"Inattentive”, “naughty”, “lazy”. Nine-year-old Vinay (name changed) had grown accustomed to being told off by his teachers at school. His report cards, through primary and secondary school, were curiously erratic — he would score brilliantly in some examinations and fare poorly in others. Once, as “punishment”, his exam sheet (on which he had scored a single digit) was pinned to his shirt.
Vinay’s case is among scores that Vasudha Prakash, founder-director of the Chennai-based V-Excel Educational Trust for children with special needs, has encountered.
“There is now growing awareness, but teachers — and parents — often just do not recognise the signs of attention-deficit/hyperactivity disorder (ADHD) in children. And they don’t know how to address it. This can translate into hugely humiliating scenarios for the child,” says Dr. Prakash.
Commonly diagnosed disorder Around the globe, between 6 to 7 per cent of children are diagnosed with ADHD, making it the most commonly diagnosed paediatric neurodevelopmental disorder. It is associated most frequently with inattentiveness, hyperactivity and impulsivity.
Now, a new research paper adds a vital new dimension to the existing literature on ADHD. It looks at an understudied core of the condition: an acute difficulty in adapting to changing situations (a child, for instance, might continue to talk to his classmates even after lessons begin). And one that can help give caregivers and educationists an insight into the condition.
To understand responses to changing “reinforcement contingencies” (or actions that get socially rewarded) in children with ADHD, researchers devised a simple game-based experiment. A group of 167 children — 97 of them with ADHD — participated in a “signal detection” task, where they were shown on a screen a chequerboard of red and blue cartoon characters.
They were told to press one of two buttons to indicate which characters were more predominant on the screen: red or blue.
The correct responses, the children were told, would (sometimes) earn them rewards — in the form of a message on the screen ‘You won a token, well done!’ or verbal praise from the experimenter (for example, ‘good’, ‘that’s right’) and a coloured token placed near the child. When the answer was incorrect, the screen remained blank and the experimenter silent.
At the beginning of the experiment, more blues were rewarded and then later, the cue was reversed and more reds were rewarded. The reward stimulus was switched again to blue.
The results, published in the latest issue of the Journal of Child Psychology and Psychiatry , were unambiguous. While children with ADHD initially did develop a bias toward the more frequently-rewarded colour and later shifted their bias to the new colour, “this shift was significantly smaller” than in children without ADHD, says the paper, adding that “This indicates poorer behavioral adaptation to changing reinforcement contingencies in children with ADHD.”
In other words, children without ADHD were more willing to “abandon a pattern of behavior that is no longer effective, reinstating a previously effective strategy”. Children with ADHD, on the other hand, were “persisting with an unsuccessful strategy.”
In context
Co-author of the paper Gail Tripp, who is director of the Human Development Neurobiology Unit of the Okinawa Institute of Science and Technology Graduate University, Japan, explained what this means for a child with ADHD in daily life: “An example for children in school might be that in the playground they might be rewarded for running fast, or for entertaining their friends with stories and jokes (i.e. their friends laugh, praise them, encourage them for these behaviours), but in the classroom these are not the behaviours that are praised or rewarded.”
The research reminds parents and teachers “that children with ADHD are not deliberately misbehaving, and that they may better adapt their behaviour to a given situation if they are made aware or reminded of the expectations of a given situation and also warned/reminded when these expectations change”. In a way, it gives parents and teachers “permission to provide more support or scaffolding to help children with ADHD adapt their behaviour to the different and changing situations they find themselves in,” Prof. Tripp told The Hindu .
divya.gandhi@thehindu.co.in
