Review of the Evidence for Motivation Deficits in Youth with ADHD and Their Association with Functional Outcomes

Abstract

Preeminent theories of attention-deficit/hyperactivity disorder (ADHD) suggest that motivation deficits are core underlying features of the disorder. However, it is currently unclear whether empirical evidence supports the assertion that significant group (ADHD v. comparison) differences in motivation exist or that problems with motivation contribute to the functional impairments that youth with ADHD experience. Accordingly, this review focused on evaluating and summarizing the empirical literature on the presence of motivation deficits and their association with functional outcomes in samples of youth with ADHD. Twenty studies met the review inclusion criteria. Results support the assertion that youth with ADHD have lower academic-related motivation in comparison to their peers and that motivation plays an important role in academic outcomes, with the strongest evidence to date for reading achievement. However, the available evidence is limited, and few existing studies are aligned with the much larger theoretical and empirical motivation literature in typically developing youth. Given preliminary evidence that motivation plays a role in the academic impairments of youth with ADHD, the review concludes with a discussion of whether current ADHD interventions adequately target motivation and highlights important future directions.

How to Improve Behavioral Parent and Teacher Training for Children with ADHD: Integrating Empirical Research on Learning and Motivation into Treatment

“…Behavior therapy is defined as being based upon empirical psychology and striving toward continuous development (Margraf 1998 ). The body of empirical evidence for specific deficits in motivation or altered processing of reinforcement (Luman et al 2005 , 2010 ; Smith and Langberg 2018 ) has not, to our knowledge, led to adaptation of the core elements or delivery of BPTs in ADHD. In other areas of psychopathology evidence from experimental studies on core deficits and treatment methods has clearly changed the way the basic elements of behavioral treatments are implemented (Emmelkamp et al 2013 ; Wittchen et al 2014 ).…”

“…There clearly seems to be a research-practice gap given that a sizable body of empirical and theoretical work has been conducted on motivational deficits in ADHD (for reviews see Luman et al 2005 , 2010 ; Smith and Langberg 2018 ; note there is much less research available on punishment). Therefore in the current paper, we first discuss the core elements of most behavioral parent/teacher training programs used in samples of children with ADHD, next we highlight the relevant motivational accounts of ADHD for BPT (i.e., those that focus on instrumental learning in ADHD) their predictions for the behavior of children with ADHD in response to reward and punishment, and the empirical evidence for the behavioral predictions arising from these theories.…”

Event-Based Prospective Memory Deficit in Children with ADHD: Underlying Cognitive Factors and Association with Symptoms

“…Another element to take into account when studying PM performances of children with ADHD is the reward amount. Individuals with ADHD exhibit an alteration of reward mechanisms, resulting in an aberrant sensitivity to reinforcement [39]. These alterations have been linked to the concept of delay aversion, which indicates the preference for small immediate rewards over large, delayed rewards [40,41].…”

Neurofeedback in ADHD: A qualitative study of strategy use in slow cortical potential training

“…Various cognitive training procedures have reported positive effects of including game-elements in order to increase motivation within cognitive treatment approaches [63][64][65]. Evidence suggests that young individuals with ADHD have lower levels of motivation, as indicated by alterations of cognitiveattentional and motivational neural networks [66], reduced self-regulation of motivation [67], as well as low task engagement and performance in the school context [68]. These motivational alterations of individuals with ADHD are likely to be associated with dysregulation of the dopamine pathway [69][70][71][72][73].…”