Treating Defiance with Reward

Attention deficit hyperactivity disorder and oppositional defiant disorder increase response to rewards when combined

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(RxWiki News) If your preschooler has excess energy that he or she uses for arguments and temper tantrums then it may seem counterintuitive to start rewarding their good behavior, yet research suggests it helps.

A new study discovered that young children with co-occurring attention deficit-hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) change their behavior more drastically in response to feedback and rewards than other young kids might. 

"Offer incentives for focused and good behavior."

Corresponding author on the study, Jeffrey Halperin, PhD of Mount Sinai School of Medicine explains to dailyRx that while it is always tough to take research findings and make generalizations and treatment suggestions, if he were "to take the leap, these data suggest that preschool children with ADHD+ODD have reduced levels of motivation in response to environmental situations that are adequate to motivate most children. However, when the level of reinforcement or environmental stimulation becomes more rewarding, children with ADHD+ODD are highly responsive, more so than other children, and their behavior seems to 'normalize.'" 

Insights into reward response were unveiled as part of larger ADHD research investigating neuropsychological and familial similarities of patients in their preschool years.

The original investigation recruited 73 students’ ages 3-5 in public and private schools throughout New York City and surrounding areas.

Of those students, 17 had ADHD with ODD, 20 ADHD without ODD, and the remaining 36 acted as healthy controls. All of the preschoolers’ parents and teachers submitted behavioral ratings for the children while doctors performed diagnostic interviews and assessed their intellectual function and neuropsychological attributes.

During one of their computer assessments, the preschoolers engaged in a balloon popping game where the kids received special auditory and visual recognition if they popped a balloon quickly. In all categories, the reinforcing feedback caused reaction time to speed up.

Dr. Halperin and his colleagues uncovered that preschoolers with ADHD and ODD sped up the most when their feats were celebrated, significantly more than the healthy controls. The ADHDers without ODD fell somewhere in between.

“Based on these results, one can speculate that there may be a disturbance in the frontostriatal dopamine circuitry, such that the reward system associated with ADHD+ODD is deficient relative to typically developing children,” Halperin and co-authors write. “In contrast, the reward system in ADHD− [without ODD] appears fairly age appropriate.”

The authors recommend parents of children with co-occurring ADHD and ODD use positive feedback to encourage the impressionable minds to be less rambunctious and more focused.

"An important component of most behavior modification programs for children with ADHD is to teach parents and teachers how to use reinforcement and mild punishments/reprimands to effectively manage their children's behavior," says Halperin.

And he believes that most researchers and clinical health care professionals would agree that in order for this to be successful, reward must heavily outweigh punishment.  

"It is even more important for this to be true when employing such a program with children with ADHD+ODD. The challenge is that children with comorbid ODD are much more likely to elicit punishing behaviors from their parents and teachers.

Thus, these adults must work extra hard and be particularly vigilant to 'catch-em being good.'"  

This study was published in the Journal of Attention Disorders on February 8, 2012 and funded through a grant from the National Institute of Health. No conflicts were reported during the course of the study.

Last Updated:
October 2, 2012