ADHD: Prolonged MPH Treatment Restores Normal Response to Rewards

Attention-deficit/hyperactivity disorder (ADHD) is characterized by abnormal behavioral traits such as inattention, impulsivity and hyperactivity.

It is also associated with impaired processing of reward in the brain, meaning that patients need much greater rewards to become motivated.

One of the common treatments for ADHD, methylphenidate (MPH), is known to improve reward processing in the short term, but the long-term effects have remained unclear.

Kei Mizuno from the RIKEN Center for Life Science Technologies, in collaboration with colleagues from several other Japanese research institutions, has now demonstrated that prolonged treatment with MPH brings about stable changes in brain activity that improve reward processing with a commensurate improvement in ADHD symptoms.

ADHD is thought to affect up to 5% of children worldwide, and about half of those will go on to experience symptoms of the disorder into adulthood.

MPH treats the disorder by increasing the levels of the brain chemical dopamine, which is involved in reward processing.

To understand the effect of MPH on ADHD symptoms and specifically reward processing over the longer term, the researchers studied the reward response behavior of ADHD and healthy patients—all children or adolescents—before and after treatment with osmotic release oral system (OROS) MPH.

They used functional magnetic resonance imaging (fMRI) to measure brain activity during a task that saw participants rewarded with payment, but in two different scenarios: a high and a low monetary reward condition.

"In the high monetary reward condition, participants earned higher than the expected reward; whereas in the low monetary condition, participants earned an average reward that was consistently lower than expected," says Mizuno.

The brain images showed that before treatment with OROS-MPH, ADHD patients had lower than normal sensitivity to reward, as demonstrated by their abnormally low brain activity in two parts of the brain associated with reward processing—the nucleus accumbens and the thalamus—during testing under the low monetary reward scenario.

However, after three months of treatment with OROS-MPH, there was no difference in the activity of these brain areas in ADHD patients compared with the healthy controls under any of the reward conditions.

Their sensitivity to reward had returned to normal, and the patients' other ADHD symptoms also showed improvement.

Mizuno says that this study goes further than previous work. "We knew that acute MPH treatment improves reward processing in ADHD," he explains.

"Now we've revealed that decreased reward sensitivity and ADHD symptoms are improved by treatment for three months."

More information: Mizuno, K., et al. Osmotic release oral system-methylphenidate improves neural activity during low reward processing in children and adolescents with attention-deficit/hyperactivity disorder. NeuroImage: Clinical 2, 366–376 (2013). dx.doi.org/10.1016/j.nicl.2013.03.004

Rewarding Children and Playing is not about Toys

Xmas is over and your purse is empty. So now you can forget consumerism for another year but how are you going to keep the kids happy now?


Well, forget trying to buy the happiness of your children with stuff because that does not work.

No amount of shiney beads and fluffy toys can replace the love and enjoyment they get from just being with their parents. They crave your attention. Do they not smile and run towards you at every opportunity.

They want to feel that they are a vital part of your life. They want to be with you and they want you to simply play with them. They want you to help them grow, learn new things from you and to grow up more like you or is that something given over to the 'nanny.'

Fun and Adventure
The greatest pleasure your children get is when you sit down with them and play a game or read them a story. OK, it can be difficult to get them to fit in with your busy schedule or to get them straight off to sleep at the first chime of the clock but believe me when I say, a child who feels loved, secure and embraced by a loving family or parent, is going to sleep better, have good dreams and wake up refreshed the next morning. They will start every day by looking forward to another fun filled adventure in your world.

Quality Time
It's a much used and abused phrase, 'quality time' but it's still an important concept. It is vitally important that you spend time with your children, fully involved in their activities, being a part of their imaginative and exploring play.

Attention substitutes
It is not good enough to simply give your children toys and expect them to go away and play with them and not give them your attention as well. Remember, supplying them with toys is a great way of avoiding the responsibility of playing with your children.

The same thing applies to sitting them down in front of the TV. Is that really what you intended?

Down and dirty
When was the last time you got down on the floor with your children, entered their world and actually played with them. How often have your children had more fun with the packaging and boxes that presents came in, than with the very expensive toy that was in it.

Remote view
If you do not spend time playing with your children then you are disconnected from them. You don't really know who they are, what they really want or what they are experiencing on a daily basis.

Teenage angst
This may not seem to be an issue now but wait until they grow into teenagers and you discover that you have no 'history' or relationship established with them.

You're missing out
There is a big piece of the puzzle missing, preventing you from being a 'complete' parent. You are not fully experiencing the 'joy' of being a parent and arguably, you cannot have a full grasp on what it is to be part of a 'complete' family.

The way ahead
Don't panic! There is hope for you and your children but you will need to make time for them and you will need to play with them.

Start by sitting down with them and asking them simply what their favourite toys are and why. This will spark off a whole series of stories and conversations with them.

Add value
The next thing is to add value to their play. Help them do something or make something that they cannot do on their own. This can be as simple as making cardboard or paper cutouts of animals and pasting them together to make 'disposable' toys.

This can be great fun at this time of year with plenty of Xmas cards to be recycled, there are a number of websites that offer free templates for toys and games. Another simple activity is painting and decorating clay flower pots and it brightens up a dull terrace or winter garden.

Projects
More complicated things like treehouses, bird tables, squirrel feeders, etc. or my particular favourites; water rockets and soapbox carts made from scrap wood and old pram wheels. These can be easily knocked together with a little effort and some simple tools.

The great joy for the kids is to see a 'project' come together, to be a part of it and to 'share' and be involved in the experience. Under no circumstances do you exclude them. At the very least, let them name it and paint the name on it. After that, it's all about playing and having fun with your parent(s).

Remember, the end result is of little concern. The level of 'sophistication' is of no interest to the children and should not get in the way of that special time spent 'playing with Mum/Dad.'

Teenagers 'n Geeks
If you are really feeling adveturous and have a geeky hi-tech streak in you, try some of the DIY projects from the MIT. I particularly like the Sea Pearch - underwater ROV with on-board cameras. It puts a whole new slant on rock pooling and fishing off the end of the pier.

Summary
So, the next time you are looking for a way to 'reward' your children consider this; spend some time with them. Take them to the Zoo, the beach or a play park and kick a ball or throw a frizbee for them. Your family will be healthier, happier and fitter for it.