Document Type



Doctor of Philosophy (PhD)



First Advisor's Name

William E. Pelham, Jr.

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Daniel Waschbusch

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Joseph Raiker

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Aaron Mattfeld

Fourth Advisor's Committee Title

Committee Member

Fifth Advisor's Name

Andy Pham

Fifth Advisor's Committee Title

Committee Member


ADHD, stimulant medication, associative learning

Date of Defense



Despite strong evidence supporting the short-term efficacy of interventions for youth with Attention-Deficit/Hyperactivity Disorder (ADHD), and despite the fact that the majority of youth with ADHD receive treatment for the disorder at some point over the course of childhood, the long-term prognosis for individuals with ADHD remains poor. One potential explanation for the gap between short-term efficacy and long-term outcomes is that the most common intervention for youth with ADHD, stimulant medication, paradoxically undermines children’s abilities to learn from contingencies through their action on the dopaminergic system. The dynamic dopamine theory posits that by increasing levels of dopamine, stimulant medication enhances reward-based learning but prevents phasic dips in dopamine necessary for punishment-based learning to occur. The current study explored the hypothesis that stimulant medication undermines punishment-based learning among school-aged youth diagnosed with ADHD using an associative learning task. The study used a 4 (stimulant medication dose: placebo, low, moderate, high) x 2 (trial type: reward, punishment) x 2 (punishment condition: regular, enhanced) design to evaluate children’s ability to learn stimuli-category associations following reward and punishment. On reward-based trials, participants earned points following correct associations and received no feedback following incorrect associations. On punishment trials, participants lost points (20 in the regular condition, 100 in the enhanced condition) following incorrect associations and received no feedback following correct associations. Results indicated that there was no significant main effect of medication on children’s associative learning. Rather, children demonstrated better overall performance in response to rewards regardless of medication condition. Children performed worse when they received the enhanced punishment condition, an effect that was moderated by higher doses of medication. Results indicate that other factors, aside from dopamine levels, likely contribute to associative learning among youth with ADHD. Specifically, the punishment to reward ratio is likely an important factor that should be considered when designing interventions for youth with ADHD.





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