Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders – differentiating decision making in attention‐deficit/hyperactivity disorder, conduct disorder, depression, and anxiety. (26th December 2015)

• Record Type: Journal Article
• Authors: Sonuga‐Barke, Edmund J. S.; Cortese, Samuele; Fairchild, Graeme; Stringaris, Argyris
• Is Part Of: Journal of child psychology and psychiatry and allied disciplines. Volume 57:Number 3(2016)
• Page Start: 321
• Page End: 349
• Publication Date: 2015-12-26
• Subjects: Transdiagnostic -- decision making -- reinforcement learning -- delayed reinforcement -- executive functions -- working memory -- inhibition -- prefrontal cortex -- ventral striatum -- amygdala: CD -- attention‐deficit/hyperactivity disorder -- anxiety -- depression; Child psychology -- Periodicals; Child psychiatry -- Periodicals; 155.4
• DOI: 10.1111/jcpp.12496
• Languages: English
• ISSNs: 0021-9630

Abstract

Abstract : Background: Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review. Scope and methodology: We first propose a neuroeconomic model of the decision‐making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self‐referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes. Findings and conclusion: Based on clinical insights and considering each of the decision‐making stages in turn, we outline disorder‐specific hypotheses about impaired decision making in four childhood disorders: attention‐deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk‐averse, and self‐deprecating. A survey of current empirical indications related to these disorder‐specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research. Abstract : Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. In this review, we first propose a neuroeconomic model of the decision‐making process with four separate stages and suggest that the decision making is mediated by neuropsychological processes operating within three domains, with the processes underpinned by the interplay of multiple brain networks. Based on the clinical insights and considering each of the decision‐making stages in turn, we outline disorder‐specific hypotheses about impaired decision making in four childhood disorders. We hypothesize that decision making is inefficient, impulsive, and inconsistent in ADHD; reckless and insensitive to negative outcomes in CD; disengaged/perseverative/pessimistic in depression; and hesitant/risk‐aversive/self‐deprecating in anxiety. We conclude that the limited and fragmentary nature of the evidence base illustrates the need for a major research initiative in decision making in childhood disorders and highlight a number of themes to be considered in this future research. Read the Commentary on this article at doi:10.1111/jcpp.12531