Reward sensitivity in ADHD: what do we know and how can we use it?

Children and adults with attention-deficit/hyperactivity disorder (ADHD) experience concentration problems and/or excessive impulsivity and restlessness. Worldwide, there has already been a lot of research conducted on the role of sensitivity to reward in ADHD. Therefore, this thesis includes systematic literature reviews to summarize knowledge about several aspects of reward sensitivity in ADHD. In the first literature review, we found evidence that children and adolescents with ADHD take more risks on gambling tasks than peers without ADHD, in which they often prefer a less likely, large reward over a more likely, smaller reward. This evidence is weaker for adults with ADHD. A second literature review revealed that children with ADHD often respond in the same way to social rewards than other children and are sometimes even hyperresponsive to social rewards. Thus, children with ADHD may have more difficulty estimating risks but do not necessarily differ in their sensitivity to social rewards. The third literature review concerned a meta-analysis based on 40 years of educational research, assessing the effectiveness of classroom interventions for ADHD. This review showed that classroom interventions using rewards (linked to desired behavior) result in large improvements in behavior of students with symptoms of ADHD. Finally, a survey study among teachers provided important insights into Dutch teachers’ experiences with such evidence-based effective classroom interventions for ADHD. These findings emphasize the need for (the development of) adequate teacher support and for bridging the gap between science and practice.