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ADHD

Adult ADHD and Impulsivity

It is much more than ready-fire-aim.

Key points

  • Impulsivity is one of the three main diagnostic symptom domains for ADHD.
  • Impulsivity is defined as acting without forethought.
  • Even though it is a symptom of ADHD, the problems it causes are much more wide-ranging than is typically appreciated.
  • Coping with impulsivity and adult ADHD requires thinking ahead and planning for how to avoid or manage risky situations.

Impulsivity numbers among the core symptom domains of ADHD, though it takes up only four of the 18 symptoms in the diagnostic criteria:

  1. Talks excessively in social situations
  2. Has difficulty waiting their turn
  3. Blurts out answers before questions are completely asked, completes others’ sentences, jumps the gun
  4. Interrupts or intrudes on others (butts into conversations or activities without permission or takes over what others are doing)

Though only comprising a smidge more than 22 percent of the list, impulsivity creates proportionally much more than its share of problems. Like the other official symptoms of ADHD, they are not flawed but they simply do not capture the full array of difficulties faced by those with ADHD. Impulsivity in particular gets short shrift in terms of its role in the struggles of adults with ADHD.

Common problems for adults with ADHD from impulsivity

Impulsivity is considered to be acting without forethought, but this does not do justice to the visceral feeling and emotional dyscontrol driving the impulses in the first place. Coupled with a proneness for disinhibition and its interaction with the emotional dyscontrol central to ADHD, there are many facets of life where adults with ADHD find themselves in trouble due to impulsivity.

Even as listed in DSM-5, impulsive symptoms seem innocuous and may be annoying to others, but nothing too impairing. In isolation, such miscues represent relatively minor social gaffes that are quickly overlooked or forgiven. However, these lackluster descriptions do not do justice to the negative effects of the more frequent and very public behaviors and accompanying feelings of embarrassment, shame on one’s relationships and social standing among adults with ADHD.

Repeated instances of saying the wrong thing at the wrong time, including indiscrete or hurtful comments, and dominating conversations may lead to the slow withdrawal of people from an adult with ADHD, a slow-motion rejection if not swift a rebuke. Interruptions, completing others’ thoughts, difficulties with impatience and distraction, often sprinkled with missed social cues, defensiveness, and emotional outbursts combine to erode one’s social standing and reputation. It's no surprise that this can be particularly detrimental when tending to a long-term, committed relationship or friendship.

Impulsivity and its emotional correlates also affect other areas of functioning and impairment. Poor impulse control plays a role in imprudent shopping and overspending, impulsive compliance (saying “yes” to any invitation or interesting project), which results in overextending oneself, thereby setting the stage for poor follow through on promises.

Procrastination also has roots in impulsivity: “I know I should work on this now, but I’ll do this other thing first.” Often driven by subtle, but notable emotional aversion (the “ugh” feeling) to a priority task and a drive toward something more enjoyable, or at least anything that is not the have-to chore. Impetuous excitement may set off a stretch of hyper-focus and overdoing even positive activities to the detriment of other priorities. In a similar vein, many addictive behaviors (or merely succumbing to other temptations, including overeating and unsafe sex) are initiated and maintained by impulsivity. What is the most insidious feature of impulsivity for adults with ADHD is that it may result in acting on suicidal thoughts with tragic consequences.

Coping with ADHD and impulsivity

Medications for ADHD can be helpful with impulsivity as they are for other core symptoms of ADHD. In terms of behavioral coping strategies, a starting point for them is challenging the mindset that one has “no control over impulses.” While the relapse rate for impulsivity is 100 percent—it will happen, at times—there are strategies to reduce its frequency, reduce risks, and deal with slip-ups, which include:

  • Recognize situations where you are prone to impulsivity (dinner party, meeting at work, arriving home after work)
  • Identify personal risk factors for impulsivity (alcohol, tiredness, moodiness, anger, medications wearing off)
  • Avoid risky situations (avoid temptations; deal with impatience with long line at a coffee shop by going to a less crowded one)
  • Prepare a game plan for handling risky situations that cannot be avoided (limit or avoid alcohol at a business dinner, log off of online stores and create a delay before purchasing)
  • Create time buffers (24-hour delay on purchases, respond to requests by saying “let me check and get back to you”)
  • Have externalized reminders for coping plans (index card with coping reminders, have coping rules, such as a three-sentence rule when talking before pausing to allow others to speak)
  • Have daily impulsivity coping goals (Focus on one setting or domain, plan and script how you want to handle a meeting, parenting issue with a child, etc.)
  • Normalize slip-ups and make amends (apologize, undo a situation [“It turns out I will not be able to coordinate the school fundraiser, after all.”], identify the lesson learned from the situation, and create a coping plan)
  • Define managing impulsivity as part of an overall treatment and self-care plan for adult ADHD

As with most facets of managing adult ADHD, there are no trade secrets about what works, but the job is the implementation of what works. Impulsivity is a trickier ADHD symptom to manage but with recognizing in advance one’s risk factors and having some plans in place, the problems can be reduced and one’s passions better harnessed and directed towards positive outcomes.

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