Avaliação dos processos de desconto temporal em pacientes com Déficit de Atenção/Hiperatividade (TDAH), Transtorno do Espectro Autista (TEA) e casos comórbidos

Abstract

Children with Attention Deficit/Hyperactivity Disorder (ADHD) and Autistic Spectrum Disorder (ASD) seem to present significant differences in the affective-motivational processes of executive functioning. Despite the heterogeneity of the studies, a high temporal discount is usually observed in reinforcing postponement tasks in children with ADHD whereas the performance of children with ASD would be more similar to that of children with typical development. The motivational affective domain seems therefore particularly interesting for the differentiation of the disorders in terms of cognitive profiles and the investigation of the changes related to ADHD + ASD comorbidity. There is no literature available to investigate the temporal discounting in younger children with comorbid ADHD and autism. In this study, our objective was to investigate differences in performance in a temporal discounting task among children with 1) ADHD, 2) ASD, 3) Comorbidity of ADHD and ASD, and 4) typical development. Initially, a systematic review of the literature was conducted to investigate the consistency of the evidence found regarding temporal discounting patterns in children aged 6 to 12 years with autism and ADHD, discussing potential differences between these groups in the affective-motivational domain of executive functions. Subsequently, a cross-sectional study was conducted using a hypothetical monetary reward temporal discounting task, which was applied to a sample of 100 children (35 children with typical development, 35 with ADHD, 18 children with ASD, and 13 comorbid cases). Regarding the literature review, 6 of 8 articles involving the ADHD group pointed to a greater temporal discounting in relation to the controls in the age group investigated. The only study involving children with ASD pointed in the same direction. In the group analyses of the experimental study, we observed that children with typical development and with ASD tend to have a similar temporal discounting, whereas children with ADHD and comorbid cases presented a significantly more impulsive pattern of choices, with a higher preference for smaller and immediate rewards, not differing from each other. We conclude that in the comorbid cases of ADHD and autism the occurrence of ADHD seems to significantly impair affective-motivational processing, leading to higher temporal discounts, whereas the ASD does not seem to present changes in the affective-motivational processes involving postponement of reinforcement.