Thursday, August 12, 2010

ADHD , Motivation and Behavior modification

When it comes to the treatment of ADHD , behaviorism is very much alive. Most parenting books recommend token economy systems for ADHD kids , recommending rewards rather than punishments - honey catches more flies than vinegar.




On the otherhand , Ross Greene - Collaborative Problem solving sees challenging behavior as a learning disability , a developmental delay in the areas of frustration tolerance , flexibility and adaptability when demands for these skills outstrip the skills these kids have. These lacking skills are trained by using the collaborative problem solving process rather than rewards or punishments . There is research showing that rewards and punishments actually trigger the inappropiate behaviors the extrinsic motivation is trying to deal with.


The theory behind behavior modification was presented by Russel Barkley - see the link below 40 pgs imho page 20 onwards relevant - explaining ADHD as a deficit in self control and inhibition. If I understand him correctly the ability to inhibit response enables the 4 executive functions ,- nonverbal working memory , verbal working memory= privatization of speech, privatization of emotion which is the source of intrinsic motivation , and playing with ideas-problem solving. ADHD kids lack the ability to privatize emotion , the source of intrinsic emotion and need to be compensated by extrinsic motivation. He says cognitive therapy does not work because it assumes the presence of verbal working memory=privatization of speech. On page 28 onwards he deals with behavior modification and motivation.



Because ADHD kids  lack the capacity for intrinsic motivation , we need to create an environment which compensates with extrinsic motivation - rewards and consequences. Barkley says that Medication helps with executive functions and hyperactivity and allows us to reduce extrinsic motivation. The drug use for ADHD have minimal impact on executive test performance according to Seidman's 2006 review.
He does however mention that behavior modification only compensates and does not generalize.



S.D.T theory and research shows that extrinsic motivation undermines interest and intrinsic motivation. So while rewards may compensate in the moment , looking a little long term, the value of rewards decreases and have a negative impact.



From the Self Determined theory  site ' Some of the most surprising insights to emerge from SDT research call into question the traditional use of incentives. For example, behavioral research has shown that extrinsic rewards, like money or grades, actually undermine a person's interest in voluntarily engaging in a task. In short, rewards can backfire.



Kou Murayama from the University of Munich, Germany explored the neurobiology underlying this counterintuitive finding at the conference. In a recent study, Murayama and his colleagues scanned the brains of participants before and after completing a timed task. One group of participants was promised a reward. A second group performed the task with no incentive, although afterward they were surprised with compensation.



Using functional magnetic resonance imaging (fMRI), the study showed that entirely different areas of the brain are activated by the same task depending on whether a person anticipates a payoff or not. When focused on a reward, the brain switches off those areas associated with voluntary or self-initiated activities. '



Imho there maybe a developmental delay , but the lack of intrinsic motivation has more to do about the boring and uneganging nature of school and the parenting strategies of reward and punishments. Education and Parenting that supports children's autonomy - ( not independence but interdependence ) helps them be more self determined more intrinsically motivated. SDT says that 3 needs  - autonomy , competence , relatendness  facilitate intrinsic motivation and being determined . Cps  parenting supports the child's autonomy by addressing his concerns and inviting him to problem solve and be part of the solution , promotes competence by addressing lacking cognitive skills , and encourages ' relatedness ' through the collaborative nature of the process.

http://www.greatschools.org/pdfs/2200_7-barktran.pdf?date=4-12-05   Barkley article

http://www.help4adhd.org/faq.cfm?fid=40&varLang=en        Executive functions - Brown and Barkley



Allan

3 comments:

  1. ADHD children have their own mind and ideas which sometimes can deal to ADHD behavior problems.

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  2. This is a pretty confusing and inaccurate post.

    Rewards are recommended for ADHD, not behaviorism. Behaviorism is about training the person to do something. For people with ADHD rewards aren’t for training, they provide the motivation to do a task (now, not in the future). Barkley talked about using rewards as a motivation "prosthetic." Like an artificial limb. Because people with ADHD have brains that haven't fully developed the ability to self-motivate.

    Greene’s specialty is behavioral problems, not ADHD. ADHD is neither a “challenging behavior” nor a “learning disability.” It’s not a problem with skills or knowledge. If you want to teach kids skills, using a collaborative problem solving process seems great. If you want to help people with ADHD deal with self-motivation, teaching skills is useless no matter what methods you use.

    You say, "Barkley says that Medication helps with executive functions and hyperactivity and allows us to reduce extrinsic motivation." Yes, medication helps with executive functions. Hyperactivity is one symptom. Medication is not used to allow the reduction of extrinsic motivation. It’s to help the person function better without prosthetic interventions because there is no way to provide extrinsic motivations at all times for all situations in anyone's life.

    Then you say, “The drug use for ADHD have minimal impact on executive test performance according to Seidman's 2006 review.” In 2006 Seidman did a review of the literature (not a review of drugs) and it doesn’t say that. One paragraph did talk about psychopharmacology (drugs) but did not say that any medications have “minimal impact.” It’s about the effects the different types of medications have on different parts of the brain.

    You go on, “He does however mention that behavior modification only compensates and does not generalize.” This seems to be about Barkley, not Seidman. Barkley does not just “mention” that rewards compensate for the lack of intrinsic motivation and that they won’t be “generalized” (that is, learned). That’s Barkley’s *main point* about using extrinsic motivations.

    Then you go back to the idea that extrinsic motivations can inhibit intrinsic ones and you talk about Self-Determination Theory. That research was not done on people with ADHD. In fact it requires subjects to have functional intrinsic motivational systems. The conclusion about one study is interesting: “…the study showed that entirely different areas of the brain are activated by the same task depending on whether a person anticipates a payoff or not. When focused on a reward, the brain switches off those areas associated with voluntary or self-initiated activities.” Think about what that would mean for people who have ADHD, in which those brain areas *have never switched on.* People like that need to rely on the areas of the brain that are activated by anticipation of a payoff.

    The problem with SDT is, it’s not a one-size-fits-all idea. You can’t foster an ADHD child’s ability to be self-determined by ignoring the fact that they have an impaired ability to be intrinsically motivated, to make long range plans, avoid distraction, implement the things they want to do, stick with them over time and through obstacles, and to self-regulate in a number of other ways. That’s just pretending they don’t have ADHD. Denial does not make it go away.

    The research is clear that ADHD involves a developmental delay in the brain. The areas responsible for the executive functions grow more slowly and are less active than normal. ADHD is not caused by boring schools or bad parenting. ADHD is usually genetic but sometimes caused by brain injury.

    I understand that you like the ideas of SDT and CPS and don’t like behaviorism. Unfortunately, both SDT and CPS rely on abilities that are exactly the problems that ADHD people have. It’s kind of like saying you prefer golfing over hiking. That’s fine for you, perhaps, but probably not so great for someone with no hands.

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