Behavioral rewards 'work like drugs' for ADHD

The brains of children with attention-deficit disorders respond to on-the-spot rewards in the same way as they do to medication, say scientists. A Nottingham University team measured brain activity as children played a computer game, offering extra points for less impulsive behavior. Their findings, published in Biological Psychiatry, could mean lower doses of drugs such as Ritalin in severe cases. But they warn teachers and parents may often struggle to give instant rewards.

In severe cases, stimulant drugs such as Ritalin, which act on parts of the brain associated with attention and behavior, can be given. In addition, parents are often asked to try to influence the child's actions directly by rewarding positive behavior and making sure that there are negative consequences if a child behaves badly. Research has suggested that, unlike in non-ADHD children, these incentives and disincentives only work well if delivered on the spot, as opposed to later in the day or week.

The Nottingham team wanted to look at the effects of this "behavior therapy" in the brain of the child. They devised a computer game in which children had to "catch" aliens of a certain color, while avoiding aliens of a different color. The game was designed to test the children's ability to resist the impulse to grab the wrong sort of alien. To test whether incentives made a difference, in one variant of the game the reward for catching the right alien was increased fivefold, as was the penalty for catching the wrong one.

Professor Chris Hollis, who led the research, said that the combination of drugs and incentives produced the best results, and might mean children with ADHD could take lower doses of drugs while maintaining control of their behaviour. He said: "Although medication and behaviour therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their effect on the brain."

Steve - any non-invasive therapy that can reduce the amount of stimulant drugs for these children is a benefit.