Ph.D. Archives - NESCA

Behind the simple sticker chart or reward chart is decades of solid science. Psychologists and brain researchers have found that these charts work because they tap into how the human brain naturally learns and stays motivated. When a child gets a sticker or a point towards a reward immediately after doing a good job, their brain releases a tiny splash of dopamine, the “feel-good” chemical that helps us focus and feel successful. Decades of research, especially with kids who have ADHD, shows that rewards make boring or difficult tasks feel achievable. By focusing on positive rewards rather than nagging or punishment, these charts help shape behavior through slowly motivating changes which become habits or routines.

Incentive charts are highly versatile tools. While most commonly associated with young children, they are effective for anyone, including elementary-aged students and teenagers, who need help changing behaviors, building new habits, or staying motivated.

Despite these benefits, many parents I work with share the same frustration: “I’ve tried a sticker/reward chart, and it just didn’t work.”

When I dig a little deeper, I usually find that the incentive system wasn’t set up in a way that allowed the child, and the family, to succeed. I provide the following guidance to make their incentive plans more effective:

1. Pick Your Battles: Focus on just 2 to 3 goals at a time (or even just one for very young kids). Ask yourself: What is the most pressing behavior change we need right now? Is it brushing teeth without an argument? Getting out the door on time for school? Stopping hitting or food-throwing? Trying to change too many things at once is a major reason why these charts fail. Think of it like New Year’s resolutions: when we try to overhaul our diet, go to sleep early, start a daily workout routine, complete a gratitude journal, and read a book a week all at the same time, we quickly burn out. It is simply too hard to maintain that much change long enough for new habits to stick. The same is true for your child. Keep it simple. Once your child masters one specific goal, you can “graduate” them from that goal and introduce a new one.
2. State Goals Clearly and Positively: Tell your child exactly what you want them to do, rather than what you want them to stop doing. Instead of “Don’t be late for school,” phrase the goal as “Be ready with your shoes on and backpack packed by 7:20 AM.”
3. Start with “Easy Wins”: Incentive plans often fail when parents set the bar too high right away; if a child goes several days without earning a reward, they will lose motivation and give up. Instead, start with an easy, highly achievable version of your goal and slowly raise the bar. For example, if your ultimate goal is for your child to have their shoes on and backpack packed by 7:20 AM, start by rewarding them just for having their shoes on by 7:20. Once that becomes a habit, you can raise the bar to include the backpack. Slowly shaping the behavior in these small, manageable steps keeps your child winning, building the momentum they need to succeed rather than setting the bar out of reach and causing them to throw in the towel.
4. Reward the Behavior Immediately: Timing is everything. To help your child’s brain connect the good behavior with the reward, hand over the incentive right away. For timed tasks (like being ready by 7:20 AM), give the sticker, token, or point the second they finish. For all-day goals (like keeping hands to themselves), have a set time every day (like right after dinner) to hand out the reward. Connect the dots for them by saying: “Because you kept your hands to yourself today, you earned your sticker!” The more immediate or consistent the reward process is, the more likely the incentive system will be a success.
5. Let Your Child Choose the Rewards: Children are far more motivated by rewards they actually care about. Sit down together and make a list of prizes. Remember, rewards do not have to be toys or cost money. Kids are highly motivated by quality time and special privileges, such as an extra bedtime story, 10 minutes of one-on-one time with a parent, choosing what’s for dinner, or picking the movie for family night.
6. Make the “Exchange Rate” Clear: Make sure your child knows exactly what their stickers/points can buy. For young kids: Keep it simple. Placing the sticker on the chart might be enough, or they can “cash in” 3 stickers for a reward (like 10 minutes of screen time). For older kids, let them save up. They can earn points daily, but saving up 5 points might earn them a larger weekend reward (like a trip to get ice cream).
7. Never Take Stickers Away: This is the golden rule of incentive charts. Once a sticker or point is earned, it is locked in. If your child has a great morning and earns a sticker/point, but has a meltdown in the afternoon, do not peel the morning sticker off or take away a point. Taking away earned rewards feels unfair to kids and ruins their motivation to keep trying. If they have a tough afternoon, simply say: “You didn’t earn your sticker/point for this afternoon, but you can try again tomorrow.”

Why Summer is the Perfect Time to Start

Summer is a fantastic time to introduce an incentive plan because it provides a light, predictable structure to those otherwise unstructured summer days. Furthermore, behavior change can be easier to accomplish when kids are relaxed and free from the daily stress of the school year. Making small, positive changes over the summer months can pay large dividends and set your family up for a smooth transition back to school in the fall. Not only will your child be accustomed to using a reward system by then, but they will also have already established several positive habits that will make the start of the school year much easier for everyone!

About the Author

NESCA is a pediatric neuropsychology practice and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Although the concept of executive functioning has existed since the 19th century, it began to gain significant attention in the fields of psychology, education, and neuroscience in the late 1990s and early 2000s. Executive functioning can be thought of as the brain’s “management system.” It enables us to plan ahead, stay organized, remember important information, initiate tasks, control impulses, adapt to changes, and manage our emotions. These skills help us get started on homework or chores, remember what we need to buy at the store, keep track of our schedules, stay calm when upset, switch gears when plans change, and finish tasks without getting distracted. When executive functioning skills are strong, individuals are able to juggle responsibilities, solve problems, and cope effectively with everyday challenges.

Executive functioning difficulties can arise from a variety of causes. Neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder, and learning disabilities frequently involve challenges with executive skills. Neurological conditions – including brain injury or stroke, particularly those affecting the frontal lobes – can impair executive functioning. Mental health disorders such as depression, anxiety, bipolar disorder, and schizophrenia may also impact these skills, making it harder to plan, organize, or regulate emotions. Environmental factors, including chronic stress, lack of sleep, poor nutrition, or substance use (alcohol or drugs), can temporarily or permanently weaken executive functioning. Additionally, some individuals may have a genetic predisposition to weaker executive functioning, and developmental delays due to prematurity, or early childhood adversity can further contribute to difficulties in these areas.

Fortunately, executive functioning weaknesses can be improved through targeted interventions. Direct interventions may include cognitive-behavioral therapy to enhance skills such as self-regulation, cognitive flexibility, and self-monitoring. Executive function coaching can also be beneficial, focusing on skills like planning, organization, and time management by identifying barriers and providing practical strategies for implementation.

In addition to direct intervention, accommodations can be provided to help individuals compensate for areas of challenge. Accommodations should be matched to an individual’s specific executive functioning weaknesses. Below are examples of accommodations for specific areas of challenge. This is not meant to be an exhaustive list, but rather to provide examples of the types of accommodations that may be recommended depending on an individual’s specific profile.

Planning & Organization

• Use a paper planner, wall calendar, or smartphone app to record assignments, appointments, and deadlines. Review these tools daily to clearly see what needs to be done and when.
• Divide complex assignments or larger projects into smaller, more manageable tasks, and set individual deadlines for each one. This approach will make the overall project less overwhelming and easier to tackle.
• Use visual tools such as graphic organizers, outlines, or flow charts to organize ideas and information before beginning an assignment or task.
• Use folders, color-coding, and binders to organize physical belongings. Use trial and error to identify what works best and take time every day to maintain organizational systems (i.e., put it away before it piles up and feels overwhelming).

Working Memory (the brain’s “scratch pad” where we hold and manipulate information)

• Use detailed checklists for tasks that require memory of several steps to reduce the burden on working memory. Check off each step when completed. Apply this strategy to recurring tasks, such as morning or bedtime routines, but also schoolwork or chores that have multiple steps or components.
• Give the individual verbal instructions more than once and ask them to repeat the instructions back to ensure they understand what needs to be done. Instructions should be provided in in small chunks, rather than all at once, so the individual can focus on one step before moving to the next.
• Permit individuals to use audio recorders or AI technology to capture information during lectures or meetings, so they can replay and review content as needed.

Task Initiation

• Define the first action required for a task, such as “open your book to page 10,” so it is clear exactly how to begin.
• Sentence starters or example problems can be helpful in clarifying task expectations, and, in turn, improving task initiation.
• Establish regular routines and schedules, such as starting homework at the same time each day, to make it easier to get started on tasks.

Inhibition (Impulse Control)

• Have a teacher, supervisor, or caregiver nearby to provide quick feedback or reminders when impulsive behaviors occur.
• Provide items like fidget spinners, putty, or doodling pads to give individuals a safe way to channel their energy and reduce impulsive actions. Allow individuals to take short movement breaks to help manage restlessness or impulsivity.
• Provide praise or rewards when individuals demonstrate restraint or appropriate behavior, encouraging them to continue using impulse control strategies.

Cognitive Flexibility

• Inform individuals ahead of time about changes in plans or schedules so they can mentally prepare and reduce stress. Give warnings ahead of transitions (e.g., “You have five minutes to finish up that essay) to assist in the transition from one activity to the next, particularly when shifting from a preferred to non-preferred task.
• Using written or visual stories that describe upcoming events and expected behaviors will help individuals anticipate and cope with new experiences.
• Teachers or supervisors should preview any partner and group work ahead of time, including carefully outlining roles and expectations.

Emotional Regulation

• Offer designated quiet areas or allow breaks for individuals to calm down when feeling overwhelmed or upset.
• Use charts, cards, or other visual tools to help individuals recognize and communicate their emotions.
• Allow individuals a few minutes to reflect or calm down after an emotional incident before discussing their behavior or asking them to resume work or activities.

Self-Monitoring

• Provide tools that allow individuals to evaluate their own work against specific criteria and track their progress over time. For example, an editing checklist for a writing assignment should include specifics such as a review of content, spelling, punctuation/capitalization, and grammar/run-ons. This would help shift the vague task of “check your work” into a more actionable task with greater success of being beneficial.
• Schedule frequent reviews and provide constructive feedback to help individuals stay on track and make adjustments as needed.
• Allow individuals extra time to double-check their work for errors or improvements before turning it in or finishing a task.

This vast network of skills, collectively referred to as executive functioning, plays a critical role in an individual’s ability to function in daily life. Comprehensive neuropsychological evaluations can provide valuable insight into specific areas of weakness and how they impact an individual’s functioning. This understanding allows for tailored, targeted recommendations that are more likely to be effective than implementing broad, non-specific executive functioning supports.

If your child or student can benefit from executive function coaching, complete NESCA’s online inquiry/intake form to receive additional information or book sessions.

About the Author

NESCA is a pediatric neuropsychology practice and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.