Reinforcement enhances vigilance among children with ADHD: comparisons to typically developing children and to the effects of methylphenidate

Abstract

Sustained attention and reinforcement are posited as causal mechanisms in Attention-Deficit/Hyperactivity Disorder (ADHD), but their interaction has received little empirical study. In two studies, we examined the impact of performance-based reinforcement on sustained attention over time, or vigilance, among 9- to 12-year-old children. Study 1 demonstrated the expected vigilance deficit among children with ADHD (n = 25; 12% female) compared to typically developing (TD) controls (n = 33; 22% female) on a standard continuous performance task (CPT). During a subsequent visit, reinforcement improved attention more among children with ADHD than controls. Study 2 examined the separate and combined effects of reinforcement and acute methylphenidate (MPH) on CPT performance in children with ADHD (n = 19; 21% female). Both reinforcement and MPH enhanced overall target detection and attenuated the vigilance decrement that occurred in no-reinforcement, placebo condition. Cross-study comparisons suggested that the combination of MPH and reinforcement eliminated the vigilance deficit in children with ADHD, normalizing sustained attention. This work highlights the clinically and theoretically interesting intersection of reinforcement and sustained attention.

Figure 1

A schematic of the baseline visit CPT. Three trials are depicted. Arrows indicate the trials on which the participant responded.

Figure 2

A schematic of the reinforcement visit CPT. Three trials are depicted from the (A) no-reinforcement and (B) reinforcement conditions. Arrows indicate the trials on which the participant responded.

Figure 3

Mean percent (A) hits and (B) false alarms for all Group × Epoch conditions during the baseline visit. Error bars reflect standard error.

Figure 4

Mean percent (A) hits and (B) false alarms for all Group × Reinforcement × Epoch conditions in Study 1, Reinforcement visit. The grey box represents the brief time allowed for instructions following every two epochs. Error bars reflect standard error. R= Reinforcement, NR= No Reinforcement.

Figure 5

Mean percent (A) hits and (B) false alarms for all Medication × Reinforcement × Epoch conditions in Study 2. Performance for TD controls during the baseline visit is re-presented for normalization analyses. The grey box represents the brief time allowed for instructions following every four epochs. Error bars reflect standard error. R= Reinforcement, NR= No Reinforcement, MPH= Methylphenidate, Plac= Placebo.