Decision-Making Deficits in ADHD Are Not Related to Risk Seeking But to Suboptimal Decision-Making

This paper distinguishes between "risky" decision-making (choosing options with high outcome variance) and "suboptimal" decision-making (choosing options with lower expected value), arguing that prior ADHD research using gambling tasks has confounded the two. Through a meta-analysis of studies comparing ADHD and control groups, the authors find that decision-making deficits in ADHD are significantly larger when the risky option is also disadvantageous in expected value, and an accompanying empirical study shows adults with ADHD actually make fewer risky choices than controls when risk-taking would be advantageous. Together, this indicates ADHD-related decision-making problems stem from suboptimal choice-making rather than a general tendency toward risk-seeking. The authors attribute this to executive function deficits (working memory and inhibition) that make it harder for people with ADHD to track and update the expected values of different options and to resist tempting but suboptimal alternatives.