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Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders - differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety

Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders - differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety
Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders - differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety
Background

Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review.

Scope and methodology

We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes.

Findings and conclusion

Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.
0021-9630
1-29
Sonuga-Barke, Edmund J.S.
bc80bf95-6cf9-4c76-a09d-eaaf0b717635
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Fairchild, Graeme
f99bc911-978e-48c2-9754-c6460666a95f
Stringaris, Argyris
b813012e-7b67-432b-9799-2187bf675c30
Sonuga-Barke, Edmund J.S.
bc80bf95-6cf9-4c76-a09d-eaaf0b717635
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Fairchild, Graeme
f99bc911-978e-48c2-9754-c6460666a95f
Stringaris, Argyris
b813012e-7b67-432b-9799-2187bf675c30

Sonuga-Barke, Edmund J.S., Cortese, Samuele, Fairchild, Graeme and Stringaris, Argyris (2015) Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders - differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety. Journal of Child Psychology and Psychiatry, 1-29. (doi:10.1111/jcpp.12496). (PMID:26705858)

Record type: Article

Abstract

Background

Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review.

Scope and methodology

We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes.

Findings and conclusion

Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.

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More information

e-pub ahead of print date: 26 December 2015
Published date: 26 December 2015
Organisations: Clinical Neuroscience

Identifiers

Local EPrints ID: 385607
URI: http://eprints.soton.ac.uk/id/eprint/385607
ISSN: 0021-9630
PURE UUID: 69f91fea-8d18-4d4b-ae01-2ca98bf2b679
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075
ORCID for Graeme Fairchild: ORCID iD orcid.org/0000-0001-7814-9938

Catalogue record

Date deposited: 20 Jan 2016 15:21
Last modified: 15 Mar 2024 03:52

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Contributors

Author: Edmund J.S. Sonuga-Barke
Author: Samuele Cortese ORCID iD
Author: Graeme Fairchild ORCID iD
Author: Argyris Stringaris

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