Just-in-time response to reward as a function of ADHD symptom severity: An fMRI study on motivational context

AIM: Attention-deficit hyperactivity disorder (ADHD) neuroimaging studies have identified substantial differences in reward-related circuits on a trial-by-trial basis. However, no research to date has evaluated the effect of motivational context on neural activity in settings with intermittent reward in ADHD. The present study was designed to identify neural processes underlying both immediate effects of reward and sustained effects of reward associated with motivational context in adult ADHD patients. METHODS: We used a functional magnetic resonance imaging paradigm, including a time estimation task with constant versus intermittent reward conditions, in a sample of 21 medication-naive adults with combined ADHD and 24 healthy adults. RESULTS: Although no between-group neural differences were detected, orbitofrontal activity dropped in association with high ADHD symptom severity during the transition from initial non-reward context blocks to subsequent reward context blocks. In turn, ADHD symptom severity predicted higher orbitofrontal activity in response to immediate reward versus no reward within reward context blocks. CONCLUSION: These results suggest that high ADHD symptom severity scorers adopted a 'just-in-time' strategy, involving the recruitment of reward processing brain areas in the face of immediate reward rather than a sustained response to motivational context.