Dorien Bangma

DECISION-MAKING IN ADHD | 131 Introduction In society we face a multitude of decisions on a daily basis. These decisions range from simple to more complex, where the complexity of a decision depends mainly on the number of response options to consider, and the immediate and future consequences of the decision made (Damasio, 1994). A simple decision could, e.g., be the choice between white or whole-wheat bread for lunch, while buying a house or taking out insurance are more complex decision- making situations. During the process of decision making, we try to make the best choice to prevent experiencing regret (Schepman et al., 2012). The decision-making process involves both deliberative and intuitive thought processes (e.g., Kahneman, 2003; Kahneman & Frederick, 2005) and is of great importance for independent functioning. Difficulties in decisions making can have a strong impact on everyday life and can, e.g., lead to unnecessary risk-taking (e.g., Balogh et al., 2013). Attention-deficit/hyperactivity disorder (ADHD) is a disorder characterized by attentional problems, hyperactivity and impulsivity (American Psychiatric Association, 2013) that affects about 5.3% and 4.4% of the child- and adult population, respectively (Polanczyk et al., 2007; Polanczyk & Rohde, 2007). The characteristics of ADHD seem to be related to problems in the decision-making process. Research shows that individuals with ADHD (i.e., children, adolescents and adults) are more likely to make poor (life) decisions (Toplak et al., 2005) and to engage in risky activities (Barkley, 1997a, 1998) than individuals without ADHD. This puts individuals with ADHD at an increased risk of substance abuse (Charach et al., 2011), engagement in criminal behavior (Fletcher & Wolfe, 2009), unprotected sex (Sarver et al., 2014), and dangerous driving (Fuermaier et al., 2017). The problems in decision making experienced by individuals with ADHD may be explained by the dual-pathway model of ADHD (Sonuga-Barke, 2003, 2005) and the dual- process models of judgment and decision making (e.g., Kahneman, 2003; Kahneman & Frederick, 2005). The dual-pathway model of ADHD describes ADHD symptomatology to originate from: (1) a dysregulation of the motivational-emotional pathway in the brain, which has been related to an impairment of the reward system (Luman et al., 2005; Sonuga-Barke, 2003, 2005), and (2) a dysregulation of the cognitive pathways, which has been related in particular to deficits in the executive functions, including response inhibition and working memory (Barkley, 1997b; Sonuga-Barke, 2003, 2005). The dual-process models of judgment and decision making distinguish in turn intuitive and affective decision-making processes from analytic and deliberative decision-making processes (e.g., Kahneman, 2003; Kahneman & Frederick, 2005). Within the context of these two models, it is hypothesized that ADHD-related impairments in the motivational-emotional pathway reflect problems in making emotional or intuitive evaluations, and that impairments in the cognitive pathways reflect problems in deliberative decision making (Mäntylä et al., 2012). Research into ADHD and decision making has so far focused mainly on children and adolescents with ADHD. These studies have persistently shown that children and adolescents with ADHD encounter difficulties with various aspects of decision making. Specifically, in comparison to children and adolescents without ADHD, children and adolescents with ADHD