Working memory and decision making in children with ADHD: an analysis of delay discounting with the use of the dual-task paradigm

Rosa Angela Fabio, Marilla Bianco, Tindara Caprì, Flavia Marino, Liliana Ruta, David Vagni, Giovanni Pioggia, Rosa Angela Fabio, Marilla Bianco, Tindara Caprì, Flavia Marino, Liliana Ruta, David Vagni, Giovanni Pioggia

Abstract

Background: Deficits in working memory tasks have been widely documented in Attention Deficit Hyperactivity Disorder (ADHD) studies. The aim of this study is to evaluate the effects of working memory load in impulsivity during decision-making processes. A delayed discounting (DD) paradigm was used, comparing children with ADHD and age-matched controls.

Method: Thirty-two children equally divided between typically developing and ADHD, from 8 to 10 years of age were assigned to sessions of a dual-task paradigm. In the primary task the child has to choose between two different amounts of money at different time delays, while in the secondary task the child has to repeat a random series of digits with different lengths. The experiment was conducted in a school setting.

Results: Compared to peers with typical development, delayed discounting was significantly stronger in children with ADHD and discounting rates increased in both groups for heavier memory loads. Furthermore, the memory load impact on frequency of immediate rewards was stronger in children with ADHD compared to typically developing children.

Discussion: Results are discussed in terms of the relation between working memory load and decision-making processes, their impact on impulsive behaviour in ADHD and the need for future research to understand possible neurocognitive correlates and use that information to develop better inclusive policies.

Keywords: ADHD; Cognitive load; Decision-making; Delayed discounting; Working memory.

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Subjects Recruitment, Assignment, and Assessment Procedures
Fig. 2
Fig. 2
k-value Comparison Between Control and Experimental (ADHD) Group for Different Memory Load Conditions. Footnote: In the Box and Whisker Plot a box is drawn from the first quartile to the third quartile, while a line is drawn at the median and the cross is the mean value. The whiskers extend from each quartile to the minimum or maximum. Outliers are depicted as dots
Fig. 3
Fig. 3
Effect Size Matrix of The Difference Between ADHD and Control Groups for Different Delays and Memory Loads
Fig. 4
Fig. 4
k-value Comparison of Choose Delayed Reward Between Control and Experimental (ADHD) Group for Different Conditions. Footnote: Error bars are standard errors. All differences between the two groups are significant (p < .05) with the exception of the three 1-year conditions. A table with the plot-data and the statistical analysis is reported in Supplementary Materials in Table S.10

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