Authors: Jeroen Van Dessel; Edmund J. S. Sonuga-Barke; Matthijs Moerkerke; Saskia Van der Oord; Sarah Morsink; Jurgen Lemiere; Marina Danckaerts · Research
How Do Children and Teens with ADHD Process Monetary Loss?
A study examining how the brains of youth with ADHD respond to avoiding monetary loss compared to typically developing peers.
Source: Van Dessel, J., Sonuga-Barke, E. J. S., Moerkerke, M., Van der Oord, S., Morsink, S., Lemiere, J., & Danckaerts, M. (2022). The limits of motivational influence in ADHD: no evidence for an altered reaction to negative reinforcement. Social Cognitive and Affective Neuroscience, 17(5), 482-492. https://doi.org/10.1093/scan/nsab111
What you need to know
- Children and teens with ADHD showed similar brain responses as typically developing peers when anticipating opportunities to avoid losing money.
- This suggests the ability to process negative consequences is intact in ADHD, contrary to some theories.
- However, those with ADHD did show reduced brain response to successfully avoiding loss and increased response to failing to avoid loss.
- The findings indicate motivation deficits in ADHD may be specific to certain types of outcomes rather than a general impairment.
Understanding motivation in ADHD
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterized by persistent inattention, hyperactivity, and impulsivity that interferes with functioning and development. Some theories suggest that ADHD involves impaired processing of rewards and consequences, which may contribute to difficulties with motivation and behavior regulation.
Previous brain imaging studies have found that children and adolescents with ADHD often show reduced activity in brain reward centers when anticipating monetary gains compared to typically developing youth. However, less is known about how the ADHD brain processes the anticipation and experience of negative outcomes, such as monetary loss. Understanding this is important, as both positive and negative consequences can impact behavior in those with ADHD.
A new approach to studying loss avoidance
To examine this, researchers conducted a brain imaging study comparing youth with and without ADHD as they completed a specially designed task involving opportunities to avoid losing money. The study included 33 boys with ADHD and 33 typically developing boys between ages 8-18.
The task, called the Escape Monetary Loss Incentive (EMLI) task, allowed researchers to separate brain responses related to:
- Contingency - whether one’s actions could influence the outcome
- Valence - whether the cue signaled a positive or negative outcome
Participants saw different symbols that indicated:
- Conditional loss avoidance - They could avoid losing money by responding quickly enough
- Certain loss - They would definitely lose money regardless of their response
- Certain loss avoidance - They would definitely not lose money regardless of their response
The amount of potential loss also varied between €0.20, €1, and €5. This design improved upon previous studies by distinguishing between responses to having control over outcomes versus responses to positive/negative outcomes themselves.
Similar motivation and brain activity between groups
Contrary to some predictions, the study found that youth with ADHD showed very similar behavioral and brain responses as the typically developing group when anticipating opportunities to avoid losing money.
Key findings included:
- Both groups responded fastest when they had the opportunity to avoid loss through quick reactions.
- Both groups rated cues signaling definite loss as most negative and cues signaling definite loss avoidance as most positive.
- Brain scans showed increased activity in motivation and motor preparation regions for both groups when seeing cues that meant they could avoid loss through their actions.
- This brain activity increased for larger potential loss amounts in both groups.
These results suggest that the ability to process contingencies between one’s actions and negative outcomes is intact in ADHD. It also indicates that youth with ADHD are not more or less sensitive to negative outcomes compared to their peers, at least for monetary loss.
The salience and motor preparation networks
The brain regions activated during loss avoidance opportunities included areas involved in:
- Salience processing - Regions like the anterior insula and cingulate cortex that help detect important stimuli
- Motor preparation - Areas like the supplementary motor area that get ready to initiate quick movements
This activation pattern makes sense given the task required quickly noticing relevant cues and preparing speeded responses. The similar activation between groups implies youth with ADHD can engage these neural systems effectively when motivated to avoid negative outcomes.
Differences in feedback processing
While anticipatory responses were alike between groups, some differences emerged in how the brain responded to feedback about performance:
- Youth with ADHD showed reduced activation in reward-related brain areas when successfully avoiding loss.
- They displayed increased activation in emotion-processing regions when failing to avoid loss.
This suggests that while the anticipation of avoiding negative outcomes is similar, the actual experience of success or failure may be processed differently in ADHD. Reduced neural response to positive outcomes and heightened response to negative ones could potentially contribute to motivation challenges over time.
Age-related findings
The study also examined how responses changed with age across the 8-18 year range. Some key age-related findings included:
- Adolescents showed greater activation than children in motivation and motor preparation brain regions when seeing loss avoidance opportunities.
- This age difference was seen in both the ADHD and control groups.
- No age differences were found in how the brain responded to positive versus negative cues or to feedback.
These results align with typical neurodevelopmental patterns of increased engagement of motivation-related brain systems during adolescence. The similar age effects between groups suggest this aspect of brain development may progress normally in ADHD.
Implications for understanding ADHD
This study provides new insights into motivation and reinforcement processing in ADHD:
- It suggests deficits may be specific to certain types of outcomes (e.g. rewards) rather than a general impairment in processing consequences.
- The intact responses to avoiding monetary loss indicate youth with ADHD can engage motivation and cognitive control systems when sufficiently incentivized.
- Differences in feedback processing highlight the importance of considering both anticipation and outcome stages when studying motivation in ADHD.
The findings also demonstrate the value of carefully designed tasks that can isolate different cognitive and motivational components. By separating contingency and valence effects, this study was able to show preserved function in some areas despite deficits in others.
Relevance for treatment approaches
Understanding the specifics of motivation processing in ADHD can help inform more targeted interventions. Some potential implications include:
- Emphasizing opportunities to avoid negative outcomes may be as motivating as offering rewards for youth with ADHD.
- Enhancing the saliency and immediacy of consequences (both positive and negative) may help engage motivation systems.
- Interventions to improve processing of performance feedback could be beneficial, given the differences seen in neural responses to success and failure.
Overall, the results support approaches that provide clear action-outcome contingencies and meaningful consequences, while also addressing how youth interpret their performance.
Limitations and future directions
As with any study, there are some limitations to consider:
- The sample included only boys, so findings may not generalize to girls with ADHD.
- Participants practiced the task beforehand, so learning effects could not be examined.
- The study focused on monetary incentives, while real-world motivation involves many other factors.
Future research could expand on these findings by:
- Including female participants and a broader range of ages
- Examining responses to other types of negative outcomes beyond monetary loss
- Investigating how these processes may differ across ADHD subtypes or in the presence of common co-occurring conditions
Additionally, longitudinal studies tracking motivation processing from childhood through adolescence could provide valuable insights into how these systems develop over time in ADHD.
Conclusions
- Youth with ADHD showed intact ability to process opportunities for avoiding monetary loss, contrary to some theories of general motivation deficits.
- Brain responses when anticipating loss avoidance were similar between ADHD and control groups.
- However, those with ADHD did display differences in how the brain processed feedback about performance outcomes.
- The findings highlight the importance of distinguishing between different components of motivation and reinforcement when studying ADHD.
This research advances our understanding of the neurocognitive processes underlying motivation in ADHD. It suggests that while some aspects of reinforcement processing may be impaired, others remain intact. This nuanced picture can inform the development of more targeted and effective interventions to support youth with ADHD.