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January 2011




Today I wanted to write about a study published recently in the journal Biological Psychiatry, which surprisingly didn’t get much press coverage. The study examined the way that rewards and consequences affect how kids with oppositional defiant disorder make decisions. Previous studies suggest that kids with ODD and conduct disorder have a reduced physiological response to aversive conditions, such as punishment. This is often used to explain why these kids don’t respond well to discipline styles that relay solely or mostly on punishment. But few studies have examined how different types of rewards and consequences actually affect the way these kids make decisions.

In this study a Dutch team used a modified version of a game called the Iowa Gambling Task. In this task, people are asked to choose a card from 4 decks.  Each card has a reward and a penalty. In some decks, the reward is large but the penalty also tends to be high. In other decks the reward is low, but the penalty is also low and often non-existing. In the long run, you earn more money by selecting cards from the low reward decks. Most people realize this quickly and begin to draw cards from the low reward decks more often than from the more risky decks.

In this study the authors examined the performance to a modified version of this task among 18 children with oppositional defiant disorder and 24 non-affected peers. The modified task included 3 conditions decks):

Choice 1 was the advantageous choice.  Cards from this choice included small rewards every trial and small penalties every 3rd trial. In the long run, you make money if you select this choice often.

Choice 2 was the seductive choice. Cards from this choice included large rewards in every trial but very large penalties every 3rd trial. In the long run, you lose money if you select this choice often.

Choice 3 was the disadvantageous choice. Cards from this choice included small rewards in every trial but very largerd trial. penalties every 3

Furthermore, as the game progress either the magnitude or the frequency of the penalties increased linearly. That is, in the magnitude condition, the size of the penalties increased. In the frequency condition, the penalty was provided progressively more often.

Below you can see the performance of the non-affected peers in the magnitude condition.

Non-affected Peers during magnitude condition

As you can see, by trial 18 the kids have increased the selection of the advantageous choice and have decreased the selection of the other two choices. Now see below the performance of kids with ODD in the magnitude condition.

ODD Kids during magnitude condition

Similarly to their non-affected peers, kids with ODD showed a decrease in preference for the disadvantageous choice by the 18th trial. However, they continued to select the seductive (but eventually disadvantageous) and the advantageous conditions equally. Furthermore, the ODD kids had a significantly greater preference for the seductive and disadvantageous condition when compared to their peers.

ODD and peers during the frequency condition

It is very interesting that the size of the penalties increased equally in the seductive and the disadvantageous conditions, yet the ODD kids seemed to prefer the advantageous and the seductive position equally. What does this mean? That in the face of increasing penalties, the child’s behavior doesn’t change if the reward is high!!! It is only in conditions of low reward, that increasing the magnitude (severity) of penalties led to a change in behavior. Here, by ‘reward’ I’m taking about the child’s gain obtained from their actions. So for example, a child that receives significant pleasure from engaging in one activity would not respond to increasing the intensity of penalties for engaging in such activities.

Now, see the performance of both groups of children in the frequency condition. Remember, in this condition the size of the penalty does not increase. Instead, the frequency of the penalty is what increases.

The results of this condition were actually the opposite! The ODD kids showed a greater preference for the advantageous condition as the frequency of penalties increased than their non-affected peers! In this case the size of the reward did not make a difference. Facing more frequent (as opposed to larger) penalties, the ODD kids rapidly desisted from picking the “high reward – high penalty” choice and instead increased their preference for the low reward-low penalty choice.

In sum, the results from the magnitude condition were a bit surprising. The fact that ODD children showed a decrease in preference for the disadvantageous choice shows that they in fact respond to negative consequences. However, the fact that they didn’t decrease the selection of the seductive choice, suggests that they do not respond to increasing the intensity of consequences if the benefits of their actions are high. On the other hand, the results from the frequency condition were very surprising. It is often believed that children with OOD have difficulty responding to consequences, even severe consequences. Yet these results suggest that they are as responsive to consequences as their non-affected peers if the consequences increase in frequency rather than intensity! Although generalizing these results to real life behavior management is not a simple process, this is the type of research that could have a major impact on the development of new interventions for children with conduct problems.


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