The Association Between Adolescent Adhd and Callous-unemotional Traits is Moderated by Electrophysiological Reinforcement Sensitivity

Reward processing is a hypothesized ADHD intermediate phenotype and, as such, is suggested to improve prediction of relevant outcomes, above and beyond the clinical phenotype. Although both reward and punishment processing and ADHD are associated with CU traits, gaps in knowledge remain about adolescents, electrophysiological indices, and longitudinal relations. We examined, in N  = 297 adolescents, whether accounting for ODD and sex, ERPs to gain and loss moderate the prospective association between ADHD symptoms and CU traits and whether any moderational effects are driven by ADHD risk status and domain of symptoms. Findings indicated ADHD symptoms were positively associated with Uncaring traits at low ( b  = .255, SE  = .109, p  = .020; 95% CI[.040, .469]), but not at moderate ( b  = .136, SE  = .078, p  = .085; 95% CI[-.019, .291]) or high ( b  = .016, SE  = .080, p  = .842; 95% CI[-.142, .174]) levels of Target P3, with this moderational effect apparent in adolescents at-risk for ADHD, for inattention symptoms ( F (6, 92) = 2.299, Δ R ²  = .138, p  = .010). Electrophysiological reward and punishment processing improves prediction of CU traits above and beyond the ADHD clinical phenotype; in adolescents at-risk for ADHD, low electrophysiological response links elevated inattention symptoms to greater Uncaring traits whereas moderate and higher response may be protective.