Japanese children with attention deficit hyperactivity disorder (ADHD) are more sensitive to punishment than those without the condition, reports a study from the Okinawa Institute of Science and Technology Graduate University (OIST). The finding replicates work with children from the US and New Zealand and suggests that this is a common feature of ADHD. It also has implications for managing the condition.
Studies of ADHD in non-Western children are rare, so researchers know little about how cultural norms affect the condition. Writing in ADHD Attention Deficit and Hyperactivity Disorders, the OIST team explains the need to understand how the condition manifests in non-Western cultures — particularly as Western-style approaches to managing the condition are adopted worldwide.
“Knowing that altered punishment sensitivity is consistent across cultures improves our understanding of the condition,” says Professor Gail Tripp, a lead author on the study. “And now this understanding should be applied to how ADHD is managed.”
Children with ADHD show heightened sensitivity to punishment versus their peers without the condition. This was determined through a trial using computer games.
A group of 34 children with ADHD and a control group of 59 without the condition were invited to play two computer games. The games were presented on a screen with a score in the middle. The children were told that they could switch between the games at any time, and that they should collect as many points as possible to win a prize.
To play the games, the children clicked a button to make four cartoon faces spin. If they all matched when the spinning stopped, players were rewarded with an animation and points added to their score. If four sad faces appeared, players were “punished” with a laughing sound and points taken from their score. A mismatch of faces gave neither reward nor punishment.
One of the games led to the punishment outcome four times as often. The children with ADHD displayed a strong preference for the game with lower rates of punishment. They also took longer than children in the non-ADHD group to re-engage with the game following punishment, suggesting they had a stronger emotional response.
The control group, meanwhile, spent equal time on both games. Interestingly, they also persisted in playing the punishment game more than what has been observed in Western children. While the mechanisms underlying punishment sensitivity appear to be shared across cultures, Tripp suggests that cultural factors could still be at play.
Prof. Gail Tripp and Dr. Shizuka Shimabukuro, who completed the study with colleagues Dr. Emi Furukawa and Dr. Brent Alsop.
Gaman is a Japanese term usually translated as perseverance. It is considered a virtue in Japan, where children are encouraged to persist through adversity in order to better themselves and others. This may help to explain why the control group persisted with the punishment game.
“In a culture that values gaman, heightened punishment sensitivity should not be seen as a personal failure on the part of the child,” says Tripp.
Future training programs
The OIST team is continuing to investigate punishment and reward sensitivity in ADHD. Meanwhile, the researchers encourage parents, teachers and clinicians to incorporate this new knowledge into how they manage children with the condition.
In doing so, Tripp hopes to shift attitudes and prevent “negative halo effects” being created around children with ADHD. In other words, she hopes this study and others like it can raise awareness that the behaviors these children display are part of ADHD — not just a lack of gaman.
“ADHD is a condition — not bad behavior and not a result of poor parenting,” says Tripp. “Above all, praise and positive attention for good behavior should always be emphasized.”
Members of the OIST team are now partnering with Ryukyu Hospital, University of Fukui Hospital and Kurume University Hospital on a randomized controlled trial of their adaptation of a UK parenting program for mothers of children with ADHD.
If you have a child with ADHD and wish to participate in upcoming studies, please contact the OIST Children's Research Center.