Kids with ADHD Thrive When "Unspoken" Rules are Clearly Explained

A new study finds that children with attention-deficit/hyperactivity disorder (ADHD) are less inclined to intuitively notice subtle rule changes relating to behavior. For example, they may have trouble detecting the unspoken rule that behavior should shift from playful to serious — such as during the transition from a game to a test — particularly when it all takes place in the same classroom. This misunderstanding often leads to inappropriate behavior.

However, explicitly explaining these otherwise unspoken rule changes will greatly improve understanding, and therefore behavior, in children with ADHD, say the team of researchers from Japan and New Zealand.

“What we argue is that, for these children, we need to make explicit what the requirements are in any given situations,” said Professor Gail Tripp, director of the Human Developmental Neurobiology Unit at the Okinawa Institute of Science and Technology Graduate University (OIST).

“So, we are not relying on them to identify what the conditions are, but we are actually explicitly telling them: this is what you will be rewarded for. And we also need to tell them when we are no longer going to reward them for that.”

“All of us tend to repeat those actions that get rewarded. That’s how we learn: we do the things that have a positive outcome for us.”

For the study, the scientists explored how children with attention deficit disorder behave when they play a game that has rules that change slightly, without explanation. The researchers tested 167 children (more than half with ADHD) between the ages of 8 and 13 in Japan and New Zealand.

All of the young participants played a simple game in which they had to decide if there were more blue or red faces on the screen in front of them. The screen showed a ten by ten grid full of mixed blue and red faces, and the children were asked to push a blue or red button according to the predominant color they saw on the screen.

The game had some specific rules. The researchers explained to the children that they were going to receive verbal praise and a plastic token when they choose the right answer — but only sometimes and not each time they choose correctly.

At first, the children were rewarded four times more often for correct ‘blue’ answers. Then, after 20 rewards, the researchers began to reward the children more often for correct ‘red’ answers. Finally, after another 20 rewards, the game switched back to rewarding more frequently for ‘blue’ answers. This change in the rewarding system was not explained to the children.

The findings reveal that, initially, the children developed a bias for blue. In fact, when in doubt, the children started to give the answer that was rewarded more often during the first part of the game.

However, when the rewarding system switched to red, differences began to emerge among the children. Kids without attention deficit hyperactivity disorder started showing a clear bias for red, while children with ADHD shifted only slightly their answers towards red.

Furthermore, when the rewarding system switched back to favoring blue, the gap in behavior widened. Typically developing children went back to more often choosing blue, while children with ADHD almost did not change their answers’ pattern.

Therefore, as the rewarding system flip-flopped between blue and red, the children had to intuitively adapt to maximize their chances to get a reward. The data suggests that children with ADHD were not as good as typically developing children at responding to such unspoken changes.

“I am really excited about this research, because I think it has important implications for how we manage the behavior of children with ADHD,” said Tripp.

Children with ADHD are not naughty children. They may appear to misbehave and they may appear not to follow the rules, but this research suggests that this happens because they are not picking up on subtle rules changes.

“Explaining the requirements in any given situation, and rewarding them accordingly, is not spoiling them,” said Tripp. “It is a good parenting strategy. It is about trying to give them the same life opportunities.”

Their findings are published in the Journal of Child Psychology and Psychiatry.

Source: Okinawa Institute of Science and Technology Graduate University