Study: Risk-Taking Behavior May Predict ADHD, ODD in Children

November 30, 2021

Select measures of impulsivity and risk-taking in children with attention deficit hyperactivity disorder (ADHD) are linked to symptoms of comorbid oppositional defiant disorder (ODD), according to a longitudinal study recently published in Frontiers in Psychiatry¹ that examines the relationship between these disorders, reward-related dysfunctions, and other factors.

Specifically, the study found that high approach motivation (the tendency to approach a rewarding stimulus while dismissing any associated threats or risks) in children might indicate a higher likelihood of developing comorbid symptoms of ADHD or ODD. The researchers also argue that another overlapping psychopathological dimension called callous-unemotional (CU) traits — associated with reduced guilt and remorse, callousness, and low empathy — may appear alongside dimensions of ADHD and ODD/CD in children who exhibit this high approach motivation.

Research Background

Existing research has established a significant link between ADHD, ODD, and conduct disorder (CD). Reward-related dysfunctions are, likewise, prevalent in individuals with ADHD and ODD/CD. Early emerging measures of impulsivity, including high approach motivation and low inhibitory control (IC) may indicate later development of these disorders.

While low reward-related inhibitory control (RRIC) is common in children with ADHD as well as in those with ODD/CD, it is thought that children with ADHD symptoms and comorbid CU traits show fewer RRIC deficits.

Studies also show that children with ADHD exhibit low autonomic reactivity in response to reward-related tasks, which may be caused by comorbid ODD/CD symptoms. These studies, however, have not assessed the role of CU traits in this relationship.

The authors of the new study examined all these factors in a sample of 198 preschool children, hypothesizing that:

• Low RRIC would be associated with developing ADHD, and would overlap with comorbid ODD symptoms
• High reward-related approach behavior would be associated with developing ADHD and could be explained by ODD symptoms and CU traits
• Low autonomic reactivity to reward-related stimuli would be linked to ADHD and overlap with ODD symptoms and CU traits

Approach Motivation Study

Participants, aged 4 to 5 years at the start of the study, were all screened for ADHD. (Children with high ADHD symptoms were oversampled.) To measure RRIC, researchers used a Snack-Delay task (participants wait for a cue before they can take a snack). The Stranger-with-Toys task (how long it takes the child to talk to a stranger) was used to measure approach motivation. Parents also completed ADHD and ODD rating scales.

Researchers assessed the participants again at age 8. RRIC was measured using a Gift-Bag task (children wait for a cue to look at their gift). To measure approach motivation, children were scored based on how long it took for them to speak to a stranger who placed toys in front of them while asking a series of questions. Autonomic reactivity was measured based on the participants’ reactions to the stranger’s questions. (Electrodes were attached to participants’ hands.) Parents also completed ADHD, ODD, and CU scales/questionnaires.

Findings show that low RRIC, whether at preschool age or school age, is uniquely related to ADHD, and is not associated with ODD or CU traits. Preschool RRIC, in particular, predicted later ADHD development. Low autonomic reactivity was also uniquely associated with ADHD alone.

High approach motivation at preschool, however, is associated with ADHD at school age — particularly in children with comorbid ODD symptoms and CU traits.

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