Are ADHD Symptoms Associated With Delay Aversion or Choice Impulsivity? A General Population Study

Objective: The term delay aversion has been used both to describe a behavioral tendency of greater preference for smaller-immediate over larger-delayed rewards (choice impulsivity) and to refer to a secondary explanatory construct put forward by delay aversion theory. In this study, we examined the association of attention-deficit/hyperactivity disorder (ADHD) symptoms with choice impulsivity and tested the specific hypothesis derived from delay aversion theory. Method: A total of 1,062 children aged 7.90 to 10.90 years (49% girls) made a fixed number of repeated choices between a smaller reward delivered immediately and a larger reward delivered after a delay (choice-delay task), under two conditions (including and excluding a postreward delay). We assessed the unique contribution of each ADHD symptom dimension to the prediction of choice impulsivity and delay aversion, controlling for age (or age and IQ). Sex effects were examined. Results: Inattention ratings uniquely predicted preference for smaller-immediate rewards under both task conditions for both sexes. An index of delay aversion was associated with inattention only in boys; the effect size was small yet significant. Hyperactivity-impulsivity ratings were negatively associated with choice impulsivity in girls in the postreward delay condition, whereas no significant association with hype ractivity-impulsivity ratings was observed in boys. Categorical analyses using groups with high ADHD symptoms yielded similar results. Conclusions: This is the first study to report a unique association between inattention symptoms and behavioral measures of choice impulsivity and delay aversion. The findings indicate the importance of the primary constitutional processes that underlie choice impulsivity and their potential role in behavioral inattention. Understanding the behavioral and brain processes underlying choice impulsivity may lead to the improved targeting of behavioral and pharmacological interventions. J. Am. Acad. Child Adolesc. Psychiatty, 2009;48(8):837-846.