We make decisions everyday, and although most of them require minimal thought and small rewards, being able to understand which choice is the better one is still an important process. Unfortunately, children with attention deficity hyperactivity disorder (ADHD) have a difficult time differentiating the decisions that will provide greater rewards. Researchers at the University Clinics for Child and Adolescent Psychiatry, University of Zurich, looked inside the brains of children, and published their findings in JAMA Psychiatry.

Researchers observed the decision-making processes in 40 children with and without ADHD. In the United States, there are 5.9 million children between the ages of 3 and 17 who are diagnosed with ADHD, and who’ve demonstrated a consistent pattern of inattention in addition to hyperactivity and impulsiveness, according to the Centers for Disease Control and Prevention. This learning disorder interferes with the child’s development in school because they typically fail to pay close attention to details, have trouble organizing tasks, and oftentimes make careless mistakes in homework.

For the study, the children laid down in a functional magnetic resonance imaging (fMRI) machine, which enabled researchers to watch their brains’ movements while the participants played a game. Children had to learn which image yielded the greater reward, and then mathematical models were used to evaluate the data. They found that children with ADHD weren’t choosing the image that gave a reward. Brain scans revealed the activity in the medial prefrontal cortex, which controls the decision-making processes of the brain, was different in ADHD children. The learning impairment occurred in less than half a second, quickly interrupting the child’s decision making process and causing them to make the wrong choice.

The speed of the mistake shows how the hyperactivity and impulsive-nature of children with ADHD function in the classroom setting. Now that researchers understand the difficulty of decision-making and where in the brain the mistakes are happening, researchers plan on studying the brain messengers that play a role in ADHD children’s decision-making process.

"We were able to demonstrate that young people with ADHD do not inherently have difficulties in learning new information; instead, they evidently use less differentiated learning patterns, which is presumably why suboptimal decisions are often made," said the study’s co-author Tobias Hauser, a neuroscientist at the University of Zurich in a press release. "If our findings are confirmed, they will provide key clues as to how we might be able to design therapeutic interventions in future."

Source: Hauser TU, Iannaccone R, Ball J, Mathys C, Brandeis D, Walitza S, et al. Role of the Medial Prefrontal Cortex in Impaired Decision Making in Juvenile Attention-Deficit/Hyperactivity Disorder. JAMA Psychiatry. 2014.