Rewards & Consequences

Carrots vs. Sticks: The Science of Reward and Punishment for Children with ADHD

Neurology shows that the ADHD brain is particularly sensitive to positive reinforcement and to punishment — insights that should influence parenting and teaching strategies.

8 year old school girl with good work reward button badges.
Credit: Peter Dazeley/Getty Images

Do rewards and punishments — standards in every neurotypical parenting arsenal — actually inspire better behavior in children with ADHD? What about positive reinforcement? The answers to these questions from parents and educators, like most things ADHD-related, are nuanced.

Science suggests that children with attention deficit hyperactivity disorder (ADHD) differ from their neurotypical peers in their responses to positive reinforcement and punishment. The central differences: Children with ADHD are not effectively motivated by promises (of privileges to be earned or lost); and positive reinforcement is particularly powerful, but also ephemeral, in ADHD brains. Researchers have made these conclusions after studying children’s performance on cognitive tasks and monitoring their physiological responses.

Altered sensitivity to rewards and punishments may be a core characteristic of ADHD.1 Prolific research on how changes at the brain’s cellular level explain individuals’ responses to rewards may offer compelling clues to the neurobiology of ADHD, and they may suggest effective approaches to behavior modification for children with ADHD.

Dopamine, Rewards, and the ADHD Brain

In primates and rats, dopamine neurons in the brain get a boost when they are given an unexpected reward. 2 3 4 When a reward is expected, after repetition and training, these dopamine boosts occur when the brain receives cues that predict the reward. This anticipatory dopamine boost helps to propel the action that will unlock the reward.

Similarly, it is hypothesized that neurotypical brains experience a surge of dopamine when they predict a forthcoming reward.5 This provides immediate and continuous reinforcement at the cellular level even when the reward is delayed or discontinued.

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In children with ADHD, it appears, this process is incomplete. When rewards are slowed or stopped, there is a delay in the dopamine signal of the ADHD brain, which has an increased preference for immediate rewards.5 When rewards are withheld or efforts go unrewarded, the result is poorer learning and performance.

Positive Reinforcement Fuels Learning

Few behavior-management programs take into consideration how children with ADHD respond differently to rewards and punishments, and how to modify reinforcement accordingly. It’s well-established that positive reinforcement increases performance across a range of cognitive tasks. Studies show that under continuous positive reinforcement, children with and without ADHD learn tasks more quickly than they do with less frequent reinforcement.6 7 When offered only partial reinforcement, children with ADHD show poorer sustained attention and demonstrate less predictable responses to tasks, the research shows.8

In the absence of reinforcement, children produce fewer correct responses; they don’t learn tasks as quickly or as well. Children with ADHD who are struggling to learn a task under these circumstances may feel increased frustration and simply stop engaging. This behavior may look like poor motivation, but it is actually a neurological response to poor reinforcement from caregivers and educators. With partial reinforcement, a child with ADHD may learn a task or skill more slowly — but they retain more of their learning for a longer time than with constant reinforcement.

Several studies also show that children with ADHD are less able to adapt to demands when expectations change9 10; when expectations are very clear, they are better able to meet demands. It is critical for children with ADHD to fully understand rules and expectations, especially when they change. Frequent reminders from caregivers and teachers can help.

[Read: It’s Not Bribery. It’s Brain Chemistry.]

ADHD Brains Prefer Immediate Rewards

In one study, children with and without ADHD were asked at the beginning of a task to choose between a smaller immediate reward and a larger delayed reward.11 The reward alternatives were available throughout the task, and the amount of time that the children had to wait for the reward varied.

The children with ADHD tried to wait for the larger later reward, but in the end, they were more likely to choose the smaller immediate reward.11 This suggests that children with ADHD are more likely to seek immediate and available rewards, particularly when frustrated or distracted.

This also suggests that children with ADHD may become more upset when they don’t receive anticipated rewards, and they may give up more easily when tasks are perceived as too difficult. Teachers and caregivers should pay particular attention when the child’s task persistence drops away and he begins to respond impulsively or become emotional.

There is evidence that punishment can keep a child with ADHD on task in the short term.12 13 14 Studies also show that children with ADHD are more sensitive than their neurotypical peers to punishment.15 16

Punishment, or the perception of punishment, used to motivate children to learn or stay on task, may carry serious long-term consequences if the child’s emotion regulation skills are weak. In most scenarios, positive reinforcement is a more effective motivator than is punishment.

Reward and Punishment: Better Strategies for Children with ADHD

1. Make sure that waiting times are within a child’s capacity so that they can be successful in their efforts to wait. Consider building up a child’s stamina for waiting. Start small and gradually increase waiting times, acknowledging and praising efforts to wait. Introduce strategies to make waiting easier, such as self-praise.

2. Bolster executive functions during transitions. Children who have ADHD often fail to meet behavioral demands or expectations, especially when transitioning from one activity or setting to another — and when rules are not obvious. Make sure students know the rules in different classes or settings. Praise them when they get it right and calmly remind them when they forget. Alert them when expectations change; give them time to adapt.

3. Match homework demands to a childs capacity. Many kids with ADHD are distracted by more immediately rewarding activities, or when they find the work too difficult. When the work is challenging, reduce the amount and duration of time spent on it, keep levels of praise high, and reward effort.

The content for this article was derived with permission from “From Research to Clinical Practice: Applying What We Know About Altered Reinforcement Sensitivity to the Management of ADHD” presented by Gail Tripp, Ph.D., at the APSARD 2022 Annual Conference.

Positive Reinforcement: Next Steps

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