Do adolescents with attention-deficit/hyperactivity disorder show risk seeking? Disentangling probabilistic decision making by equalizing the favorability of alternatives

The clinical literature provides evidence for increased risk taking by individuals with attention-deficit/hyperactivity disorder (ADHD). Most of the experimental tasks used to measure risk taking, confounded risky and disadvantageous alternatives, and therefore did not disentangle increased risk seeking from suboptimal decision making. The aim of the study was to examine whether adolescents with ADHD show risk seeking by equalizing the expected value of both certain and risky alternatives. In 3 different samples, adolescents with and without ADHD performed gambling tasks, in which they had to choose between certain and risky alternatives. Notably, the expected values of both alternatives were equal. Various personal and contextual intervening factors were controlled for. The rate of risky choices was compared across groups. In addition, participants reported on risk taking in real-life. We found that adolescents with ADHD did not choose the risky alternative more often than controls, but reported higher engagement in real-life risky behavior. These findings suggest that risky behavior shown by people with ADHD in daily life and on some experimental tasks may not be accounted for by increased risk seeking, but rather may reflect suboptimal decision making.