August 12 2005
Rewarding children for positive performance may produce similar effects in the brain as stimulant medication used to treat attention deficit/hyperactivity disorder (ADHD), University of Nottingham academics believe.
Traditionally, behavioural approaches to treating ADHD have thought to work quite differently from medication, one approach seen as 'psychological', the other as 'medical'. However, the combination of behavioural approaches with medication could mean that lower doses of drugs could be used to treat children with ADHD, offering some protection from associated side effects including insomnia, loss of appetite, weight loss and growth restriction.
ADHD is the commonest neurodevelopmental disorder, affecting between one and five per cent of children worldwide. Typically, children with ADHD are impulsive, easily distracted and many have difficulty with their social development and learning, often causing them to fall behind at school. While previous studies have supported the argument that ADHD may be a genetic condition, the causes of the disorder are still poorly understood. The new Nottingham study will centre on the theory that a fundamental problem in ADHD may lie in the brain's regulation of its 'braking system' responsible for inhibiting or controlling behaviour before it occurs. It is groundbreaking and novel in that it will combine the focus on these inhibition difficulties with what is known about the role of motivation.
The main drug used to treat ADHD, methylphenidate (commonly known as Ritalin), works by increasing levels of the brain chemical dopamine, which may in turn help by kick-starting this inhibitory system. The researchers from the University's Division of Psychiatry and School of Psychology will be using a novel approach by investigating whether offering greater incentives and rewards to children with ADHD also improves their inhibitory control in a similar way to medication.
Professor Chris Hollis, who is leading the research, said: “Both behavioural and drug treatments have an affect on the brain — what's unique about this study is that in this case we believe both increase motivation and thereby switch on the brain's 'braking mechanism'.
“Understanding how medication and a system of incentives and rewards interact is very important. Currently, when dealing with children with ADHD it tends to be that either medication or behavioural treatment is prescribed. If we can show that both work in a similar way, we are then in a position to develop more effective behavioural treatments and possibly reduce the reliance on medication.”
Over the course of the three-year project, funded with more than half a million pounds from the Wellcome Trust, the team will use functional magnetic resonance imaging and recordings of brain electrical activity to study the brain functions of both normally developing children and those with ADHD taking drugs for the condition. The project draws on expertise across the disciplines of clinical and cognitive neuroscience: ADHD (Professor Chris Hollis), electroencephalography (Dr Mario Liotti), functional magnetic resonance imaging (Professor Peter Liddle) and cognitive development (Dr Gaia Scerif).
It is hoped that by asking the two groups of children to perform simple computer tasks while measuring brain activity, the researchers can identify the mechanisms at work when either medication or rewards for correct performance are given.
The project will also study a number of genes that have been linked to ADHD —in an effort to tailor the most effective intervention to the child's genetic profile.
When more is understood about the processes involved, child psychiatrists, paediatricians and child psychologists may be able to work much more closely to develop a programme of combined medication and behavioural approaches that are tailored to the individual child.
The researchers will work with a local support group, RUSH, to recruit young people aged seven to 17 years old who have ADHD to volunteer for the study. Focusing on this broad age group will allow the researchers to get a clearer idea of how the disorder may change as the child gets older.
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