Citation

Dir AL, Allebach CL, Hummer TA, Adams ZW, Aalsma MC, Finn PR, Nurnberger JI, Hulvershorn LA. Biol. Psychiatry Cogn. Neurosci. Neuroimaging 2019; ePub(ePub): ePub.

Affiliation

Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana; Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: lhulvers@iupui.edu.

Copyright

(Copyright © 2019, Society of Biological Psychiatry, Publisher Elsevier Publishing)

DOI

10.1016/j.bpsc.2019.10.016

PMID

32007432

Abstract

BACKGROUND: Suicidality is a leading cause of death among adolescents. In addition to other psychiatric conditions, youths with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs) are at heightened risk for suicide. Decision-making deficits are a hallmark symptom of ADHD and DBDs and are also implicated in suicidal behavior. We examined behavioral and neural differences in decision making among youths with ADHD and DBDs with (SI+) and without (SI-) histories of suicidal ideation.

METHODS: The Balloon Analog Risk Task, a risky decision-making task, was completed by 57 youths with ADHD and DBDs (38% SI+) during functional magnetic resonance imaging. Mean stop wager (mean wager at which youths bank money) was the primary measure of risk taking. We conducted whole-brain and region-of-interest analyses in the anterior cingulate cortex and orbitofrontal cortex (OFC) during choice (win vs. inflate) and outcome (inflate vs. explode) contrasts using parametric modulators accounting for probability of balloon explosion.

RESULTS: There were no differences between SI+ and SI- youths in Balloon Analog Risk Task performance. SI+ youths showed decreasing activation in the right medial frontal gyrus when choosing inflate as explosion probability increased compared with SI- youths. During explosions, SI- youths showed increasing activation in the left OFC as explosions became more likely. SI+ showed increasing left medial OFC activity in response to inflations as explosion probability increased.

CONCLUSIONS: SI+ youths may show heightened sensitivity to immediate reward and decreased sensitivity to potential loss as evidenced by medial frontal gyrus activity. OFC findings suggest that SI+ youths may be drawn to reward even when there is high probability of loss.

Copyright © 2019 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Language: en

Keywords

ADHD; Adolescent; Decision making; Disruptive behavior disorders; Suicidality; fMRI