Synergy Between Behavioral And Pharmacologic Interventions For ADHD
Main Category: ADHDAlso Included In: Psychology / Psychiatry
Article Date: 07 Apr 2010 - 2:00 PDT
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Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental health disorders affecting children and adolescents. Children with ADHD are excessively restless, impulsive, and distractible and experience difficulties at home and in school. Problems inhibiting behavior are a common theme for ADHD symptoms. These symptoms are usually treated with stimulant medications, behavioral approaches or a combination of the two.
In a new study appearing in Biological Psychiatry, published by Elsevier, researchers compared children with ADHD and typically developing children using a video-game task, which required them to focus their attention and to control impulsive actions. The children performed this task under three different motivational conditions, and the children with ADHD were tested both on and off their usual dose of medication. This allowed the researchers to compare the effects of both medication and motivation on the children's response inhibition.
Dr. Madeleine Groom, corresponding author of the study and Professor Chris Hollis, principal investigator, explained their findings: "We found that brain electrical activity in children with ADHD when attending to the task and restraining impulsive responses differed from a comparison group of children without ADHD, but became more similar when they took stimulant medication. Intriguingly, rewards and penalties given to improve task performance also changed brain activity, and did so in both children with ADHD and in the control group, although these motivational effects were much smaller than those associated with medication."
These findings suggest that stimulant medication tends to normalize brain function in children with ADHD and enables them to better maintain attention and restrain impulsive responses. Motivational incentives also seem to play a role in modulating similar neural circuits and work additively with medication to improve performance in children with ADHD.
Dr. John Krystal, Editor of Biological Psychiatry, commented that "the findings suggest that there may be important additive effects of stimulant medications and behavioral strategies for increasing motivation in ADHD. These interactive effects are important to bear in mind when optimizing the performance of children in school and other settings that require control of attention and behavior."
Source: Elsevier
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13 Feb. 2012. <http://www.medicalnewstoday.com/releases/184625.php>
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http://www.medicalnewstoday.com/releases/184625.php.
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Visitor Opinions In Chronological Order (2)
Yes And No
posted by anonymous on 10 Apr 2010 at 12:45 pmI am a health professional who also has ADHD. It's nice to see concrete evidence that stimulant medication improves attention and impulse control. It's odd, though, that while the findings indicated a lesser role for "motivational" factors of reward and penalty, the conclusion of the article was that these behavior mod interventions should be utilized more than they are.
While I agree that motivation is very important for managing behavior in ADHD, I find that anticipation of reward or penalty makes it harder to focus - the excitement or anxiety regarding the results of my efforts is very distracting, and I usually perform much worse than I would without this pressure. I would assert that what most motivates people with ADHD is that which they find INTERESTING, not that which will result in an external consequence later.
The article clearly states that medication has a significantly greater impact than behavior mod. Do the medication first, then your behavior mod, so the child has a chance of succeeding. But teach the child and counsel the adolescent and the parents to choose activities, environments, careers and so on that will engage the individual's strengths and interests. This will minimize the need for rewards and punishments as motivation and maximize their chance to be happy and successful as adults.
note about behavior mod
posted by Shirley Johnson on 13 Oct 2010 at 7:49 pmI read your opinion with great interest since the reward/consequence modus operandi works very poorly with my 8 year old grandson. But when he is with his grandpa on the farm and doing lots of things he seems to find quite interesting, the behavioral change is marked. We are becoming more and more aware that he needs to be enthralled with an activity and the behavior just seems to naturally follow along.
If confronted with rewards or consequences, he simply becomes uncooperative and does not communicate even if the rewards/consequences have been clarified, discussed beforehand in a different setting, and presented in a calm manner.
I had a most frustrating afternoon with him today and your opinion was a godsend to me. He was quite able to conduct himself well while enjoying a game of football with the neighborhood boys. Both of his parents say that to keep him challenged and engaged in hands-on activities
seems to alleviate much of the behavioral difficulties.
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