Feasibility of Shaping Tolerance for Delayed Rewards in Impulsive 3-5 year olds

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Problems with self-control are of major relevance to public health as they are associated with increased substance abuse, impulsive suicidality, poor academic and social success, financial planning, physical and mental health, impacting both individuals and society. The development of self-control is a critically important process toward success in the school environment and in peer relationships, yet there are few nonpharmacological approaches that have been successful in increasing self-control. Parents prefer nonpharmacological approaches, particularly for young children. A study by Schweitzer and Sulzer-Azaroff [1] demonstrated that self-control could be increased in preschool-aged children with high rates of impulsivity by using a “shaping” procedure in which delays to larger, more delayed rewards were gradually increased. This finding has yet to be replicated. Our goal in this current proof of project study is to test the feasibility of adapting the procedure to gaming technology. In this proof of concept study we will develop and test an Android-based application, DelTA (delay tolerance app), designed to run on current generation tablet computers and cell phones and assess its feasibility for increasing choices of larger delayed rewards over small, sooner rewards. The app will be designed to present choices to the children between immediate, short periods of game playing versus delayed, longer periods of game playing. The delays to the game playing will be gradually increased, thereby teaching the child “tolerance” to delay, or self-control, as the child learns to wait for the reward. The app will also titrate the delays to the reward depending upon the child’s individual response. This project is necessary to help identify the procedures necessary to assess self-control in this age group, including the timing and size of the rewards used in the procedures, for preparation of a clinical trial. The use of real time rewards in the experimental setting with humans is rare, but also potentially much more effective over the traditional use of hypothetical rewards and delays. Our real time, “consumable-game playing rewards” will be developmentally appropriate and ecologically-valid. This proof of concept project is necessary to establish feasibility including to test if gaming technology can be used to deliver the rewards in discrete units, for this age group, in a manner that is developmentally appropriate. Findings from this project will then be used to further modify the intervention and to ultimately test it in future R21 or R01 projects that will develop ways to build in generalization of the intervention to the home and school environment. This project is consistent with the translational approach in response to NIDA’s Prevention and Treatment Objectives in the 2010 Strategic Plan and NIMH’s RDoC Objective “Developing new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures.”