Risky decision making in adults with ADHD

J Behav Ther Exp Psychiatry. 2012 Sep;43(3):938-46. doi: 10.1016/j.jbtep.2012.02.002. Epub 2012 Feb 25.


Background and objectives: Risky decision making and disadvantageous choices constitute core characteristics of patients with attention-deficit/hyperactivity disorder (ADHD). Consequences include negative psychosocial and health-related outcomes. However, risky decision making and its interrelations with emotional states in ADHD are poorly understood. Therefore, the authors investigated risky decision making without and after boredom induction in adults with and without ADHD.

Methods: In study 1, ADHD patients (n = 15) and age/education matched controls (CG; n = 16) were compared on the Game of Dice Task (GDT), an established task measuring decision making in unambiguous situations. In study 2, ADHD patients (n = 14) and CG (n = 13) underwent boredom induction prior to the GDT.

Results: In study 1, ADHD patients selected the disadvantageous alternatives significantly more often than CG. In study 2, no significant group differences were found due to an increase in risky decision making in CG following the boredom induction.

Limitations: Even if severity of depression did not affect our results, it may be necessary to compare GDT responses in ADHD patients with and without current depression.

Conclusions: Risk as a motor of disadvantageous decision making needs to be taken into account in therapeutic contexts as a maintenance factor of dysfunctional behaviour. The findings of study 2 are in line with postulated alterations of emotional state adjustment in ADHD. The link between decisions making and emotional regulation in ADHD needs further attention in research.

MeSH terms

  • Adult
  • Attention Deficit Disorder with Hyperactivity / psychology*
  • Boredom
  • Case-Control Studies
  • Decision Making*
  • Feedback, Psychological
  • Female
  • Humans
  • Male
  • Neuropsychological Tests / statistics & numerical data
  • Psychomotor Performance
  • Risk-Taking*
  • Self Report