Neural response during anticipation of monetary loss is elevated in adult attention deficit hyperactivity disorder.
Risky behaviour seriously impacts the life of adult patients with attention deficit hyperactivity disorder (ADHD). Such behaviours have often been attributed to their exaggerated reward seeking, but dysfunctional anticipation of negative outcomes might also play a role.



The present study compared adult patients with ADHD (n = 28) with matched healthy controls (n = 28) during anticipation of monetary losses versus gains while undergoing functional magnetic resonance imaging (fMRI) and skin conductance recording.



Skin conductance was higher during anticipation of losses compared to gains in both groups. Affective ratings of predictive cues did not differ between groups. ADHD patients showed increased activity in bilateral amygdalae, left anterior insula (region of interest analysis) and left temporal pole (whole brain analysis) compared to healthy controls during loss versus gain anticipation. In the ADHD group higher insula and temporal pole activations went along with more negative affective ratings.



Neural correlates of loss anticipation are not blunted but rather increased in ADHD, possibly due to a life history of repeated failures and the respective environmental sanctions. Behavioural adaptations to such losses, however, might differentiate them from controls: future research should study whether negative affect might drive more risk seeking than risk avoidance.
a Department of Psychology , University of Freiburg , Freiburg , Germany.|b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany.|c Department of Psychiatry and Psychotherapy , Charité - Universitätsmedizin Berlin , Berlin , Germany.
Gregor
G
Wilbertz
d Department of Psychology , Rutgers University , Newark , NJ 07102 , USA.
Mauricio R
MR
Delgado
b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany.
Ludger
L
Tebartz Van Elst
b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany.
Simon
S
Maier
b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany.|e Medical Campus University of Oldenburg, School of Medicine and Health Sciences , Psychiatry and Psychotherapy - University Hospital , Karl-Jaspers-Klinik, Bad Zwischenahn , Germany.
Alexandra
A
Philipsen
f Center for Cognitive Neuroscience, University of Salzburg , Salzburg , Austria.|g Department of Psychology, University of Salzburg , Salzburg , Austria.
Jens
J
Blechert
D000328:Adult; D000679:Amygdala / Q000000981:diagnostic imaging / Q000503:physiopathology*; D059031:Anticipation, Psychological / Q000502:physiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005712:Galvanic Skin Response; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012201:Reward
ADHD; anticipation; fMRI; monetary loss; reward