Impulsivity: A Symptom of ADHD

ADHD label doesn't accurately identify this impairing symptom

Posted Mar 24, 2013

Tegan was always impulsive. As a child, she loved adrenaline-like activities and literally would swing in the trees, just like she was in gym class, swinging on the parallel bars. Numerous trips to the ER were a consequence. She was a daredevil with her bike and when she was able to finally drive dirt bikes, ATVs and snow machines, she went as fast as she could, loving the adrenaline. As a teen, bingeing on alcohol, drugs and food became habitual. Now, as a young adult, impulsive decision making – quitting school, quitting jobs impulsively and spending money without considering a budget – was common. She lost her job because of an impulsive email that she sent to her boss in the heat of the moment and couldn’t seem to stop texting and voice-messaging an ex-boyfriend. Tegan is impulsive.

The official DSM label, Attention-Deficit Hyperactivity Disorder, actually doesn’t describe one of the most invisible of the symptoms, impulsivity. There are certainly consequences to a child being impulsive. Why did you throw the snowball? Don’t you know that’s wrong? But as we age, impulsivity can have greater consequences across the timeline.

Decision making is part of the prefrontal cortex, which is the thinking part of the brain behind your forehead. It is the last part of the brain to mature and this doesn’t occur until our 20s. Decision making is an important part of the brain function in the prefrontal cortex. This explains impulsive decision making in teens, for example. People with ADHD have an even greater delay in the maturity of this part of the brain, which may explain some of the impulsive traits that they have.

Three types of impulsivity actually can impact on a person’s lifespan, including impulsive experimentation with drugs or alcohol. Impulsive driving can lead to higher incidence of accidents and sexual impulsivity can lead to increased incidence of sexually transmitted diseases.

Verbal impulsivity, which is cutting people off in conversation, isn’t too great for social relationships and can be very frustrating for friends and loved ones.

So what are the key points in managing impulsivity? A good starting place is knowing your impulsive risks. For example, is it in the form of communication, spending money, bingeing on things, driving, etc? These can be considered “critical moments” of impulsivity, so getting these on the radar is very important.

A second point is when do critical moments occur? For example, does impulsivity come up in the context of being overly emotional or reacting to certain situations? Do alcohol or drugs contribute to impulsive choices?

Once a person has these on the radar, then another helpful concept is the “pause button”. All this means is that instead of immediately making a choice, using the pause button and delaying to a later time, when you can deal with this choice more effectively. Talk it over with someone else, or imagine what your best pal, friend or coach would say about the choice.

If novelty seeking plays a role in impulsive choices, again discussing that with someone close to you might be helpful.

A helpful mantra might be “Don’t just do it – think about it.”

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