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Children With ADHD Need A Bigger Incentive

January 14, 2011
Written by: , Filed in: Neuroradiology, Pediatric Radiology
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It’s true, says a new study, that children with ADHD can control themselves when they want to. You just have to give them a big enough incentive to make it worth their while.

The study, by researchers at the University of Nottingham in the United Kingdom, involved functional MRI scans of the brains of 18 children as they played a computer game. The children all had been diagnosed with ADHD (attention deficit hyperactivity disorder), and their ages ranged from 9 through 15. A control group of the same size and age range, consisting of children who did not have ADHD, also received scans while playing the same game.

The game involved catching green aliens while avoiding black aliens. Each timely and successful response gained a point, and each slow or missed response lost a point.

Previous studies had shown that children with ADHD have trouble switching off the default mode network (DMN) in their brains. The DMN, which gives rise to random thoughts and daydreams, is usually active when people are doing nothing in particular but suppressed when a task arises that requires focus.

The new study showed that in the brains of the control children, the DMN switched off whenever the children saw something that required their attention. However, the children with ADHD failed to switch off the DMN, and thus performed poorly, unless the rewards and penalties were increased to five points instead of one, or unless they had taken their medication (methylphenidate, known by the brand name Ritalin).

In other words, a routine or boring task was not enough to switch the children with ADHD out of daydream mode. When offered a big enough incentive to make the task interesting, or when helped by medication, they could concentrate.

“The results are exciting because for the first time we are beginning to understand how, in children with ADHD, incentives and stimulant medication work in a similar way to alter patterns of brain activity and enable them to concentrate and focus better,” said Chris Hollis, PhD, head of the psychiatry division at the university and leader of the study. “It also explains why in children with ADHD, their performance is often so variable and inconsistent, depending as it does on their interest in a particular task.”

Dr. Hollis was quoted in a university news release.

“The common complaint about children with ADHD,” said Elizabeth Liddle, PhD, the study’s first author, “is that ‘he can concentrate and control himself fine when he wants to,’ so some people just think the child is being naughty when he misbehaves. We have shown that this may be a very real difficulty for them. The off switch for their internal world seems to need a greater incentive to function properly and allow them to attend to their task.”

The study was published online late last year in The Journal of Child Psychology and Psychiatry.

Related seminar: Neuro & Musculoskeletal Imaging


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