Does the use of reward systems, such as points, star charts, and tokens, to encourage completion of non-preferred tasks in children with Attention Deficit Hyperactivity Disorder (ADHD) lead to eventual dependence on extrinsic motivation or does internal motivation develop with maturation?

From the Guidelines

The use of reward systems, such as points, star charts, and tokens, can be an effective way to encourage completion of non-preferred tasks in children with Attention Deficit Hyperactivity Disorder (ADHD), but it is crucial to implement these systems thoughtfully to avoid hindering the development of intrinsic motivation, as suggested by the most recent and highest quality study 1. When implementing reward systems, it is essential to consider the potential impact on intrinsic motivation, as research suggests that over-reliance on external rewards may hinder the development of internal motivation in some children 1. However, with a thoughtful approach, many children with ADHD can successfully internalize motivation as they develop better self-regulation skills.

Key Considerations for Implementation

• Start with consistent, immediate rewards for specific behaviors, then gradually extend the time between behavior and reward, as recommended by the clinical practice guideline for the diagnosis, evaluation, and treatment of ADHD in children and adolescents 1.
• Pair tangible rewards with specific praise that highlights the child's effort and achievement, to emphasize personal satisfaction in accomplishment.
• As the child progresses, shift toward intermittent reinforcement schedules and incorporate self-monitoring tools where children track their own progress, to promote self-regulation skills.
• Eventually, transition to more natural consequences and rewards that mirror real-life situations, to scaffold the development of intrinsic motivation.

Rationale for Approach

The approach of using reward systems to encourage completion of non-preferred tasks in children with ADHD is based on the understanding that ADHD involves dopamine system differences that affect motivation and reward processing 1. External rewards can temporarily compensate for these neurological differences while the child develops compensatory skills. The goal is to scaffold the development of intrinsic motivation rather than replacing it entirely with external rewards, as supported by the most recent and highest quality study 1.

From the Research

Reward Systems and Motivation in Children with ADHD

• The use of reward systems, such as points, star charts, and tokens, to encourage completion of non-preferred tasks in children with Attention Deficit Hyperactivity Disorder (ADHD) is a common practice 2, 3, 4, 5, 6.
• Research suggests that children with ADHD have problems assigning relative motivational significance to outcomes of their actions, which may lead to difficulties in developing internal motivation 2.
• Studies have shown that children with ADHD are more sensitive to rewards and punishment, and that this sensitivity can moderate the association between negative and positive parenting behaviors and child ADHD symptoms 5, 6.
• The use of behavior therapy, including reward systems, in combination with medication, has been shown to be effective in improving ADHD symptoms and functioning in children with ADHD 3, 4.
• However, the long-term effects of reward systems on internal motivation in children with ADHD are not well understood, and more research is needed to determine whether these systems lead to eventual dependence on extrinsic motivation or the development of internal motivation with maturation.

Development of Internal Motivation

• Research suggests that psychosocial treatments, including behavioral and cognitive-behavioral therapies, can help children with ADHD develop internal motivation and improve their academic and organizational skills 4.
• The use of motivational enhancement techniques, such as goal-setting and self-monitoring, may also be effective in promoting internal motivation in children with ADHD 4.
• However, the development of internal motivation in children with ADHD is a complex process, and more research is needed to understand the factors that influence this process and the most effective strategies for promoting internal motivation.

Limitations and Future Directions

• The current research on reward systems and internal motivation in children with ADHD has several limitations, including the lack of long-term follow-up studies and the need for more diverse samples 2, 3, 4, 5, 6.
• Future studies should investigate the long-term effects of reward systems on internal motivation in children with ADHD and explore the most effective strategies for promoting internal motivation in this population.