Processing of differentially valued rewards and punishments in youths with bipolar disorder or severe mood dysregulation

Background: Youths with chronic irritability and hyperarousal (i.e., severe mood dysregulation, SMD) have reward- and punishment-processing deficits distinct from those exhibited by children with episodic symptoms of mania (i.e., narrow-phenotype bipolar disorder, BD). Additionally, youths with SMD, like those with psychopathy, have prominent reactive aggression. Therefore, we hypothesized that SMD, but not BD, youths would be impaired on a decision-making task that has identified reward-and punishment-processing deficits in individuals with psychopathy. Methods: A decision-making task was used in which BD (n = 23), SMD (n = 37), and control subjects (n = 31) were asked to choose between two images associated with different levels of reward or punishment. Results: No between-group differences in task performance were found. Conclusion: These results suggest that BD, SMD, and normal youths do not differ in their ability to select between rewards and punishments of different value. Effect-size analyses suggest that this finding is not secondary to a type II error. Unlike individuals with psychopathy, neither SMD subjects nor those with BD differ from controls in their ability to select between differentially valued rewards and punishments.