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

Abstract

<b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> Of 1,240 candidate articles, seven fulfilled criteria for analysis of ADHD-C (<i>N</i> = 193), seven for ADHD-I (<i>N</i> = 256), and eight for ADHD-H (<i>N</i> = 231). Moderate effect-size were found for ADHD-C (<i>r</i> = 0.34; <i>p</i> = 0.0001; 95% CI = [0.19, 0.49]). Small effect-sizes were found for ADHD-I (<i>r</i> = 0.09; <i>p</i> = 0.0001; 95% CI = [0.008, 0.25]) and for ADHD-H (<i>r</i> = 0.1; <i>p</i> = 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. <b>Conclusion:</b> 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.