attention deficit hyperactivity (ADHD) is the impaired ability to respond to rewarding and punishing stimuli. attention deficit hyperactivity (ADHD) is the impaired ability to respond to rewarding and punishing stimuli.

Medication Affects Reward/Punishment Processing in Children with ADHD

Primary among children with attention deficit hyperactivity (ADHD) is the impaired ability to respond to rewarding and punishing stimuli. Parents and teachers of children with ADHD often report that these children are not motivated by the promise of a reward for good behavior. Likewise, they are often undeterred from engaging in negative behaviors even when threatened with punishment. This has been the case with some children with ADHD, but not all. In fact, the use of stimulant medication has been shown to have some effect on this process. But the direct influence on reward/punishment processing and on positive/negative feedback in children with ADHD is unclear. Yvonne Groen of the Department of Clinical and Developmental Neuropsychology at the University of Groningen in the Netherlands wanted to explore this deficit in children with ADHD more thoroughly.

Groen recently conducted a study involving 17 typically developing children (TD), 15 children with ADHD who were taking Methylphenidate (Mph) and 15 with ADHD who were not on medication (Mph-free). She assessed their evaluations of immediate and delayed rewards and punishments. She also measured how well they responded to feedback as persistent and intense positive feedback has been shown to improve behavior and emotional regulation in children with ADHD. Groen discovered that when compared to receiving no feedback whatsoever, children who received positive feedback outperformed children who did not, regardless of whether they had ADHD or took Mph. Additionally, all the positively reinforced children responded more accurately and reacted more cautiously to prompts than the children who received no feedback.

When she compared the groups of children, Groen found that the TD and Mph-free children had the most accurate responses to the prompts when they were provided with rewards versus punishments. However, all the ADHD children with and without Mph did show improvement in accuracy with promise of reward or punishment. But continuous positive reinforcement and promise of positive reward was more motivating for the ADHD children and led to more focus on accuracy than with Mph. In sum, the findings from this study show that ADHD children with and without Mph are able to identify positive and negative feedback immediately, but have difficulty evaluating delayed feedback. This was especially evident in the ADHD children with comorbid psychological conditions. Groen added, “This may explain the often observed positive effects of continuous reinforcement on performance and behavior in children with ADHD.”

Groen Y, Tucha O, Wijers AA, Althaus M. (2013). Processing of continuously provided punishment and reward in children with ADHD and the modulating effects of stimulant medication: An ERP study. PLoS ONE 8(3): e59240. doi:10.1371/journal.pone.0059240

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Brodie

    April 11th, 2013 at 10:18 PM

    One thing I’ve noticed about a lot of behavioral studies I read is that they are done in Europe. I wonder why that is? Many European countries (Germany and the Netherlands in particular) have a reputation for having children who are well behaved with self-control in spades. I wonder if there is any connection between the number of studies done in those areas and the behavior of the children in those countries.

  • c ferris

    April 11th, 2013 at 10:22 PM

    yet more proof that the 4:1 positive interaction:corrective interaction is right on with kids with ADHD. It drives my absolutely bonkers to go into my kids’ school. the only teacher who adheres to this is a resource teacher and her kids are always almost perfectly behaved. all the other teachers are screaming their dang heads off in the hallways and the kids are bouncing off the walls. DRIVES ME CRAZY! don’t these teachers go to school? what is it that they are learning exactly.

  • kaz

    April 13th, 2013 at 11:25 AM

    I have heard that the 4:1 pos/neg ratio applies to most kids, ratio for ADHD kids is 9:1!

    I found an app (also available on web) that has been helping for 2 days with chores/behaviour. Search for “my job chart”. Very customizable, easy to use once set up, and very visual. (Son is on the autism spectrum allso, this actuallyseems to work for him too!) Best part is, It’s free!

  • elsbeth

    April 11th, 2013 at 10:25 PM

    “Delayed feedback” is a term I’d love to never hear again my daughters therapist and doctor are always throwing it around

    i wish someone would delay their feedback and not pay them for a couple of months i wonder how much they would enjoy that

    then they could explain to all the bill people why there payments are late they can just tell t hem its delayed gratification.

  • Hal

    April 11th, 2013 at 10:26 PM

    Major key with promises of rewards or punishments with ADHD kids: follow through. You can’t have one without the other or you’re out of luck.

  • Beatrice

    April 11th, 2013 at 10:28 PM

    I’ve never heard of Mph. Is it a newer drug or is it an ingredient in common stimulants?

  • Doug A

    April 12th, 2013 at 3:47 AM

    How, as a parent, do I really know that I am doing the right thing for my child by leaving him on his meds or taking him off?
    Sometimes I think that I am doing the right thing, but then there are other times when I feel like the teachers could do more to help him in the classroom even when not on the medication and that I gave in too soon to their recommendations.
    I would love to hear some feedback from other parents who may be feeling the same thing.

  • bella

    April 12th, 2013 at 10:23 AM

    I am SO against the over medicating of our children! It’s like this has become the easy way out for parents who don’t want to have to deal with a child who might need just a little more attention, or maybe just different kind of attention to be a success in school. We are afraid that our kids won’t fit into this prescribed box of what others think that they should or shouldn’t be like, so we cave to the expectations that we should put them on medication and that this will fix everything. Sadly I think that instead of fixing it is creating a whole slew of other problems that we might not know about for years to come and to me that is pretty scary.

  • Rhonda

    April 13th, 2013 at 4:20 AM

    The one thing that really stood out for me was the emphasis that is placed on giving your child positive feedback, and how important this is in the success of the child no matter whether he has ADHD or not, and no matter whether he is medicated or not.
    Giving your child notice that you see the things that he is doing well and working hard on and that you are proud of him for that. That’s it- doing this one little thing can be the thing that improves how well your child behaves and does in school just like that. And the one thing that so many parents just fail miserably at.

  • Addie

    April 15th, 2013 at 4:00 AM

    Combined with great teachers and parent interaction, then the medication doesn’t have to be all bad, right?

  • trenton

    April 15th, 2013 at 1:16 PM

    any child will respond to positive feedback. you dont have to fake it the child can tel. you dont have to lie the child will know you just have to say it from your heart and the child will be happy. whether the child has adhd or not some things are always is one such thing and something no one cannot do without.

  • Gwen

    April 22nd, 2013 at 6:50 AM

    Just out of curiosity, did you look at the ADHD sub-type, age, and comorbid conditions the children had. Did that have any impact?

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