Brain Bytes: ADHD and motivation, the benefits of incentives and rewards

One thing that we often hear from families of children with ADHD are frustrations related to observed patterns of variability around attentional control. One of the hallmark difficulties experienced by children who struggle with ADHD is that, while they have no problem with sustained attention when they’re involved in things that are highly interesting to them (i.e., video games, sports, crafting, etc.), and may even demonstrate hyper-focus in these situations, they demonstrate significant difficulties paying attention to things that are not of interest to them, like schoolwork/homework. To help understand this phenomenon, it is helpful to learn more about how attention works in our brain, and how our reward system plays an important role in regulating attention.

Attention is a widely distributed network in the brain. That means that it doesn’t “live” in one particular place in the brain. Instead, attentional control requires lots of different areas in our brain to work together at the same time in order to function properly. As infants begin to interact with the outside world, evidence of control over their attentional networks emerges. The outside world is brand new to infants, and their job is to learn about all the new things. When you present infants with a new toy next to a toy they have seen before, they spend more time focusing their attention on the new toy as compared to the old one. As they get a little bit older, infants learn to further control their “attentional” system by turning their gaze and attention away from things that are distressing to them to help with self-soothing. In toddlerhood, a rather hedonistic phase of development, kids spend lots of time focusing their attention on things they find rewarding. We enter the phase of childhood where fun and enjoyable activities are requested “Again!”…”Again!”…”Again!” Toddlers often find adult attention and interaction to be particularly rewarding, and they may repeatedly engage in behaviors (both positive and negative) that attract the attention of their care providers. As kids enter school, we also start to see some individual characteristics emerge regarding the developing relationship between attention and reward that is unique to each child, such as interests in certain sports, in art, in socializing, in animals, or in the outdoors. Kids at this age begin to demonstrate an eagerness to engage in and learn more about these subjects, as well as a willingness to dedicate time and attention to these subjects. Additionally, to varying degrees, children will have a harder time learning how to engage in activities about topics that are not of particular interest to them.

For kids with ADHD, engaging in these not-so-interesting activities is incredibly difficult. Brain scans have shown a pattern of overall brain development that reflects differences in the early development of the attentional networks in the brain that normalize, to a certain degree, in adulthood. In addition to the normalization of these networks over the course of development, individuals with ADHD also develop compensatory strategies that help them manage their challenges with attentional control, distractibility, and motivation. Even adults who have never been diagnosed with ADHD can relate to situations where we may be forced to do something we find incredibly boring and tedious, and for which we find little intrinsic motivation to complete – like watching a workplace compliance webinar, going to the DMV, cleaning out the basement/garage, making dinner, or doing our taxes. We may initially avoid the process. We may moan and groan. We may procrastinate and make a mental note to take care of it later. However, in the end, we usually find a way to muster the energy we need to do what is required of us. How do we do that? Very few of us are able to truly convince ourselves that these onerous tasks are actually rewarding in and of themselves. Instead, we may think about known consequences. If we can, we break down the task into smaller pieces so that the entire task doesn’t seem so painful. We may watch a funny video or go for a run to lift our spirits up before engaging in the task. We make appointments for ourselves in the future to help us commit to deadlines. We treat ourselves to foods/drinks/activities of choice when we are done. Once we’re done, some of us may even feel a positive sense of accomplishment at having completed something that was hard for us to do.

Kids, on the other hand, don’t have many of these tools readily available to them. For elementary school students, few have the foresight to evaluate the potential consequences of not learning a particular lesson in school, or understand the cumulative nature of early learning skills. A child’s executive functioning capacity has not developed to the point where they are able to break down a larger task into smaller, more manageable pieces to help make an activity look less daunting. Young kids do not have the emotional intelligence to know that improving their mood may support their ability to complete a tough task. Schoolwork deadlines are often set for them, so they have little control and choice over when things must be done. Feelings of accomplishment about having completed something that they didn’t want to do in the first place requires meta-cognitive skills that just aren’t there yet.

So what do kids have left? Research has demonstrated that concrete expectations, structure, and rewards are really helpful for children who struggle with attentional control and task engagement when it comes to work completion, as these things work to support underlying weaknesses in these domains. Concrete expectations provide the kids with a known entity, a tangible end goal, that they can work towards and point to when done. Structure and scaffolding provided by teachers and parents serves three goals: (1) it provides positive attention from an adult, (2) it allows for opportunities to help them learn how to prioritize and break down tasks into more manageable pieces, (3) it provides opportunities for parents/teachers to give positive feedback regarding progress. Finally, much like adults, it is hard for children to always see the intrinsic value of the schoolwork that they have to complete, and while parents/teachers should consistently praise/reward the child’s effort and hard work in order to help build up those values, working towards a personal goal and/or receiving a pleasant treat can provide the extra boost needed to push them over the finish line.