ADHD awareness week: Impulsivity

One of the most common symptoms for many kids with ADHD is impulsivity. This impulsive behavior leads kids to act before they think. We neurotypical (non-ADHD) people may evaluate a situation for social norm or potential danger and decide to not partake in an action that could be seen as socially unacceptable or dangerous. Those with ADHD who have impulsive characteristics will generally not self-regulate and decide against an unpleasant or potentially harmful situation. This impulsive behavior leads kids to spending extended amounts of time in trouble at home. They may end up in time-out or end up grounded. Of all the symptoms of ADHD, impulsivity is often the most difficult to control.

So what is impulsivity? This is described as behavior without adequate thought. The person with impulsive behavior may have a tendency to act with less forethought than others.  They may react to stimuli without regard to the consequences that could occur.

I recall a story a friend told me about her ADHD son. When he was about 7 or 8 years old and they were riding their bikes in their neighborhood. There was a vicious looking dog barking relentlessly at them from a backyard, behind a chain link fence. Her son got off of his bike and started walking towards the dog. The mom yelled “What are you doing?” In his innocent, sweet voice he said “I’m going to pet the dog.” My friend was in shock! She yelled to him to stop! “That dog might bite you! Get back here!” They had a discussion about the dangers of approaching a dog they don’t know. My friend said they had conversations like this many times in the past, as she always wanted to be sure he respected animals and their space. His impulsive behavior led him to nearly put himself in a potentially harmful situation.

Not only does impulsivity commonly occur in those with ADHD, but it is associated with other mental disorders, such as mania, substance abuse, and personality disorders as well.  The International Society for Research on Impulsivity (yes, there is actually a society dedicated to the research on this characteristic!) studies impulsive behavior that occurs with mental disorders, such as ADHD. This society has developed several rating scales as measurement tools to make research projects more meaningful.

One of the most commonly used tools is a questionnaire designed to assess the personality/behavioral construct of impulsiveness is the Barratt Impulsiveness Scale. There are 30 items on the scale that describe common impulsive and non-impulsive behaviors and preferences. These behaviors are rated as: Rarely/Never, Occasionally, Often, Almost Always/Always. This scale can be viewed at: http://www.impulsivity.org/pdf/BIS11English.pdf

Other scales include the Balloon Analogue Risk Task: http://www.impulsivity.org/measurement/BART

Cued Go No-Go Task: http://www.impulsivity.org/measurement/cued_Go_NoGo

Immediate and Delayed Memory Tasks: http://www.impulsivity.org/measurement/IMTDMT

Okay, enough about rating scales, as I’m sure that has bored many of you!

Impulsivity has for many years been linked to the neurotransmitter dopamine. Neurotransmitters are chemical substances that transmit nerve impulses across a synapse from one a neuron (nerve cell) to a “target” cell. They carry, boost, and modulate signals between neurons and other cells in the body. There have been over 100 neurotransmitters identified. Dopamine is a neurotransmitter that helps control the reward and pleasure centers of the brain. It allows us to see a reward and to take action to move towards the reward. Dopamine also plays a role in movement, sleep, mood, sustained attention, working memory, motivation, learning, and emotional responses.  

For years scientists have believed that one of the primary causes of ADHD is low dopamine levels, but recent research suggested that structural differences in the brain’s grey matter may play a significant role. Structural differences in the ADHD brain and non-ADHD brain include variations in the prefrontal cortex, the caudate nucleus and globus pallidus, and the cerebellum. Nerve pathways, in particular the basal-ganglia thalamocortical pathways have been found to have abnormalities in the ADHD brain. The research will likely continue on the link between chemical and structural differences in the ADHD brain. Regardless of the cause, the symptom of impulsivity can lead the ADHD person to take risky, dangerous actions.

So is impulsivity always considered bad or a negative characteristic? The answer is no. There are times when impulsive behavior is the right response to a particular situation. We may act of off a gut instinct in an impulsive manner. An impulsive action may lead us to seize a valuable opportunity. But high levels of impulsivity is where this characteristic can be maladaptive.

With proper treatment of medication and behavioral therapy, those with ADHD and this prominent symptom of impulsivity can find success in controlling some impulsive behaviors.

There may be those outliers with ADHD who don’t have symptoms such as impulsivity. They may have a little trouble focusing & managed to get doctor to put them on a stimulant medication so they can maintain a greater than 4.0 GPA in school.  I’ve heard colleagues speak of this issue in their practice. This information doesn’t really pertain to them. This pertains to the millions of individuals with ADHD who have presenting symptoms, such as impulsivity, that greatly affects their life on a daily basis. Hopefully, these individuals will receive the care they need to treat this symptom and the others associated with ADHD.  

Dr. Donna Poma Fife, DNP, ARNP

Disclaimer: This blog is meant for informational purposes only and does not constitute or substitute medical care. I speak of generalizations and do not speak to any particular individual with ADHD, so don't feel singled out if it does/doesn't apply to you!  If you think you or your child may have ADHD please see a healthcare provider, preferably a psychiatrist or a neurologist, as they are best equipped to make a proper diagnosis.