Multi-modal Assessment of Reward Functioning in Adolescent Anhedonia

Background: Anhedonia is a core symptom of depression that predicts worse treatment outcomes. Dysfunction in neural reward circuits is thought to contribute to anhedonia. However, it remains unclear whether laboratory-based assessments of anhedonia and reward-related neural function translate to adolescents' subjective affective experiences in real-world contexts. Methods: We recruited a sample of adolescents (ages 12-18; mean=15.83) who varied in anhedonia (N=82) and examined the relationships among clinician-rated and self-reported anhedonia, behaviorally assessed reward learning ability, fMRI-measured neural response to monetary reward and loss, and repeated ecological momentary assessment (EMA) of positive affect (PA) and negative affect (NA). Results: Anhedonia was associated with lower mean PA and higher mean NA across the 5-day EMA period. Anhedonia was not associated with impaired behavioral reward learning but was consistently associated with attenuated nucleus accumbens response to reward across categorical, dimensional, and ecological assessments. Greater mean NA and NA variability were associated with increased medial prefrontal response to loss, and mean NA predicted reduced insula activity to reward. Conclusions: Traditional laboratory-based measures of anhedonia were associated with lower subjective PA and higher subjective NA in youths' daily lives. Across multiple assessment modalities, anhedonia was associated with reduced reward-related striatal functioning, whereas greater subjective NA was associated with both reward and loss-related neural response in the broader corticostriatal system. Collectively, these findings demonstrate that diagnostic and self-report measures of anhedonia translate to real-world contexts, and that subjective ratings of PA and NA may be associated with distinct patterns of neural response to reward and loss.