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Impulsivity

ADHD and Impulsivity: How to Overcome your Impulses

adhd adhd ambition create balance courses impulsivity Oct 05, 2021

ADHD and Impulsivity: How to overcome your impulses

Impulsivity and Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) makes it hard for people to control themselves. If you have a diagnosis of ADHD, you might not be able to control your urges, or impulses. The inability to control urges or impulses can be referred to as impulsivity. In this article we will go through why people with ADHD struggle with overcoming their impulses, the specific risk factors for impulsivity and how to overcome impulse control difficulties.

Most people act impulsively from time to time. The difference is that ADHD — particularly the hyperactive-impulsive subtype — affects impulse control to the point that these behaviors become persistent over time and across situations. Impulsivity issues affect everyone differently and are hard for both adults and children who have a diagnosis of Attention Deficit Hyperactivity Disorder. Common symptoms often include restlessness and difficulty planning. Impulse control symptoms are sometimes recognised in school aged kids, but may also reveal themselves in adult ADHD. Both children with ADHD and those with adult ADHD also find it difficult to follow through on important tasks and maintaining helpful habits.

Negative consequences of Impulsive Behaviors

Impulsive behaviour can be very harmful in a lot of situations. It can be bad for your relationships, budget, and self-esteem. Impulsive people are less likely to think about the consequences or plan ahead. So they are likely to do something on impulse or find themselves easily distracted. This can often make it hard to manage a range of life areas including relationships, financial situations, work life balance and to generally live a stable, consistent and successful life. Impulse control issues make it difficult to manage these life areas often because it leads to distraction which makes it hard to commit to good behaviors. Impulsive behaviors often happen without much insight or forethought into future consequences. The inability to assess, plan or think of risks and consequences in the moment can lead to negative consequences in different forms of behavior or finding yourself easily distracted. Impulsivity can lead to serious addictions such as alcohol, substance misuse, problematic gambling, excessive working, extreme online shopping, or other behaviors which lead to trouble. These outcomes often result in the diagnosis of other mental health issues and poor self esteem due to impulsive actions resulting in problematic circumstances.

The Difference between Impulsivity and Spontaneity

Impulsivity issues may also be mistaken for spontaneity. Spontaneity is different from impulsivity in that it is planned and controlled. Impulsive behaviours on the other hand, are often more hyperactive in nature. They are often not controlled or planned in advance, or even the inability to stop in the moment to assess danger. Spontaneity on the other hand is more of a carefully though-out decision. While spontaneity may not be planned in advance, it involves the ability to stop, or press pause on a quick decision. So you can look at the consequences of actions while being present to actively choose to become swept away by a new adventure or situation. Impulsivity is often driven by heightened emotions, stress, anxiety, or a compulsion to avoid discomfort and move towards a short-term pleasure, which often leads to a loss of control.

ADHD, Impulsivity and Emotion Regulation

Impulsiveness is a challenge for people with ADHD due to problems with emotional dysregulation and hypersensitivity. Hypersensitivity often occurs for people with ADHD due to a generalised negative emotional state, or affect. Impulsive behaviours are often a way of trying to escape or act out negative feelings, when it's not possible to regulate emotions. Impulsive behaviors are also driven by other emotions or uncomfortable feelings such as boredom, sadness and anger. For example, boredom could manifest itself through the tendency to seek pleasure or excitement by acting out risk-taking behaviours, or even excessive online shopping. Also, impulsivity can make it hard to cope with frustration which often leads to poor outcomes including aggressive behavior, or interactions resulting in conflict.

Impulsive behavior and conflict problems

When people with ADHD behave impulsively, they may run into a range of interpersonal difficulties. These are common in ADHD because the person may have difficulty understanding or comprehending social rules and expectations. This may result in tendencies to interrupt conversations or asking for something out of turn. Further to this, impulsivity has relation to aggression due to acting out impulses in a destructive way. This can lead to the perception by parents, another family member, or friends that the person with ADHD has personality problems, or is difficult to get along with.

Impulsivity tests

The five-choice serial reaction time task

The Five-choice serial reaction time task (5CSRT) is a computerized task that measures how much time it takes the participant to make a response out of five possible choices. Once the participant chooses their response they are given visual feedback for 500 msec. The visual feedback indicates whether or not their response was correct. If it is incorrect, they are provided with the correct answer and told to make another choice in 500 msec. The purpose of the 5CSRT is to measure response inhibition, which is the ability to inhibit a prepotent or automatic impulse in favour of a less dominant but more appropriate one.

Delay-discounting paradigms

A person's ability to not want a reward right immediately is called impulse delay. Impulse delay is the ability to resist acting on an urge or temptation, especially if doing so would result in a long-term reward. In humans, this can be measured by using a delay discounting paradigm in which participants choose between a smaller reward that's available sooner and a larger reward that they have to wait for. People who tend towards impulsivity will often favour the immediate gratification of receiving the smaller reward immediately over waiting longer for a larger reward. This system of measurement can provide an indication of the level of impulsivity in adults and children with ADHD.

The causes of ADHD impulsivity

Neurochemical and biological causes of impulse control

A number of medically reviewed clinical and preclinical studies have found that ADHD comes from problems in parts of the frontal cortex areas of the brain. The frontal cortical area of the brain is responsible for motivation, planning, attention to tasks and inhibition of impulsive responses. There is a collection of evidence suggesting that frontal lobe damage is increasingly linked to a range of impulsive behaviors including aggression, destructive behavior and other self control or impulsive behaviors (Reddy, Menon & Hunjan, 2018). Further studies have been able to identify the prefrontal cortex as the main area of the brain responsible for impulsive behaviors. Specifically, dopamine in the prefrontal cortex is involved in the cognitive control behaviors including planning, inhibition and task completion (Murray & Nowicki, 2020). Further research has found that either overactivity or underactivity of dopamine can cause problems with impulsivity, through the tendency to seek more pleasure through impulsive and destructive behaviors (Williams & Dayan, 2005).

Genetic causes of Impulse control

Medically reviewed studies have found that there is a strong genetic link with ADHD. Impulsivity can be attributed to the combined influence of multiple genes or polymorphisms (Larsson et al., 2017). The research has identified dopamine transporter and receptor gene variants were linked with ADHD inattention, impulsivity and hyperactivity. Specifically, these genes play a role in impulsivity by regulating the activity of the dopamine neurotransmitter, which creates difficulty with self-control and places a person at risk of impulsivity (D'Onofrio et al., 2017).

Psychological causes of Impulse control

There are many psychological factors that can create an environment where impulse behaviors become more likely. ADHD diagnosis and comorbid disorders such as depression and anxiety and having fewer coping strategies all increase the likelihood of impulsivity (Kessler et al., 2010). Impulsivity can be exacerbated by the presence of an anxiety disorder. Anxiety disorders can lead to difficulty with impulsivity due to the high levels of stress and tendency to overthink things, which can diminish impulse control (Chapman et al., 2014).

Environmental causes of impulse control

A number of environmental factors have been known to specifically affect impulse control. Impulsivity can be both a cause and an effect of ADHD, as well as being caused or made worse by certain things such as:

Stress

Is often the biggest issue that people with ADHD face because it's part of their daily experience. Impulsivity is often the way that people with ADHD cope or act out stress. This can cause further problems because impulsivity usually makes the problem worse than before acting on impulse (e.g., overspending, taking drugs)

Family or home environment

Can also affect impulsivity. Impulsivity is often exacerbated by parents that have authority issues themselves, or are not able to set boundaries for their children. Parenting style affects the child's impulse control. There are several different parenting styles which influence how a child responds to stress and rules in general. Certain types of parenting include authoritarian, authoritative, or permissive. Impulsive behaviors can be associated with authoritarian and permissive styles of parenting. When a parent is permissive the child has less rules and boundaries to follow, which may cause problems with impulse control. When the parent is authoritarian, the child has more rules and boundaries, but they're strict. Impulsive behaviors can be associated with this parenting style as well due to the child's need to break free of too much restriction, or over involvement from the parent.

Peer influence

Is another factor that affects impulsivity in children with ADHD because it makes them feel accepted or important to follow what their friends do without thinking about consequences of engaging in harmful actions. Impulsive children may engage in riskier behaviors such as unprotected sex or illicit drug use, or even getting in trouble with the law (Marshall et al., 2003). Impulsivity is often increased when ADHD teens spend time with friends who do not have ADHD and therefore lack awareness of the consequences associated with what they are doing. Children with ADHD are more prone to engaging in impulsive behaviors because their brain has not fully developed and they are not necessarily receiving helpful guidance to stay on the right path. Often the tendency to engage in destructive behaviors is due to kids not having a supportive family member to keep them on track. From an early age, the right type of guidance is highly important for children with ADHD.

How to Improve impulse control

There is hope for people who struggle with impulsivity, it is possible to make changes in how you live to make it easier to manage impulses. There are various behavioral models which provide effective interventions to help both the adhd child and adults ADHD.

Behavior therapy

Behavioral therapy is a type of treatment that uses positive reinforcement to decrease impulsive behaviors in people with ADHD. Behavioral therapy can help people with ADHD learn how to control their impulses by teaching them about the consequences of certain behaviors, learning new skills to manage impulsivity, and changing harmful routines. Behavioral therapy can also help reward positive, or healthy behaviors to encourage repitition of better habits.

Cognitive behavioral therapy

Is a type of behavior therapy that uses problem-solving and goal planning to help people with ADHD make better choices. Cognitive Behavioral Therapy helps people learn how to monitor their behaviors, thoughts and feelings in order to change harmful habits (Young & Bramham, 2012). CBT can help people with ADHD to recognize harmful thoughts and behaviors they engage in, which ultimately helps them make better decisions.

You should talk with a mental health specialist about how to implement behavioral therapy in your own life. Behavioral therapies are often used in conjunction with other types of mental health treatments such as medication or psychotherapy.

Medication

Is another treatment option for impulsivity associated with ADHD. ADHD is often treated with stimulant medications. It might seem strange that stimulants that make people more active would help with ADHD, but this may be because they have a specific function in the brain which helps regulate important neurotransmitters for reward, motivation and impulse control. Stimulant medications work by increasing dopamine activity in the prefrontal cortex area of your brain. There are several different types of medication that may be used as a form of Impulse Control Disorder Treatment. Methylphenidate (Ritalin) is a stimulant that helps the brain maintain balanced levels of dopamine to help with inhibitory regulation and mental endurance when applying yourself to difficult tasks. Methylphenidate has been clinically found to help improve impulse control in various findings (e.g., Weyandt, 2009). Other medications like Bupropion (Wellbutrin), Atomoxetine (Strattera) or Clonidine, may also be prescribed to help with Impulsivity (McDougle, 2008). Before getting started on medication, it is necessary to see a psychiatrist, or medical professional to receive a diagnosis, medical advice and suitable treatment.

Other impulse support solutions

Impulse problems can also be a problem for people who do not have ADHD, but it is possible to learn coping strategies if you want help learning how to manage your impulsivity better.

Mindfulness

Mindfulness is a type of practice that has been found to improve impulsivity. A systematic review found mindfulness to be helpful in treating symptoms of ADHD including impulsivity, across a number of studies (Poissant, et al., 2018). Mindfulness is the practice of attending to the present moment without judgment or criticism. Mindfulness helps people to be more aware of the triggers that lead them to engage in impulsive behaviors, which can help reduce their frequency and severity (Poissant et al., 2018). Mindfulness can also help with managing uncomfortable thoughts and feelings that lead to impulsive behaviors. By learning to relate to discomfort with more ease, the impulsive urge is reduced.

Self-control techniques

There are various self control skills you can learn for impulse control problems including relaxation training and cognitive strategies. Relaxation training can help decrease a person’s stress and anxiety, which is often the trigger for impulsivity (Young & Bramham, 2012). Cognitive skills are used to change negative thoughts or beliefs that lead to impulsive behaviors like: “I shouldn’t have done that!” into more positive statements such as : “I want to make healthier choices!”

Impulse control: What can you do about it? Our top tips

1) Make goals for yourself and work towards them. Small, incremental achievements often help retrain the reward pathways, so that you learn to wait for positive outcomes, while also building smaller rewards along the way.

2) Identify what causes your impulsivity, are there certain times of day it happens or particular people that push your buttons? By becoming aware of what triggers your impulses, you can make suitable adjustments in your life.

3) Have Impulsive Situations Covered: Impulsive behaviours often happen in specific situations. For example, you may feel the urge to shop impulsively when you walk by a mall or see an ad for a sale online. Make sure that you have already purchased anything that is needed before those situations arise and that your wardrobe is up-to-date as well!

3) Set up schedules and routines to help you stick with goals. Routines and schedules create consistency which helps build a level of certainty and stability in your life, which can reduce impulsivity and help you achieve an important task.

4) Get rid of any distractions around you. Distractions are often the cause of impulses. By managing your distractions you can avoid impulsive behaviors. One of the best ways to manage distractions is to place them outside of your awareness. Such placement can allow you to forget about the distraction and focus on your priorities.

5) Get support. Making sure you seek the right treatment and support you need can allow you to prevent your impulse control issues from becoming more destructive. By having helpful conversations with people who have experienced impulse difficulties as a part of their ADHD, you could be steered in the right direction. Support and treatment could include medical advice, but may also include help from parents, peers and other networks to keep on track.

6) Online courses and programs. To help you stay on track and resist urges and impulses, it is useful to have a structured, tailored program. There are a range of online courses that you can commit to, so you can stay on track and reach your goals. ADHD Ambition is a self-paced course to help you master the habits to build success in your life and help manage your impulses.

Use your impulses to your advantage

Impulsivity can be a good thing, especially if it helps you to take action and improvise. Impulsivity is often rooted in self-doubt or fear of failure which is why learning how to work with your impulses rather than against them may help prevent impulsivity from derailing your success. When you feel an impulsive urge coming on, use it as motivation for something productive. In other words, harness those impulses and utilise it to choose what you wish to focus your attention on. Impulsivity is not always bad thing - it can be used as motivation.

Conclusion

Impulsive behaviours are often common for people who have ADHD but they don’t need to control your life or derail your success! Impulse control issues can pose a barrier in everyday situations, which is why learning how to work with impulses rather than against them can help you avoid impulsivity from getting in the way of achieving your goals. Impulsivity can be a major problem for those who have ADHD and it is important to learn coping strategies that help control impulses. This can allow you to make healthier choices, manage stress or anxiety as well as prevent any impulsive behaviours from sabotaging your success both professionally and personally.

Co-Authors

Daniel Van der Pluym is a Psychotherapist Coach
Founder of Deeper Potential and Part Founder of ADHD Ambition Daniel specialises in Mindfulness as a way of regulating difficult emotions and working with impulsive behaviors.
He has a lived experience of anxiety and impulsive behaviors and is a passionate advocate for those affected by it.
He is an Associate Member of the Australian Psychological Society and Member of Meditation Australia

Shannon Bowman is the SJB Clinical Consulting Pty Ltd
Director and Create Balance Psychotherapy & Counselling VIEW HERE.
Shannon has a clinical interest in treating trauma, PTSD and ADHD.
He has a lived experience of ADHD and is a passionate advocate for those affected by it.
He is accredited as a Mental Health Social Worker AMHSW,
psychotherapist and registered EMDR practitioner. Associations below. 
Australian Association of Social Workers
EMDR Association of Australia.
Psychology Today Profile

References 

Kessler, R. C., Green, J. G., Adler, L. A., Barkley, R. A., Chatterji, S., Faraone, S. V., & Van Brunt, D. L. (2010). Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. Archives of general psychiatry, 67 (11), 1168-1178.

Larsson H, Chang Z, D'Onofrio BM, Lichtenstein P. (2014). The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan. Psychol Med. 44:2223–9

Marshall, M. P., Molina, B. S. G., & Pelham, W. G. (2003). Childhood ADHD and Adolescent Substance Use: An Examination of Deviant Peer Group Affiliation as a Risk Factor. Psychology of Addictive Behaviors. 

Murray, M. T., & Nowicki, J. (2020). 82 - Ginkgo biloba (Ginkgo Tree) in. Text Book of Natural Medicine (5). (pp. 620-628). Churchill: Livingstone

Poissant, H., Mendrek, A., Talbot, N., & Khoury, B. (2019). Behavioral and Cognitive Impacts of Mindfulness-Based Interventions on Adults with Attention-Deficit Hyperactivity Disorder: A Systematic Review. Journal of Behavioural Neurology. 

Reddy, K. J., Menon, R. K., & Unnati, G. (2018). Deficits in Frontal Lobe Function and Neurotransmitters 1. International Journal of Criminal Justice Sciences

Weyandt L. L., Janusis G, Wilson K. G., Verdi G., Paquin G., Lopes J., Dussault C. (2009) Nonmedical prescription stimulant use among a sample of college students: relationship with psychological variables. Journal of Attention Disorders

Williams, J., & Dayan, P. (2005). Dopamine, learning, and impulsivity: a biological account of attention-deficit/hyperactivity disorder. Journal of child and adolescent psychopharmacology.

Young, S., & Bramham, J. (2012). Cognitive-behavioural therapy for ADHD in adolescents and adults: A psychological guide to practice (2nd ed.). Wiley-Blackwell

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