Executive Functioning Characteristics Associated with ADHD Comorbidity in Adolescents with Disruptive Behavior Disorders

The nature of executive dysfunction in youth with disruptive behavior disorders (DBD) remains unclear, despite extensive research in samples of children with attention-deficit hyperactivity disorder (ADHD). To determine the relationship between DBD, ADHD, and executive function deficits in aggressive teens, adolescents with DBD and comorbid ADHD (DBD + ADHD; n = 25), DBD without ADHD (DBD-ADHD; n = 23), and healthy controls (HC; n = 25) were compared on neurocognitive tests and questionnaires measuring executive functioning. Teens with DBD + ADHD performed worse on both neurocognitive and questionnaire measures of executive function than the DBD-ADHD and HC groups. Results suggest that subgroups of DBD may exist depending on the presence or absence of comorbid ADHD, which may have implications for the selection and efficacy of treatment strategies.     

Mother still knows best: Maternal influence uniquely modulates adolescent reward sensitivity during risk taking

Adolescent decision‐making is highly sensitive to input from the social environment. In particular, adult and maternal presence influence adolescents to make safer decisions when encountered with risky scenarios. However, it is currently unknown whether maternal presence confers a greater advantage than mere adult presence in buffering adolescent risk taking. In the current study, 23 adolescents completed a risk‐taking task during an fMRI scan in the presence of their mother and an unknown adult. Results reveal that maternal presence elicits greater activation in reward‐related neural circuits when making safe decisions but decreased activation following risky choices. Moreover, adolescents evidenced a more immature neural phenotype when making risky choices in the presence of an adult compared to mother, as evidenced by positive functional coupling between the ventral striatum and medial prefrontal cortex. Our results underscore the importance of maternal stimuli in bolstering adolescent decision‐making in risky scenarios.     

Rewards decrease risky decisions for adolescent drivers: Implications for crash prevention

Motor vehicle crashes (MVCs) are a major contributor to adolescent mortality. Adolescent drivers are more likely to make risky decisions in the presence of peers. However, rewards have also been shown to improve decision making in adolescence. Our goal was to determine if peer observation and reward effects on decision-making were dependent upon adolescent driving styles.Twenty-four healthy adolescents played a driving game in a 2 (no peer; peer) × 2 (no rewards; rewards) within-subjects experiment. Driving styles were measured by self-report.Rewards favoring safe choices reduced risky decision making, but this effect was especially robust for adolescents with driving styles that increase risk of MVCs (i.e., dangerous, fast, angry, or distracted styles). Findings suggest that rewards for safe driving can be an effective mechanism for reducing MVCs, especially for the most at-risk drivers, if they can be made appetizing to adolescents.     

Family conflict shapes how adolescents take risks when their family is affected

Numerous studies have established that the social context greatly affects adolescent risk taking. However, it remains unexplored whether adolescents' decision‐making behaviors change when they take risks that affect other individuals such as a parent. In the current study, we sought to investigate how the social context influences risky decisions when adolescents' behavior affects their family using a formalized risk‐taking model. Sixty‐three early adolescents (M_age = 13.3 years; 51% female) played a risk‐taking task twice, once during which they could make risky choices that only affected themselves and another during which their risky choices only affected their parent. Results showed that adolescents reporting high family conflict made more risky decisions when taking risks for their parent compared to themselves, whereas adolescents reporting low family conflict made fewer risky decisions when taking risks for their parent compared to themselves. These findings are the first to show that adolescents change their decision‐making behaviors when their risks affect their family and have important implications for current theories of adolescent risk taking.     

RD, ADHD, and their comorbidity from a dual route perspective

In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical processing contains two parallel processes: lexical route processing and sublexical route processing. An orthographic decision task and a phonological decision task were used to measure lexical and sublexical route processing, respectively. In addition, a rapid naming task was used to compare 27 children with RD, 18 children with ADHD, 20 children with ADHD+RD, and 29 controls. RD and ADHD shared impairments in accuracy of orthographic and phonological decision making as well as in rapid naming, which suggest that RD and ADHD may be overlapping disorders that share deficits in both lexical route and sublexical route processing. RD was dissociated from ADHD by being slower in both orthographical and phonological decision making that indicates unique deficits in RD on lexical and sublexical speed.     

RD,ADHD, and their comorbidity from a dual route perspective

In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical processing contains two parallel processes: lexical route processing and sublexical route processing. An orthographic decision task and a phonological decision task were used to measure lexical and sublexical route processing, respectively. In addition, a rapid naming task was used to compare 27 children with RD, 18 children with ADHD, 20 children with ADHD+RD, and 29 controls. RD and ADHD shared impairments in accuracy of orthographic and phonological decision making as well as in rapid naming, which suggest that RD and ADHD may be overlapping disorders that share deficits in both lexical route and sublexical route processing. RD was dissociated from ADHD by being slower in both orthographical and phonological decision making that indicates unique deficits in RD on lexical and sublexical speed.     

Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study

In this study, 306 individuals in 3 age groups--adolescents (13-16), youths (18-22), and adults (24 and older)--completed 2 questionnaire measures assessing risk preference and risky decision making, and 1 behavioral task measuring risk taking. Participants in each age group were randomly assigned to complete the measures either alone or with 2 same-aged peers. Analyses indicated that (a) risk taking and risky decision making decreased with age; (b) participants took more risks, focused more on the benefits than the costs of risky behavior, and made riskier decisions when in peer groups than alone; and (c) peer effects on risk taking and risky decision making were stronger among adolescents and youths than adults. These findings support the idea that adolescents are more inclined toward risky behavior and risky decision making than are adults and that peer influence plays an important role in explaining risky behavior during adolescence.     

Individual differences in the response to forgone payoffs: an examination of high functioning drug abusers

This study evaluates the effect of forgone payoffs in decision‐making tasks used for studying individual differences. We investigate whether the disclosure of forgone payoffs (defined as payoffs associated with un‐chosen alternatives) has selective effects for drug abusers. Evidence suggests that drug abusers are hypersensitive to signals of positive reward. Accordingly, because the forgone payoffs of risky high‐variability options include rewarding outcomes, this may create a distraction and lead drug abusers to make more risky choices. In a controlled experiment, we examined the behavior of high‐functioning drug abusers and healthy controls using the Iowa gambling task. The results showed that in a forgone payoff condition, drug abusers made more risky choices. The results demonstrate that adding information about forgone payoffs can be useful for studying individual differences, and that studying individual differences can be valuable in evaluating the effects of forgone payoffs. Copyright © 2005 John Wiley & Sons, Ltd.     

Framing effects in group investment decision making: role of group polarization

Prospect theory proposes that framing effects result in a preference for risk-averse choices in gain situations and risk-seeking choices in loss situations. However, in group polarization situations, groups show a pronounced tendency to shift toward more extreme positions than those they initially held. Whether framing effects in group decision making are more prominent as a result of the group-polarization effect was examined. Purposive sampling of 120 college students (57 men, 63 women; M age = 20.1 yr., SD = 0.9) allowed assessment of relative preference between cautious and risky choices in individual and group decisions. Findings indicated that both group polarization and framing effects occur in investment decisions. More importantly, group decisions in a gain situation appear to be more cautious, i.e., risk averse, than individual decisions, whereas group decisions in the loss situation appear to be more risky than individual decisions. Thus, group decision making may expand framing effects when it comes to investment choices through group polarization.     

Stability of choices in a risky decision‐making task: a 3‐year longitudinal study with children and adults

In a 3‐year follow‐up to Levin and Hart's ( 2003 ) study, we observed the same children, now 9–11 years old, and their parents in the same risky decision‐making task. At the aggregate level the same pattern of means was observed across time periods. At the individual level the key variables were significantly correlated across time periods for both children and adults. Taken together with the results from the original study and earlier studies, these results solidify the following conclusions: children utilize both probability and outcome information in risky decision‐making; the tendency to make more risky choices to avoid a loss than to achieve a gain of equal magnitude, which is a major tenet of the leading theories of risky decision‐making, occurs for children as well as adults; children make more risky choices than adults; temperamental predictors of risky choice are valid for children as well as for adults. Copyright © 2006 John Wiley & Sons, Ltd.     

Verbal, Facial and Autonomic Responses to Empathy-Eliciting Film Clips by Disruptive Male Adolescents with High Versus Low Callous-Unemotional Traits

This study examined empathy-related responding in male adolescents with disruptive behavior disorder (DBD), high or low on callous-unemotional (CU) traits. Facial electromyographic (EMG) and heart rate (HR) responses were monitored during exposure to empathy-inducing film clips portraying sadness, anger or happiness. Self-reports were assessed afterward. In agreement with expectations, DBD adolescents with high CU traits showed significantly lower levels of empathic sadness than healthy controls across all response systems. Between DBD subgroups significant differences emerged at the level of autonomic (not verbal or facial) reactions to sadness, with high CU respondents showing less HR change from baseline than low CU respondents. The study also examined basal patterns of autonomic function. Resting HR was not different between groups, but resting respiratory sinus arrhythmia (RSA) was significantly lower in DBD adolescents with high CU traits compared to controls. Results support the notion that CU traits designate a distinct subgroup of DBD individuals.     

Developmental patterns of change in the influence of safe and risky peer choices on risky decision‐making

Adolescents take more risks when peers monitor their behavior. However, it is largely unknown how different types of peer influence affect adolescent decision‐making. In this study, we investigate how information about previous choices of peers differentially influences decision‐making in adolescence and young adulthood. Participants (N = 99, age range 12–22) completed an economic choice task in which choice options were systematically varied on levels of risk and ambiguity. On each trial, participants selected between a safer choice (low variability in outcome) and a riskier choice (high variability in outcome). Participants made choices in three conditions: a solo condition in which they made choices with no additional information, a social condition in which they saw choices of supposed peers, and a computer condition in which they saw choices of a computer. Results showed that participants’ choices conform to the choices made by the peers, but not a computer. Furthermore, when peers chose the safe option, late adolescents were especially likely to make a safe choice. Conversely, when the peer made a risky choice, late adolescents were least likely to follow choices made by the peer. We did not find evidence for differential influence of social information on decisions depending on their level of risk and ambiguity. These results show that information about previous decisions of peers are a powerful modifier for behavior and that the effect of peers on adolescents’ decisions is less ubiquitous and more specific than previously assumed.     

I felt low and my purse feels light: depleting mood regulation attempts affect risk decision making

We propose that negative affect can induce people to engage in risky decisions. We test two alternative hypotheses as to how this effect may emerge. The mood repair hypothesis states that risky choices in risk decision making serve as a means to repair one's negative affect. The depletion hypothesis, in contrast, states that risky choices in risk decision making are the mere consequence of a state of depletion resulting from engagement in active mood regulation attempts. The results of a first laboratory study establish a link between risky choices in risk decision making and negative affect. Subsequent experiments provide evidence that depletion due to active mood regulation attempts, rather than mood repair, is the underlying process for this link. Copyright © 2008 John Wiley & Sons, Ltd.     

Examining the Validity of ADHD as a Diagnosis for Adolescents with Intellectual Disabilities: Clinical Presentation

Children with intellectual and developmental disabilities are at heightened risk for mental disorders. Using current diagnostic criteria, disruptive behavior disorders, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), appear to be the most prevalent co-occurring disorders. However, the validity of ADHD as a diagnosis for children and adolescents with intellectual disabilities remains unclear. The present study examined the clinical presentation of ADHD (prevalence, sex differences, and comorbidity) among adolescents with and without intellectual disability (ID) as well as investigated the validity of ADHD for adolescents with ID by examining similarities in terms of symptom presentation, developmental course, and associated functional impairment. The sample included 142 adolescents and their families, about a third of whom were classified in the ID group and the remaining were in the typically developing (TD) group. Findings indicated that adolescents with ID continue to be at elevated risk for ADHD (risk ratio: 3.38:1) compared to their typically developing peers. Additionally, the presentation of ADHD appeared similar among adolescents with and without ID, supporting the validity of an ADHD diagnosis for this population of adolescents. Implications for public policy and intervention are discussed.     

Specificity of Reward Sensitivity and Parasympathetic-Based Regulation among Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

Attention-deficit/hyperactivity disorder (ADHD) is associated with disruptionsin reward sensitivity and regulatory processes. However, it is unclear whether thesedisruptions are better explained by comorbid disruptive behavior disorder (DBD)symptomology. This study sought to examine this question using multiple levels ofanalysis (i.e., behavior, autonomic reactivity). One hundred seventeen children (aged 6 to 12 years; 72.6% male; 69 with ADHD) completed theBalloon-Analogue Risk Task (BART) to assess external reward sensitivity behaviorally.Sympathetic-based internal reward sensitivity and parasympathetic-based regulationwere indexed via cardiac pre-ejection period (PEP) and respiratory sinus arrhythmia(RSA), respectively. Children with ADHD exhibited reduced internal reward sensitivity (i.e.,lengthened PEP; F(1,112)=4.01, p=0.047) compared to healthy controls and werecharacterized by greater parasympathetic-based dysregulation (i.e., reduced RSAaugmentation F(1,112)=10.12, p=0.002). However, follow-up analyses indicated theADHD effect was better accounted for by comorbid DBD diagnoses; that is, childrenwith ADHD and comorbid ODD were characterized by reduced internal rewardsensitivity (i.e., lengthened PEP; t=2.47, p=0.046) and by parasympathetic-baseddysregulation (i.e., reduced RSA augmentation; t=3.51, p=0.002) in response to rewardwhen compared to typically developing youth. Furthermore, children with ADHD and comorbid CD exhibited greater behaviorally-based external reward sensitivity (i.e.,more total pops; F(3,110)= 5.96, p=0.001) compared to children with ADHD only (t=3.87, p=0.001) and children with ADHD and ODD (t=3.56, p=0.003). Results suggest that disruptions in sensitivity to reward may be betteraccounted for, in part, by comorbid DBD.Key Words: attention-deficit/hyperactivity disorder, autonomic nervous system,disruptive behavior disorders, reward sensitivityPowered     

Common and distinct factors in decision making under ambiguity and risk: A psychometric study of individual differences

The relation between decision making under ambiguity and risky decision making was examined. In Studies 1 and 2, choices under ambiguity were measured for a large sample receiving an Ellsberg-type Ambiguity-Probability Tradeoff Task. Participants with extreme scores were recruited for Part 2 of each study which consisted of a risky decision making task (Study 1) or a series of decisions under ambiguity in “real life” scenarios (Study 2). Despite a time gap of up to 2 months, individual differences in scores on Part 1 predicted scores on Part 2. In Study 3 participants received in a single session several risky decision making tasks, several measures of decision making under ambiguity, and several personality scales related to uncertainty and decision making style. Taken together, the findings support the existence of a stable dispositional trait to reduce uncertainty in decision making but also task-specific differences related to gains and losses.     

The Academic Experience of Male High School Students with ADHD

This study compared the high school academic experience of adolescents with and without childhood ADHD using data from the Pittsburgh ADHD Longitudinal Study (PALS). Participants were 326 males with childhood ADHD and 213 demographically similar males without ADHD who were recruited at the start of the follow-up study. Data were collected yearly from parents, teachers and schools. The current study used assessment points at which the participants were currently in or had recently completed grades 9, 10, 11, and 12. Results indicated that adolescents with ADHD experienced significant academic impairment in high school relative to comparison adolescents, including lower overall and main academic subject grade point averages (GPA), lower levels of class placement (e.g. remedial vs. honors), and higher rates of course failure. In addition, teacher reports indicated that adolescents with ADHD completed and turned in a significantly lower percentage of assignments and were significantly less likely to be working up to their potential. Adolescents with ADHD were also significantly more likely to be absent or tardy during the academic year, and they were over eight times more likely than adolescents without ADHD to drop out of high school. These findings demonstrate that children with ADHD continue to experience severe academic impairment into high school.     

The effect of cognitive behavior therapy on decision making in adolescents who self-harm: a pilot study

Research shows poor decision making in adolescents who self-harm and a positive correlation between decision-making abilities and duration since last self-harm episode. This exploratory study investigated whether decision making in self-harming adolescents could be improved through treatment with a novel cognitive behavior therapy (CBT). It also investigated whether improvement in decision making following treatment was linked to self-harm cessation. Adolescent self-harmers receiving CBT (n = 24) or no treatment (n = 9) and healthy controls (n = 22) were longitudinally compared on the Iowa gambling task (IGT). Significant IGT improvements were only observed for adolescents who self-harm following CBT. CBT may benefit adolescent self-harmers and generate decision-making improvements.     

Parental rearing behavior prospectively predicts adolescents’ risky decision‐making and feedback‐related electrical brain activity

The present study examined the role of parental rearing behavior in adolescents’ risky decision‐making and the brain's feedback processing mechanisms. Healthy adolescent participants (n = 110) completed the EMBU‐C, a self‐report questionnaire on perceived parental rearing behaviors between 2006 and 2008 (T1). Subsequently, after an average of 3.5 years, we assessed (a) risky decision‐making during performance of the Balloon Analogue Risk Task (BART); (b) event‐related brain potentials (ERPs) elicited by positive (gain) and negative feedback (loss) during the BART; and (c) self‐reported substance use behavior (T2). Age‐corrected regression analyses showed that parental rejection at T1 accounted for a unique and significant proportion of the variance in risk‐taking during the BART; the more adolescents perceived their parents as rejecting, the more risky decisions were made. Higher levels of perceived emotional warmth predicted increased P300 amplitudes in response to positive feedback at T2. Moreover, these larger P300 amplitudes (gain) significantly predicted risky decision‐making during the BART. Parental rearing behaviors during childhood thus seem to be significant predictors of both behavioral and electrophysiological indices of risky decision‐making in adolescence several years later. This is in keeping with the notion that environmental factors such as parental rearing are important in explaining adolescents’ risk‐taking propensities.     

Prenatal testosterone and preschool Disruptive Behavior Disorders

Disruptive Behavior Disorders (DBD), including Oppositional-Defiant Disorder (ODD) and Attention-Deficit/Hyperactivity Disorder (ADHD), are fairly common and highly impairing childhood behavior disorders that can be diagnosed as early as preschool. Prenatal exposure to testosterone may be particularly relevant to these early-emerging DBDs that exhibit a sex-biased prevalence rate favoring males. The current study examined associations between preschool DBD symptom domains and prenatal exposure to testosterone measured indirectly via right 2D:4D finger-length ratios. The study sample consisted of 109 preschool-age children between ages 3 and 6 (64% males; 72% with DBD) and their primary caregivers. Primary caregivers completed a semi-structured interview (i.e., Kiddie Disruptive Behavior Disorder Schedule), as well as symptom questionnaires (i.e., Disruptive Behavior Rating Scale, Peer Conflict Scale); teachers and/or daycare providers completed symptom questionnaires and children provided measures of prenatal testosterone exposure, measured indirectly via finger-length ratios (i.e., right 2D:4D). Study results indicated a significant association of high prenatal testosterone (i.e., smaller right 2D:4D) with high hyperactive–impulsive ADHD symptoms in girls but not boys, suggesting that the effect may be driven by, or might only exist in, girls. The present study suggests that prenatal exposure to testosterone may increase risk for early ADHD, particularly hyperactivity–impulsivity, in preschool girls.