Dorien Bangma

FDM AND CURRENT SYMPTOMS OF ADHD | 185 Introduction Attention-deficit/hyperactivity disorder (ADHD), characterized by symptoms of inattention, hyperactivity and impulsivity (American Psychiatric Association, 2013), is historically known as a developmental disorder that only affects children. However, in on average 50% of children with ADHD (32.8% – 84.1% cross-national variation; Lara et al., 2009), the condition persists into adulthood resulting in an estimated prevalence of adult ADHD of 3.4% internationally (range 1.2 – 7.3%; Fayyad et al., 2007). Adults with ADHD have more difficulties in daily life compared to adults without ADHD with, e.g., educational and occupational performances and social functioning (Barkley et al., 2008; Daley & Birchwood, 2010; Michielsen et al., 2015). Adults with ADHD are, furthermore, often involved in risky behavior, such as risky driving, risky sexual-behavior or substance abuse (Barkley et al., 2002; Flory et al., 2006; Fuermaier et al., 2017; Lee et al., 2011). Although financial decision-making has hardly been investigated in adults with ADHD, there are indications that adults with ADHD also have problems with this important capability in everyday life. Financial decision-making describes several components related to the ability to manage or direct to manage financial affairs. It involves practical skills and abilities, e.g., counting coins, but also financial knowledge and judgment to perform financial actions (Appelbaum et al., 2016). The limited research available indicates an association between symptoms of hyperactivity-impulsivity and inattention and problems with financial decision- making (Altszuler et al., 2016; Barkley & Fischer, 2010; Das et al., 2012). Adults with ADHD are more often financially dependent (Altszuler et al., 2016) and report more financial problems compared to age-matched controls (e.g., debts, exceeding credit card limits, difficulties saving money and impulsive buying; Barkley et al., 2008). A recent study, using standardized objective measures in addition to self-report questionnaires, confirmed that adults with ADHD compared to healthy controls have difficulties with several aspects of financial decision-making, including problems with understanding bank protocols and evaluating financial problems, having debts, not saving money and problems with financial decisions with implications for the future. Furthermore, compared to healthy controls, adults with ADHD were found to have a stronger tendency to buy on impulse and more often used inadequate financial decision styles (i.e., avoiding decisions and spontaneously making a decision; Bangma et al., 2019). In the dual-pathway model of decision-making, affective processing of information is described as one of two systems involved in decision-making (Evans, 2008; Kahneman, 2003; Peters et al., 2007). Together with deliberative/analytic processing of information, which strongly relies on cognitive control, both systems are considered to be crucial for adequate decision-making (Kahneman, 2003; Peters et al., 2007). Motivational/affective dysregulation in adults with ADHD (Shaw et al., 2014; Sonuga-Barke, 2003) might, therefore, underlie problems with financial decision-making in adults with ADHD. On the other hand, cognitive dysregulation of adults with ADHD (e.g., impairments in executive functions and numeracy (Bangma et al., 2019; Boonstra et al., 2005, 2010; Fuermaier et al., 2015) might also have an impact on (financial) decision-making (Bangma et al., 2019; Mäntylä et al., 2012).