning.

Adults with ADHD showed less distinction in their brain activity between choices with different values. This reduced “neural sensitivity” to value differences may make it more challenging to prioritize options effectively. The lack of typical connections between key decision-making brain regions in ADHD may also contribute to less optimal choices.

Importantly, these differences were observed even when the task did not require learning patterns over time or inhibiting impulses. This suggests the need to consider how adults with ADHD process value information as a potential target for intervention, rather than focusing solely on impulse control or learning strategies.

Limitations and Future Directions

The study had a relatively small sample size, and the behavioral differences in decision-making were trends rather than strongly significant findings. Larger studies are needed to confirm and expand on these results. Additionally, research examining how these neural differences relate to real-world decision-making and risk-taking behaviors in adults with ADHD would be valuable.

Conclusions

• Adults with ADHD show differences in brain activity when processing value-based decisions, even when learning and impulse control are not major factors.
• These neural differences may contribute to riskier decision-making by making it more difficult to distinguish between the values of different options.
• Interventions for adult ADHD may need to consider strategies for enhancing how the brain represents and computes value information, not just managing impulsivity or improving learning.