Psychological Medicine

Original Articles

Impaired probabilistic reversal learning in youths with mood and anxiety disorders

D. P. Dicksteina1 c1, E. C. Fingera1, M. A. Brotmana1, B. A. Richa1, D. S. Pinea1, J. R. Blaira1 and E. Leibenlufta1

a1 National Institute of Mental Health (NIMH) Mood and Anxiety Disorders Program


Background From an affective neuroscience perspective, our understanding of psychiatric illness may be advanced by neuropsychological test paradigms probing emotional processes. Reversal learning is one such process, whereby subjects must first acquire stimulus/reward and stimulus/punishment associations through trial and error and then reverse them. We sought to determine the specificity of previously demonstrated reversal learning impairments in youths with bipolar disorder (BD) by now comparing BD youths to those with severe mood dysregulation (SMD), major depressive disorder (MDD), anxiety (ANX), and healthy controls.

Method We administered the probabilistic response reversal (PRR) task to 165 pediatric participants aged 7–17 years with BD (n=35), SMD (n=35), ANX (n=42), MDD (n=18) and normal controls (NC; n=35). Our primary analysis compared PRR performance across all five groups matched for age, sex and IQ.

Results Compared to typically developing controls, probabilistic reversal learning was impaired in BD youths, with a trend in those with MDD (p=0.07).

Conclusions Our results suggest that reversal learning deficits are present in youths with BD and possibly those with MDD. Further work is necessary to elucidate the specificity of neural mechanisms underlying such behavioral deficits.

(Received May 19 2009)

(Revised August 27 2009)

(Accepted August 27 2009)

(Online publication October 12 2009)


c1 Address for correspondence: D. P. Dickstein, M.D., EP Bradley Hospital, Bradley/Hasbro Children's Research Center, 1 Hoppin Street, Coro West 2nd Floor, Providence, RI 02903, USA. (Email: