So I just dug through my results and I got this question right, so I will try and explain my reasoning to you!
So, there's several ways you can get to A as the right answer. First, if you're totally lost and have no idea what's going on, you can recognize that answer choices A and B are pretty much opposites (one reduces impulsivity, one increases it), and usually when the MCAT lists two similar answer choices, the correct answer is one of those. Of course, this isn't always true, but if you're totally lost, it's best to assume this.
So the difference between the 2 groups being studied was that one group was a "non-gaming condition" and the other was a "gaming condition". The passage states that in the gaming condition, the participants were able to earn points for correct responses or lose points for incorrect responses.
I could see how you would think this would have to do with motivation: you probably connected reward with motivation and selected this answer. However, you have to make sure to read the answer choice fully! It says that low levels of intrinsic motivation are minimally enhanced with external reinforcers. These external reinforcers would be the point system. If this were true, the children in the gaming condition would barely, if at all, improve as compared to the non-gaming condition. However, the last paragraph of the passage tells us that this isn't true. It explicitly states that children in the gaming condition spent more time playing the game, made fewer errors, etc. Therefore, you can conclude that choice D is incorrect, because external reinforcers increased levels of motivation. This leaves us with the correct answer, A (I'm assuming you had no trouble throwing out B or C, but if you did, I can explain those as well). Getting that immediate performance feedback (via the point system) reduced impulsivity (which is an issue with ADHD kids), thereby allowing them to spend more time playing the game and make fewer errors.