The impact of affective functions on decision-making behaviour in adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental psychiatric disorder that often persists throughout a patient’s life. ADHD is characterized by a particularly heterogeneous clinical profile, influenced not only by its progression over the years but also by differences between men and women. Deficits in affective functions, which are still rarely considered in adult patients, highlight these gender distinctions as symptoms attributed to emotional processes are more pronounced in female patients. Alongside cognitive functions, these emotional processes are critical in shaping behaviour, particularly in quick and intuitive decision-making and risk-engagement. Emotional arousal, which is coupled with changes in the autonomic nervous system, can modulate and guide unconscious decision-making behaviours. However, the extent to which impairments in decision-making behaviour in adult patients with ADHD depend on this interaction, and whether differences exist between male and female patients in terms of affective symptoms remains largely unexplored. Thus, this thesis aims to investigate the underlying mechanisms of affectively driven decision-making behaviour in adult patients with ADHD compared to healthy controls. Using measurements of physiological changes via skin conductance responses and neural changes via functional MRI, decision-making behaviour was examined in more detail across three consecutive studies. Behavioural data were collected through reaction times in a modified version of the Balloon Analogue Risk Task and self-assessment were gathered using self-report questionnaires that assessed emotional competence, risk attitude, and reward sensitivity. Analyses using a linear mixed-effects model demonstrated that increased risk-taking is not accompanied by an increase in physiological activity in adults with ADHD. Further analyses also revealed that this effect was primarily driven by female patients. Compared to self-reports from questionnaires, an impaired self-perception of one's own behaviour was also demonstrated. Neural correlates further substantiated the connection between physiological response and behaviour, indicating reduced neural activity in the region of the right precuneus and the right superior frontal gyrus in patients with ADHD. Furthermore, hyperactive neural patterns were found in women compared to men within the patient group, emphasizing the critical role of the left insula in emotional processing across genders. Overall, this thesis underscores the significant role of affective processes during decision-making behaviour and highlights gender-specific differences in patients with ADHD. These differences can be attributed to an altered relationship between emotional processing of an event, physiological change and behaviour, primarily related to disturbed interoceptive perception and metacognitive functions. Based on this work, further studies are needed to explore the understanding and gender-specific effects of autonomic nervous system functions in adult ADHD. This could not only deepen our understanding of the behavioural difficulties in adult patients with ADHD but also provide an opportunity for individualized and transdiagnostic treatments

Glucose-sensitive hypothalamic nuclei traced through functional magnetic resonance imaging

IntroductionHypothalamic glucose-sensitive neural circuits, which regulate energy metabolism and can contribute to diseases such as obesity and type 2 diabetes, have been difficult to study in humans. We developed an approach to assess hypothalamic functional connectivity changes during glucose loading using functional magnetic resonance imaging (fMRI).MethodsTo do so, we conducted oral glucose tolerance tests while acquiring functional images before, and 10 and 45 min after glucose ingestion in a healthy male and cross-sectionally in 20 healthy participants on two different diets.ResultsAt group level, 39 fMRI sessions were not sufficient to detect glucose-mediated connectivity changes. However, 10 repeated sessions in a single subject revealed significant intrinsic functional connectivity increases 45 min after glucose intake in the arcuate, paraventricular, and dorsomedial nuclei, as well as in the posterior hypothalamic area, median eminence, and mammillary bodies.DiscussionOur methodology allowed to outline glucose-sensitive hypothalamic pathways in a single human being and holds promise in delineating individual pathophysiology mechanisms in patients with dysglycemia

Effects of a video game intervention on symptoms, training motivation, and visuo-spatial memory in depression

BackgroundPeople with Major Depressive Disorder (MDD) often experience reduced affect, mood, and cognitive impairments such as memory problems. Although there are various treatments for MDD, many of them do not address the cognitive deficits associated with the disorder. Playing 3D video games has been found to improve cognitive functioning in healthy people, but it is not clear how they may affect depressed mood and motivation in people with MDD. The aim of this study was to investigate whether a six-week video game intervention leads to improvements in depressed mood, training motivation, and visuo-spatial (working) memory functions in patients with MDD.MethodsA total of 46 clinically depressed individuals were randomly assigned to one of three groups: an experimental “3D video gaming” group (n = 14) which played a video game, an active control group (n = 16) which trained with a computer program “CogPack,” and a treatment-as-usual group (n = 16) which received a standard clinical treatment including psychotherapy and/or pharmacotherapy. Participants performed a neuropsychological assessment, including self-report questionnaires asking for depressive symptoms, training motivation, and visuo-spatial (working) memory functions before and after the training intervention.ResultsRegarding depressive symptoms, a significant decrease in the proportion of participants who showed clinical levels of depressive symptoms as measured by the Beck Depression Inventory was only found in the 3D video gaming group. Additionally, mean motivational levels of performing the training were significantly higher in the 3D video gaming group when compared with the active control group. Moreover, whereas the 3D Video Gaming group only significantly improved on one visuo-spatial memory test, the active control group improved in all visuo-spatial memory functions. The 3D video gaming group did not perform significantly better than the CogPack group, and the TAU group.ConclusionBesides a standalone cognitive training, the current findings suggest that cognitive trainings using a video game have potential to increase subjective well-being, show higher levels of training motivation, and lead to improvements in visuo-spatial (working) memory functions in MDD. However, given the mixed and unblinded nature of this study, the results should be interpreted with caution. Further research with larger samples and follow-up measurements is needed

Altered interaction of physiological activity and behavior affects risky decision-making in ADHD

BackgroundAdult attention-deficit/hyperactivity disorder (ADHD) is often associated with risky decision-making behavior. However, current research studies are often limited by the ability to adequately reflect daily behavior in a laboratory setting. Over the lifespan impairments in cognitive functions appear to improve, whereas affective functions become more severe. We assume that risk behavior in ADHD arises predominantly from deficits in affective processes. This study will therefore aim to investigate whether a dysfunction in affective pathways causes an abnormal risky decision-making (DM) behavior in adult ADHD.MethodsTwenty-eight participants with ADHD and twenty-eight healthy controls completed a battery of questionnaires regarding clinical symptoms, self-assessment of behavior and emotional competence. Furthermore, skin conductance responses were measured during the performance in a modified version of the Balloon Analogue Risk Task. A linear mixed-effects model analysis was used to analyze emotional arousal prior to a decision and after feedback display.ResultsResults showed higher emotional arousal in ADHD participants before decision-making (β = −0.12, SE = 0.05, t = −2.63, p < 0.001) and after feedback display (β = −0.14, SE = 0.05, t = −2.66, p = 0.008). Although risky behavior was greater in HC than in ADHD, we found a significant interaction effect of group and anticipatory skin conductance responses regarding the response behavior (β = 107.17, SE = 41.91, t = 2.56, p = 0.011). Post hoc analyses revealed a positive correlation between anticipatory skin conductance responses and reaction time in HC, whereas this correlation was negative in ADHD. Self-assessment results were in line with the objective measurements.ConclusionWe found altered changes in physiological activity during a risky decision-making task. The results confirm the assumption of an aberrant relationship between bodily response and risky behavior in adult ADHD. However, further research is needed with respect to age and gender when considering physiological activities

The impact of affective functions on decision-making behaviour in adult ADHD

© 2025 Eva HalbeAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental psychiatric disorder that often persists throughout a patient’s life. ADHD is characterized by a particularly heterogeneous clinical profile, influenced not only by its progression over the years but also by differences between men and women. Deficits in affective functions, which are still rarely considered in adult patients, highlight these gender distinctions as symptoms attributed to emotional processes are more pronounced in female patients. Alongside cognitive functions, these emotional processes are critical in shaping behaviour, particularly in quick and intuitive decision-making and risk-engagement. Emotional arousal, which is coupled with changes in the autonomic nervous system, can modulate and guide unconscious decision-making behaviours. However, the extent to which impairments in decision-making behaviour in adult patients with ADHD depend on this interaction, and whether differences exist between male and female patients in terms of affective symptoms remains largely unexplored. Thus, this thesis aims to investigate the underlying mechanisms of affectively driven decision-making behaviour in adult patients with ADHD compared to healthy controls. Using measurements of physiological changes via skin conductance responses and neural changes via functional MRI, decision-making behaviour was examined in more detail across three consecutive studies. Behavioural data were collected through reaction times in a modified version of the Balloon Analogue Risk Task and self-assessment were gathered using self-report questionnaires that assessed emotional competence, risk attitude, and reward sensitivity. Analyses using a linear mixed-effects model demonstratedthat increased risk-taking is not accompanied by an increase in physiological activity in adults with ADHD. Further analyses also revealed that this effect was primarily driven by female patients. Compared to self-reports from questionnaires, an impaired self-perception of one's own behaviour was also demonstrated. Neural correlates further substantiated the connection between physiological response and behaviour, indicating reduced neural activity in the region of the right precuneus and the right superior frontal gyrus in patients with ADHD. Furthermore, hyperactive neural patterns were found in women compared to men within the patient group, emphasizing the critical role of the left insula in emotional processing across genders. Overall, this thesis underscores the significant role of affective processes during decision-making behaviour and highlights gender-specific differences in patients with ADHD. These differences can be attributed to an altered relationship between emotional processing of an event, physiological change and behaviour, primarily related to disturbed interoceptive perception and metacognitive functions. Based on this work, further studies are needed to explore the understanding and gender-specific effects of autonomic nervous system functions in adult ADHD. This could not only deepen our understanding of the behavioural difficulties in adult patients with ADHD but also provide an opportunity for individualized and transdiagnostic treatments

Sex differences in physiological correlates of affectively driven decision-making behavior in adult ADHD

BACKGROUND: Sex differences in the symptomatology of adults with attention-deficit/hyperactivity disorder (ADHD) have often been overlooked when studying behavioral abnormalities. However, it is known that women exhibit considerably more stronger symptoms related to emotional competence than men. Since affective functions significantly influence the processing of risky decision-making and risk-engagement, we assume that risky behavior in ADHD is affected by sex differences. Therefore, we specifically investigated sex-specific effects on the interaction between emotionally induced changes in physiology and behavioral performance on a decision-making task. METHODS: Skin conductance responses of twenty-nine adults with ADHD (n = 16 male; n = 13 female) and thirty-three adults in the control group (n = 14 male; n = 19 female) were recorded during the performance in a modified version of the Balloon Analogue Risk Task (BART). Additional questionnaires were used to reveal insights in the self-assessment of emotional competence, risk perception, and feedback sensitivity. Emotional arousal and decision-making behavior were analyzed using linear mixed-effects models. RESULTS: Results showed different effects of sex on risk behaviors in controls and ADHD. In contrast to healthy controls, female adults with ADHD showed a significantly greater risk engagement in the BART compared to males with ADHD. This contrary sex relation was not observed in skin conductance responses and revealed a significantly different sex-dependent correlation of body response and behavioral task performance in ADHD. Comparisons with results from self-assessments furthermore indicate a reduced behavioral self-perception in women with ADHD, but not in men. CONCLUSION: In summary, we found an altered interaction between physiological activity and risky behavior in women with ADHD. Thus, the present study indicates a reduced sensitivity towards the own bodily responses in women with ADHD, which could consequently cause increased risky DM behavior in daily life. The current results suggest that more consideration needs to be given to sex-specific effects on physiological processes and behavior in adults with ADHD

Data_Sheet_1_Glucose-sensitive hypothalamic nuclei traced through functional magnetic resonance imaging.PDF

IntroductionHypothalamic glucose-sensitive neural circuits, which regulate energy metabolism and can contribute to diseases such as obesity and type 2 diabetes, have been difficult to study in humans. We developed an approach to assess hypothalamic functional connectivity changes during glucose loading using functional magnetic resonance imaging (fMRI).MethodsTo do so, we conducted oral glucose tolerance tests while acquiring functional images before, and 10 and 45 min after glucose ingestion in a healthy male and cross-sectionally in 20 healthy participants on two different diets.ResultsAt group level, 39 fMRI sessions were not sufficient to detect glucose-mediated connectivity changes. However, 10 repeated sessions in a single subject revealed significant intrinsic functional connectivity increases 45 min after glucose intake in the arcuate, paraventricular, and dorsomedial nuclei, as well as in the posterior hypothalamic area, median eminence, and mammillary bodies.DiscussionOur methodology allowed to outline glucose-sensitive hypothalamic pathways in a single human being and holds promise in delineating individual pathophysiology mechanisms in patients with dysglycemia.</p