Differential outcomes training improves face recognition memory in children and in adults with Down syndrome

Systematic Review: Attention-Deficit/Hyperactivity Disorder and Instrumental Learning

OBJECTIVE

Although instrumental learning deficits are, among other deficits, assumed to contribute to attention-deficit/hyperactivity disorder (ADHD), no comprehensive systematic review of instrumental learning deficits in ADHD exists. This review examines differences between ADHD and typically developing (TD) children in basic instrumental learning and the effects of reinforcement form, magnitude, schedule, and complexity, as well as effects of medication, on instrumental learning in children with ADHD.

METHOD

A systematic search of PubMed, PsyINFO, CINAHL, EMBASE+EMBASE CLASSIC, ERIC, and Web of Science was conducted for articles up to March 16, 2020. Experimental studies comparing instrumental learning between groups (ADHD versus TD) or a manipulation of reinforcement/medication within an ADHD sample were included. Quality of studies was assessed with an adapted version of the Hombrados and Waddington criteria to assess risk of bias in (quasi-) experimental studies.

RESULTS

A total of 19 studies from among 3,384 non-duplicate screened articles were included. No difference in basic instrumental learning was found between children with ADHD and TD children, nor effects of form or magnitude of reinforcement. Results regarding reinforcement schedule and reversal learning were mixed, but children with ADHD seemed to show deficits in conditional discrimination learning compared to TD children. Methylphenidate improved instrumental learning in children with ADHD. Quality assessment showed poor quality of studies with respect to sample sizes and outcome and missing data reporting.

CONCLUSION

The review identified very few and highly heterogenous studies, with inconsistent findings. No clear deficit was found in instrumental learning under laboratory conditions. Children with ADHD do show deficits in complex forms of learning, that is, conditional discrimination learning. Clearly more research is needed, using more similar task designs and manipulations.

Conditional Learning Deficits in Children with ADHD can be Reduced Through Reward Optimization and Response-Specific Reinforcement

When children with ADHD are presented with behavioral choices, they struggle more than Typically Developing [TD] children to take into account contextual information necessary for making adaptive choices. The challenge presented by this type of behavioral decision making can be operationalized as a Conditional Discrimination Learning [CDL] task. We previously showed that CDL is impaired in children with ADHD. The present study explores whether this impairment can be remediated by increasing reward for correct responding or by reinforcing correct conditional choice behavior with situationally specific outcomes (Differential Outcomes). An arbitrary Delayed Matching-To-Sample [aDMTS] procedure was used, in which children had to learn to select the correct response given the sample stimulus presented (CDL). We compared children with ADHD (N = 45) and TD children (N = 49) on a baseline aDMTS task and sequentially adapted the aDMTS task so that correct choice behavior was rewarded with a more potent reinforcer (reward manipulation) or with sample-specific (and hence response-specific) reinforcers (Differential Outcomes manipulation). At baseline, children with ADHD performed significantly worse than TD children. Both manipulations (reward optimization and Differential Outcomes) improved performance in the ADHD group, resulting in a similar level of performance to the TD group. Increasing the reward value or the response-specificity of reinforcement enhances Conditional Discrimination Learning in children with ADHD. These behavioral techniques may be effective in promoting the learning of adaptive behavioral choices in children with ADHD.

Executive function in Down syndrome: A meta-analysis

BACKGROUND

Executive function (EF) refers to a set of cognitive processes involved in goal-oriented behavior-especially inhibition, attention shifting, and working memory. EF has been identified as a probable area of difficulty in Down syndrome (DS), but the exact nature of the difficulty has not been well-established.

AIMS

The meta-analysis sought to confirm or disconfirm EF as an area of difficulty in DS and elucidate an EF profile.

METHODS AND PROCEDURES

A random-effects meta-analysis was conducted on 57 studies that compared a group with DS to a typically developing (TD) mental age matched group on one or more executive function tasks. Heterogeneity was examined and moderators analyzed.

OUTCOMES AND RESULTS

The overall mean weighted effect size was large (d = -0.87), indicating poorer EF in groups with DS vs TD groups. Heterogeneity was significant, and moderator analysis revealed an EF profile with a very large effect for verbal WM/STM, a large effect for shifting, and moderate effects for inhibition and nonverbal WM/STM. Skewness analysis suggested that mean effect sizes might have been dampened, especially for WM/STM and shifting.

CONCLUSIONS AND IMPLICATIONS

Individuals with DS display a pronounced difficulty in EFs; implications for interventions and future research are discussed.

How to Improve Behavioral Parent and Teacher Training for Children with ADHD: Integrating Empirical Research on Learning and Motivation into Treatment

Attention deficit hyperactivity disorder [ADHD] is one of the most common psychiatric disorders of childhood with poor prognosis if not treated effectively. Recommended psychosocial evidence-based treatment for preschool and school-aged children is behavioral parent and teacher training [BPT]. The core elements of BPT are instrumental learning principles, i.e., reinforcement of adaptive and the ignoring or punishment of non-adaptive behaviors together with stimulus control techniques. BPT is moderately effective in reducing oppositional behavior and improving parenting practices; however, it does not reduce blinded ratings of ADHD symptoms. Also after training effects dissipate. This practitioner review proposes steps that can be taken to improve BPT outcomes for ADHD, based on purported causal processes underlying ADHD. The focus is on altered motivational processes (reward and punishment sensitivity), as they closely link to the instrumental processes used in BPT. Following a critical analysis of current behavioral treatments for ADHD, we selectively review motivational reinforcement-based theories of ADHD, including the empirical evidence for the behavioral predictions arising from these theories. This includes consideration of children's emotional reactions to expected and unexpected outcomes. Next we translate this evidence into potential ADHD-specific adjustments designed to enhance the immediate and long-term effectiveness of BPT programs in addressing the needs of children with ADHD. This includes the use of remediation strategies for proposed deficits in learning not commonly used in BPT programs and cautions regarding the use of punishment. Finally, we address how these recommendations can be effectively transferred to clinical practice.

Vicarious Value Learning: Knowledge transfer through affective processing on a social differential outcomes task

The findings of differential outcomes training procedures in controlled stimulus-response learning settings have been explained through theorizing two processes of response control. These processes concern: i) a stimulus-response route, and, ii) an outcome expectancy route through which valuations of stimuli (typically auditory or visual) may be represented. Critically, under certain contingencies of learning, the interaction of these two processes enables a transfer of knowledge. Transfer is hypothesized to occur via implicit inference for response selection given novel stimulus-response pairings. In this article, we test this transfer of knowledge, previously only examined in individual settings, in novel social settings. We find that participants are able to achieve transfer of knowledge and suggest they achieve this through vicariously learning the differential valuations of stimuli made by the (confederate) 'other' involved in the task. We test this effect under two experimental conditions through manipulation of the information made available to participants observing the confederate other's choices. The results of EEG recordings are, additionally, evaluated and discussed in the context of social signalling and emotional and cognitive empathy. We also consider implications for clinical and technological social learning settings.

Electrophysiological correlates of the differential outcomes effect in visual short-term memory

The differential outcomes procedure (DOP) consists in applying a specific outcome after each discriminative stimulus-correct response pairing, leading to improved performance in both memory and learning tasks (faster acquisition and/or higher response accuracy), compared to the non-differential outcomes procedure (NOP). The main aim of this study was to explore the electrophysiological correlates (ERPs) of the DOP in a visual short-term memory task, and to test whether a differential activation pattern would be observed depending on the outcomes condition (DOP vs. NOP). The ERP signals showed differences between both outcomes condition in all three phases of the short-term memory task: encoding, maintenance and retrieval. Our results are in accordance with the view that in the DOP condition the probe stimulus triggers a representation of the unique outcome, which remains active over the maintenance period (prospective process). In the NOP condition, in contrast, a representation of the probe stimulus is maintained (retrospective process). In addition, these results suggested that stimuli associated with unique outcomes captured attention involuntary at retrieval, decreasing the interference from distractor stimuli in the retrieval phase.

Intervención temprana en Síndrome de Down: Una revisión sistemática

Introducción: El síndrome de Down presenta importantes diferencias en tasas de incidencia según territorios y países, siendo además una de los trastornos genéticos más complejos, aunque su detección sea la más precoz de los trastornos genéticos. En España se ha producido una drástica reducción de nacimientos, existiendo un aumento en otras zonas del mundo como Latinoamérica. Objetivo y método: Se pretende realizar una revisión sistemática sobre el conocimiento científico actual relacionado con intervenciones tempranas en SD desde los años 2000 al 2017, utilizando la metodología PRISMA. Resultados: Se observa intensas lagunas metodológicas, enfatizándose las investigaciones transversales por encima de los longitudinales y sobre todo en zonas concretas del mundo. De este síndrome siguen interesando los factores cognitivos en detrimento de variables familiares y otros aspectos claves para un desarrollo psicoevolutivo adecuado. No se observan trabajos de intervención temprana ni de evaluación de programas en países hispanohablantes, y la mayoría de publicaciones científicas mezclan edades y sexos en sus muestras. Discusión: Se discuten los resultados obtenidos de la revisión realizada. Conclusiones: A lo largo del tiempo se observa una importante reducción del interés científico por este síndrome. Se siguen realizando trabajos de manera redundante sobre los mismos aspectos, sin valorar subdimensiones imprescindibles para el desarrollo biopsicosocial de este colectivo.

Does the implicit outcomes expectancies shape learning and memory processes?

Does the explicit or implicit knowledge about the consequences of our choices shape learning and memory processes? This seems to be the case according to previous studies demonstrating improvements in learning and retention of symbolic relations and in visuospatial recognition memory when each correct choice is reinforced with its own unique and explicit outcome (the differential outcomes procedure, DOP). In the present study, we aim to extend these findings by exploring the impact of the DOP under conditions of non-conscious processing. To test for this, both the outcomes (Experiment 1A) and the sample stimuli (Experiment 1B) were presented under subliminal (non-conscious) and supraliminal conditions in a delayed visual recognition memory task. Results from both experiments showed a better visual recognition memory when participants were trained with the DOP regardless the awareness of the outcomes or even of the stimuli used for training. To our knowledge, this is the first demonstration that the DOP can be effective under unconscious conditions. This finding is discussed in the light of the two-memory systems model developed by Savage and colleagues to explain the beneficial effects observed on learning and memory when differential outcomes are applied.

Differential Outcomes Training Ameliorates Visual Memory Impairments in Patients With Alzheimer's Disease: A Pilot Study

It is well known that Alzheimer's disease (AD), the most common form of dementia, is associated with deficits in cognitive processes including visual memory impairments. One technique that might be used to ameliorate these impairments is the differential outcomes procedure (DOP) that involves associating each to-be-remembered stimulus with a specific outcome. Objective: Previous research has demonstrated that the DOP can be used to reduce or eliminate the learning and memory deficits associated with animal models of amnesia and dementia. Furthermore, this procedure has been shown to improve delayed facial recognition in healthy older adults as well as in patients diagnosed with AD. The main aim of the present study is twofold: to extend these findings to other types of visual stimulus and to investigate the effect of the DOP in memory retention in AD patients. Method: Ten patients diagnosed with AD and 10 healthy controls participated in this study. The experiment included two phases. In the first one, they had to perform a delayed matching-to-sample task. In the second phase, participants performed a recognition memory task, designed to assess long-term retention, 1 h and 1 week after the training. Results: Participants showed a better memory-based performance as well as a higher long-term retention of the information when trained under the differential outcomes condition, relative to the non-differential outcomes condition. Conclusions: The DOP seems to be an effective, easy-to-implement, technique to enhance visual memory in AD patients.

Learning and Recall of Medical Treatment-Related Information in Older Adults Using the Differential Outcomes Procedure

It has recently been reported that the differential outcomes procedure (DOP) might be one of the therapeutical techniques focused at promoting autonomy in the elderly to deal with their medical issues. Molina et al. (2015) found that a group of healthy young adults improved their learning and long-term retention of six disorder/pill associations when each relationship to be learned was associated with a particular reinforcer (the differential outcomes condition) compared to when they were randomly administered (the non-differential outcomes condition). In the present study, we extend these findings to older adults who usually show difficulties to remember to take their medications as prescribed. Participants were asked to learn the association between three pills and the specific time at the day when they had to take each medication. Two memory tests were also performed 1 h and 1 week after completing the training phase. Results showed a faster learning of the task and long-term retention of the previously learned associations (pill/time of day) when differential outcomes were used. Furthermore, the older adults’ performance in the learning and memory phases did not differ from that of the younger adults in the DOP condition. These findings demonstrate that this procedure can help elderly people to ameliorate not only their learning, but also their long-term memory difficulties, suggesting the potential for the DOP to promote adherence to treatment in this population.

The Differential Outcomes Effect Using Sensory Outcomes in a Many-to-One Matching-to-Sample Task

Abstract The present study was designed to evaluate the use of sensory outcomes (visual vs. auditory) using a differential outcomes procedure to facilitate learning in a many-to-one matching-to-sample task. For one group of participants (differential outcomes) each correct stimulus-choice sequence was always followed by a different outcome; whereas for the rest of participants (non-differential outcomes) each correct sequence was followed by the same outcome. Participants trained with differential outcomes showed a faster acquisition and higher overall accuracy than participants trained with non-differential outcomes. The results provide a new extension the differential outcomes effect by using sensory outcomes and many-to-one matching to-sample task; applications of the differential outcomes procedure are discussed.

El efecto de consecuencias diferenciales: un caso de investigación traslacional

La investigación traslacional representa un esfuerzo por integrar los hallazgos derivados de la investigación básica y aproximarlos al ámbito aplicado. El presente trabajo plantea al área de investigación relativa al Efecto de Consecuencias Diferenciales (ECD) como un caso de investigación traslacional caracterizada por su contribución en el aprendizaje de discriminaciones condicionales. Se realiza una revisión que parte de algunos de los trabajos germinales con animales de laboratorio y que continúa con los primeros estudios con humanos. Posteriormente, se revisan algunos estudios que destacan el potencial de aplicación de los Procedimientos con Consecuencias Diferenciales (PCD) como herramienta para el tratamiento de personas con diversos padecimientos asociados a deficiencias en el aprendizaje y la memoria, así como su empleo en el ámbito educativo en situaciones que implican el aprendizaje de discriminaciones condicionales.

Minimalist Social-Affective Value for Use in Joint Action: A Neural-Computational Hypothesis

Joint Action is typically described as social interaction that requires coordination among two or more co-actors in order to achieve a common goal. In this article, we put forward a hypothesis for the existence of a neural-computational mechanism of affective valuation that may be critically exploited in Joint Action. Such a mechanism would serve to facilitate coordination between co-actors permitting a reduction of required information. Our hypothesized affective mechanism provides a value function based implementation of Associative Two-Process (ATP) theory that entails the classification of external stimuli according to outcome expectancies. This approach has been used to describe animal and human action that concerns differential outcome expectancies. Until now it has not been applied to social interaction. We describe our Affective ATP model as applied to social learning consistent with an “extended common currency” perspective in the social neuroscience literature. We contrast this to an alternative mechanism that provides an example implementation of the so-called social-specific value perspective. In brief, our Social-Affective ATP mechanism builds upon established formalisms for reinforcement learning (temporal difference learning models) nuanced to accommodate expectations (consistent with ATP theory) and extended to integrate non-social and social cues for use in Joint Action.

Spatial working memory is enhanced in children by differential outcomes

Working memory (WM) is essential to academic achievement. Any enhancement of WM abilities may improve children’s school performance. We tested the usefulness of the differential outcomes procedure (DOP) to enhance typically developing children’s performance on a spatial WM task. The DOP involves a conditional discriminative learning task in which a correct choice response to a specific stimulus-stimulus association is reinforced with a particular reinforcer (outcome). We adapted a spatial memory task to be used with the DOP. Participants had to learn and retain in their WM four target locations of eight possible locations where a shape could be presented. Two groups of 5- and 7-year-old children performed the low-attentional version of the spatial task, and an additional group of 7-year-old children performed the high-attentional version. The results showed that compared with the standard non-differential outcomes procedure (NOP), the DOP produced better memory-based performance in 5-year-old children with the low-attentional task and in 7-year-old children with the high-attentional task. Additionally, delay intervals impaired performance in the NOP but not in the DOP. These findings suggest that the DOP may be a useful complement to other WM intervention programs targeted to improve children´s academic performance at school.

The Differential Outcomes Procedure Enhances Adherence to Treatment: A Simulated Study with Healthy Adults

Memory for medical recommendations is a prerequisite for good adherence to treatment, and therefore to ameliorate the negative effects of the disease, a problem that mainly affects people with memory deficits. We conducted a simulated study to test the utility of a procedure (the differential outcomes procedure, DOP) that may improve adherence to treatment by increasing the patient's learning and retention of medical recommendations regarding medication. The DOP requires the structure of a conditional discriminative learning task in which correct choice responses to specific stimulus-stimulus associations are reinforced with a particular reinforcer or outcome. In two experiments, participants had to learn and retain in their memory the pills that were associated with particular disorders. To assess whether the DOP improved long-term retention of the learned disorder/pill associations, participants were asked to perform two recognition memory tests, 1 h and 1 week after completing the learning phase. The results showed that compared with the standard non-differential outcomes procedure, the DOP produced better learning and long-term retention of the previously learned associations. These findings suggest that the DOP can be used as a useful complementary technique in intervention programs targeted at increasing adherence to clinical recommendations.