Last year, researchers from the Brookhaven National Laboratory discovered that ADHD symptoms are partially caused by a problem in the brain’s reward pathway. Specifically, children with ADHD lack a protein in their brain, which causes a dysfunction in the way a person experiences reward and motivation. For instance, the prestige of getting good grades is not enough to motivate ADHD kids to do well in school; teachers need to provide extra engagement to get children interested in their lessons. These findings can probably explain why short attention spans and lack of focus are key behaviors of kids suffering from this disorder.

This discovery also helps explain how ADHD stimulant drugs work. These medications increase the production of the neurotransmitter dopamine, which is associated with the brain’s reward and pleasure systems. However, stimulant medications are inadequate long-term solutions that often come with harmful side effects. Can the brain’s reward pathway deficits be corrected without drugs?

Researchers from the University of Nottingham recently came up with an answer to this question – it turns out that behavioral rewards work just as well as medication in managing ADHD symptoms. In their Motivation, Inhibition, and Development in ADHD Study (MIDAS), 28 children with ADHD and 28 children without were asked to play a simple computer game. The game involves “catching” green aliens, which appear at random. At the same time, the child needs to avoid catching black aliens, which appear less frequently. For each green alien caught, the child would get a point. For every black alien caught or green alien missed, the child would lose a point.

To measure incentives, the rewards for avoiding black aliens were increased to five points. There was also a five point penalty imposed for catching the wrong alien.
Throughout the game, each child’s EEG waves were measured to keep track of brain activity. In the analysis, researchers looked at the markers of brain activity related to attention and impulsivity and observed how these were affected by motivational incentives and medication.

The researchers discovered that when the children took their usual dose of ADHD medications, they performed significantly better than when they did not take any drugs. It was also noted that the increased incentives normalized their brain activity. The EEG scans showed reduced impulsivity and improved attention once the points were increased.

Although experts are doing more research before applying these findings to the classroom or everyday clinical practice, many parents already use incentives and rewards to manage tantrums and other problematic behavior. Simple behavior management techniques can do much to reduce the impact of ADHD symptoms at school and at home. Together with a comprehensive treatment program, using rewards and incentives can increase the chances of long-term recovery from ADHD.