Stop and Think: A Useful Strategy for Cognitive Performance with ADHD

Research has shown that people with attention deficit hyperactivity (ADHD) have cognitive and functioning deficits. They often have high levels of impulsivity and low levels of task attention. These deficits can result in social, personal, and academic difficulties. In the study of ADHD, numerous strategies have been tested to improve attention and decrease impulsivity. Among them are behavioral and cognitive approaches, some of which have been shown to be successful.

But an existing theory at the core of ADHD research is that of reward motivation, which suggests that people with ADHD respond better and demonstrate less impulsivity and more attention when rewarded compared to when there is no reward for a task. To test this theory further, Ivo Marx of the Department of Psychiatry and Psychotherapy at the University of Rostock in Germany recently recruited 38 adults with ADHD and 40 without ADHD for a controlled experiment. In the experiment, the participants underwent a battery of cognitive tests with and without rewards. The response times, false positives, impulsivity rates, and overall performances were measured and compared.

Marx found that the individuals with ADHD exhibited higher levels of impulsivity and lower levels of attention when there was no reward present. However, when a reward was offered, they were less impulsive and their outcomes had fewer false positives. In other words, their performance was better and far improved in the presence of a reward. In fact, the participants with ADHD performed similarly to those without ADHD when they were motivated by a reward.

Marx believes that these findings, which are in line with existing research, underscore the importance of reward motivation for people who tend to be impulsive. The results suggest that perhaps being motivated by a reward encourages individuals with ADHD to slow down their reaction times and engage a “stop-and-think” strategy. Additionally, these results show the importance of such a strategy for improving outcomes for cognitive tasks. This could be extremely useful at helping ADHD individuals improve their cognitive outcomes in various settings, including personal, academic and professional arenas. Marx added, “Taken together, our results support the existence of both cognitive and motivational mechanisms for the disorder, which is in line with current models of ADHD.”

Reference:
Marx, I., Höpcke, C., Berger, C., Wandschneider, R., Herpertz, S.C. (2013). The impact of financial reward contingencies on cognitive function profiles in adult ADHD. PLoS ONE 8(6): e67002. doi:10.1371/journal.pone.0067002

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  • Casey

    July 15th, 2013 at 10:17 AM

    I do find that this works pretty well with the students in my classroom, who really do need that reward offered to them in order to concentrate and really make an effort to be a better student in the classroom setting. The problem that I keep running into however is the other students, they don’t see things this way and think that I am being unfair to them by not offering the same thing to them even though they don’t need it. How do I overcome this? I would love to hear from other educators!

  • brynn

    July 16th, 2013 at 4:23 AM

    If there is a way to start this with children who are young and struggling with ADHD then possibly it will not affacet them in the negative ways that we have all seen before. Give them the skills to cope early, and this will help thme find more success later.

  • Jonathan

    July 24th, 2013 at 3:40 AM

    I can see why those other kids might have some trouble with the concept of them not getting rewards when the ‘bad’ kids (as they almost assuredly see them) do. I have adult ADHD myself and know a little about this subject. But before I answer, I think that it’s important to realize some other things about ADHD that the article neglected to mention.
    #1. ADHD is frustrating for EVERYONE: ADHD is a disorder that is not only frustrating to those who have to deal with the people afflicted, but also for the sufferer. It’s (in my opinion) one of the reasons that reward motivation works so well with us. It helps to relieve the frustration of constantly “failing”.
    #2. Rewards should be frequent: Because long range thinking and attention is difficult, it is helpful to break up tasks into smaller manageable goals. Lets say for example that you are trying to teach me how to solve the following equation: 2•7(9 – 5)=. You could tell me, “Jonathan, in this problem you must do everything inside the parenthesis first.” Then let me do it. When I have changed the equation to 2•7 (4)=, (and here comes the reward) follow with praise. “Excellent work! Now, …” This may sound silly, but you may be surprised at how many of us crave to please people. To hear people tell us that we have succeeded at something. So often we hear the opposite! The rewards should be given at proper intervals that challenge the child but don’t set her up for failure.
    #3. Rewards should be appropriate: rewards can be anything from praise (as mentioned above) to “creative time” to stickers, etc. My wife is a special education aide who also teaches reading mastery. She brings Goldfish crackers which she uses as a negative reinforcement aid. The kids get their four goldfish up front but lose them, one at a time, for poor behavior or poor participation. Personally I think they would work better as a positive reinforcement aid, especially for a child with ADHD. “Great Job Johnny! Here’s your goldfish!”
    So now on to answer the original question of how to deal with complaints from the “normal” kids who aren’t getting rewards…
    I think that you would do well to expand the rewards model to the ENTIRE class! This would actually serve a couple purposes.
    #1. None of the children would feel alienated. This is a biggie. Think about it! Any other way just leaves the “normal” kids feeling like they are being penalized for doing what they are supposed to do. You’ve really gotta avoid this..
    #2. You prevent the ADHD kids from feeling singled out. Just because we tend to have cognitive problems doesn’t mean we aren’t smart. In fact, ADHD sufferers tend to be very creative and smart. The point here being that if a kid with ADHD senses that you are giving them “extra help” or rewards that no one else is getting, they may come to resent it. This could be due to peer pressure, or simply because they don’t want to admit their deficiency (I mean who does?).
    #3. It gives the kid with ADHD a real sense of accomplishment and that he is able to “keep up” with the rest of the class. Trust me, nothing is more maddening than knowing you are smart, but not being able to prove it to the people you want desperately to please (everybody)!
    Anyway, I hope this was helpful!

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