ADHD & Impulsivity: Understanding the Connection

What Is Impulsivity?

Impulsivity is usually defined as acting in the moment without any planning or consideration for consequences.¹ In the DSM V, impulsivity is “an immediate reaction to stimuli, leading to impulsive behavior driven by current thoughts, feelings, without regard for past learning or consideration for consequences.”² Impulsive behaviors can range from harmless to highly dangerous. A harmless impulse may be starting a task without planning, like painting one wall of your living room before covering any existing furniture. An example of a more dangerous impulse would be running across the highway without checking for traffic.

Poor impulse control impacts not only your behaviors and actions but also your emotions and social interactions. It can lead to anxiety, depression, low self-esteem and low self-worth. Someone with poor impulse control may isolate themselves from loved ones, struggle with aggressive behaviors, and experience moments of emotional detachment. These rollercoaster emotions can, in turn, negatively impact social interactions, such as having difficulty focusing when others are speaking to you, disregarding the feelings of others, and putting your needs before anyone else’s. In work or school settings, someone with poor impulse control may have difficulty completing tasks, start tasks without a clear plan to finish them, be unpredictable, or be irritable and agitated.

Examples of impulsivity also include:

• Being impatient
• Racing and unorganized thoughts that are hard to control
• Self-destructive, risky behaviors, such as stealing or fire-starting
• Hypersexual behaviors
• Inattentiveness
• Hopelessness
• Guilt
• Feelings of inadequacy
• Poor decision making
• Unreliable

The Neuroscience Connection Between ADHD & Impulsivity

The prefrontal cortex in the human brain is the center of impulse control. It utilizes neurotransmitters to signal information and trigger specific responses.³ Dopamine is the motivator, it makes you feel happy, activates the brain, and encourages you to take action. Serotonin is the regulator of the contentment; serotonin triggers a calming response to help you slow down and take a moment. When these neurotransmitters are balanced and working as expected, dopamine enables you to do what you need to do, while serotonin tells you that you accomplished your goal and allows you to enjoy the effects, sometimes motivating you as well. In a healthy brain where these neurotransmitters are balanced, the relationship between the two helps you avoid making rash and unwanted decisions and engaging in risky behaviors.

In people who have ADHD, the balance between serotonin and dopamine is not as well regulated. People with ADHD are believed to have decreased numbers of dopamine receptors; and this can cause symptoms such as struggling with getting on task, making decisions, and finishing what they started. It’s also believed that people with ADHD may have decreased serotonin receptors, resulting in difficulty regulating impulses and an increase in poor decision-making.

Individuals with ADHD are considered neurodivergent.

Prefrontal Cortex

The prefrontal cortex (PFC) is the forward most part of your brain- right where your forehead is. The prefrontal cortex regulates thoughts, actions, and emotions. It serves our most advanced cognitive functions, such as decision-making. The PFC is involved in nine executive functions: empathy, insight, response flexibility, emotion and body regulation, morality, intuition, communication, and fear modulation.⁴

It is believed that ADHD may be associated with irregular function of the frontal lobe, leading to executive dysfunction which is your conscious control of thoughts and actions.

Neurotransmitters

Neurotransmitters are chemicals that allow neurons to communicate.¹ Dopamine and serotonin are two neurotransmitters and they work together to motivate you and regulate mood and behavior.

What are the impacts of ADHD impulsivity? The primary symptom of ADHD impulsivity is that it impairs the ability to stop and think about your actions and the consequences of your actions. Individuals struggling with ADHD impulsivity don’t fully create plans or map out issues caused by what they say or do. ADHD impulsivity may cause you to start a project you can’t finish. When struggling with productivity, it can make you feel inadequate when you can’t get your thoughts and actions in order, leading to poor self-esteem and self-worth and can progress into depression and anxiety.

ADHD is usually diagnosed in school-age children and can progress into adulthood, some evidence has shown that ADHD symptoms improve over time as individuals learn to manage and cope with their symptoms, but plenty of adults struggle with ADHD impulsivity.

Common impacts of impulsivity:

• Losing your job: Individuals with ADHD may struggle with the workplace’s structure, impacting how they complete tasks and leading to poor work performance.
• Making poor decisions: because of the difficulty in planning or thinking about consequences, ADHD impulsivity impacts decision-making.
• Getting into arguments/increased aggression: Due to the inability to regulate emotions, individuals may struggle to control behaviors and reactions when feeling frustrated.
• Isolation from others: An individual may not engage with others due to the inability to agree to interact with others.
• Poor self-esteem and self-image: Because these individuals struggle with productivity and completing tasks, they may begin to feel hopeless and worthless.
• Engaging in risky behaviors: Individuals are likely to engage in dangerous behaviors, including sexual encounters.
• Inability to plan for the future: Difficulty working towards a long-term goal, such as purchasing a home or saving money is a challenge.

Treatment Options for ADHD Impulsivity

ADHD impulsivity can be treated with medication and therapy. Medications work best when paired with therapy. In therapy, individuals will learn coping skills to help them manage the impact and consequences of ADHD impulsivity. Individuals will also learn relaxation skills to help regulate emotions, calm their thoughts, and reduce impulses.

Treatment plans for ADHD impulsivity work best when they address triggers, behaviors, and consequences. This helps make individuals aware of what is causing them to experience symptoms, making them more successful in using therapeutic tools to regulate their impulses.² Medications will help regulate neurotransmitters. Everyone is different, so medication effectiveness and side effects vary from person to person.

Treatment options for executive dysfunction:

• Behavior therapy: Cognitive behavior therapy (CBT) for ADHD and applied behavioral analysis (ABA) successfully treat ADHD impulsivity as they identify triggers for individuals and help them develop the skills needed to address behaviors and accept consequences properly. CBT uses thought restructuring to help individuals break down racing thoughts and develop clearer and concise thinking patterns. ABA uses behavior charts, reward systems, and consequences to help individuals think about the consequences of their actions and reward them for appropriate behaviors.
• Medication therapy: ADHD medications help reduce some symptoms of ADHD, such as impulsivity. Stimulants increase dopamine production, and non-stimulants increase serotonin uptake in the brain.
• Parent training/ specialized school programs and social-emotional training: Because ADHD is mostly diagnosed in childhood, parents need to understand how to implement coping strategies at home to help children regulate their adhd impulsivity.
• Appropriate school placement: it may be helpful to enroll your child in a school with additional support to address impulsive behaviors. You also want to make sure your child is learning appropriate social-emotional communication to reduce shame and poor self-esteem due to poor interactions with peers.

8 Tips to Help Cope With ADHD Impulsivity

Although ADHD impulsivity can be challenging to manage, you can use techniques to reduce the impact of impulsivity. Learning your triggers and developing a toolbox of coping skills can help you manage impulsive behaviors. Mindfulness, meditation, and body regulation are other techniques you can do to reduce impulsiveness.¹ Psychoeducation about ADHD diagnosis and the effects of engaging in impulsive behaviors can also be helpful, the more you know about what is going on in your body, the more prepared you will be to address the problem. Along with building your coping skills toolbox, exploring whether medication is right for you can help you manage the unbalanced chemical compound on the neuronal level in your brain.

Here are eight tips for coping with impulsivity:

1. Create calendars with reminders for deadlines and other important dates
2. Use a a journal to write and think through anxious and ADHD racing thoughts
3. Deep breathing and meditation for ADHD to reduce somatic symptoms associated with impulsivity
4. Physical activity like playing sports, working out, or simply taking a walk outside
5. Creative arts such as drawing, writing, painting, and all good ways to channel those impulses
6. Support groups allow you to spend time with like-minded people and can help you learn new coping techniques
7. Build an alliance with a neurodiversity-affirming therapist familiar with impulsive behaviors to improve self-esteem and self-worth
8. Learn and practice problem-solving skills

When to Seek Professional Help for ADHD Impulsivity

Impulsivity is not always a bad thing, sometimes, that surge of dopamine helps you get through a creative block or hump in productivity, but without appropriate regulation, it can very well become problematic, especially when your impulses impact daily functioning.  Impulsivity that puts you in dangerous situations that can cause serious harm. Impulsivity that causes interpersonal problems, isolates you from friends and family, or affects your work productivity should be addressed with therapy and medication if needed. Step one would be to connect with a neurodiversity-affirming therapist. You want someone who understands that ADHD impulsivity cannot be cured or solved but will meet you where you are and help you build a toolbox of skills to manage symptoms. An online therapist directory is a convenient way to locate therapists who specialize in neurodiversity.

Finding an online therapist can help depending on your ability to engage virtually. It may be more difficult for young children who may experience difficulty sitting in front of a computer screen. It is important to ask for a consultation to make sure the therapist is the right fit for you.

In My Experience

In my experience, ADHD impulsivity is manageable, with therapy and medication (as needed), individuals with this diagnosis can live everyday lives and, with time, experience a decrease in overall symptoms. It is important to seek help at the first sign of a problem if you are a parent, getting your child in the appropriate school setting, connecting with a behavior therapist, and learning skills to help your child manage impulsivity is key. With time, age, and practice, children can learn to reduce the impact of ADHD and ensure a positive academic, social, and emotional experience throughout life. It is also my belief that when treating a child with ADHD impulsivity, it is important to explore several options before medicating, however, there is no shame in needing medication, and it should always remain on the table as an option. School programs beneficial to children struggling with ADHD impulsivity include programs with a school assessment team that can test and develop an individualized education plan for your child. This plan will include accommodations like a small classroom with extra teaching and paraprofessional support.

ADHD impulsivity in adulthood is also manageable, with the help of a therapist, you can develop the skill set needed to cope with your impulses and reduce symptoms. Therapy can help you increase your self-awareness, self-esteem, and overall self-image, empowering you to feel confident in creating plans and schedules to help you stay on track. ADHD Impulsivity should be something you treat as you would the flu, If you are experiencing symptoms and having difficulty, seek professional help.