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Reinforcement Processing as a Predictor of Behavioral Treatment Response in the ADHD Summer Treatment Program

James D. Lynch,Allison P. Fisher,Gabriela M. Rodríguez,Allison K. Zoromski,Heather A. Ciesielski,Jeffery N. Epstein

Published 2024 in Evidence-Based Practice in Child and Adolescent Mental Health

ABSTRACT

ABSTRACT Background Behavioral interventions for attention-deficit/hyperactivity disorder (ADHD) are well-established interventions, but not all children benefit from these approaches. One factor that may accurately predict treatment outcomes is how individuals process reinforcement. Objective The present study examined the association between reinforcement processing and treatment response to a well-established behavioral intervention for ADHD, the Summer Treatment Program (STP). Methods Participants included two cohorts of patients from a Midwest academic medical center STP (n = 47). Reinforcement processing was assessed via a parent-rated questionnaire and computerized neuropsychological tasks. Behavioral improvement was determined from weekly parent- and counselor-rated measures of children’s behavior over the course of the STP, as well as from STP behavioral data. Repeated measures mixed-linear models were used to determine associations between the reinforcement processing predictors and behavioral ratings. Results Greater parent-rated child impulsive/fun-seeking behavior was significantly associated with both greater counselor- and parent-rated behavioral difficulties. However, greater parent-rated child reward responsiveness was significantly associated with lower counselor-rated behavioral difficulties. Objective, task-based measures did not have any significant associations. Conclusions Impulsive/fun-seeking behaviors appear to be the strongest predictor of behavioral treatment response, with results suggesting that children with high rates of these behaviors might benefit from higher rates or values of positive reinforcement to outweigh the immediate reinforcement gained by negative behavior. Reward responsiveness results suggest that a match between a child’s specific reward preferences and the types of reinforcement provided by a behavioral intervention may also be important to treatment outcomes.

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