Do children with ADHD differ from children with ODD in behavioral inhibition?

According to an article by Humphreys, K. L, & Lee, S. S. (2011). Risk Taking and Sensitivity to Punishment in Children with ADHD, ODD, ADHD + ODD, and Controls

In this article, we will present two aspects of behavioral inhibition: risk taking and sensitivity to punishment, among children with ADHD and ODD (Oppositional Defiant Disorder).

Risk-taking – is related to behavioral inhibition and consists of the tendency to engage in negative behavior, which endangers health, well-being, and lifestyle. Risk-taking is associated with ADHD – for a number of reasons. For example, risk-taking is associated with the use of hazardous substances in people with ADHD. Also, dangerous driving, dangerous sexual behavior, gambling and unintentional injuries.

However, it is not clear whether the association between risk-taking and ADHD is explained by the comorbidities with ODD? Previous studies dealing with ADHD and risk-taking have ignored the effects of comorbidities with ODD. That is, the association between risk-taking and ADHD may be mediated by a behavioral disorder that is in very high comorbidity with ADHD. Risk-taking may be related to behavioral disorders.

Sensitivity to punishment – the potential for punishment affects risk-taking. Children with ADHD are spurred on by the chance of being punished. For example, children with ADHD were more accurate in tasks, when failure resulted in negative punishment. A study that examined profit and negative punishment found that a loss of even a small amount of money increased the response time in behavioral tasks in children with ADHD.

It is not clear whether the degree of sensitivity to punishment is consistent among children with and without ADHD. There are studies that have actually found that children with ADHD took more risk in punishment conditions, and responded less to punishment. ODD – the disorder is associated with a decrease in susceptibility to adverse punishment. For example, children with ODD are less sensitive to punishment compared to children with normal development. In most studies we examined two groups: with and without ADHD, and were unable to elucidate the uniqueness of many clinical groups (e.g., ADHD in comorbidities with ODD).


In this study, risk-taking and sensitivity to punishment were examined among 4 groups of children: ADHD, ODD, ADHD + ODD, without ADHD and without ODD (control group), using the BART task- Balloon Analog Risk Task. It is a computerized analogy that presents 30 separate balloons. Participants must inflate balloons for points (more inflations / clicks = more points). The balloons explode in a variable and unknown number of inflations (clicks). Balloon exploded = no points. Simultaneous display of reward (points) and negative penalty (points canceled for the balloon that exploded). The average explosion point is 65 clicks. The reward is stickers as the number of points at the end of the task.

Two variables were examined: 1. The total number of clicks along the task (risk-taking index). 2. To estimate sensitivity to negative punishment, for each balloon that exploded, the researchers subtracted the number of clicks made immediately after the balloon exploded from the number of clicks in the attempt prior to the balloon that exploded, with positive values ​​constituting fewer clicks after balloon explosion, and negative values ​​constituting more clicks after exploding.

This study found that on average children were less stressed after a balloon exploded (were more sensitive to punishment). It was also found that all groups were different from each other in taking a risk: ADHD + ODD clicked the most times in general (took the most risk), after them ODD, followed by ADHD and finally – control children clicked the fewest times. Moreover, the ODD group showed the least sensitivity to punishment (clicked the most times after a balloon exploded), followed by the ADHD group, followed by the control group and finally, the ADHD + ODD group who were surprisingly most sensitive to punishment (clicked the least times after balloon explosion).

Thus, “pure” ADHD appears to have positively predicted an increase in risk-taking compared with control subjects. ODD predicted the most risk-taking, with children with ODD and ODD + ADHD inflated more compared to ADHD alone and control subjects. Children with ADHD + ODD showed the most risk-taking – this group is at increasing risk for adverse consequences. The ADHD + ODD group was the most sensitive to punishment.

Although “pure” ADHD is associated with high levels of risk-taking compared with control subjects, ODD is associated with the highest levels of risk-taking. The increase in risk-taking found in children with ADHD + ODD provides further evidence that this group is different from the ADHD group and the ODD group. The findings of this study support previous studies that ODD predicts risk-taking and reduces responsiveness to punishment. The findings of this study indicate that children with ADHD were less sensitive to punishment in only a few of the control subjects, but more sensitive than children with ODD.

Some argue that children with ADHD and behavioral disorders (combined) are primarily characterized by poor regulatory abilities. Therefore, although these children take more risks, they cannot be assumed to be immune to punitive feedback. Therefore they will tend to take more risks but will also moderate their behavior, even excessively, when their action leads to an undesirable outcome.

The comorbid group (ADHD + ODD) in the next step after punishment, drastically reduced the number of clicks, while in general throughout the task their total clicks were the highest among the groups. It can be seen that they were wrong and thought that the next attempt after an explosion, with a greater probability, will also explode early, although this is clearly not true, and each attempt does not depend on its predecessor, everyone has the same probability of a balloon exploding.


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