Journal of Abnormal Child Psychology

, Volume 40, Issue 7, pp 1193–1207 | Cite as

Improving Working Memory in Children with Attention-Deficit/Hyperactivity Disorder: The Separate and Combined Effects of Incentives and Stimulant Medication

  • Michael T. Strand
  • Larry W. HawkJr.
  • Michelle Bubnik
  • Keri Shiels
  • William E. PelhamJr.
  • James G. Waxmonsky
Article

Abstract

Working memory (WM) is considered a core deficit in Attention-Deficit/ Hyperactivity Disorder (ADHD), with numerous studies demonstrating impaired WM among children with ADHD. We tested the degree to which WM in children with ADHD was improved by performance-based incentives, an analog of behavioral intervention. In two studies, WM performance was assessed using a visuo-spatial n-back task. Study 1 compared children (ages 9–12 years) with ADHD–Combined type (n = 24) to a group of typically developing (TD) children (n = 32). Study 1 replicated WM deficits among children with ADHD. Incentives improved WM, particularly among children with ADHD. The provision of incentives reduced the ADHD-control group difference by approximately half but did not normalize WM. Study 2 examined the separate and combined effects of incentives and stimulant medication among 17 children with ADHD-Combined type. Both incentives and a moderate dose of long-acting methylphenidate (MPH; ~0.3 mg/kg t.i.d. equivalent) robustly improved WM relative to the no-incentive, placebo condition. The combination of incentives and medication improved WM significantly more than either incentives or MPH alone. These studies indicate that contingencies markedly improve WM among children with ADHD–Combined type, with effect sizes comparable to a moderate dose of stimulant medication. More broadly, this work calls attention to the role of motivation in studying cognitive deficits in ADHD and in testing multifactorial models of ADHD.

Keywords

Attention-Deficit/Hyperactivity Disorder ADHD Working memory Incentives Reinforcement Methylphenidate 

References

  1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ASEBA School-Age Forms and Profiles. Burlington: University of Vermont, Research Center for Children, Youth, and Families.Google Scholar
  2. Alderson, R. M., Rapport, M. D., Hudek, K. L., Sarver, D. E., & Kofler, M. J. (2010). Competing core processes in attention-deficit/hyperactivity disorder (ADHD): do working memory deficiencies underlie behavioral inhibition deficits? Journal of Abnormal Child Psychology, 38(4), 497–507.PubMedCrossRefGoogle Scholar
  3. American Academy of Pediatrics. (2011). Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics, 108(4), 1033–1044.Google Scholar
  4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  5. Baddeley, A. (2007). Working memory, thought, and action. New York: Oxford University Press.CrossRefGoogle Scholar
  6. Bedard, A. C., Jain, U., Johnson, S. H., & Tannock, R. (2007). Effects of methylphenidate on working memory components: influence of measurement. Journal of Child Psychology and Psychiatry, 48(9), 872–880.PubMedCrossRefGoogle Scholar
  7. Bedard, A. C., Martinussen, R., Ickowicz, A., & Tannock, R. (2004). Methylphenidate improves visual-spatial memory in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43(3), 260–280.PubMedCrossRefGoogle Scholar
  8. Bedard, A. C., & Tannock, R. (2008). Anxiety, methylphenidate response, and working memory in children with ADHD. Journal of Attention Disorders, 11(5), 546–557.PubMedCrossRefGoogle Scholar
  9. Carlson, C. L., Pelham, W. E., Milich, R., & Dixon, J. (1992). Single and combined effects of methylphenidate and behavior therapy on the classroom performance of children with attention-deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 20(2), 213–232.PubMedCrossRefGoogle Scholar
  10. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.Google Scholar
  11. Douglas, V. I., & Parry, P. A. (1994). Effects of reward and nonreward on frustration and attention in attention deficit disorder. Journal of Abnormal Child Psychology, 22, 281-302Google Scholar
  12. Dovis, S., Van der Oord, S., Wiers, R.W., & Prins, P.J.M. (2012). Can motivation normalize working memory and task persistence in children with attention-deficit/hyperactivity disorder? The effects of money and computer-gaming. Journal of Abnormal Child Psychology. Google Scholar
  13. Ehlis, A. C., Bähne, C. G., Jacob, C. P., Herrmann, M. J., & Fallgatter, A. J. (2008). Reduced lateral prefrontal activation in adult patients with attention-deficit/hyperactivity disorder (ADHD) during a working memory task: a functional near-infrared spectroscopy (fNIRS) study. Journal of Psychiatric Research, 42(13), 1060–1067.PubMedCrossRefGoogle Scholar
  14. Epstein, J. N., Brinkman, W. B., Froehlich, T., Langberg, J. M., Narad, M. E., Antonini, T. N., Shiels, K., Simon, J. O., & Altaye, M. (2011). Effects of stimulant medication, incentives, and event rate on reaction time variability in children with ADHD. Neuropsychopharmacology, 36(5), 1060–1072.PubMedCrossRefGoogle Scholar
  15. Epstein, J. N., Langberg, J. M., Rosen, P. J., Graham, A., Narad, M. E., Antonini, T. N., Brinkman, W. B., Froehlich, T., Simon, J. O., & Altaye, M. (2011). Evidence for higher reaction time variability in children with ADHD on a range of cognitive tasks including reward and event rate manipulations. Neuropsychology, 25(4), 427–441.PubMedCrossRefGoogle Scholar
  16. Fabiano, G. A., Pelham, W. E., Jr., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O'Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129–140.PubMedCrossRefGoogle Scholar
  17. Fabiano, G. A., Pelham, W. E., Jr., Gnagy, E. M., Burrows-MacLean, L., Coles, E. K., Chacko, A., & Robb, J. A. (2007). The single and combined effects of multiple intensities of behavior modification and methylphenidate for children with attention deficit hyperactivity disorder in a classroom setting. School Psychology Review, 36(2), 195–216.Google Scholar
  18. Fabiano, G. A., Pelham, W. E., Jr., Waschbusch, D. A., Gnagy, E. M., Lahey, B. B., Chronis, A. M., Onyango, A. N., Kipp, H., Lopez-Williams, A., & Burrows-Maclean, L. (2006). A practical measure of impairment: psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. Journal of Clinical Child and Adolescent Psychology, 35(3), 369–285.PubMedCrossRefGoogle Scholar
  19. Greenhill, L., Beyer, D. H., Finkleson, J., Shaffer, D., Biederman, J., Conners, C. K., Gillberg, C., Huss, M., Jensen, P., Kennedy, J. L., Klein, R., Rapoport, J., Sagvolden, T., Spencer, T., Swanson, J. M., & Volkow, N. (2002). Guidelines and algorithms for the use of methylphenidate in children with attention-deficit/ hyperactivity disorder. Journal of Attention Disorders, 6, 89–100.Google Scholar
  20. Haenlein, M., & Caul, W. F. (1987). Attention deficit disorder with hyperactivity: a specific hypothesis of reward dysfunction. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 356–362.PubMedCrossRefGoogle Scholar
  21. Iaboni, F., Douglas, V. I., & Baker, A. G. (1995). Effects of reward and response costs on Inhibition in ADHD children. Journal of Abnormal Psychology, 104(1), 232–240.PubMedCrossRefGoogle Scholar
  22. Jaeggi, S.M., Buschkuehl, M., Perrig, W.J., Meier, B. (2009). The concurrent validity of the N-back task as a working memory measure. Memory, e-pub ahead of print, 1–19.Google Scholar
  23. Karatekin, C., Bingham, C., & White, T. (2009). Regulation of cognitive resources during an n-back task in youth-onset psychosis and attention-deficit/hyperactivity disorder (ADHD). International Journal of Psychophysiology, 73(3), 294–307.PubMedCrossRefGoogle Scholar
  24. Klein, C., Wendling, K., Huettner, P., Ruder, H., & Peper, M. (2006). Intra-subject variability in attention-deficit/hyperactivity disorder. Biological Psychiatry, 60(10), 1088–1097.PubMedCrossRefGoogle Scholar
  25. Klingberg, T., Fernell, E., Olesen, P. J., Johnson, M., Gustafsson, P., Dahlstrom, K., et al. (2005). Computerized training of working memory in children with ADHD—A randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 44(2), 177–186.PubMedCrossRefGoogle Scholar
  26. Kobel, M., Bechtel, N., Weber, P., Specht, K., Klarhöfer, M., Scheffler, K., Opwis, K., & Penner, I. K. (2008). Effects of methylphenidate on working memory functioning in children with attention deficit/hyperactivity disorder. European Journal of Paediatric Neurology, 13(6), 516–523.PubMedCrossRefGoogle Scholar
  27. Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., & Raiker, J. S. (2010). ADHD and working memory: the impact of central executive deficits and exceeding storage/rehearsal capacity on observed inattentive behavior. Journal of Abnormal Child Psychology, 38(2), 149–161.PubMedCrossRefGoogle Scholar
  28. Konrad, K., Gauggel, S., Manz, A., & Schöll, M. (2000). Lack of inhibition: a motivational deficit in children with attention deficit/hyperactivity disorder and children with traumatic brain injury. Child Neuropsychology, 6(4), 286–296.PubMedCrossRefGoogle Scholar
  29. Luman, M., Oosterlaan, J., & Sergeant, J. A. (2005). The impact of reinforcement contingencies on AD/HD: a review and theoretical appraisal. Clinical Psychology Review, 25, 183–213.PubMedCrossRefGoogle Scholar
  30. Luman, M., Oosterlaan, J., & Sergeant, J. A. (2007). Modulation of response timing in ADHD, effects of reinforcement valence and magnitude. Journal of Abnormal Child Psychology, 36, 445–456.PubMedCrossRefGoogle Scholar
  31. Luman, M., Tripp, G., & Scheres, A. (2010). Identifying the neurobiology of altered reinforcement sensitivity in ADHD: a review and research agenda. Neuroscience and Biobehavioral Reviews, 34, 744–754.PubMedCrossRefGoogle Scholar
  32. Martinussen, R., Hayden, D., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of working memory impairments in children with attention- deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44(4), 377–384.PubMedCrossRefGoogle Scholar
  33. Nigg, J. T. (2003). Response inhibition and disruptive behaviors: toward a multiprocess conception of etiological heterogeneity for ADHD combined type and conduct disorder early-onset type. Annals of the New York Academy of Sciences, 1008, 170–182.PubMedCrossRefGoogle Scholar
  34. Nigg, J. T., Willcutt, E. G., Doyle, A. E., & Sonuga-Barke, E. J. (2005). Causal heterogeneity in attention deficit/hyperactivity disorder: do we need neuropsychologically impaired subtypes? Biological Psychiatry, 57(11), 1224–1230.PubMedCrossRefGoogle Scholar
  35. Oosterlaan, J., & Sergeant, J. A. (1998). Effects of reward and response cost on response inhibition in AD/HD, disruptive, anxious, and normal children. Journal of Abnormal Child Psychology, 26, 161–174.PubMedCrossRefGoogle Scholar
  36. Pelham, W. E., Jr. (1999). The NIMH multimodal treatment study for attention-deficit hyperactivity disorder: just say yes to drugs alone? Canadian Journal of Psychiatry, 44(10), 981–990.Google Scholar
  37. Pelham, W. E., Jr., Burrows-Maclean, L., Gnagy, E. M., Fabiano, G. A., Coles, E. K., Tresco, K. E., & Hoffman, M. T. (2005). Transdermal methylphenidate, behavioral, and combined treatment for children with ADHD. Experimental and Clinical Psychopharmacology, 13(2), 111–126.PubMedCrossRefGoogle Scholar
  38. Pelham, W. E., Jr., Carlson, C. L., Sames, S. E., Vallano, G., Dixon, M. J., & Hoza, B. (1993). Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom. Journal of Consulting and Clinical Psychology, 61, 506–515.PubMedCrossRefGoogle Scholar
  39. Pelham, W. E., Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 449–476.PubMedCrossRefGoogle Scholar
  40. Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210–218.PubMedCrossRefGoogle Scholar
  41. Pennington, B. F. (2005). Toward a new neuropsychological model of attention-deficit/hyperactivity disorder: subtypes and multiple deficits. Biological Psychiatry, 57, 1221–1223.PubMedCrossRefGoogle Scholar
  42. Pietrzak, R. H., Mollica, C. M., Maruff, P., & Snyder, P. J. (2006). Cognitive effects of immediate-release methylphenidate in children with attention-deficit/hyperactivity disorder. Neuroscience and Biobehavioral Reviews, 30(8), 1225–1245.PubMedCrossRefGoogle Scholar
  43. Pliska, S., & AACAP Work Group on Quality Issues. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 894–92.PubMedCrossRefGoogle Scholar
  44. Postle, B. R., D’Esposito, M., & Corkin, S. (2005). Effects of verbal and non-verbal interference on spatial and object visual working memory. Memory & Cognition, 33(2), 203–212.CrossRefGoogle Scholar
  45. Quay, H. C. (1988). Attention-deficit disorder and the behavioral inhibition system: The relevance of the neuropsychological theory of Jeffrey A. Gray. In L. M. Bloomingdale & J. Sergeant (Eds.), Attention-deficit disorder: criteria, cognition, intervention (pp. 117–126). New York: Pergamon Press.Google Scholar
  46. Rapport, M. D., Alderson, R. M., Kofler, M. J., Sarver, D. E., Bolden, J., & Sims, V. (2008). Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): the contribution of central executive and subsystem processes. Journal of Abnormal Child Psychology, 36(6), 825–837.PubMedCrossRefGoogle Scholar
  47. Reynolds, C. R., & Richmond, B. O. (2005). Revised Children’s Manifest Anxiety Scale (RCMAS) (9th ed.). Los Angeles: Western Psychological Services.Google Scholar
  48. Sagvolden, T., Johansen, E. B., Aase, H., & Russell, V. A. (2005). A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. The Behavioral and Brain Sciences, 28(3), 397–419.PubMedCrossRefGoogle Scholar
  49. Saylor, C. F., Finch, A. J., Jr., Spirito, A., & Bennett, B. (1984). The children's depression inventory: a systematic evaluation of psychometric properties. Journal of Consulting and Clinical Psychology, 52(6), 955–967.PubMedCrossRefGoogle Scholar
  50. Scheres, A., Oosterlaan, J., & Sergeant, J. A. (2001). Response inhibition in children with DSM-IV subtypes of AD/HD and related disruptive disorders: the role of reward. Child Neuropsychology, 7(3), 172–189.PubMedCrossRefGoogle Scholar
  51. Shaffer, D., Fisher, P., Lucas, C. P., Dulkan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39(1), 28–38.PubMedCrossRefGoogle Scholar
  52. Shallice, T., Marzocchi, G. M., Coser, S., Del Savio, M., Meuter, R. F., & Rumiati, R. I. (2002). Executive function profile of children with attention deficit hyperactivity disorder. Developmental Neuropsychology, 21(1), 43–71.PubMedCrossRefGoogle Scholar
  53. Shiels, K., Hawk, L. W., Jr., Lysczek, C. L., Tannock, R., Pelham, W. E., Jr., Spencer, S. V., Gangloff, B. P., & Waschbusch, D. A. (2008). The effects of incentives on visual-spatial working memory in children with attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 36(6), 903–913.PubMedCrossRefGoogle Scholar
  54. Shiels, K., Hawk, L. W., Jr., Reynolds, B., Mazzullo, R. J., Rhodes, J. D., Pelham, W. E., Jr., & Gangloff, B. P. (2009). Effects of methylphenidate on discounting of delayed rewards in attention deficit/hyperactivity disorder. Experimental and Clinical Psychopharmacology, 17(5), 291–301.PubMedCrossRefGoogle Scholar
  55. Slusarek, M., Velling, S., Bunk, D., & Eggers, C. (2001). Motivational effects on inhibitory control in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 355–363.PubMedCrossRefGoogle Scholar
  56. Solanto, M. V., Wender, E. H., & Bartell, S. S. (1997). Effects of methylphenidate and behavioral contingencies on sustained attention in attention-deficit hyperactivity disorder: a test of the reward dysfunction hypothesis. Journal of Child and Adolescent Psychopharmacology, 7(2), 123–136.PubMedCrossRefGoogle Scholar
  57. Sonuga-Barke, E. J. (2002). Psychological heterogeneity in AD/HD- A dual pathway model of behaviour and cognition. Behavioural Brain Research, 130(1–2), 29–36.PubMedCrossRefGoogle Scholar
  58. Sonuga-Barke, E. J. (2005). Causal models of attention-deficit/hyperactivity disorder: from common simple deficits to multiple developmental pathways. Biological Psychiatry, 57(11), 1231–1238.PubMedCrossRefGoogle Scholar
  59. Tannock, R., Ickowicz, A., & Schachar, R. (1995). Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. Journal of the American Academy of Child and Adolescent Psychiatry, 34(7), 886–896.PubMedCrossRefGoogle Scholar
  60. Tripp, G., & Alsop, B. (2001). Sensitivity to reward delay in children with attention deficit hyperactivity disorder (ADHD). Journal of Child Psychology and Psychiatry, 42(5), 691–698.PubMedCrossRefGoogle Scholar
  61. Tripp, G., & Wickens, J. R. (2008). Research review: dopamine transfer deficit: a neurobiological theory of altered reinforcement mechanisms in ADHD. Journal of Child Psychology and Psychiatry, 49(7), 691–704.PubMedCrossRefGoogle Scholar
  62. Wechsler, D., Kaplan, E., Fein, D., Kramer, J., Delis, D., Morris, R., & Maerlender, A. (2004). Manual for the Wechsler Intelligence Scale for Children, 4th Edition, Integrated (WISC-IV). San Antonio: The Psychological Corp.Google Scholar
  63. Willcutt, E. G., Doyle, A., Nigg, J., Faraone, S., & Pennington, B. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biological Psychiatry, 57(11), 1336–1346.PubMedCrossRefGoogle Scholar
  64. Woodcock, R. W., McGrew, K. S., & Mather, N. (2001). Woodcock-Johnson® III Test. Itasca: Riverside Publishing Company.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Michael T. Strand
    • 1
  • Larry W. HawkJr.
    • 1
    • 4
    • 5
  • Michelle Bubnik
    • 1
  • Keri Shiels
    • 1
  • William E. PelhamJr.
    • 1
    • 2
    • 4
  • James G. Waxmonsky
    • 3
    • 4
  1. 1.Department of PsychologyUniversity at Buffalo, SUNYBuffaloUSA
  2. 2.Department of PediatricsUniversity at Buffalo, SUNYBuffaloUSA
  3. 3.Department of PsychiatryUniversity at Buffalo, SUNYBuffaloUSA
  4. 4.Center for Children and FamiliesUniversity at Buffalo, SUNYBuffaloUSA
  5. 5.University at BuffaloBuffaloUSA

Personalised recommendations