Decision-Making Deficits in ADHD Are Not Related to Risk Seeking But to Suboptimal Decision-Making: Meta-Analytical and Novel Experimental Evidence

Tycho J. Dekkers*, Joost A. Agelink van Rentergem, Hilde M. Huizenga, Hamutal Raber, Rachel Shoham, Arne Popma, Yehuda Pollak

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objective: ADHD is related to decision-making deficits in real-life (e.g., substance abuse) and on experimental tasks (increased preference for risky options). In most tasks, risk and expected value are confounded (risky options have lowest expected value), making it impossible to disentangle risky from suboptimal (i.e., not choosing highest expected value) decision-making. We differentiated between risky and suboptimal decision-making in ADHD in two studies. Method and Results: First, on a multilevel meta-regression analysis (k = 48, n_ADHD = 1,144, n_Control = 1,108), ADHD and controls differed if the risky option was suboptimal (ADHD choosing more risky/suboptimal), whereas groups performed similar if the risky option was not suboptimal. Second, an empirical study showed that adults with ADHD (n = 40) made more suboptimal, but not more risky choices than controls (n = 40). Conclusion: These results contribute to a growing body of evidence that decision-making deficits in ADHD are driven by suboptimal decision-making and not by risk seeking.

Original languageAmerican English
Pages (from-to)486-501
Number of pages16
JournalJournal of Attention Disorders
Issue number4
StatePublished - Feb 2021

Bibliographical note

Funding Information:
The authors would like to thank all participants. Furthermore, we are grateful for all data that has been kindly provided for the meta-analysis by authors of the included articles and would like to thank Danielle Haham for her excellent help in running the experiment. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is supported by a VICI grant 45312015 (H.M.H., T.J.D.) and by a MaGW grant 48012015 (H.M.H., J.A.vR.) from the Netherlands Organization for Scientific Research (NWO), and by an internal grant of the Authority for Research and Development from the Hebrew University of Jerusalem (Y.P.). Funding sources had no role in the study design, collection, analysis or interpretation of the data, writing of the manuscript, nor the decision to submit the paper for publication.

Publisher Copyright:
© The Author(s) 2018.


  • ADHD
  • decision-making
  • expected value
  • meta-analysis
  • risk-taking


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