Impact of ADHD symptoms on clinical and cognitive aspects of problem gambling


How does ADHD impact impulsivity, gambling behaviour, and symptom severity among problem gamblers?



Problem gambling is a public health concern with serious negative consequences. Problem gambling is understood to involve cognitive and behavioural impulsivity. Attention-deficit hyperactivity disorder (ADHD) is an impulsivity disorder, and has been linked to problem gambling. Previous research found associations between childhood ADHD and problem gambling in later life, as well as more severe problem gambling among those with adult ADHD. However, research to date has not examined the how ADHD impacts impulsivity, gambling behaviour, and symptom severity among problem gamblers.



Problem gamblers with ADHD would have more severe gambling symptoms, more substance use, and a more impulsive way of thinking and making decisions (cognitive profile).



Participants were young adults: 27 problem gamblers with ADHD (average age = 23 years, 55% male) and 99 problem gamblers without ADHD (average age = 23 years, 65% male). None of the participants were currently seeking treatment for their gambling problems.



Participants were recruited from the Chicago community as part of a longitudinal study of impulsivity.  Participants completed psychiatric assessments of problem gambling and ADHD, as well as measures of caffeine consumption, substance use, gambling history and habits, and impulsivity. Participants then completed assessments of cognitive impulsivity domains. These domains, previously linked with problem gambling, included response inhibition, set-shifting, spatial working memory, decision making, and executive planning. 



Problem gambling and ADHD were assessed using a clinical psychiatric interview. Caffeine consumption, alcohol and cigarette use, gambling history, and current gambling habits were all assessed using self-report questions. Impulsivity was assessed using a self-report scale, and through cognitive measures. Cognitive impulsivity was measured as performance on computerized tasks related to response inhibition, set-shifting, spatial working memory, decision making, and executive planning.



As expected, problem gamblers with ADHD had higher self-reported impulsivity and a cognitive profile showing worse response inhibition and decision-making skills compared to problem gamblers without ADHD.  However, there was no difference in set-shifting, spatial working memory, or executive planning between the two groups.   Contrary to expectations, problem gambling was not more severe in the ADHD group, and there was no evidence that ADHD status impacted frequency of gambling, amount lost, or substance use. However, problem gamblers with ADHD began gambling at a younger age and consumed more caffeine compared to the non-ADHD group.



The non-random sample of problem gamblers is not representative of the general population of problem gamblers. The relatively small sample may not have had enough power to detect the hypothesized effects. This research did not examine childhood ADHD, only current symptoms.



These findings suggest that although problem gamblers with ADHD score higher on self-reported impulsivity and have trouble with response inhibition and decision-making, ADHD does not necessarily impact all aspects of impulsivity among problem gamblers. This study also did not find evidence that ADHD impacts problem gambling severity or substance use. More research is needed to understand how impulsivity, ADHD, and problem gambling evolve together from childhood into adulthood.