Can motivation normalize working memory and task persistence in children with attention-deficit/hyperactivity disorder? The effects of money and computer-gaming

Sebastiaan Dovis, Saskia Van der Oord, Reinout W Wiers, Pier J M Prins, Sebastiaan Dovis, Saskia Van der Oord, Reinout W Wiers, Pier J M Prins

Abstract

Visual-spatial Working Memory (WM) is the most impaired executive function in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Some suggest that deficits in executive functioning are caused by motivational deficits. However, there are no studies that investigate the effects of motivation on the visual-spatial WM of children with- and without ADHD. Studies examining this in executive functions other than WM, show inconsistent results. These inconsistencies may be related to differences in the reinforcement used. The effects of different reinforcers on WM performance were investigated in 30 children with ADHD and 31 non-ADHD controls. A visual-spatial WM task was administered in four reinforcement conditions: Feedback-only, 1 euro, 10 euros, and a computer-game version of the task. In the Feedback-only condition, children with ADHD performed worse on the WM measure than controls. Although incentives significantly improved the WM performance of children with ADHD, even the strongest incentives (10 euros and Gaming) were unable to normalize their performance. Feedback-only provided sufficient reinforcement for controls to reach optimal performance, while children with ADHD required extra reinforcement. Only children with ADHD showed a decrease in performance over time. Importantly, the strongest incentives (10 euros and Gaming) normalized persistence of performance in these children, whereas 1 euro had no such effect. Both executive and motivational deficits give rise to visual-spatial WM deficits in ADHD. Problems with task-persistence in ADHD result from motivational deficits. In ADHD-reinforcement studies and clinical practice (e.g., assessment), reinforcement intensity can be a confounding factor and should be taken into account. Gaming can be a cost-effective way to maximize performance in ADHD.

Figures

Fig. 1
Fig. 1
A trial on the Chessboardtask. a To start a trial the arrowhead-button in the bottom-right corner of the screen has to be clicked. b Then the focus screen (a black screen with a little white cross) is presented. c Subsequently, a sequence of stimuli (squares that light up) is presented one by one on a 4 × 4 grid with green and blue squares ordered in a chessboard formation. Each stimulus lights up for 900 ms and is followed by an inter-stimulus interval of 500 ms. d After the stimulus-sequence is presented the participant responds by mouse-clicking on the squares. To respond correctly the presented stimuli have to be reproduced in a reorganized way: The green stimuli have to be reproduced before the blue stimuli; both in the same order as presented (the numbers in picture d show an example of a correct reorganization). e After a response feedback is presented. (A) After feedback-presentation, the participant can start the next trial by clicking on the arrowhead button
Fig. 2
Fig. 2
a Visual feedback in the Feedback-Only (FO) and monetary conditions b A trial in the game condition. The Megabot stands on the left, the enemies to the right
Fig. 3
Fig. 3
Mean performance of children with ADHD and control children on the visual-spatial working memory (WM) task in the Feedback-only (FO), 1 euro, 10 euros, and Game condition
Fig. 4
Fig. 4
Mean performance over time of children with ADHD, and control children on the visual-spatial working memory (WM) task in the Feedback-only (FO), 1 euro, 10 euros, and Game condition

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