Risk-taking propensity and sensitivity to punishment in adolescents with attention deficit and hyperactivity disorder symptoms and/or reading disability.

Poon et al. (2016) asked teens to play computer games that measured risk-taking and punishment learning. The team sorted the teens into four groups: ADHD only, reading disability only, both ADHD and reading disability, and a typical group.

They also asked about real-world rule-breaking like skipping school or stealing. The goal was to see which group took the biggest risks and ignored penalties the most.

ADHD-only teens chased big rewards but still slowed down after penalties. Reading-disability-only teens played it safe yet often missed the lesson penalties taught. The teens with both conditions showed the highest risk-taking, the weakest response to punishment, and the most self-reported delinquency.

In plain words, one disorder raised reward drive; the other dulled penalty cues. Together they created the steepest risk profile.

ACummings et al. (2024) extends this picture downward to younger kids. They found that elementary children with ADHD still avoid punished games, but their frustration rises faster and their reaction times slow. The lesson: punishment signals still work in ADHD; emotion regulation, not contingency change, needs your attention.

Martinussen et al. (2015) is a clear predecessor. That study first showed that teens with ADHD alone already score low on reading comprehension. Poon et al. (2016) adds the warning that when reading deficits are formally present, behavior risk jumps even more.

Zhuang et al. (2025) conceptually replicates the "double-diagnosis = extra impulsivity" pattern. They swapped reading disability for internet-gaming disorder and again saw higher risk scores on lab tasks, strengthening the rule: each added diagnosis amplifies impulsive behavior.

If you work with adolescents, screen for both ADHD and reading problems even when only one label is on the file. Use quick vocabulary or passage-comprehension probes during intake. When both issues appear, build extra punishment salience into your plan—clear immediate consequences, visual loss displays, and emotion-regulation primers before tasks. Share the risk profile with teachers and parents so they expect rule-testing and plan calm, consistent responses.