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Research on Child and Adolescent Psychopathology

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01-10-2012

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

Auteurs: Michael T. Strand, Larry W. Hawk Jr., Michelle Bubnik, Keri Shiels, William E. Pelham Jr., James G. Waxmonsky

Gepubliceerd in: Research on Child and Adolescent Psychopathology | Uitgave 7/2012

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.

vorige artikel Memory in Early Onset Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder: Similarities and Differences

volgende artikel Erratum to: Youth Appraisals of Inter-parental Conflict and Genetic and Environmental Contributions to Attention-Deficit Hyperactivity Disorder: Examination of GxE Effects in a Twin Sample

Four additional participants were excluded from the sample due to invalid data caused by equipment malfunction (n = 2) or failure to follow task intstructions (n = 2)

Due to a programming error, 23 (10 %) of the 224 0-back trial blocks in Study 1 had a target probability of 0.1, rather than 0.3. A supplementary analysis excluding the 11 children (4 with ADHD) with one or more of these blocks revealed a nearly identical pattern of results to that obtained for the full sample. Overall, the reduced number of 0-back target stimuli in the subset of the sample did not appear to exert a significant influence on the present data. Nevertheless, the error was corrected prior to Study 2.

Because the order in which incentive and no-incentive conditions are presented can impact performance (see Shiels et al. 2008), we included incentive order as a between-subjects factor. However, despite random assignment, accuracy during the baseline week – in which there were no incentives – varied as a function of incentive order assignment among children with ADHD, F(1, 52) = 4.6, p < 0.05; Group × Incentive Order F(1,52) = 4.5, p = 0.039. This pattern suggests some pre-existing difference that occurred by chance but nonetheless precludes clear interpretation of “incentive order” effects. Therefore, incentive order is retained in all models to account for this extraneous variance, but incentive order effects are not discussed.

Supplemental models included FSIQ as a covariate. FSIQ was a statistically significant predictor of overall n-back performance on the baseline day, F(1,51) = 4.2, p < 0.05, but not on the incentive day, F(1,51) = 2.3, p = 0.14. More importantly, inclusion of FSIQ did not appreciably alter any of the interactions with group and/or incentive in either the baseline or incentive day analyses.

Two additional participants were excluded from the sample due to invalid data resulting from failure to follow task instructions.

Preliminary analyses indicated that neither incentive order nor medication order accounted for significant variance in working memory performance; therefore, to conserve degrees of freedom these factors were removed from subsequent analyses.

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Titel: Improving Working Memory in Children with Attention-Deficit/Hyperactivity Disorder: The Separate and Combined Effects of Incentives and Stimulant Medication
Auteurs: Michael T. Strand
Larry W. Hawk Jr.
Michelle Bubnik
Keri Shiels
William E. Pelham Jr.
James G. Waxmonsky
Publicatiedatum: 01-10-2012
Uitgeverij: Springer US
Gepubliceerd in: Research on Child and Adolescent Psychopathology / Uitgave 7/2012
Print ISSN: 2730-7166
Elektronisch ISSN: 2730-7174
DOI: https://doi.org/10.1007/s10802-012-9627-6

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