AUTHOR=Schulze Marcel , Coghill David , Lux Silke , Philipsen Alexandra 

TITLE=Disentangling ADHD's Presentation-Related Decision-Making—A Meta-Analytic Approach on Predominant Presentations

JOURNAL=Frontiers in Psychiatry

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.519840

DOI=10.3389/fpsyt.2021.519840

ISSN=1664-0640

ABSTRACT=<p><bold>Background:</bold> Deficient decision-making (DM) in attention deficit/hyperactivity disorder (ADHD) is marked by altered reward sensitivity, higher risk taking, and aberrant reinforcement learning. Previous meta-analysis aggregate findings for the ADHD combined presentation (ADHD-C) mostly, while the ADHD predominantly inattentive presentation (ADHD-I) and the predominantly hyperactive/impulsive presentation (ADHD-H) were not disentangled. The objectives of the current meta-analysis were to aggregate findings from DM for each presentation separately.</p><p><bold>Methods:</bold> A comprehensive literature search of the PubMed (Medline) and Web of Science Database took place using the keywords “ADHD,” “attention-deficit/hyperactivity disorder,” “decision-making,” “risk-taking,” “reinforcement learning,” and “risky.” Random-effects models based on correlational effect-sizes were conducted. Heterogeneity analysis and sensitivity/outlier analysis were performed, and publication biases were assessed with funnel-plots and the egger intercept.</p><p><bold>Results:</bold> Of 1,240 candidate articles, seven fulfilled criteria for analysis of ADHD-C (<italic>N</italic> = 193), seven for ADHD-I (<italic>N</italic> = 256), and eight for ADHD-H (<italic>N</italic> = 231). Moderate effect-size were found for ADHD-C (<italic>r</italic> = 0.34; <italic>p</italic> = 0.0001; 95% CI = [0.19, 0.49]). Small effect-sizes were found for ADHD-I (<italic>r</italic> = 0.09; <italic>p</italic> = 0.0001; 95% CI = [0.008, 0.25]) and for ADHD-H (<italic>r</italic> = 0.1; <italic>p</italic> = 0.0001; 95% CI = [−0.012, 0.32]). Heterogeneity was moderate for ADHD-H. Sensitivity analyses show robustness of the analysis, and no outliers were detected. No publication bias was evident.</p><p><bold>Conclusion:</bold> This is the first study that uses a meta-analytic approach to investigate the relationship between the different presentations of ADHD separately. These findings provide first evidence of lesser pronounced impairment in DM for ADHD-I and ADHD-I compared to ADHD-C. While the exact factors remain elusive, the current study can be considered as a starting point to reveal the relationship of ADHD presentations and DM more detailed.</p>