Neural response during anticipation of monetary loss is elevated in adult attention deficit hyperactivity disorder

Abstract

Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.

Keywords:

• ADHD
• fMRI
• monetary loss
• reward
• anticipation

Acknowledgements

This work was supported by the German Federal Ministry of Education and Research (BMBF 01GV0606 to LTvE and AP) and the German Research Foundation (Deutsche Forschungsge-meinschaft, DFG, BL 1009/2-1 to JB, LTvE and AP).

Statement of interest

LTvE received fees from Lilly, EISAI, Unimed, and UCB. AP from advisory boards, lectures, phase-III studies or travel grants within the last 2 years: Eli Lilly, Medice Arzneimittel Pütter GmbH, Novartis and Shire; she is author of books and articles on treatment of adult ADHD published by Elsevier, Hogrefe, Schattauer, Kohlhammer and Karger. All other authors report no potential conflicts of interest.