Behavioral and Emotional Responding to Punishment in ADHD: Is Increased Emotionality Related to Altered Behavioral Responding?

Children with ADHD are theorized to experience increased negative emotional responses to punishment, compared to typically developing (TD) children, resulting in altered behavioral responding (Amsel, 1992). However, this has not been empirically tested. The current study evaluated the effects of punishment and reward on the behavioral and emotional responding of children with and without ADHD. Fifty-three children with ADHD (64.15% boys) and 46 TD children (47.83% boys), age 6-12, completed a task in which they chose between playing two simultaneously available games. Reward was arranged symmetrically across the games; responses on one game were punished four times as often as responses on the other game. Children's negative and positive emotional expressions were assessed during task completion with facial expression coding. Results indicated both groups showed a preference for playing the less punished game. Children with ADHD took longer to respond after punishment and reward compared to TD children. Negative emotional expressions increased with time on task for those with ADHD, the opposite pattern was seen in TD children. Children with ADHD showed more positive emotional expressions overall. The effect of ADHD on increased response times after reward was statistically fully mediated by increased positive facial expressions. Findings indicate children with ADHD do not show an altered response bias under punishment compared to TD children, but their cumulative negative emotional responding may indicate problems with building frustration tolerance as hypothesized by Amsel (1992). Results are theoretically important as they suggest increased emotional responding in ADHD is associated with slower responding.

Instrumental learning and behavioral persistence in children with attention-deficit/hyperactivity-disorder: does reinforcement frequency matter?

BACKGROUND: Prominent theoretical accounts of attention-deficit/hyperactivity-disorder (ADHD) hypothesize that reinforcement learning deficits underlie symptoms of ADHD. The Dynamic Developmental Theory and the Dopamine Transfer Deficit hypothesis assume impairments in both the acquisition and extinction of behavior, especially when learning occurs under partial (non-continuous) reinforcement, and subsequently the Partial Reinforcement Extinction Effect (PREE). Few studies have evaluated instrumental learning in ADHD and the results are inconsistent. The current study investigates instrumental learning under partial and continuous reinforcement schedules and subsequent behavioral persistence when reinforcement is withheld (extinction) in children with and without ADHD. METHODS: Large well-defined samples of children with ADHD (n = 93) and typically developing (TD) children (n = 73) completed a simple instrumental learning task. The children completed acquisition under continuous (100%) or partial (20%) reinforcement, followed by a 4-min extinction phase. Two-way (diagnosis by condition) ANOVAs evaluated responses needed to reach the learning criterion during acquisition, and target and total responses during extinction. RESULTS: Children with ADHD required more trials to reach criterion compared to TD children under both continuous and partial reinforcement. After partial reinforcement, children with ADHD executed fewer target responses during extinction than TD children. Children with ADHD executed more responses than TD children during extinction, irrespective of learning condition. CONCLUSIONS: The findings demonstrate general difficulties in instrumental learning in ADHD, that is, slower learning irrespective of reinforcement schedule. They also show faster extinction following learning under partial reinforcement in those with ADHD, that is, a diminished PREE. Children with ADHD executed more responses during extinction. Results are theoretically important, with clinical implications for understanding and managing learning difficulties in those with ADHD, as they suggest poorer reinforcement learning and lower behavioral persistence.

Systematic Review: Attention-Deficit/Hyperactivity Disorder and Instrumental Learning.

OBJECTIVE: Although instrumental learning deficits are, among other deficits, assumed to contribute to attention-deficit/hyperactivity disorder (ADHD), no comprehensive systematic review of instrumental learning deficits in ADHD exists. This review examines differences between ADHD and typically developing (TD) children in basic instrumental learning and the effects of reinforcement form, magnitude, schedule, and complexity, as well as effects of medication, on instrumental learning in children with ADHD. METHOD: A systematic search of PubMed, PsyINFO, CINAHL, EMBASE+EMBASE CLASSIC, ERIC, and Web of Science was conducted for articles up to March 16, 2020. Experimental studies comparing instrumental learning between groups (ADHD versus TD) or a manipulation of reinforcement/medication within an ADHD sample were included. Quality of studies was assessed with an adapted version of the Hombrados and Waddington criteria to assess risk of bias in (quasi-) experimental studies. RESULTS: A total of 19 studies from among 3,384 non-duplicate screened articles were included. No difference in basic instrumental learning was found between children with ADHD and TD children, nor effects of form or magnitude of reinforcement. Results regarding reinforcement schedule and reversal learning were mixed, but children with ADHD seemed to show deficits in conditional discrimination learning compared to TD children. Methylphenidate improved instrumental learning in children with ADHD. Quality assessment showed poor quality of studies with respect to sample sizes and outcome and missing data reporting. CONCLUSION: The review identified very few and highly heterogenous studies, with inconsistent findings. No clear deficit was found in instrumental learning under laboratory conditions. Children with ADHD do show deficits in complex forms of learning, that is, conditional discrimination learning. Clearly more research is needed, using more similar task designs and manipulations.