Dorien Bangma

GENERAL DISCUSSION AND CONCLUSION | 217 Altszuler et al., 2016; Barkley et al., 2006, 2008), the study presented in chapter 7 was the first study using performance-based tests in order to evaluate FDM capability in adults with ADHD. Because of the sensitive nature of this topic and the possible tremendous negative consequences of problems with FDM capability, it is of utmost importance that FDM capability is a topic that is acknowledged in scientific and clinical practice when investigating everyday functioning of adults with ADHD. Direct examination of FDM capability may contribute to the (early) detection of adults with ADHD with FDM capability problems, or at risk to develop financial problems, and to better assist and protect these patients. Financial decision-making capability in relation to cognition Three studies in this thesis, presented in chapters 3, 4 and 7 , directly assessed specific cognitive functions in order to evaluate which cognitive functions were related to FDM capability. Numeracy, i.e., the ability to use basic mathematics as frequently measured with an arithmetic test, was most consistently found to be a significant predictor of FDM capability. Depending on the sample, numeracy mediated differences between groups in FDM capability on three aspects of FDM (i.e., financial knowledge or financial competence as measured with the Financial Competence Assessment Inventory; financial judgment as measured with the Financial Decision-Making Interview; and financial performance, specifically the ability to use decision rules, as measured with the Competence in Decision Rules test). Numeracy could, however, only explain a part of the problems with these aspects of FDM, since the direct effect remained significant in both healthy individuals (evaluating the effects of age on FDM capability; chapter 3 ) and adults with and without ADHD (evaluating group differences on FDM capability; chapter 7 ). Besides numeracy, also other cognitive functions were found to be related to FDM capability. Lower performances on measures of processing speed, working memory and verbal memory were found to be related to more difficulties with making financial decisions ( chapter 4 ). It seems that the associations between these functions of cognition, including numeracy, and FDM capability are however not consistent for all aspects of FDM capability, since some aspects of FDM do not appear to be related to these cognitive functions ( chapter 3 ). Furthermore, differences between studies (as presented in Table 4.3 ) might be dependent on the sample evaluated, the FDM aspect assessed and/or the measures used to determine FDM and cognitive functioning. Also, visuospatial memory, verbal fluency, attention and executive functions (including abstract reasoning, planning and cognitive flexibility) were found to be related to FDM, however, the evidence was limited and/or results were mixed. Finally, the studies presented in this thesis and in previous studies demonstrate that cognitive functioning, as measured with standard neuropsychological measures, cannot fully explain FDM capability, since only small to moderate amounts of variance could be explained by cognition. Other factors must therefore play a role as well. Financial decision-making capability and the influence of contextual factors Several contextual factors were found to be related to specific FDM capability aspects. In the present thesis, the associations between aspects of FDM capability and age, sex, level of education, gross annual year income, personality traits, symptoms of depression and disease