Br i e f s RESEARCH BRIEFS . CONSEQUENCES—rewards and punish- ments—have demonstrated benefts in the behavior management of ADHD. Recent meta-analyses of behavioral interventions have consistently demonstrated strong, posi- tive effects on the behavior of children with ADHD. In this column, we review a number of recent studies examining the impact of rewards and punishments on the behavior of children with ADHD. Beginning in the 1960s, systematic efforts to use contingency management techniques for children with ADHD relied on manual or elec- tronic devices to provide contingent feedback for behavior. The second generation of studies utilizing behavior management sought to im- prove children’s behavior by utilizing contin- gent social praise, modeling, tokens, and home- based reinforcement systems. As research in this area progressed, the initial tendency to focus on a single dimension of behavior progressed to treating broader classes of behavior. The pri- mary focus has been on the use of positive rein- forcement to increase task-related attention and completion of tasks at school and in the home. Effective management of consequences not only increases motivation but also the likelihood that the child will appreciate what he or she is being required to do. These inter- ventions for ADHD have demonstrated con- sistent effectiveness, even in the absence of ac- companying psychiatric medication, and have been found to generalize from one setting to another. Researchers have examined the effects of reward size, timing, the impact incentives may have on reducing intrinsic interest, and the use of strategies such as response cost. ® Groom MJ, Scerif G, Liddle PF, Batty MJ, Liddle EB, Roberts KL, Cahill JD, Liotti M, & Hollis C. (2010). Effects of motivation and medication on electrophysiological markers of response inhibition in children with attention-defcit/hyperactivity disorder. Biological Psychiatry, 67(7), 624-631. The authors studied the behavioral and neu- rophysiologic effects of motivational incen- tives on 28 children (aged nine to ffteen years) with combined-type ADHD and 28 control children without ADHD as they performed a go/no-go task under three conditions—re- ward, response-cost, and baseline. The chil- dren with ADHD were tested both on and off their usual dose of methylphenidate; the con- trol children were never medicated. Analyses of N2 and P3 amplitudes showed effects from diagnosis (controls > ADHD unmedicated), medication (on > off), and motivation (re- ward and/or response cost > baseline). Mo- tivational incentives increased amplitudes in children with ADHD towards the baseline of the control group. The authors concluded that motivational incentives have similar effects in children with and without ADHD but have additive effects in conjunction with stimulant medication, which appears to enhance atten- tion resources during response inhibition. ® Luman M, Oosterlaan J, Knol DL, & Sergeant JA. (2008). Decision-making in ADHD: Sensitive to frequency but blind to the magnitude of penalty? Journal of Child Psychology and Psychiatry, 49(7), 712-722. The authors investigated decision- making and reinforcement sensi- tivity in 23 children with ADHD and 20 healthy controls using a gambling task in which penalties increased in either frequency or magnitude. Children had to choose among alternatives involving small rewards and small penalties (advantageous), large rewards and increasing penalties, and small rewards and increasing penalties (both disadvantageous). Heart rate and skin conductance were moni- tored to see if impaired decisionmaking was ac- companied by different autonomic responses. Compared to the control group, children with ADHD displayed a smaller preference for the advantageous alternative when penalties in- creased in size, but they performed like con- trols when penalties increased in frequency. The ADHD group also showed increased heart rate compared to controls following large rewards and greater skin conductance for the advanta- geous over disadvantageous condition, while controls showed the opposite pattern. The authors suggested that a maladaptive response during decisionmaking may cause children with ADHD to be sensitive to the frequency but blind to the magnitude of the penalty. ® Masunami T, Okazaki S, & Maekawa H. (2009). Decision-making patterns and sensitivity to reward and punishment in children with attention-defcit hyperactivity disorder. International Journal of Psychophysiology, 72(3), 283-288. The authors studied decision-making strate- gies in 14 children with ADHD and 11 healthy control children (aged seven to fourteen years) as they performed a gambling task under three conditions: rewards, punishments, and no rewards or punishments. T-patterns and skin conductance responses were ana- lyzed for the different task condi- tions. Researchers found that chil- dren with ADHD displayed fewer T-patterns with punishments and more T-patterns with rewards than the control children, while T-patterns without rewards and punishments did not differ be- tween groups. Moreover, children The Use of Consequences and Managed Behavior in ADHD by Sam Goldstein, PhD, with Soleil Gregg, MA Sam Goldstein, PhD, is a member of the faculty at the University of Utah School of Medicine. He is editor of the Journal of Attention Disorders. A former chair of CHADD’S professional advisory board, Goldstein is a contributing editor to Attention and sits on its editorial advisory board. Educational consultant Soleil Gregg, MA, is a former member of CHADD’s board of directors and a current member and former chair of Attention’s editorial advisory board. ONLINE ONLY Visit Attention 2.0 at chadd.org to read additional summaries of studies on this topic. 30 Attention