Hyperactivity-Impulsivity

 

A young child has very little ability to control or inhibit impulsive behaviour in response to a strong stimulus. Instead, their responses are typically reactive or instinctual in nature. That is, they impulsively do whatever pops into their mind without much or any consideration.

Impulsivity is on display when a young child runs across the road without looking to pat the dog on the other side, or when they kick their sibling when teased.

When a young child refrains from acting on an impulse, it is usually due to the implementation of an external source of control. For example, the clutch of their mother’s arm prevents them from running across the road, or the fact they will be punished if they hurt their sibling makes them stop and think twice about kicking their sister or brother. 

As a child matures the control exerted over their behaviour gradually shifts from external sources (parents, teachers, carers, etc.) to their own inner self-regulatory mechanisms until they are able to independently self-regulate. These mechanisms are called executive functions and they enable an individual to regulate their thoughts, words, behaviour and emotions.

 

Self-regulation and ADHD

As individuals with ADHD lag behind in the development of their executive functions, they lack the ability to control their thoughts, words, actions and emotions in line with their peers. As a result, individuals with ADHD often struggle to inhibit their reactive or instinctual responses to internal and external stimuli. This inability to self regulate manifests in the hyperactive and impulsive behaviour associated with ADHD.

Hyperactivity can be defined as excess movement or excessive task-irrelevant activity that does no fit with the setting in which it is displayed (i.e. fidgeting, jittering legs, leaving one’s seat inappropriately, etc.). Although this excessive movement mostly resolves in adulthood, many adults continue to experience internal hyperactivity (i.e. feelings of restlessness, thought bombardment, excessive mind wandering, etc.).

Impulsivity can be defined as hasty acts that occur in the moment without thought (i.e. speaking out of turn or without putting one’s hand up, speaking without thinking or “foot in mouth,” over spending, driving above the speed limit, etc.).

Individuals who experience hyperactive-impulsive symptoms may:

• experience though bombardment, excessive mind wandering or tangential thoughts and as a result feel internally restless
• fidget, tap objects, restlessly wiggle legs and generally move around more than other people
• find boredom intolerable, constantly seek stimulation, take more risks and participate in more dangerous behaviour
• talk excessively, blurt out answers or interrupt others. Children may also make loud noises or narrate their actions
• respond quickly to situations without anticipating the consequences (i.e. make rash decisions or rush in without waiting to hear all of the instructions)
• impatiently badger their parent, partner, friends etc. when they want something
• exhibit risk taking behaviour
• choose a smaller reward rather than postpone gratification in order to receive a larger, more significant reward
• apply the least amount of effort required, take short cuts and make simple errors, especially when a task is boring or tedious.

Individuals with hyperactive-impulsive traits are also more likely to experience problems regulating and moderating their emotions. As a result they are prone to being moody, impatient, overly excitable and highly sensitive to rejection. Additionally, they are more likely to become frustrated and to react with anger or aggression (Barkley, 2016). To find out more about ADHD associated emotional dysregulation please go here.

 

Presentation

Hyperactivity and impulsivity are classified together in the DSM-5 (American Psychiatric Association, 2013) as they both result from difficulties with inhibition. Additionally, their presentation is often indistinguishable from one another.

The diagnostic symptoms of hyperactive-impulsivity listed in the DSM include:

• often fidgets with or taps hands or feet, or squirms in seat
• often leaves seat in situations when remaining seated is expected
• often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
• often unable to play or take part in leisure activities quietly
• is often “on the go” acting as if “driven by a motor”
• often talks excessively
• often blurts out an answer before a question has been completed
• often has trouble waiting his/her turn
• often interrupts or intrudes on others (e.g., butts into conversations or games).

 

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References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC.

Barkley, R.A. (2015). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th ed. New York: Guilford Publications.

Barkley, R.A. (2016). Managing ADHD in School: the best evidence-based methods for teachers. Eau Claire: PESI Publishing.

Rabiner, D. (2008) Self-regulation and Barkley’s Theory of ADHD. Retrieved from https://sharpbrains.com/blog/2008/02/23/self-regulation-and-barkleys-theory-of-adhd/