Conditional Learning Deficits in Children with ADHD can be Reduced Through Reward Optimization and Response-Specific Reinforcement

Hasse De Meyer,Gail Tripp,Saskia Van Der Oord,Tom Beckers

doi:10.1007/s10802-021-00781-5

Abstract

When children with ADHD are presented with behavioral choices, they struggle more than Typically Developing [TD] children to take into account contextual information necessary for making adaptive choices. The challenge presented by this type of behavioral decision making can be operationalized as a Conditional Discrimination Learning [CDL] task. We previously showed that CDL is impaired in children with ADHD. The present study explores whether this impairment can be remediated by increasing reward for correct responding or by reinforcing correct conditional choice behavior with situationally specific outcomes (Differential Outcomes). An arbitrary Delayed Matching-To-Sample [aDMTS] procedure was used, in which children had to learn to select the correct response given the sample stimulus presented (CDL). We compared children with ADHD (N = 45) and TD children (N = 49) on a baseline aDMTS task and sequentially adapted the aDMTS task so that correct choice behavior was rewarded with a more potent reinforcer (reward manipulation) or with sample-specific (and hence response-specific) reinforcers (Differential Outcomes manipulation). At baseline, children with ADHD performed significantly worse than TD children. Both manipulations (reward optimization and Differential Outcomes) improved performance in the ADHD group, resulting in a similar level of performance to the TD group. Increasing the reward value or the response-specificity of reinforcement enhances Conditional Discrimination Learning in children with ADHD. These behavioral techniques may be effective in promoting the learning of adaptive behavioral choices in children with ADHD.

Highlights

ADHD is marked by elevated levels of inattention, hyperactivity and impulsiveness that are inconsistent with a child’s developmental stage (American Psychiatric Association, 2013)
Which choice response is correct is dependent on the sample stimulus presented: R 1 may be the correct choice for S 1, but for another stimulus S 2, R2 may be the correct choice response
Developing children were required to fall within the normal range on the Inattentive and Hyperactivity/Impulsivity section (≤ 90.9th percentile), Oppositional Defiant Disorder [ODD] section (≤ 95.2nd percentile) and CD section (≤ 95.2nd percentile) of the Disruptive Behavior Disorder Rating Scale (DBDRS; Dutch translation: Oosterlaan et al, 2008) as endorsed by parents

Summary

Introduction

ADHD is marked by elevated levels of inattention, hyperactivity and impulsiveness that are inconsistent with a child’s developmental stage (American Psychiatric Association, 2013). A widely used paradigm for testing behavioral adaptation to environmental expectations in laboratory research is a Conditional Discrimination Learning [CDL] task (Martínez et al, 2012; Mok et al, 2017). Conditional Discrimination Learning can be tested in an arbitrary Matching-To-Sample [aMTS] procedure in which associations have to be learned between non-similar, non-related sample stimuli and choice responses (Estévez et al, 2001; Trapold, 1970). On a given trial participants are presented with a single sample stimulus, e.g., S1, followed by a choice between two responses R1 and R2, and they have to learn to select the correct response. Due to its conditional nature, this instrumental learning task models the capacity to adapt choice behavior to situational requirements or hierarchical reinforcement contingencies (Mok et al, 2009)

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