Lack of inhibition: a motivational deficit in children with attention deficit/hyperactivity disorder and children with traumatic brain injury
Abstract
Recent research has demonstrated that both brain-injured children and children with attention deficit/hyperactivity disorder (ADHD) suffer from response inhibition deficits. To investigate whether these deficits can be influenced by motivational factors, the stop-signal task was performed with and without reward contingencies for successful inhibition. Three groups of children between 8 and 12 years of age, participated in the study: 31 children with ADHD, 37 with traumatic brain injuries (TBI), and 26 normal controls. Results indicated that, although all groups showed comparable learning effects, reward contingencies had different effects on the groups. Whereas the performance of children with ADHD under reward contingencies were brought up to the performance level of normal controls, rewards were found less effective at improving response inhibition in children with TBI. The results further support a motivational/energetic explanation of the inhibitory deficit in children with ADHD, and of a primary response inhibition deficit due to structural brain damage in children with TBI.
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The CEM explains a phenomenon that performance can be improved to normal levels under conditions that are thought to increase arousal and/or motivation, such as the provision of external rewards or the faster presentation of stimuli.
“It explained a phenomenon that performance can be improved to normal levels under conditions that are thought to increase arousal and/or motivation, such as the provision of external rewards (Konrad et al., 2000; Slusarek et al., 2001) or the faster presentation of stimuli (Scheres et al., 2001).”
From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Konrad et al., 2000
Boys with ADHD were particularly hyperresponsive to social rewards (smiles and friendly faces) in a previous behavioral study.
“In a previous behavioral study, we could demonstrate that boys with ADHD were particularly hyperresponsive to social rewards (i.e., smiles and friendly faces), indicating that the motivational context as defined by the type of attainable reward plays a significant role in influencing goal-directed behavior in children and adolescents with ADHD versus typically developing controls (Geurts et al., 2”
From Differentiating neural reward responsiveness in autism versus ADHD (2014) · cites this paper as Konrad et al., 2000
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BackgroundAbnormal striatal BOLD responses to reward anticipation and reward delivery in ADHD
Furukawa, E., Bado, P., Tripp, G., Mattos, P., Wickens, J. R., Bramati, I. E., Alsop, B., Ferreira, F. M., Lima, D., Tovar-Moll, F., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0089129 · Cited by 90 · see citing works
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“2007; Karalunas & Huang-Pollock, 2013), or following the introduction of incentives (Konrad et al. 2000; Slusarek et al. 2001; Kuntsi et al. 2009), and contradict inhibitory theories (Barkley, 1997; Quay, 1997; Wood et al.”
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ResultSteenbergen, L., Sellaro, R., Stock, A., Beste, C., & Colzato, L. S. (2015) · PLoS ONE · doi:10.1371/journal.pone.0144364 · Cited by 73 · see citing works
What would Karl Popper say? Are current psychological theories of ADHD falsifiable?
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“Other studies have reported inhibitory control deficits in TBI individuals in go-no-go tasks (Konrad et al., 2000a,b), stop-signal tasks (Schachar et al., 2004), and shifting tasks (Levin et al., 1993). executive function in tRaumatic bRain injuRy Adolescents with TBI frequently have disruptions of…”
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Gorman, S. A., Barnes, M. A., Swank, P. R., Prasad, M. R., & Ewing‐Cobbs, L. (2011) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617711001251 · Cited by 46 · see citing works
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“Konrad et al 2000 [37] Comparative study Three groups (n 1⁄494) ages 8-12 years (ADHD 1⁄4 31, TBI 1⁄4 37, normal controls 1⁄4 26), TBI group 6 months to 6 years after injury; Germany Reward conditions during tasks”
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“Studies examining the impact of contingencies on SST performance have used reinforcement either by itself (Huang-Pollock et al. 2007; Konrad et al. 2000; Scheres et al. 2001; Stevens et al. 2002), or in combination with or in comparison to punishment (Michel et al.”
InfluentialTatla, S. K., Sauve, K., Jarus, T., Virji‐Babul, N., & Holsti, L. (2014) · Brain Injury · doi:10.3109/02699052.2014.890747 · Cited by 43 · see citing works
“47) in response to reward reinforcement (level II–W) [20].”
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“However, the ADHD groups were not directly compared in this study (Konrad et al., 2000b), so it is unknown whether or not they responded similarly to reward.”
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“The hypothesis also concurs with observations that cognitive deficits in children with ADHD can be remediated by increases in motivation (Konrad et al., 2000; Slusarek et al., 2001; Uebel et al., 2010), although inconsistent findings have also been reported (Oosterlaan and Sergeant, 1998; Desman et al.”
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Self-citationWhen response inhibition is followed by response reengagement: an event-related fMRI study
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“…mental and neurological disorders (e.g., attention deficit hyperactivity disorder, obsessive-compulsive disor- der, trichotillomania, and Parkinson’s disease [Aron et al., 2003a; Chamberlain et al., 2006; Gauggel et al., 2004; Konrad et al., 2000a,b; Rieger et al., 2003; Van den Wildenberg, 2006]).”
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“…that motivationally salient rewards can normalize the impaired cognitive functions associated with ADHD (Dovis et al., 2012; Kohls et al., 2009; Konrad et al., 2000; Rubia et al., 2009; Shiels et al., 2008), and with the proposal that ACC is responsible for motivating task selection and…”
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Theory of mind in children with traumatic brain injury
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“Difficulties with behavioural response inhibition in children with TBI have been found in a number of studies [52, 53] and others have shown that reward contingencies were less effective in improving behavioural inhibition than in children with TBI than with attention deficit hyperactivity disorder [54], supporting th…”
Reinforcement, Dopamine and Rodent Models in Drug Development for ADHD
Tripp, G., & Wickens, J. R. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0132-y · Cited by 33 · see citing works
“[33], Luman et al.”
The Effect of Reinforcement Variables on Inhibition in Children with ADHD
Michel, J. A., Kerns, K. A., & Mateer, C. A. (2005) · Child Neuropsychology · doi:10.1080/092970490911270 · Cited by 32 · see citing works
“In one study ( Konrad, Gauggel, Manz, & Scholl, 2000 ), children with ADHD showed a comparable practice effect to children with traumatic brain injury and nonclinical controls.”
ResultTohda, C., Nakanishi, R., & Kadowaki, M. (2008) · Brain and Development · doi:10.1016/j.braindev.2008.04.006 · Cited by 29 · see citing works
“The core features of ADHD are inattention, and impairments in motor inhibition, impulsivity [12], motivation-deficit [13–16] learning and memory impairement [17].”
BackgroundDisorders of Attention and Impulse Regulation
Nigg, J. T., Hinshaw, S. P., & Huang‐Pollock, C. L. (2015) · Wiley eBooks · doi:10.1002/9780470939406.ch9 · Cited by 29 · see citing works
Inhibitory control after traumatic brain injury in children
Sinopoli, K. J., & Dennis, M. (2011) · International Journal of Developmental Neuroscience · doi:10.1016/j.ijdevneu.2011.08.006 · Cited by 28 · see citing works
“Similarly, Konrad et al. (2000a) reported that children with TBI make an increased number of commission errors, but this effect was found only with a long delay between the onset of the go and no-go stimuli, which suggests delay aversion rather than restraint as the impaired process.”
BackgroundMethodInfluentialVidarte, J. A., García-Noblejas, M. E., & García, M. A. G. (2009) · Revista de Neurología · doi:10.33588/rn.4902.2008619 · Cited by 22 · see citing works
Stephens, J. A., Salorio, C. F., Gomes, J. P., Nebel, M. B., Mostofsky, S. H., & Suskauer, S. J. (2017) · Journal of Neurotrauma · doi:10.1089/neu.2017.5081 · Cited by 21 · see citing works
“To determine if response inhibition can be augmented with reward, one study used a motivational SST in a population of children with moderate to severe TBI.(6) They found that motivation improved performance in children with chronic TBI (> 6 months post-injury), but that children with attention-deficit/hyperactivity d…”
Obesity in children and adolescents with acquired brain injury
Patradoon‐Ho, P. S., Scheinberg, A. M., & Baur, L. A. (2005) · Developmental Neurorehabilitation · doi:10.1080/13638490500049578 · Cited by 20 · see citing works
“For example, disinhibition in children and adolescents with ABI is more resistant to behavioural management strategy than disinhibition due to other causes [21].”
BackgroundManaging dysexecutive disorders
Mahone, E. M., & Slomine, B. S. (2001) · Cambridge University Press eBooks · doi:10.1017/cbo9780511545894.014 · Cited by 20 · see citing works
Wilbertz, G., Delgado, M. R., Tebartz Van Elst, L., Maier, S., Philipsen, A., & Blechert, J. (2017) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2015.1112032 · Cited by 18 · see citing works
“Behaviourally, individuals with ADHD often show performance deficits compared to healthy controls in tasks without reward but tend to increase their performance to a greater extent than healthy controls when reward is provided (Konrad et al. 2000; Marx et al. 2013).”
Emotional memory in ADHD patients with and without comorbid ODD/CD
Krauel, K., Düzel, E., Hinrichs, H., Rellum, T., Santel, S., & Baving, L. (2008) · Journal of Neural Transmission · doi:10.1007/s00702-008-0154-0 · Cited by 18 · see citing works
The 100 most cited papers about pediatric traumatic brain injury: a bibliometric analysis
Karydakis, P., Giakoumettis, D., & Themistocleous, M. S. (2019) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-019-02085-6 · Cited by 17 · see citing works
“Lack of inhibition: A motivational deficit in children with attention deficit/hyperactivity disorder and children with traumatic brain injury [50] Konrad et al.”
BackgroundKarch, S., Segmiller, F. M., Hantschk, I., Cerovecki, A., Opgen-Rhein, M., Hock, B., Dargel, S., Leicht, G., Hennig‐Fast, K., Riedel, M. J., et al. (2012) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.07.017 · Cited by 15 · see citing works
“Difficulties in response inhibition and decision making in patients with ADHD are highlighted in numerous studies (Konrad et al., 2000; Nigg, 2001; Williams et al., 2000).”
BackgroundAbbott, R., Mickail, T., Richards, T. L., Renninger, K. A., Hidi, S. E., Beers, S. F., & Berninger, V. W. (2017) · International Journal of Educational Methodology · doi:10.12973/ijem.3.1.41 · Cited by 14 · see citing works
The Neuropsychology of Attention Deficit Hyperactivity Disorder
Willcutt, E. G., Brodsky, K. L., Chhabildas, N. A., Shanahan, M. A., Yerys, B. E., Scott, A., & Pennington, B. F. (2005) · Contemporary clinical neuroscience · doi:10.1385/1-59259-891-9:185 · Cited by 13 · see citing works
Incentives improve the clarity of school-age children's referential statements
Varghese, A. L., & Nilsen, E. S. (2013) · Cognitive Development · doi:10.1016/j.cogdev.2013.07.001 · Cited by 12 · see citing works
Hahnefeld, A., & Heuschen, U. (2009) · Kindheit und Entwicklung · doi:10.1026/0942-5403.18.1.30 · Cited by 12 · see citing works
Palma, S. M. M., Fernandes, D. R. M., Muszkat, M., & Calil, H. M. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2011.10.016 · Cited by 11 · see citing works
“Lastly, there have been studies showing that emotional factors, such as motivation, might improve cognitive control and performance on assessment tests (Kohls et al., 2009a, 2009b; Konrad et al., 2000).”
BackgroundHoushmand, K., Bräunig, P., Gauggel, S., Kliesow, K., Sarkar, R., & Krüger, S. (2010) · Acta Neuropsychiatrica · doi:10.1111/j.1601-5215.2010.00451.x · Cited by 11 · see citing works
Self-citationDrechsler, R., Rizzo, P., & Steinhausen, H. (2010) · Behavioral and Brain Functions · doi:10.1186/1744-9081-6-31 · Cited by 10 · see citing works
“Motor timing performance and inhibition may improve with reward in children with ADHD [42-45] indicating an association between cognitive and motivational mechanisms.”
BackgroundVloet, T. D., Konrad, K., Herpertz‐Dahlmann, B., & Kohls, G. (2011) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000127 · Cited by 8 · see citing works
Self-citationPatten, R. V., Keith, C. M., Bertolin, M., & Wright, J. D. (2015) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2015.1091064 · Cited by 7 · see citing works
Flannery, J. S., Parr, A. C., Lindquist, K. A., & Telzer, E. H. (2025) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2025.101594 · Cited by 6 · see citing works
“As incentives have been shown to improve cognitive control deficits among individuals with ADHD (Kohls et al., 2009), it is proposed that some ADHD symptoms may result from deficits in motivation to employ cognitive control (Modesto-Lowe et al., 2013; Konrad et al., 2000).”
Attention Deficit Hyperactivity Disorder
Noordermeer, S. D. S., & Oosterlaan, J. (2023) · Oxford University Press eBooks · doi:10.1093/med-psych/9780197542521.003.0020 · Cited by 7 · see citing works
la Torre, G. G. D., Barroso, J. M., León‐Carrión, J., Navas, J. M. M., & Bozal, R. G. (2012) · Journal of Attention Disorders · doi:10.1177/1087054712466440 · Cited by 5 · see citing works
Examining the Impact of Motivation on Working Memory Training in Youth With ADHD.
Sadeghi, M., McAuley, T., & Sandberg, S. (2020) · Europe PMC (PubMed Central) · Cited by 5 · see citing works
Costanzo, F., Fucà, E., Menghini, D., Circelli, A. R., Carlesimo, G., Costa, A., & Vicari, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115849 · Cited by 2 · see citing works
“Indeed, the presence of specific behaviors in various contexts represents the most successful method of identifying ADHD and, in spite of the documented presence of structural and functional brain peculiarities [68] and an estimated high heritability of 74% [69], these elements are not diagnostically specific.”
BackgroundYeates, K. O., Max, J. E., & Narad, M. E. (2021) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2021.2038 · Cited by 4 · see citing works
- Authors
- Konrad, K., Gauggel, S., Manz, A., & Schöll, M.
- Affiliations
- RWTH Aachen University (DE)
- Venue
- Child Neuropsychology
- Publisher
- Informa UK Limited
- Published
- 2000-12
- Volume
- 6
- Issue
- 4
- Pages
- 286-296
- ISSN
- 0929-7049 (ISSN-L)
- 1744-4136
- OpenAlex
- W2018757898
- Cited by
- 126
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 4 · 2016: 5 · 2015: 6 · 2014: 10 · 2013: 5 · 2012: 11
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Child Neuropsychology (publishedVersion)
- PubMed (publishedVersion)
- RWTH Publications (RWTH Aachen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- response inhibition, attention deficit hyperactivity disorder, traumatic brain injury, motivational factors, reward contingency, stop-signal task, inhibitory deficits, children, learning effects
- MeSH terms
- Analysis of Variance, Attention Deficit Disorder with Hyperactivity, Brain Injuries, Child, Female, Humans, Inhibition, Psychological, Male, Motivation, Reaction Time, Reward
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