Attention-Deficit/Hyperactivity Disorder as a Disorder of Value-Based Decision-Making and Action Initiation
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition that can also persist across the lifespan and can impair everyday functioning in a variety of domains, including executive function, value processing, decision-making, motivation, and initiation. While ADHD has traditionally been conceptualized as a disorder of executive dysfunction, current research suggests that impairments extend beyond cognitive control to include fundamental disruptions in how individuals evaluate and act upon rewards. Evidence from behavioral, neuroimaging, and computational studies indicates that individuals with ADHD exhibit altered reinforcement learning, particularly in assigning value to actions associated with delayed outcomes. Recent computational research has begun to view ADHD algorithmically, finding that individuals with ADHD place disproportionately more value on actions with more immediate (as opposed to delayed) rewards, even in multi-step action sequences, resulting in reduced motivational salience of early action. This review discusses ADHD from a perspective that integrates all of these domains to present ADHD as a disorder characterized by more expansive, broader dysfunction in value-based decision-making and action initiation.