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 large penalties every 3rd trial.

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.

The reference:
Luman, M., Sergeant, J., Knol, D., & Oosterlaan, J. (2010). Impaired Decision Making in Oppositional Defiant Disorder Related to Altered Psychophysiological Responses to Reinforcement Biological Psychiatry DOI: 10.1016/j.biopsych.2009.12.037

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6 Responses to Kids with Oppositional Defiant Disorder respond to frequency but not intensity of consequences!

  1. Ron Huxley says:

    This is very interesting information. I am not sure how to apply it in a way that can help parents. You certainly can suggest parents offer more frequent negative consequences. I am also curious about the interest in the seductive rewards you mentioned in this research. Is their a different type of payoff/reward that ODD children are getting from the activity or game itself. Perhaps the outcome (positive or negative) is not as enjoyable as the risk taking nature of the game itself.

  2. Karen DeBolt says:

    This is fascinating information. I think the key is that even mildly negative consequences given frequently were more effective than infrequent severe consequences. I think that this could very dramatically impact a behavior plan.

    In other words, applying a 2 minute time out given consistently for a behavior that you are working on actively is more effective than mild warnings leading up to a big melt down. I don’t think this is big news to any of us that work with families.

    The secondary gain of the excitement of anticipation before you actually pick a card from the seductive pile is also quite telling. That little adrenaline hit may be more exciting than the actual small reward of the advantageous pile to these children. Perhaps setting up a reward system that contains that element of the unknown would be very enticing and motivating to these children??? With the caveat that we are not trying to create little gamblers here!

    Thank you for this interesting article! Definitely food for thought.. .

  3. [...] a very interesting article on ODD children a while back that I thought I’d share with you: http://www.child-psych.org/2010/04/oppositional-defiant-disorder-what-type-o.html#more-1073. We all know how difficult it is to get ODD kids to behave. Not only do they know what they want to [...]

  4. Rochel Speal says:

    This study confirms what I’ve seen in working with difficult children: you need to be consistent not only in what you give consequences for, but also in how frequently you give them. Basically, all kids-not just ODD kids- will test you and try and see how serious you are about what you say. If they feel you are not serious or not willing to follow through, they will try and go as far as they can.

    One of the things that differentiates ODD kids is that they are extremely persistent in trying to get what they want. They can outargue, outmaneuver, and just plain wear you down- if you let them. Where most kids would just give up, they are just getting started.

    I find that if you are able to catch yourself before you get into an argument with them (you may need someone else to help point this out to you when it happens-it often happens before you even realize it), you’ve already won half the battle.

    The other important factor that works is not letting anything go-even the little stuff. Good teachers know this; if they see a child in class start to act up, they never let it pass, because the behavior will eventually spiral out of control. They will use very clear but non-confrontational methods to stop the behavior.

    The NY Times has an article about an educator who developed a teacher training system by observing master teachers. In the article at http://www.nytimes.com/2010/03/07/magazine/07Teachers-t.html?emc=eta1 you can watch how master teachers do this and apply it in your home.

    As for giving rewards-especially “surprise” rewards, this is unlikely to work for the long-term, and will possibly even backfire. Generally while ODD children like surprises they like to be in charge of the surprises. They would view this as a trick or an attempt to somehow gain control over them. You would have to give them such a big reward to make it worthwhile for them that in the end it would not be worthwhile for you.

    My experience working with kids shows that timing- out kids for every little thing works wonders. My article goes into more detail about this. The only time I use rewards is when a parent needs to get a very aggressive or abusive child into time-out. Then those rewards involve a point system where the child first has to earn privileges that up until then he or she considered a right. After those privileges are earned, then they can begin to earn the “extras.” But again, this only goes on for a limited time period, perhaps 6 weeks at most.

    Good luck to all of you out there with a difficult child, and thanks for the great article I might not otherwise have seen!

  5. Sheila C says:

    LOLOL. (story continued)…

    until the ‘child’ reaches the age of 16 when all of this research goes to the wind and the only thing that works is medication to alleviate the stress which triggers the anti-social behavior. That, and support groups for parents utterly fed up with the constant confrontations and emotional upheaval from their darling little offspring that they’re ready for the rubber room.

    I am amazed at the simplicity of ‘research.’ Come now. We all know that ODD kids are desensitized to consequences – that they have an uncanny resistance to aversion techniques that will curtail the behavior of non-ODD children. This is news how?

    Not to pop a balloon, but parents dealing with ODD children had this figured out by year one.

  6. HI EVERYONE! There needs to be another crucial factor added into the body of research sited! Without taking into account the effects of personality and temperament there is no systematic way to diagnose whether or not young children are acting out of individual (personal) traits, experience (once in a while behavior) or personal and inherited traits , or extreme and deviant behavior! Thomas and Chess, S. Escalona, et al., are the experts in this research. You will find this hugely helpful as an element of testing or just observing! Referrals and other means of intervention are hugely enhanced by adding info of this kind along with diagnostics ……write back what you think!
    Susan Turben

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