Schulze Marcel, Coghill David, Lux Silke, Philipsen Alexandra
Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.
Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.
Front Psychiatry. 2021 Feb 18;12:519840. doi: 10.3389/fpsyt.2021.519840. eCollection 2021.
Deficient decision-making (DM) in attention deficit/hyperactivity disorder (ADHD) is marked by altered reward sensitivity, higher risk taking, and aberrant reinforcement learning. Previous meta-analysis aggregate findings for the ADHD combined presentation (ADHD-C) mostly, while the ADHD predominantly inattentive presentation (ADHD-I) and the predominantly hyperactive/impulsive presentation (ADHD-H) were not disentangled. The objectives of the current meta-analysis were to aggregate findings from DM for each presentation separately. A comprehensive literature search of the PubMed (Medline) and Web of Science Database took place using the keywords "ADHD," "attention-deficit/hyperactivity disorder," "decision-making," "risk-taking," "reinforcement learning," and "risky." Random-effects models based on correlational effect-sizes were conducted. Heterogeneity analysis and sensitivity/outlier analysis were performed, and publication biases were assessed with funnel-plots and the egger intercept. Of 1,240 candidate articles, seven fulfilled criteria for analysis of ADHD-C ( = 193), seven for ADHD-I ( = 256), and eight for ADHD-H ( = 231). Moderate effect-size were found for ADHD-C ( = 0.34; = 0.0001; 95% CI = [0.19, 0.49]). Small effect-sizes were found for ADHD-I ( = 0.09; = 0.0001; 95% CI = [0.008, 0.25]) and for ADHD-H ( = 0.1; = 0.0001; 95% CI = [-0.012, 0.32]). Heterogeneity was moderate for ADHD-H. Sensitivity analyses show robustness of the analysis, and no outliers were detected. No publication bias was evident. This is the first study that uses a meta-analytic approach to investigate the relationship between the different presentations of ADHD separately. These findings provide first evidence of lesser pronounced impairment in DM for ADHD-I and ADHD-I compared to ADHD-C. While the exact factors remain elusive, the current study can be considered as a starting point to reveal the relationship of ADHD presentations and DM more detailed.
注意力缺陷多动障碍（ADHD）患者的决策缺陷（DM）表现为奖励敏感性改变、更高的冒险行为以及异常的强化学习。以往的荟萃分析大多汇总了ADHD混合型（ADHD-C）的研究结果，而ADHD主要为注意力不集中型（ADHD-I）和主要为多动/冲动型（ADHD-H）的研究结果并未分开分析。本荟萃分析的目的是分别汇总每种类型ADHD在决策方面的研究结果。使用关键词“ADHD”、“注意力缺陷多动障碍”、“决策”、“冒险行为”、“强化学习”和“风险”对PubMed（Medline）和科学网数据库进行了全面的文献检索。基于相关效应量进行随机效应模型分析。进行了异质性分析和敏感性/异常值分析，并通过漏斗图和埃格截距评估发表偏倚。在1240篇候选文章中，7篇符合ADHD-C分析标准（n = 193），7篇符合ADHD-I分析标准（n = 256），8篇符合ADHD-H分析标准（n = 231）。发现ADHD-C的效应量中等（r = 0.34；p = 0.0001；95%CI = [0.19, 0.49]）。ADHD-I（r = 0.09；p = 0.0001；95%CI = [0.008, 0.25]）和ADHD-H（r = 0.1；p = 0.0001；95%CI = [-0.012, 0.32]）的效应量较小。ADHD-H的异质性中等。敏感性分析表明分析结果具有稳健性，未检测到异常值。未发现明显的发表偏倚。这是第一项采用荟萃分析方法分别研究ADHD不同类型与决策之间关系的研究。这些发现首次证明，与ADHD-C相比，ADHD-I和ADHD-H在决策方面的损害不太明显。虽然确切因素尚不清楚，但本研究可被视为更详细揭示ADHD类型与决策关系的起点。
