The effects of methylphenidate on decision making in attention-deficit/hyperactivity disorder.
BACKGROUND
Children with attention-deficit/hyperactivity disorder (ADHD) frequently display poor judgment and risk taking in their everyday behavior, but there are little empirical data on decision-making cognition in this disorder. The objectives of the study were to assess the effects of stimulant medication on decision making in ADHD and compare performance on the Cambridge Gamble Task between boys with and without ADHD.


METHODS
Twenty-one boys (aged 7-13) diagnosed with ADHD underwent a double-blind, placebo-controlled trial of methylphenidate (.5 mg/kg) during which they performed the Cambridge Gamble Task (CGT). A healthy age-matched control group was tested on two occasions off drug.


RESULTS
The ADHD group bet more conservatively on the methylphenidate session than on the placebo session. In comparison with healthy control subjects, the ADHD group made more poor decisions, placed their bets more impulsively, and adjusted their bets less according to the chances of winning. Poor decision making was correlated with parent-reported symptoms and disruptive behavior in the ADHD group.


CONCLUSIONS
Methylphenidate reduced risk-prone betting behavior on the CGT. Compared with control subjects, children with ADHD display a number of decision-making deficits on the task, and the measure of rational decision making may serve as an ecologically valid neuropsychological marker of impairment.
DeVito
Elise E
EE
Department of Psychiatry, University of Cambridge, Cambridge, UK. eed24@medschl.cam.ac.uk
Blackwell
Andrew D
AD
Kent
Lindsey
L
Ersche
Karen D
KD
Clark
Luke
L
Salmond
Claire H
CH
Dezsery
Anna Maria
AM
Sahakian
Barbara J
BJ
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000494:pharmacology* / Q000627:therapeutic use*; D002648:Child; D003657:Decision Making / Q000187:drug effects*; D005715:Gambling; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D009483:Neuropsychological Tests
D000697:Central Nervous System Stimulants; D008774:Methylphenidate