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. Author manuscript; available in PMC: 2025 Dec 6.
Published before final editing as: Int J Behav Dev. 2025 Nov 29:10.1177/01650254251394492. doi: 10.1177/01650254251394492

Reward Motives are Differentially Related to Depression, Anxiety, and ADHD Symptoms in Middle Childhood

Katie H Lee 1, Laura Hennefield 1, Katherine R Luking 2, Obed Usenbor 1, Chad M Sylvester 1, Deanna M Barch 1,3, Joan L Luby 1, Michael T Perino 1
PMCID: PMC12680018  NIHMSID: NIHMS2119244  PMID: 41356660

Abstract

Deviations in reward anticipation and response are associated with internalizing and externalizing disorders. However, relationships between different types of reward motivations and psychopathology have been less explored. We examine how preferences for absolute (gaining points) and relative (gaining more points than others) rewards relate to psychopathological symptoms in middle childhood. A community sample (N=133 6–9-year-olds) was assessed for child characteristics (gender, age, resource deprivation) and psychiatric symptoms (Child Behavior Checklist dimensional subscales: depression, anxiety, Attention-Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD)). Children completed a behavioral economic game, selecting equal or unequal point splits for themselves and another player. Each round offered one of four unequal point splits: absolute rewards (more overall points), relative rewards (more points than another player), both, or neither. Multilevel binary logistic regressions found that depression was associated with an increased preference for gaining more points than the other player (t=1.986, p=.047), anxiety was associated with a reduced preference for maximizing points (t=−3.259, p=.001) and gaining more points than the other player (t=−3.148, p=.002), and ADHD was associated with an increased preference for maximizing points regardless of what the other player received (t=2.392, p=.017). Our results suggest depression, anxiety, and ADHD may differentially influence the types of rewards children find motivating and choose to pursue. Future work should explore the impact of integrating these preferences into treatment to reduce pediatric psychopathology.

Keywords: Depression, Anxiety, ADHD, Reward Processing, Psychopathology

Introduction

Psychopathology often emerges in childhood (Costello et al., 2003; Kessler et al., 2007; Solmi et al., 2022), frequently leading to persistent difficulties throughout the lifespan (Kim-Cohen et al., 2003; Pine et al., 1998). Identifying novel and specific target mechanisms during these formative years is paramount for improving interventions to reduce negative cascades that may arise (Insel et al., 2010). Deviations in anticipating and responding to rewards are consistently associated with various psychiatric phenotypes (Auerbach et al., 2022; Belden et al., 2016; Hawes et al., 2021; Lahat et al., 2018; Paloyelis et al., 2012), and this work has already informed interventions for common childhood problems (Dimidjian et al., 2006; Jacobson et al., 2001; Miller et al., 2014; Tomarken et al., 2004). Less research has examined how preferences for different types of rewards may relate to specific presentations of psychopathology. Here, we investigate how motivations to gain different types of rewards, such as absolute (gaining resources without considering what others receive) and relative (gaining more resources compared to others) rewards, are associated with child characteristics and psychopathological symptoms in middle childhood.

Variations in reward processing are well-established and distinct across internalizing (e.g., depression (Belden et al., 2016; Forbes et al., 2006), anxiety (Lahat et al., 2018)) and externalizing (e.g., Attention-Deficit/Hyperactivity Disorder (ADHD) (Paloyelis et al., 2012), Oppositional Defiant Disorder (ODD) (Hawes et al., 2021), and Conduct Disorder (CD) (Hawes et al., 2021) psychopathology. Depression is generally associated with neural hypo-responsivity in reward circuitry (Belden et al., 2016; Forbes et al., 2006) and reduced subjective pleasure and motivation to seek out rewards (Kazdin, 1989). Depression has also been linked to diminished reward responsivity as evidenced by decreased reward seeking in behavioral tasks (Forbes et al., 2007; Henriques & and Davidson, 2000). These alterations in reward processing have been observed in preschoolers with depression (Belden et al., 2016), as well as throughout development into later childhood and adolescence (Forbes et al., 2007; Luking et al., 2016a). Decreased responsivity to reward in childhood and adolescence has also been shown to predict future depression (Forbes et al., 2007), particularly in adolescence (Luking et al., 2016b; Nelson et al., 2016), and may also predict future anxiety (Forbes et al., 2007). Certain studies suggest anxiety is similarly related to decreased neural reward responsivity (Auerbach et al., 2022), as well as decreased reward sensitivity, as evidenced by lower accuracy and slower reaction time in behavioral tasks (Dorfman et al., 2016). However, generalized and social anxiety may differentially relate to reward sensitivity (Guyer et al., 2012; Kessel et al., 2015), with social anxiety in children and adolescents linked to hyperresponsivity during reward anticipation in brain regions typically associated with reward processing. Conversely, ADHD, ODD, and CD are routinely linked to increased sensation- (Martin et al., 2004; Purper-Ouakil et al., 2010) and reward-seeking behavior (Byrd et al., 2014; Fairchild et al., 2009) and increased striatal activation in response to reward receipt (Bjork et al., 2010; Hawes et al., 2021; Paloyelis et al., 2012).

These findings have informed treatments; for example, Behavioral Activation Therapy is used to treat depression by increasing exposure to rewarding outcomes (Dimidjian et al., 2006; Jacobson et al., 2001), while externalizing disorders and disruptive behaviors are often managed using token economies and contingency management schedules (Miller et al., 2014) that reward desired prosocial behaviors. One limitation of the research base is that typical reward paradigms (e.g., Monetary Incentive Delay Task) allow participants to gain points or money based on performance without knowledge of how others may perform or be rewarded. A growing body of research has suggested that relative reward processing, the desire to gain more than others, or a focus on how one’s earned rewards compare to those of others, may be important in shaping social behaviors (“Money matters,” 2015; Pleskac et al., 2021). However, insights from studies of relative reward are not currently not well-integrated into the theory of, or interventions for, psychopathology (Isoda, 2020).

Both internalizing and externalizing disorders are composed of interpersonal symptomology, suggesting a potential impact of relative reward processing distinct from alterations in reward processing as typically studied. Additionally, treatment for various forms of psychopathology often involves goals for improving interactions in the classroom and other social environments, the efficacy of which may be affected by altered relative reward processing. Elucidating how valuing absolute and relative rewards relate to symptoms may be integral to addressing emergent psychopathology. It has long been noted that social comparison concerns—appraising oneself negatively compared to peers—are prevalent in those with internalizing symptoms (Gibbons & Buunk, 1999; Swallow & Kuiper, 1992), where individuals may view a perceived loss to a peer or rival as particularly harmful. Furthermore, individuals with externalizing symptoms may prioritize gaining more than those in their surroundings instead of maximizing their overall resources (Glenn et al., 2017), perhaps serving as a motivational explanation for bullying. Though these behaviors have not previously been framed in relation to absolute and relative rewards, they suggest that absolute and relative reward processing deviations may be associated with different types of psychopathological symptoms. They also indicate that while absolute and relative preferences are not inherently positive or negative, an increased or reduced propensity for one or the other may be suboptimal for healthy development. For example, if one primarily pursues relative rewards by engaging in behaviors that put others down (bullying) or make clear they are benefitting more than others, they may experience difficulties building trust with peers at an important time for friendship development (Ladd, 1988).

A core component of psychopathology involves interpersonal dysfunction and difficulties in social relationships. Elucidating how reward preferences relate to social behaviors and psychopathology may provide insight into how we can best treat interpersonal dysfunction. Social preference judgments regarding the fair distribution of rewards and other resources have been experimentally assessed as early as infancy (Geraci & Surian, 2011; Sloane et al., 2012), but less is known about absolute versus relative reward preferences and how these may relate to the progression of psychopathology. Furthermore, exploring these impacts in relation to childhood developmental factors, such as age, gender, and socioeconomic status (Benenson et al., 2007; Chen et al., 2013; Korndörfer et al., 2015; Piff et al., 2010), is crucial, as these factors are often understudied in the context of reward processing and may aid in identifying age- and context-appropriate treatments.

One potential methodology for tackling these questions may lie with behavioral economic games. These tasks are routinely applied to youth populations (Gummerum et al., 2008) and have provided intriguing insights into psychosocial functioning (Sharp, 2012). Internalizing psychopathology has been linked to maintaining positive relationships with others in potentially deleterious ways, such as accepting more unfair offers (Grecucci et al., 2013; Harlé et al., 2010) and displaying higher tolerance for unfair partners (McClure-Tone et al., 2011). Interestingly, depression is commonly associated with increased negative social comparison (Butzer & Kuiper, 2006; Swallow & Kuiper, 1988), which may lead to an increased awareness of one’s relative status. Some research has even found associations between depression and “social” externalizing behaviors, such as increased relational aggression (Crick & Grotpeter, 1995; Zimmer-Gembeck & Pronk, 2012), suggesting that depression may be associated with a preference for relative rewards. On the other hand, much of the literature suggests anxiety is unrelated (Perino et al., 2019) or negatively related (Perino et al., 2024) to such behaviors, suggesting that anxiety might be associated with a diminished preference for relative rewards. Meanwhile, externalizing symptoms are associated with decision-making patterns indicative of counterproductive social behaviors, such as prioritizing personal gain over fairness (Ma et al., 2017) and not building trust (Sharp et al., 2011), which may indicate an increased preference for relative, comparative gains.

The present study aims to elucidate how reward motive preferences relate to pediatric psychopathology. Using a behavioral economic game, we assessed how absolute and relative reward motives were associated with developmental factors and symptoms of psychopathology in middle childhood. We hypothesized that internalizing symptoms would be related to a decreased preference for absolute rewards, or overall points gained, and externalizing symptoms would be related to an increased preference for absolute rewards. We also hypothesized that internalizing symptoms would be associated with a decreased preference for relative rewards, or earning more points compared to another person, while externalizing symptoms, which are often associated with bullying (Vaughn et al., 2010), would be related to an increased relative reward preference. Clarifying these relationships between reward motivations and psychopathology may identify new targets for improving therapeutic interventions.

Methods

Participants

Recruitment was focused on 7- and 8-year-old children as part of a broader assessment of reward processing development in middle childhood. The initial sample comprised 150 6-to 9-year-olds recruited from the broader St. Louis Metropolitan area through flyers and advertisements distributed to school districts, community outreach events, and word of mouth. Parents provided written consent, and child participants provided assent. Parents reported on developmental factors and socio-behavioral measures of functioning. Of those 150 children, 145 were administered the behavioral task. Our final sample consisted of 133 children (Mage= 7.99; SD=.79) who completed a behavioral task with usable data after processing (described below in Data Quality and Task Processing). Four of the 133 participants did not complete the questionnaires measuring psychopathology symptoms. Participants received $75 in exchange for participation. The study and all procedures were reviewed and approved by the Washington University Institutional Review Board (202101165).

Child Characteristics

Parents provided information about their child’s race and ethnicity, gender, and age. Additionally, neighborhood resource deprivation was assessed using the Area Deprivation Index (ADI) (Kind & Buckingham, 2018). The ADI is calculated by comparing participant home addresses to census-track data along 17 different domains, including income, education, employment, and housing quality data, to create dimensional scores (see Supplement). The ADI provides comparative rankings of socioeconomic disadvantage of neighborhoods in the United States, creating a national percentile rank (1–100), with higher numbers indicating greater neighborhood resource disadvantage.

Psychopathology Assessment

Psychiatric symptoms were primarily assessed using the parent-reported Child Behavior Checklist (CBCL) (Achenbach, 2001), a validated tool used to assess behavioral and emotional problems. The CBCL consists of 113 items, with each item answered using a 3-point Likert scale (0=not true, 1=somewhat true, 2=very true). Although the entire CBCL was administered, analyses focused on dimensional scores of the depression (13 items) and anxiety (9 items) subscales to measure internalizing psychopathology and of the ADHD (17 items), ODD (5 items), and CD (17 items) subscales to measure externalizing psychopathology (see Table 1 for descriptive statistics and Figure S1 for score distributions). Additional measures collected in the broader parent study (e.g., the Children’s Depression Inventory 2nd edition) (Kovacs, 2011), which provides further definition of emotional and functional problems of depression, and the Screen for Child Anxiety Related Disorders (Birmaher et al., 1997), which provides 5 subscales of anxiety (Panic, Generalized, Separation, Social, School Avoidance) were used to identify if certain facets or features of psychiatric conditions were related to specific effects (See Supplement).

Table 1.

Descriptive statistics for the final sample, including child characteristics and psychopathology symptoms as measured by the Child Behavior Checklist (CBCL) subscales.

Child Characteristics (N=133) N Mean SD Range
Race
 Asian 5
 Black 23
 White 85
 Multiracial 18
 Other 2
Ethnicity
 Hispanic 6
 Not Hispanic 127
Gender
 Boy 69
 Girl 64
Age (years) 7.99 0.79 6.21–9.86
Resource Deprivation
 Area Deprivation Index 52.07 24.73 4–100
Psychopathology Symptoms (N=129) Mean SD Range Possible Range Clinically Significant (T-score≥70)
 Depression 1.73 2.12 0–11 0–26 3.9%
 Anxiety 3.21 3.44 0–16 0–18 11.6%
 Attention- 3.91 3.40 0–13 0–14 5.4%
Deficit/Hyperactivity Disorder
 Oppositional Defiant Disorder 2.99 2.64 0–10 0–10 11.6%
 Conduct Disorder 2.40 3.75 0–20 0–34 10.9%
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Note: Participants included in the clinically significant percentage for psychopathology symptoms met or surpassed a clinically significant T-score of 70 (Achenbach, 2001).

Either/Or Task

Participants completed the “Either/Or” task, a modified behavioral economic game designed to evaluate reward motive preferences. In the standard dictator game, participants are given a single option to decide how to split rewards between themselves and another player. The modified “Either/Or” game provides participants with a choice between one of four different unequal point splits and an equal split, allowing us to assess their propensity to choose certain reward types over the benign equal option. Specifically, four trial types allow participants to choose whether to pursue absolute rewards, relative rewards, both, or neither over an equal split. Furthermore, modifying the types of rewards offered across different trials (e.g., absolute rewards at the expense of a relative loss; relative rewards at the expense of an absolute loss) allows us to determine when participants are inclined to choose the unequal option based on particular reward contingencies. Participants were asked to distribute points in either an equal or unequal split between themselves and another player, who was a gender-(boy/girl), race-(white/participant of color), and age-matched confederate. The confederate’s name and photo were displayed to the participant throughout the task; these photos were stock images of children smiling (Figure 1A). Participants were instructed they would be shown two different point splits on the screen and would select either the left or right option. They were told that there was no correct way to play the game and that the other player would not know which choices they made; instead, they were instructed to choose the split they preferred. To allow for participants’ own goals and motivations to drive task behavior, researchers did not discuss the purpose of the game; participants were not told that the game was cooperative or competitive, nor were they instructed that there was any benefit or detriment to splitting points evenly. The presentation of equal and unequal point splits between the left and right sides of the screen was counterbalanced and randomized.

Figure 1.

Figure 1

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The Either/Or game required participants to choose how to distribute points between themselves and another player. They could distribute points in an equal split or unequal split. The game schematic of one trial is shown below (A). Each trial contained one equal split and one of the four unequal split options (i.e., reward motives), as depicted below (B). Trials were untimed.

Note: The photo presented is of an older research participant who provided photo consent for a similar game. N=133.

Participants encountered four trial types with different unequal split options during the task: (1) abundant reward trials, where they had the opportunity to gain both absolute and relative rewards at the same time, (2) absolute reward trials, where they had the opportunity to add points to their total at the expense of relative rewards (i.e., the participant receives more overall points, but less than the other player receives), (3) relative reward trials, where they had the opportunity to gain relative rewards at the expense of absolute rewards (i.e., the participant accepts less overall points to ensure having more than the other player), (4) neither reward trials, where they had the opportunity to lose both absolute and relative rewards (Figure 1B). For example, in an abundant reward trial, the child might select an option that gives themselves 5 points and the other player 4 points (5–4), over an equal split that would give both players 3 points (3–3). In this case, the participant would choose to gain 2 points overall (5 instead of 3) and 1 point more than the other player (5 compared to 4). In an absolute rewards trial, the child might select an option that would give themselves 4 points and the other player 5 points (4–5), over an equal split that would give both players 3 points (3–3). In this case, the participant would gain 1 point overall (4 instead of 3), but earn less points than the other player (4 compared to 5) In a relative rewards trial, the child might select an option that would give themselves 2 points and the other player 1 point (2–1), over an equal split that would give both players 3 points (3–3). In this case, the participant would forfeit 1 point overall (2 instead of 3) but gain 1 point more than the other player (2 compared to 1). In a neither reward trial, the child might select an option that gives themselves 1 point and the other player 2 points (1–2), over an equal split that would give both players 3 points (3–3). Here, the participant would both forfeit 2 points overall (1 instead of 2) and earn less points than the other player (1 compared to 2). The goal of varying the trial types is to explore how shifting value contingencies may elicit different task behavior, which can then be explored in the realm of individual differences. For each trial, children were presented with one of these four unequal split options and the equal split option. The abundant reward trial type was designed to assess heightened reward-seeking, while the neither reward trial type was primarily included as a check to ensure task comprehension, as it provided neither the child nor the confederate with any benefit and cost them both absolute and relative standing. Point values ranged from 1–5 points. There were eight iterations of each of the four trial types for a total of 32 trials. Participants completed three practice trials (See Supplement). Participants were left alone in the testing room to complete the task, which was self-paced.

After completion of the Either/Or task, participants completed a brief survey that asked about their views of the other player (e.g., “Do you like the other player?”).

Data Quality and Task Processing

To ensure task fidelity, we applied several quality control steps to the Either/Or task data. First, we removed participants who were inadvertently given an incorrect gender/race-matched game (2/145 excluded). Second, we removed any trials where participant reaction time was faster than 300 ms, as this indicated participants made choices too quickly to consider their outcomes (20/4576 trials were excluded). Third, we ensured that all participants retained at least 75% of their data after the reaction time exclusion (0/143 remaining participants were excluded). Fourth, we ensured that no participants demonstrated a side preference, which was defined as having more than 75% of their trials be directed left/right (0/143 excluded). Fifth, to ensure we only included participants who attended to the task, we excluded participants who demonstrated a uniform split strategy across reward motives, as defined by identical or almost identical numbers of equal and unequal choices (e.g., 4 equal, 4 unequal; 3 equal, 5 unequal) across all reward motives (4/143 participants excluded). Sixth, we removed participants who preferentially selected the unequal option for at least 75% of trials in the neither reward trial where they would lose both absolute and relative rewards, as this indicated a lack of task comprehension (6/139 remaining participants were excluded). The final sample consisted of 133 participants and 4237 trials, and task completion took approximately two and a half minutes on average (Mean=139.0 seconds, SD=58.3). The number of trials per person excluded as a result of our quality control steps was unrelated to our variables of interest (see Table S1). Twelve participants did not complete the post-task survey (n=121/133).

Analysis Plan

We examined associations between our dimensional variables of interest (CBCL subscales for depression, anxiety, ADHD, ODD, and CD; age, ADI) using zero-order Pearson correlations. Independent samples t-tests were employed to compare categorical child characteristic variables (race, gender) on our dimensional variables of interest. We then explored task behavior using random intercept multi-level binary logistic regression models. First, we examined the impact of the type of reward motives (categorical: abundant reward, absolute reward preference, relative reward preference, neither reward) and child characteristics (gender, age, ADI) on choice behavior (the binary choice to split the points either equally or unequally). Each participant was entered as a random-effect variable (intercept-only), and gender, age, and ADI were entered as fixed effects to test both main effects and interactions with reward motives. Next, we examined the impact of individual internalizing (anxiety, depression) and externalizing (ADHD, ODD, CD) symptoms on reward motive preference. We first individually tested the effects of each form of psychopathology on task behavior to examine the standalone effects of each syndrome. Bonferroni corrections were calculated based on, and applied to, our prespecified analyses to show which effects were significant when controlling for 5 comparisons of psychopathology. Next, given that these symptoms are often co-morbid, we re-ran models including only effects identified as significant in prior analyses. To assess the robustness of results in relation to collinearity, we utilized the “car” package in R (Fox et al., 2007), which calculates generalized variance inflation factors (GVIF). We applied GVIF^(1/2*df) values <2 for terms in all of our combined psychopathology models to determine if collinearity was driving statistically significant results (Fox & Monette, 1992). To address concerns of overfitting, we employed five-fold cross-validation for all comprehensive models to assess model generalizability and detect potential overfitting. We utilized the “cv” package in R (Fox & Monette, 2025), which produces mean squared error (MSE) values for cross-validated and full sample data, along with coefficients for predictors across the five folds. Supplementary analyses explored facet and subscale scores to gauge specificity. Independent samples t-tests were used to measure how participant responses to post-task survey questions aligned with the choices they made during the task. All analyses were completed using SPSS v. 28 (IBM Corp., Armonk, NY).

Results

Relations Between Child Characteristics and Symptoms of Psychopathology

Sample demographics are presented in Table 1. Race was significantly related to neighborhood disadvantage (ADI, t(131)=−3.732, p<.001), with participants of color coming from more resource-deprived neighborhoods (M=62.23, SD=24.88) than White participants (M=46.33, SD=22.85). Gender was significantly related to ADHD (t(127)=2.755, p=.007), with boys (M=4.68, SD=3.62) having more ADHD symptoms compared to girls (M=3.07, SD=2.94). Depression (r=.191, p=.030) and ADHD scores (r=.187, p=.034) were significantly positively related to neighborhood disadvantage. All CBCL subscale scores were significantly correlated to each other (Table 2).

Table 2.

Relations between child characteristics and psychopathology symptoms.

Variable 1 2 3 4 5 6 7
 1. Age ---
 2. ADI r=−.011 ---
 3. Depression r=.133 r=.191* ---
 4. Anxiety r=.118 r=.153 r=.710*** ---
 5. ADHD r=−.041 r=.187* r=.428*** r=.375*** ---
 6. ODD r=−.001 r=.124 r=.527*** r=.500*** r=.695*** ---
 7. CD r=−.060 r=.067 r=.417*** r=.370*** r=.623*** r=.713*** ---
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Note: N=133 for child characteristics, N=129 for psychopathology symptoms. Area Deprivation Index=ADI, Attention-Deficit/Hyperactivity Disorder=ADHD, Oppositional Defiant Disorder=ODD, Conduct Disorder=CD. The numerical labels (1–7) correspond to variables numbered on the leftmost column of the table.

*

p<.05

**

p<.01

***

p<.001.

Relations Between Reward Motives and Child Characteristics

There was a significant effect of reward motive on choice behavior (F(3, 4221)=2.943, p=.032). Participants chose the unequal split option over an equal split most often when abundant rewards were offered, followed by trials offering absolute gains, then relative, and finally the option in which neither absolute nor relative rewards were offered, which participants generally did not pursue (Figure 2). There were no significant main effects or interactions of gender, age, and ADI (all ps>.05, Table S2). Gender, age, and ADI were kept as main effects (control variables) in all further analyses.

Figure 2.

Figure 2

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Multilevel binary logistic regression results revealed a significant effect of reward motive on choice behavior. Participants chose the unequal point split over the equal point split for the highest percentage of trials in abundant reward trials, followed by absolute reward trials, relative reward trials, and, finally, trials where neither reward was offered.

Note: N=133.

Relations Between Reward Motives and Psychopathology

Depression significantly interacted with reward motives (F(3, 4104)=5.026, p=.002), such that greater depression was associated with reduced pursuit of rewards in the abundant (t=−3.086, p=.002, OR=.86, 95% CI [.78, .95]) and absolute (t=−2.563, p=.010, OR=.88, 95% CI [.80, .97]) reward trials (see Table S3 for full results). Supplemental analyses using the Children’s Depression Inventory subscales found that reward motives significantly interacted with Emotional Problems (F(3, 4168)=2.658, p=.047) but were unrelated to Functional Problems (p>.05, See Tables S4A-C). Anxiety also had a significant interaction with reward motives (F(3, 4104)=6.795, p<.001), such that greater anxiety was associated with reduced pursuit of rewards in the abundant (t=−4.492, p<.001, OR=.87, 95% CI [.82, .93]), absolute (t=−2.957, p=.003, OR=.91, 95% CI [.86, .97]), and relative (t=−2.492, p=.013, OR=.93, 95% CI [.87, .98]) reward trials (see Table S5 for full results). Supplemental analyses using the Screen for Child Anxiety Related Disorders subscales found that reward motives significantly interacted with Generalized Anxiety (F(3, 4168)=7.072, p<.001) and School Avoidance (F(3, 4168)=7.706, p<.001) but no other subscales (see Tables S6–8). The interaction between reward motives and ADHD symptoms was marginal (F(3, 4104)=2.387, p=.067) and did not survive multiple comparison correction (see Table S9). We observed no significant main effects or interactions with reward motives in relation to ODD or CD symptoms.

When depression and anxiety scores were included in the same model, interactions of reward motives with both depression (F(3, 4100)=2.977, p=.030) and anxiety (F(3, 4100)=4.749, p=.003) remained statistically significant. In this comprehensive internalizing model, we observed that greater depression scores were now linked with greater pursuit of relative rewards (e.g., more points in comparison to peers, (t=1.986, p=.047, OR=1.15, 95% CI [1.00, 1.32])), but that depressive symptoms were no longer significantly associated with decreased pursuit of rewards in the abundant or absolute reward trials. The previously reported effects for anxiety symptoms of decreased pursuit in the abundant and relative reward trials persisted, but there was no longer a significant effect for the absolute reward trials (Figure S2 and Table S10). Given that preliminary analyses suggested strong associations between ADHD and internalizing symptomology and a marginal interaction with reward motives, ADHD was included in an additional analysis with depression and anxiety (see Figure 3 and Table 3). When accounting for comorbid internalizing and externalizing symptoms, we found that depression interacted with reward motives (F(3, 4096)=4.523, p=.004) and continued to be associated with greater pursuit of relative rewards (t=2.125, p=.034, OR=1.17, 95% CI [1.01, 1.35]). Anxiety also interacted with reward motives (F(3, 4096)=4.463, p=.004) and continued to be associated with reduced pursuit of rewards in the abundant (t=−3.284, p=.001, OR=.87, 95% CI [.79, .94]) and relative reward trials (t=−3.068, p=.002, OR=.87, 95% CI [.80, .95]). Finally, ADHD was found to interact with reward motives (F(3, 4096)=4.096, p=.007) and was associated with increased pursuit of absolute rewards (t=2.392, p=.017, OR=1.09, 95% CI [1.02, 1.17]). For both the combined internalizing model (anxiety, depression) and the comprehensive model (anxiety, depression, ADHD), we observed that our collinearity diagnostics (GVIF^(1/2*df) values for all terms (Gender, Age, ADI, Trial Type, psychopathology) were below 2 (max GVIF^(1/2*df)=1.31), suggesting results were not driven by multicollinearity (see Table S11). Additionally, for both models, we observed that the mean squared error (MSE) values for the cross-validated data and full sample data were very similar, supporting model generalizability and providing evidence against overfitting (see Tables S12–13).

Figure 3.

Figure 3

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Multilevel binary logistic regression results explored the effects of depression, anxiety, and ADHD on choice behavior. In this comprehensive model, we found that symptoms of depression were related to an increased pursuit of rewards in relative reward trials, symptoms of anxiety were related to a reduced pursuit of rewards in abundant and relative reward trials, and ADHD symptoms were related to an increased pursuit of rewards in absolute reward trials.

Note: N=129.

Table 3A-B.

Multilevel binary logistic regression results exploring the effects of internalizing and externalizing psychopathology on choice behavior (A). There was a significant random effect of participant and significant interactions of reward motives with depression, anxiety, and ADHD symptoms. To explore the interactions, significant coefficient effects are reported (B).

A)
Variable Significance
Fixed Effects
 Corrected Model F(18, 4096) = 29.316 <.001
 Gender F(1, 4096) = 2.505 .114
 Age F(1, 4096) = .051 .822
 ADI F(1, 4096) = .904 .342
 Reward Motive F(3, 4096) = 81.719 <.001
 Depression Symptoms F(1, 4096) = .007 .933
 Reward Motive X F(3, 4096) = 4.523 .004
 Depression
 Anxiety Symptoms F(1, 4096) = .015 .901
 Reward Motive X Anxiety F(3, 4096) = 4.463 .004
 ADHD Symptoms F(1, 4096) = 1.057 .304
 Reward Motive X ADHD F(3, 4096) = 4.096 .007
Random Effects
 Participant Z = 5.694 <.001
B)
Variable Coefficient SE t Significance Exp (Coefficient) 95% CI (lower) 95% CI (upper)
Intercept −1.631 1.0984 22121.484 .138 .196 .023 1.687
Gender=female −.329 .2079 −1.583 .114 .720 .479 1.082
Gender=male 0b . . . . . .
Age −.029 .1302 −.225 .822 .971 .752 1.253
ADI .004 .0042 .951 .342 1.004 .996 1.012
Abundant Reward Trial 2.756 .1831 15.055 .000 15.740 10.993 22.537
Absolute Reward Trial 1.547 .1759 8.795 .000 4.698 3.328 6.633
Relative Reward Trial .981 .1789 5.480 <.001 2.666 1.877 3.786
Neither Reward Trial 0b . . . . . .
Depression Symptoms −.021 .0842 −.252 .801 .979 .830 1.155
Abundant Reward Trial X Depression Symptoms .000 .0720 −.005 .996 1.000 .868 1.151
Absolute Reward Trial X Depression Symptoms −.093 .0708 −1.317 .188 .911 .793 1.047
Relative Reward Trial X Depression Symptoms .155 .0731 2.125 .034 1.168 1.012 1.348
Neither Reward Trial X Depression Symptoms 0b . . . . . .
Anxiety Symptoms .097 .0514 1.891 .059 1.102 .996 1.219
Abundant Reward Trial X Anxiety Symptoms −.145 .0443 −3.284 .001 .865 .793 .943
Absolute Reward Trial X Anxiety Symptoms −.083 .0435 −1.905 .057 .920 .845 1.002
Relative Reward Trial X Anxiety Symptoms −.140 .0455 −3.068 .002 .870 .795 .951
Neither Reward Trial X Anxiety Symptoms 0b . . . . . .
ADHD Symptoms −.055 .0427 −1.279 .201 .947 .871 1.030
Abundant Reward Trial X ADHD Symptoms .016 .0367 .443 .658 1.016 .946 1.092
Absolute Reward Trial X ADHD Symptoms .086 .0358 2.392 .017 1.089 1.016 1.169
Relative Reward Trial X ADHD Symptoms −.025 .0369 −.684 .494 .975 .907 1.048
Neither Reward Trial X ADHD Symptoms 0b . . . . . .
Open in a new tab

Note: N=129. Area Deprivation Index = ADI, Attention-Deficit/Hyperactivity Disorder = ADHD.

Participants’ responses to whether they liked the other player in the post-task survey were related to their choices in relative reward trials (t(115)=−2.738, p=.007) but only marginally related in absolute reward trials (t(115)=1.834, p=.069). Participants who answered that they did not like the other player selected the unequal split option significantly more times (M=4.30, SD=2.983) than those who answered that they liked the other player (M=2.25, SD=2.190) when relative rewards were offered (e.g., giving themselves relatively more than the other person, even at an absolute cost). Conversely, participants who answered “yes” that they liked the other player selected the unequal split option more times in absolute reward conditions (M=3.81, SD=2.671) compared to those who reported that they did not like the other person (M=2.20, SD=2.530) (e.g., giving the other player relatively more than themselves). Four “I don’t know” responses were excluded from analysis (n=117/121).

Discussion

We observed that depression, anxiety, and ADHD were related to distinct reward motive preferences. Increased depression was related to an increased pursuit of relative gains, whereas increased anxiety was related to a reduced pursuit of relative gains. Anxiety was also associated with a generalized decrease in pursuing rewards, as it also impacted the pursuit of absolute gains and abundant reward opportunities. Finally, ADHD was related to an increased pursuit of absolute gains. These results suggest that depression, anxiety, and ADHD, though related and often co-morbid, may differentially impact the types of rewards children find motivating and choose to pursue. If replicated, the dissociation in reward motive preferences for these conditions may be promising targets for tailored treatments. Incorporating the rewards most appealing to children, based on their absolute or relative reward preferences, may more effectively motivate them to reach desired classroom behavior or therapeutic goals. Alternatively, if children’s reward motive preferences prove less than beneficial, interventions might focus on altering these preferences to improve social relationships.

When examining depression alone, we found that depression symptoms were associated with a decreased tendency to pursue rewards overall, as well as a decreased tendency to pursue absolute rewards. We found our results to be consistent with past literature linking depression and reward hyporesponsivity (Belden et al., 2016; Forbes et al., 2006), particularly since we interpret absolute rewards to be more consistent with typical reward paradigms. Similarly, when examining anxiety alone, we found that anxiety symptoms were related to a decreased pursuit of all reward types. However, we found that when accounting for anxiety, higher depression symptoms were associated with greater pursuit of comparative rewards. Previous research has found that depression is associated with increased tendencies to engage in social comparison (Kupferberg & Hasler, 2023; Swallow & Kuiper, 1988), suggesting a heightened awareness of and preoccupation with where one stands in relation to peers. On the other hand, higher anxiety predicted a decreased tendency to pursue these comparative rewards. We suggest this may provide different pathways through which these traits may lead to difficulties with peers and psychosocial functioning. Conceding advantages in social situations is often done to demonstrate cooperativeness to others (Baker, 2024); in anxious individuals, this strategy may be over-utilized in an attempt to avoid drawing negative attention. On the other hand, depression may promote decision-making focused on making comparative gains even when these behaviors may be negatively interpreted by peers.

In our results, we found that increased ADHD symptoms were linked to maximizing absolute rewards when accounting for depression and anxiety. Interestingly, elevations in ODD and CD did not show significant associations with reward motive preferences as predicted. In past literature, bullying (Vaillancourt et al., 2003) and psychopathy (Glenn et al., 2017) have been linked to preferences for relative rewards, though this has not always been replicated (Gaule et al., 2024). Perhaps reward motive preferences may be symptom-specific, and the ODD and CD diagnoses are too heterogeneous due to encompassing additional symptoms (e.g., impulsivity) that may be unrelated to reward motive preferences. Future work in samples with greater enrichment of psychopathology and other levels of assessments (e.g., clinician, self-report) is needed to determine if these phenotypes may also benefit from incorporating reward motive preferences into case conceptualizations. Supplemental analyses examining subtypes of MDD and anxiety are found in the Supplement (Tables S4, S6–8). Subtypes of ADHD were not available based on the measures utilized and were unable to be examined.

Our results suggest therapeutic interventions could potentially be enhanced by incorporating reward motive preferences into tailored patient plans. Interventions in educational settings often utilize social comparison via public token economies to manage problematic behaviors. If anxious children are averse to the attention received by performing better than their peers, this current approach may be deleterious, failing to provide intrinsically motivating incentives for children to behave according to desired standards. Furthermore, if children with ADHD are motivated primarily by absolute rewards, these interventions may produce better outcomes by shifting focus to rewarding individual desired behavior without the use of social comparison. In clinical settings, framing goals toward or away from social comparison, depending on the types of rewards children find most motivating, may prove beneficial. For example, it is possible that some children may respond more to absolute reward framing while others might respond more to relative reward framing.

Alternatively, our results might be used to guide interventions that alter reward motive preferences to produce optimal outcomes. For example, if children with depression pursue comparative gains at the expense of others or respond negatively when failing to attain their desired rewards, they may undermine existing relationships and exacerbate issues of social isolation. Using therapy to reshape reward motive preferences toward those that benefit themselves and others may allow them to form and maintain interpersonal relationships. This might be done by providing feedback on unhelpful interpersonal behaviors and providing patients with insights to recognize the consequences of such behaviors, as is currently employed in the Cognitive–Behavioral Analysis System of Psychotherapy (McCullough Jr, 2003). Conversely, if children with anxious symptoms concede rewards to others to avoid confrontation, they may miss out on advantages. Therapeutic interventions such as controlled exposure that focus on reducing anxiety in confrontational or healthy competitive settings may help children build skills to engage in these settings. Future work will need to explore whether therapies should incorporate existing preferences into individualized plans or whether psychotherapy should attempt to modify reward motive preferences.

Child characteristics were not related to reward motive preferences in this study. Of particular interest, many prior studies have explored the effects of socioeconomic disadvantage on prosocial decision-making. We do not find any such effects in our results. While some research has reported that socioeconomic disadvantage leads to decreased prosociality (Andreoni et al., 2021; Benenson et al., 2007; Korndörfer et al., 2015), other studies have found the opposite effect (Chen et al., 2013; Piff et al., 2010). It is possible that the effects of socioeconomic disadvantage depend on various moderators, such as public versus private settings (Kraus & Callaghan, 2016), levels of surrounding economic inequality (Cote et al., 2015), and individual factors (e.g., compassion) (Piff et al., 2010). Alternatively, while our resource deprivation scores span the range, it is possible that its effects are small. More well-powered research in the future could explore potential moderators of socioeconomic disadvantage and reward motive preferences to determine whether any of these factors should be considered when developing or modifying reward-based interventions.

Moreover, participants’ feelings toward the other player were reflected in the types of rewards they pursued in trials where one reward type could be obtained at the cost of another. Specifically, participants who reported liking the other player were more willing to give the other player more points, even though they would gain fewer than the other player. Conversely, participants who did not like the other player chose to forgo rewards themselves to obtain more than the other player. Importantly, participants were not provided with social information about the other player (e.g., they did not observe the other player’s behavior and were not told anything about their traits). We believe that these assessments provide insight into how participants may view others and guide decision-making behavior. Future longitudinal studies could examine how reward preferences, and changes in preferences within individuals, correspond to shifts in social dynamics and peer relationship behaviors (Blieszner & Roberto, 2004).

The results of our work should be considered in light of some limitations. We relied on parent-reported measures of psychopathology, with future work likely benefitting from the addition of clinical and self-report measures. Although we examined subtypes of MDD and anxiety, we were unable to assess subtypes of ADHD. Future studies utilizing clinical assessments may also be beneficial in determining how subtypes of MDD, anxiety, and ADHD differ in their contributions to the reward motive preferences observed in our results. Additionally, our sample was community-based, so future work might consider using clinically enriched samples to establish the generalizability of our findings to populations with increased symptom severity. Furthermore, future studies could improve the ecological validity of our behavioral task by utilizing real-time counterparts, perhaps peers in a classroom setting, to ensure these effects persist outside the lab. Given that the course of psychopathology is not uniform, future work is also needed to connect reward preferences to changes in psychopathology across development. For example, some symptoms of depression are relatively rare in childhood (e.g., anhedonia) but become more prevalent in adolescence. Future longitudinal work should explore whether the onset of new symptoms can be predicted by early perturbations in reward preference or if these symptoms may reflect an altogether different reward preference profile. Finally, we presented models examining effects of a single form of psychopathology in addition to comprehensive models including multiple forms of psychopathology in our results. Future studies, particularly those utilizing clinician-based assessments which may be able to provide more fine-grained information regarding symptoms should investigate whether findings from comprehensive models are replicable and reliable.

Our study illuminates the distinct relationships between psychopathology and reward motive preferences in middle childhood. Depression, anxiety, and ADHD relate to deviations in reward motive preferences. Depression related to an increased preference for receiving rewards compared to others. Anxiety related to a decreased preference for receiving overall rewards and rewards compared to others. ADHD related to an increased preference for receiving overall rewards regardless of what others receive. Clinicians may want to consider reward motive preferences when identifying and framing goals either towards or away from comparison to others depending on patient phenotype. Future work will need to test how to leverage these insights to improve treatment outcomes and the overall efficacy of interventions for pediatric psychopathology.

Supplementary Material

1

Acknowledgments:

The authors would like to thank Olivia Smith, Allison Hollender, Caroline Maywood, and Uchechukwu Agali for their involvement in participant recruitment and data collection related to the Big Doors Study. Additionally, they would like to thank the EEDP staff for supporting this project. Finally, the authors would like to thank the families and participants for their involvement in the project.

Funding:

This work was made possible by generous funding from the following sources: the McDonnell Center for Systems Neuroscience, Small Grants Program (K01MH127412: LH), the National Institute of Mental Health (R01MH131584: CMS, R01MH122389: CMS), the National Institute of Child Health and Development (R00HD105002: MTP), the Taylor Family Institute for Innovative Psychiatric Research (CMS), the Klingenstein Third Generation Foundation Grant (KRL), and the Samuel and Mae S. Ludwig Endowment (DMB and JLL).

LH has received additional research funding from AFSP. KRL has received additional research funding from NIMH. CMS has received additional research funding from NIMH and Sage Therapeutics. JLL has received additional research funding from NIMH and AFSP. DMB has received additional research funding from NIMH and NIDA.

Footnotes

Statements and Declarations

Declaration of conflicting interests: The primary author has no additional disclosures.

Ethical considerations: The study and all procedures were reviewed and approved by the Washington University in St. Louis Institutional Review Board (IRB ID 202101165).

Consent to participate: Parents provided written consent, while child participants provided assent.

Consent for publication: Informed consent was obtained from the parent of the participant whose photo appears in Figure 1.

Data availability:

Data will be deidentified and made freely available to anyone who requests it.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

1
NIHMS2119244-supplement-1.pdf (339.9KB, pdf)

Data Availability Statement

Data will be deidentified and made freely available to anyone who requests it.

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