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Neural Plasticity
Volume 11 (2004), Issue 1-2, Pages 23-28

On the Reorganization of Incentive Structure to Promote Delay Tolerance: A Therapeutic Possibility for AD/HD?

Developmental Brain-Behavior Unit, University of Southampton, Highfield, Southampton SO17 1BJ, UK

Copyright © 2004 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


This paper brings together two recent insights into attention deficit/hyperactivity disorder (AD/HD) to provide the rationale for a novel approach to treatment. First is the suggestion, backed up by data from randomized trials, that training and practice in carefully selected cognitive activities (executive and attentional training) and tasks can provide a way of modifying the processes underlying cognitive, especially executive, deficits in AD/HD. Second, is the idea that AD/HD is a neuropsychologically heterogeneous disorder resulting from motivational alterations, specifically an increased intolerance for delay, as well as executive deficits. The paper builds on these two insights to explore the possibility that the motivational alterations underpinning delay aversion can be modified through specific training regimes in a way equivalent to that found with executive and attentional training. The requirements for such an approach are set out. Delay fading is proposed as a possible basis for reorganizing delay experience, altering the incentive value of delay (e.g., increasing tolerance for delay), thereby reducing AD/HD symptoms.