College is hard for people with ADHD

Behavioral research : Agonizing selection

“Decisions are one of the worst things ever,” moans a participant in an Internet forum for people with ADHD. Others who are also affected by attention deficit hyperactivity disorder agree, they report being spoiled for choice in the restaurant or in the jeans store. And how often you have regretted wrong decisions.

Luxury problems, one might think. But they have to do with bad experiences: Research has long agreed that people with ADHD are more likely than average to make impulsive decisions that promise quick rewards, but prove to be disadvantageous in the long term. Because it is not just about pizza or sweets, it can also block life chances, especially for children and young people.

Gambling in the tomograph

The Swiss psychologist and neuroscientist Tobias Hauser, who is currently working at the Wellcome Trust Center for Neuroimaging at University College London, has now taken a closer look at the brains of adolescents while they are had to make decisions as part of a game.

The researchers compared 20 children and adolescents between 12 and 16 years of age who had already been treated for a diagnosed ADHD with 20 children of the same age without this diagnosis. While they were lying in a functional magnetic resonance tomograph (fMRI) and at the same time their brain waves were being recorded by EEG, they all played a game of chance refined by certain principles. The decision for one of two pictures was rewarded in each case - which was the right picture, but that was initially difficult to predict.

This constellation was interesting for the researchers because it triggers learning processes when expectations are not met and there are no rewards: It is important to rethink. The researchers were not only able to prove that the electrical activity and blood flow in the middle region of the frontal lobe, the medial prefrontal cortex, are different in the two groups during the decision-making process. They were also able to narrow down the difference in terms of time: An abnormality appeared in the ADHD group less than half a second after the players had received feedback on success or failure in the game. The reaction time of the adolescents from the two groups did not differ, but the adolescents with ADHD had a little less success in playing than the participants from the control group.

Less sensitive to change

The researchers now also used mathematical methods to analyze which changing hypotheses both groups had applied during the game. It was found that the participants from the ADHD group reacted somewhat less sensitively to changes in the chances of winning. "The behavior of the control group was better explained by a flexible learning pattern, that of the ADHD patients better by a simple one," they write in their article now published in "JAMA Psychiatry Online".

ADHD is likely to suffer from the sensitivity with which one learns from unexpected changes in reward opportunities. “The children with ADHD therefore more often choose a solution that they actually already know is not the best - and then get annoyed that they have not chosen the right one,” explains Hauser on request.

Make decision-making processes more aware

Most of the participants with a diagnosis of ADHD had previously taken the drug methylphenidate (including Ritalin), but temporarily stopped it for the study. The drug intervenes in the metabolism of dopamine, the central messenger substance of the reward system. The second important pillar of treatment is usually behavioral therapy. "Work should be done there to make children more aware of decision-making processes and to pay careful attention to details," says Hauser. In addition, neurofeedback could help, a form of feedback that makes signals from certain brain regions visible. "This helps children to specifically train the regions that are affected by ADHD."

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