Preserved Initiatory Choice Performance in High-Functioning Adults With ADHD

ADHD has been linked to altered value-based learning and difficulty valuing initiatory actions, early decisions whose consequences unfold over subsequent steps. We tested whether initiatory-stage performance in ADHD is selectively affected by hierarchical task structure or temporal delay. A sample of undergraduates high-functioning adults with ADHD and typically developing (TD) participants completed a three-stage sequential decision task in three conditions: Multiple free choice, Single free choice (forced), and Single free choice (delayed). The conditions varied in whether later stages were freely chosen versus externally constrained and whether outcomes were temporally delayed. Using hierarchical Bayesian models, we examined first-stage choice accuracy and reaction-time variability (RTV) as a function of Group, Condition, and choice discriminability (the absolute expected-value difference between options). Across all conditions, accuracy increased with discriminability, indicating intact use of expected-value information at the initiatory stage. Mean first-stage accuracy did not reliably differ between ADHD and TD in any condition. However, ADHD participants showed stronger discriminability-related gains in accuracy in both Single free choice variants, whereas no such group difference emerged in Multiple free choice. RTV increased with discriminability across conditions, with no evidence that this effect differed by group. A modest elevation of RTV in ADHD was most evident in Multiple free choice. Overall, initiatory-stage performance was preserved in this high-functioning ADHD sample, while task structure influenced how value information translated into accuracy.