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Delay Aversion and Executive Functioning in Adults with Attention-Deficit/Hyperactivity Disorder: Before and after Stimulant Treatment

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Ann Marie Low, Julijana Le Sommer, Signe Vangkilde, Birgitte Fagerlund, Birte Glenthøj, Edmund Sonuga-Barke, Thomas Habekost, Jens Richardt Møllegaard Jepsen

Original languageEnglish
Pages (from-to)997-1006
Number of pages10
JournalInternational Journal of Neuropsychopharmacology
Issue number11
Publication statusPublished - 1 Nov 2018

King's Authors


Background: Attention deficit hyperactivity disorder is a heterogeneous disorder, associated with deficits in motivation (e.g., delay aversion) and cognition. Methylphenidate is recommended as a first line treatment for attention deficit hyperactivity disorder symptoms, but little is known about its nonacute effects on motivational and cognitive deficits, particularly in adults with attention deficit hyperactivity disorder. Methods: We utilized a prospective, non-randomized, non-blinded, 6-week follow-up design with 42 initially stimulant medication-nave adult patients with moderate to severe attention deficit hyperactivity disorder, and 42 age-and parental education-matched healthy controls. Delay aversion and executive functioning were assessed with 2 questionnaires and 5 performance-based tests. Results: At baseline, patients and controls differed significantly on performance-based measures (moderate to large effect sizes), and self-report of delay aversion and executive functioning (very large effect sizes). Treatment with methylphenidate medication (mean dose 65.54 mg/d, SD = 10.39) was not associated with improvements in performance-based measures of delay aversion and executive functioning compared to controls, although improvements in self-report executive functioning and delay aversion were found. Self-reported delay aversion was most consistently associated with ADHD symptomatology at baseline and after medication. Conclusion: Methylphenidate treatment does not have an effect on performance-based measures of delay aversion and executive functioning, but may have significant effects on self-reported delay aversion and executive functioning. The latter finding should be interpreted cautiously, given the subjective nature of these measures and design limitations. Self-reported delay aversion is most consistently associated with attention deficit hyperactivity disorder symptomatology.

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