problem solving planning and impulse control adhd collective name

Understanding Impulsivity in ADHD: Causes, Examples, and Management Strategies

Spontaneity may be the spice of life, but for those grappling with ADHD impulsivity, it’s often an overwhelming main course served with a side of unintended consequences. Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition that affects millions of individuals worldwide, with impulsivity being one of its core symptoms. This article delves into the intricate world of ADHD impulsivity, exploring its causes, manifestations, and management strategies to help those affected navigate their daily lives more effectively.

Understanding Impulsivity in ADHD

Impulsivity, in the context of ADHD, refers to the tendency to act without forethought or consideration of potential consequences. It’s characterized by a lack of inhibition and an inability to delay gratification. For individuals with ADHD, impulsivity is not simply a matter of poor self-control; it’s a neurological difference that affects their decision-making processes and behavioral responses.

The prevalence of impulsivity in ADHD is significant, with estimates suggesting that up to 90% of individuals diagnosed with ADHD experience some degree of impulsive behavior. This high prevalence underscores the importance of understanding and addressing impulsivity as a central component of ADHD management.

The impact of impulsivity on daily life and relationships can be profound. From blurting out inappropriate comments to making rash decisions, impulsive behaviors can lead to social difficulties, strained relationships, and challenges in academic or professional settings. ADHD and No Filter: Understanding Impulsive Speech and Social Challenges explores how impulsivity can manifest in social interactions, often leading to misunderstandings and conflicts.

The Neuroscience Behind Impulsivity and ADHD

To truly understand impulsivity in ADHD, we must delve into the neuroscience underlying this complex condition. The brain regions involved in impulse control are primarily located in the prefrontal cortex, which is responsible for executive functions such as planning, decision-making, and inhibition. In individuals with ADHD, these areas often show reduced activity or altered connectivity, leading to difficulties in controlling impulsive behaviors.

Neurotransmitter imbalances play a crucial role in ADHD impulsivity. Dopamine and norepinephrine, two key neurotransmitters involved in attention and impulse control, are often dysregulated in individuals with ADHD. This imbalance can result in a heightened sensitivity to immediate rewards and a reduced ability to consider long-term consequences.

Genetic factors also contribute significantly to impulsivity in ADHD. Research has identified several genes associated with ADHD and impulsive behaviors, including those involved in dopamine signaling and neurotransmitter regulation. These genetic variations can influence an individual’s predisposition to impulsivity and their response to various treatment approaches.

Examples of Impulsivity in ADHD

Impulsivity in ADHD manifests in various ways, affecting different aspects of an individual’s life. Understanding these manifestations is crucial for recognizing and addressing impulsive behaviors effectively.

Verbal impulsivity is one of the most common and noticeable forms of impulsivity in ADHD. This can include blurting out answers before questions are completed, interrupting conversations, or speaking without considering the appropriateness of the content or context. ADHD and Interrupting: Understanding the Connection and Strategies for Improvement provides insights into this specific aspect of verbal impulsivity and offers strategies for managing it.

Action impulsivity refers to engaging in risky behaviors or making sudden decisions without considering potential consequences. This can range from impulsively quitting a job to engaging in dangerous physical activities without proper precautions. The thrill-seeking nature of action impulsivity can lead to both exciting experiences and potentially harmful outcomes.

Emotional impulsivity is characterized by rapid and intense mood swings, as well as emotional outbursts that may seem disproportionate to the triggering situation. Individuals with ADHD may struggle to regulate their emotions, leading to impulsive expressions of anger, frustration, or excitement that can strain relationships and create social difficulties.

Financial impulsivity is another significant area of concern for many individuals with ADHD. This can manifest as impulsive spending, poor money management, or difficulty saving for long-term goals. The immediate gratification associated with purchases can be particularly appealing to those with ADHD, often leading to financial stress and instability.

Examples of ADHD Impulsivity in Adults

While ADHD is often associated with childhood, its symptoms, including impulsivity, can persist into adulthood and manifest in ways that significantly impact an individual’s life and relationships.

Impulsive career changes or job-hopping is a common manifestation of ADHD impulsivity in adults. The excitement of a new opportunity can overshadow the potential drawbacks, leading to frequent job changes without thorough consideration of long-term career goals or financial stability. This pattern can result in a fragmented work history and difficulties in career progression.

Reckless driving or frequent traffic violations are another area where ADHD impulsivity can have serious consequences. Adults with ADHD may struggle with maintaining focus while driving, leading to impulsive decisions on the road, such as speeding, changing lanes abruptly, or running red lights. These behaviors not only put the individual at risk but also endanger others on the road.

Impulsive romantic relationships or infidelity can be a particularly challenging aspect of ADHD impulsivity in adults. The excitement of new relationships or the thrill of forbidden encounters can be especially appealing to individuals with ADHD, potentially leading to hasty commitments or infidelity that can have long-lasting emotional consequences.

Substance abuse or addictive behaviors are also more prevalent among adults with ADHD. The impulsivity associated with ADHD can make individuals more susceptible to experimenting with drugs or alcohol, and the immediate reward of these substances can be particularly appealing. This can lead to a higher risk of developing substance use disorders or other addictive behaviors.

Distinguishing Impulsivity in ADHD from Other Conditions

While impulsivity is a core feature of ADHD, it’s important to distinguish it from similar symptoms present in other mental health conditions. This differentiation is crucial for accurate diagnosis and effective treatment.

When comparing ADHD impulsivity with bipolar disorder, there are some key differences to note. While both conditions can involve impulsive behaviors, the impulsivity in bipolar disorder is typically associated with manic or hypomanic episodes and is often accompanied by grandiose thoughts and decreased need for sleep. In contrast, ADHD impulsivity is more consistent and not tied to specific mood episodes.

Borderline Personality Disorder (BPD) also shares some features with ADHD, particularly in terms of impulsivity and emotional dysregulation. However, the impulsivity in BPD is often driven by intense fear of abandonment and unstable self-image, whereas ADHD impulsivity is more related to difficulties with attention and executive function.

There is also some overlap between ADHD and anxiety disorders, as both can involve restlessness and difficulty concentrating. However, the impulsivity in ADHD is not typically driven by anxiety or worry, as it is in anxiety disorders. Instead, it stems from difficulties with inhibition and self-regulation.

Management Strategies for Impulsivity in ADHD

Managing impulsivity in ADHD often requires a multi-faceted approach, combining therapeutic techniques, lifestyle modifications, and, in some cases, medication. Understanding Impulse ADHD: A Comprehensive Guide to Testing and Management provides valuable insights into identifying and addressing impulsive behaviors associated with ADHD.

Cognitive Behavioral Therapy (CBT) techniques have shown significant effectiveness in managing ADHD impulsivity. CBT helps individuals identify triggers for impulsive behaviors, develop coping strategies, and reframe negative thought patterns. Techniques such as thought stopping, impulse delay, and problem-solving training can be particularly beneficial in managing impulsive urges.

Mindfulness and meditation practices can also be powerful tools for individuals with ADHD. These techniques help cultivate awareness of the present moment, allowing individuals to pause and reflect before acting impulsively. Regular mindfulness practice can enhance self-regulation skills and improve overall emotional balance. Mastering Impulse Control: A Comprehensive Guide to Brain Training for ADHD offers additional insights into techniques for improving impulse control.

Medication options for managing ADHD impulsivity typically include stimulants and non-stimulants. Stimulant medications like methylphenidate and amphetamines work by increasing dopamine and norepinephrine levels in the brain, which can improve focus and reduce impulsive behaviors. Non-stimulant medications, such as atomoxetine, can also be effective for some individuals. The Best ADHD Medication for Impulsivity: A Comprehensive Guide to Impulse Control provides a detailed overview of medication options and their effectiveness in managing impulsivity.

Environmental modifications and support systems play a crucial role in managing ADHD impulsivity. This can include creating structured routines, using visual reminders and cues, and implementing organizational systems to reduce the likelihood of impulsive decisions. Additionally, having a strong support network of family, friends, or support groups can provide accountability and encouragement in managing impulsive behaviors.

The Role of Instant Gratification and Impatience in ADHD Impulsivity

One of the key challenges in managing ADHD impulsivity is the strong drive for instant gratification. Individuals with ADHD often struggle with delaying rewards, leading to impulsive decisions that prioritize immediate pleasure over long-term benefits. ADHD and Instant Gratification: Understanding the Struggle and Strategies for Delayed Gratification explores this aspect of ADHD in depth, offering insights into why instant gratification is so appealing and how to develop strategies for resisting impulsive urges.

Closely related to the desire for instant gratification is the challenge of impatience. Many individuals with ADHD find it difficult to wait or tolerate delays, leading to impulsive actions aimed at speeding up processes or avoiding wait times. ADHD and Impatience: Understanding and Managing the Struggle for Patience delves into the connection between ADHD and impatience, providing strategies for cultivating patience and managing impulsive reactions to delays.

Impulsive Speech and Social Challenges in ADHD

One of the most noticeable manifestations of ADHD impulsivity is in speech and social interactions. Individuals with ADHD may find themselves blurting out thoughts or comments without considering their appropriateness or relevance to the conversation. ADHD and Blurting Out Random Things: Understanding and Managing Impulsive Speech explores this phenomenon, offering insights into why it occurs and strategies for managing impulsive speech.

These impulsive verbal behaviors can lead to significant social challenges, including misunderstandings, conflicts, and difficulties in maintaining relationships. Learning to recognize the signs of impending impulsive speech and developing strategies to pause and reflect before speaking can greatly improve social interactions for individuals with ADHD.

Identifying and Managing ADHD Triggers

Understanding and managing triggers that exacerbate ADHD symptoms, including impulsivity, is crucial for effective symptom management. Understanding ADHD Triggers in Adults: Recognizing and Managing Symptoms provides a comprehensive guide to identifying common triggers and developing strategies to mitigate their impact.

Common triggers for ADHD impulsivity can include stress, lack of sleep, certain foods or substances, and overstimulating environments. By learning to recognize these triggers and implementing proactive strategies to manage them, individuals with ADHD can reduce the frequency and intensity of impulsive behaviors.

Conclusion: Embracing Strategies for Managing ADHD Impulsivity

In conclusion, impulsivity is a complex and challenging aspect of ADHD that can significantly impact an individual’s daily life and relationships. However, with a comprehensive understanding of its underlying causes and manifestations, along with the implementation of effective management strategies, individuals with ADHD can learn to harness their impulsivity and channel it in more positive directions.

It’s important to remember that managing ADHD impulsivity is an ongoing process that requires patience, persistence, and often professional support. Impulse ADHD Test: Understanding and Diagnosing Hyperactive-Impulsive ADHD can be a valuable first step in identifying the specific nature of one’s impulsive tendencies and seeking appropriate help.

For those grappling with ADHD impulsivity, it’s crucial to seek professional help from mental health experts specializing in ADHD. These professionals can provide personalized strategies, medication management if necessary, and ongoing support to help individuals navigate the challenges of ADHD impulsivity.

Ultimately, while ADHD impulsivity can present significant challenges, it’s important to recognize that it can also be a source of creativity, spontaneity, and unique problem-solving abilities when properly managed. By developing effective coping strategies and embracing their unique cognitive style, individuals with ADHD can learn to thrive, turning their impulsivity from a liability into a potential asset in their personal and professional lives.

References:

1. Barkley, R. A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. Guilford Publications.

2. Faraone, S. V., et al. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789-818.

3. Nigg, J. T. (2017). Annual Research Review: On the relations among self-regulation, self-control, executive functioning, effortful control, cognitive control, impulsivity, risk-taking, and inhibition for developmental psychopathology. Journal of Child Psychology and Psychiatry, 58(4), 361-383.

4. Volkow, N. D., et al. (2009). Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA, 302(10), 1084-1091.

5. Sonuga-Barke, E. J. (2003). The dual pathway model of AD/HD: an elaboration of neuro-developmental characteristics. Neuroscience & Biobehavioral Reviews, 27(7), 593-604.

6. Kooij, J. J. S., et al. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56(1), 14-34.

7. Safren, S. A., et al. (2010). Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behaviour Research and Therapy, 48(9), 831-839.

8. Zylowska, L., et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. Journal of Attention Disorders, 11(6), 737-746.

9. Cortese, S., et al. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727-738.

10. Young, S., et al. (2020). Cognitive-behavioral therapy for attention deficit hyperactivity disorder (ADHD) in adults. Clinical Psychology Review, 78, 101899.

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Understanding And Managing Impulsivity In ADHD

Ioanna Stavraki

Community Wellbeing Professional, Educator

BSc (Hons) Psychology, MSc, Neuropsychology, MBPsS

Ioanna Stavraki is a healthcare professional leading NHS Berkshire's Wellbeing Network Team and serving as a Teaching Assistant at The University of Malawi for the "Organisation Psychology" MSc course. With previous experience at Frontiers' "Computational Neuroscience" journal and startup "Advances in Clinical Medical Research," she contributes significantly to neuroscience and psychology research. Early career experience with Alzheimer's patients and published works, including an upcoming IET book chapter, underscore her dedication to advancing healthcare and neuroscience understanding.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Impulsivity is one of the primary ADHD symptoms characterized by more impulsive actions, emotions, and behaviors.

It is almost like a knee-jerk reaction or the inability to apply the breaks before acting. Thus, people with ADHD tend to react first and think afterward.

Due to the way the ADHD brain is functioning, resisting such impulses can be extremely difficult, with many not fully realizing and recognizing the consequences of what they have done or said until the act is well on its way or already finished (Winstanley, Eagle & Robbins, 2006). 

Signs of Impulsivity In ADHD

There are many ways impulsivity can manifest, with some being more obvious than others. Let us now look at some of the most common ways it can be expressed:

Impulsive decision-making 

People with ADHD are more prone to impulsive decision-making and quicker reactions to situations without thinking about the end result.

For example, Kimberly Quinn, during her TED talk titled “The double-edged sword: ADHD and impulsivity,” described one of her experiences as “there was no way to see around these impulse buys, there was no shut-off switch” (TEDx Talks, 2020).

Such impulsive decision-making can thus have a direct impact on various areas of one’s life, making it difficult to tune out more rational thoughts. 

Verbal impulsivity 

Verbal impulsivity is the tendency for people to verbally express their thoughts, emotions, and opinions about a situation without much thought over how they make come across or impact others.

For example, they may interrupt people, jump into conversations, change topics suddenly, or even blurt out their thoughts on what you said, did, or are even wearing.

This is not stemming from a malicious point but from them talking without thinking fully about how their words may come across to others.

Emotional impulsivity 

Emotional impulsivity can be characterized by outbursts, overreactions to situations, and feelings of being overwhelmed with strong emotions and needing to express them immediately (Mitchell et al., 2012).

For example, crying intensely when receiving constructive criticism, angrily shouting when feeling emotionally attacked, or having more heightened emotional excitability overall.

This type of impulsivity can often stem from other ADHD symptoms, such as troubles with emotional regulation , sensitivity to criticism, and perfectionistic tendencies.

Financial impulses 

Financial impulsivity is a form of reactive behavior with people being more susceptible to things such as deals, sales, or limited-time offers.

With the rise of fast fashion and heavily discounted websites, consumerism and the need to buy to get that dopamine hit of purchasing something new can exacerbate this.

Additionally, big and more expensive purchases may be more rushed without fully considering their value, need, and usability in their lives. 

Impatience 

People with ADHD are likely to be impatient in many situations, such as at work, in relationships, and even with themselves.

For example, they may get easily frustrated when queuing, waiting for their turn to speak, receiving an answer, or getting something done. They can also often experience a sense of restlessness or uneasiness and this can be exacerbated with the more they have to wait.

Such impatience can then directly link and lead to several other impulses mentioned previously, such as emotional, verbal, and even financial. 

Risky behaviors

Lastly, risky behavior in ADHD impulsivity is the tendency to seek out activities and engage in behaviors that could lead to dangerous and negative consequences, sometimes to get that instant stimulation.

For example, this can manifest as reckless driving, pranks, trespassing, gambling, or misuse of substances (Ortal, 2015), gambling, or sexual acts without adequate protection.

These actions can be destructive not only to themselves but also to their loved ones and wider circle.

What are the Consequences of Impulsivity?

Just as impulsivity can manifest in various different forms, so can the consequences of it, which can range from mild to rather dangerous.

A common one will be challenges with interpersonal relationships, such as misunderstandings, emotions being hurt, or people not feeling heard, which can lead to conflicts and falling outs. 

Safety concerns can also arise, especially if the impulsions in question are linked with risky behaviors or quick decision-making on the spot.

People can be reactive without thinking and get themselves in dangerous situations rather quickly. Repercussions of this can range from physical and mental to even law and legal troubles.

Issues at either school, university or the workplace may also manifest due to impulses. For example, focusing on tasks can be more challenging, disrupting classes or work meetings and struggling to prioritize work, which can hinder performance.

People may also be labeled as misbehaved or difficult to work with, leading to academic or occupational troubles. In severe cases, being expelled or let go from your job can also happen, or on the flip side, the impulse to quit jobs or switch educational pathways and degrees may also manifest.

Finances may take a hit as well, especially in relation to financial impulses such as erratic spending or impulse buying. Certain sale periods may be especially triggering for people.  This can lead to troubles managing finances, having savings, and budgeting for necessities (Bangma, Tucha, Fuermaier, Tucha & Koerts, 2020). 

Lastly, someone’s mental and physical well-being can be directly impacted due to all the aforementioned reasons. Feelings of regret over actions and behaviors can arise, which can also lead to higher stress .

Some people may also withdraw socially or be ostracised, increasing the chances of social isolation and loneliness (Bastien, 2013).     

What Causes Impulsivity in ADHD? 

ADHD impulsivity does not have a single attributable cause, but it is more of a collection of neurobiological and environmental factors working together to generate and sustain it.

Primarily, certain dysregulations in how the brain handles executive functions (such as impulsivity and decision-making) have been noted (Swanson, 2003). This can make it more difficult to apply critical thinking and engage in more inhibitory patterns around emotions and behavior. 

Neurotransmitter imbalances, especially those responsible for reward and pleasure such as dopamine, can also be present.

Dysregulation in these pathways can cause a reduction in dopamine, increasing the likelihood of impulsive behavior to get that sense of reward (Williams & Dayan, 2005).

People with ADHD are, thus, far more likely to act impulsively in need of that dopamine hit while also struggling to apply the breaks due to executive function challenges.

Lastly, impulsivity can also be exacerbated by comorbid conditions associated with ADHD, such as Intermittent Explosive Disorder or IED (Gnanavel, Sharma, Kaushal & Hussain, 2019) or Bipolar Disorder (Nandagopal et al., 2011).

Such conditions often exhibit their own symptoms of impulsivity, so cooccurrence increases such behaviors and emotions further. 

How to Manage ADHD Impulsivity

As impulsivity is one of the core symptoms of ADHD, its consequences can range and affect several areas of life.

Learning how better to control such actions, emotions, and behaviors can, thus, have wide-reaching benefits on someone’s well-being, relationships, and overall life.  

Let us discuss some ways in which ADHD impulsivity can be managed.

Self-compassion 

Being kind and compassionate to yourself is key. Navigating the world through an ADHD lens is no easy task, so understanding that certain behaviors are simply a byproduct and not directly linked to your personality and values is important.

Remember to give yourself time to process and reflect without going into self-destructive talks or using diminishing language to punish yourself. 

Identify behaviors 

In order to manage impulsivity, you first need to be aware of which behaviors are linked to it. People can be different in how their ADHD is expressed, so understanding how impulsivity manifests for you is a good first step.

You can speak to trusted loved ones and see their opinions as people who know you, and of course, seek advice from a professional who can better help guide you.

You can also keep a journal to document your reflection so you can keep better track of your thoughts and progress.

Remove or reduce triggers 

Ensuring your environment is not actively encouraging or triggering impulsive actions or decisions is another way to manage impulsivity.

For example, unsubscribing from marketing emails around sales periods, learning to write down your thoughts first if you tend to have verbal impulses, or asking to hang out at less stimulating places with your friends.

By doing this, you are actively limiting situations that exacerbate any impulsive tendencies.  

Create obstacles 

On a similar note, you can actively try and create obstacles that will prevent you from engaging in impulsive behaviors. Some examples can be:

• Not having card details saved to reduce impulsive online purchases
• Leaving sticky notes in places of high visibility to remind you to think first before acting
• Leaving your car key at home if you know you will be out drinking 
• Learning to deploy mindfulness and breathing when impulsive thoughts arise
• Learn emotion management skills 

Learning emotional management skills can be a great way to both prevent impulses but also de-escalate them before they enter a more dangerous or distractive zone.

These can be especially helpful if you are prone to verbal and emotional impulses such as outbursts, intense emotional fluctuations, or buying, drinking, or eating your way out of intense emotions.

Some examples of such techniques are breathing exercises, mindfulness (Virone, 2023), and physical exercise (Wigal, Emmerson, Gehricke & Galassetti, 2013).

Take responsibility 

Taking responsibility for your actions and behaviors can greatly help in several different areas and show that you have reflected on your behavior.

Firstly, in your interpersonal relationships, take accountability and apologize for any outburst or not consider your loved one’s feelings.

Secondly, in the workplace, especially if you frequently interrupt colleagues or meetings. Lastly, it can make you feel better by knowing that you are taking charge in mending situations, in addition to relieving the stress of having things left unspoken or on a rougher patch. 

Plan and think ahead 

You can also tackle impulsivity head-on by trying to plan and think ahead. For example, if you know you have a big project coming along, ensure you try and reduce triggers, create buffers, and organize yourself to tackle it better.

You can use visual cues like Post-Its or even digital apps to help you stay focused and organized. Through trial and error, you can slowly figure out what works best for you.

Break down long-term goals

Lastly, breaking down long-term goals into smaller, more manageable action points can greatly help curb impulses (it can also help with getting motivated to do tasks you struggle to focus on due to impulsivity).

Begin by reflecting on where you are at the moment and where you see yourself in the future.

You can ask loved ones for their help in keeping you accountable, and remember to celebrate all milestones and small victories. 

Consider therapy

Seeking therapy can be invaluable for gaining skills and strategies tailored to your unique needs. A therapist specializing in ADHD and impulsivity can help identify your triggers, teach coping methods, provide accountability through regular check-ins, and support you on harder days.

Whether individual or group therapy, having a safe space to process emotions and experiences can lessen impulses and build self-awareness.

Therapy need not be lifelong either – even short-term can equip you with skills to better manage impulsivity moving forward.

Therapies such as cognitive behavioral therapy ( CBT ), dialectical behavior therapy ( DBT ), or acceptance and commitment therapy ( ACT ) may all be beneficial for learning techniques for managing impulsivity.

Is impulsivity always a sign of ADHD?

Impulsivity, while being one of the core symptoms of ADHD, is not necessarily always a sign of ADHD. Other people on the neurodiverse spectrum can also experience impulsive tendencies, e.g., individuals with Autistic traits (Hlavatá, Kašpárek, Linhartová, Ošlejšková & Bareš, 2018). 

In addition, some mental health conditions, such as bipolar (Najt, 2007) or borderline personality disorder (Berlin, Rolls & Iversen, 2005), and even people with dependencies such as drugs or alcohol may show this behavior. Moreover, people in the neurotypical population may express impulsive behavior simply due to their personalities. 

Lastly, age also plays a factor, e.g., children tend to be more impulsive as they are still in their early developmental stages. 

Are people with ADHD more prone to angry outbursts?

While not every person with ADHD may experience angry outbursts, it can make people more prone to reacting this way. There are several reasons why this might happen, with the most common ones being:

– Impulsivity: quick to react verbally and in a negative way to situations – Troubles with emotional regulation: difficulty compartmentalizing feelings and controlling reactions   – Reduced ability to sustain attention: more likely to lose patience and lash out – Heightened sensitivity to conflict and criticism: angry outbursts out of being defensive

If you feel like you are prone to such reactions, reaching out to a mental health professional specializing in ADHD can be a great step in learning about emotional regulation strategies and how to navigate situations better. 

Are there any situations where it is beneficial to be impulsive?

Impulsivity is generally considered a more challenging trait; however, there can be situations where reacting a bit more quickly and impulsively can have its benefits. 

Firstly, in emergency situations where time is of the essence, thinking quickly is key and can even save a life. Secondly, in fast-paced and time-sensitive work environments, e.g., hospitals, impulsivity may help someone adjust to professional challenges more. 

Thirdly, impulsive people can be more prone to seizing opportunities and not letting them fade away, as sometimes they can be hard to come by. Lastly, impulsivity can add a feeling of adventure and spontaneity in relationships, whether platonic or romantic.

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Bastien, M. (2013). Examining the relationship between ostracism and ADHD. UC Merced Undergraduate Research Journal , 5 (1).

Berlin, H. A., Rolls, E. T., & Iversen, S. D. (2005). Borderline personality disorder, impulsivity, and the orbitofrontal cortex. American journal of psychiatry , 162 (12), 2360-2373.

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Impulsivity and the ADHD Brain: Neural Networks, Explained!

Impulsivity is not simply rudeness or lack of self-discipline. impulse controls is a function of the interior signaling system of the brain..

ADHD impairs communication between different regions of the brain. That contributes to inattention, impulsivity , and emotional dysregulation.

Impulsivity and ADHD

Impulsivity, a primary symptom of ADHD, may impair your ability to stop and think about the consequences before speaking or acting. How?

In this video, learn about the brain’s “response inhibition” center, and why it doesn’t work as well for people with ADHD .

Impulsivity, Explained

Impulsivity: a tendency to act or speak on a whim. ADHD impairs your child’s ability to stop and consider the consequences before speaking or doing. An impulsive child may…

• blurt out an answer before raising her hand
• leap off the jungle gym without considering how or where he’ll land
• react to frustration or embarrassment with a punch or scream

How Do ADHD and Impulse Control Intersect?

The thalamus area of the brain controls response inhibition. It works like a gate — sending signals to allow or stop behaviors.

When the brain detects a red flag, its limbic-hippocampal connections relay a warning from the thalamus to the frontal cortex. That’s the control center of the brain that handles emotional expression and problem solving.

In ADHD brains, the thalamus gate is broken. That means a person with ADHD may struggle to:

• Hold back a comment that may hurt someone’s feeling
• Rein in short-term desires like eating candy or spending money

“People without ADHD have the ability to stop, mid-stream if they recognize a person is not smiling,” says Joel Nigg, Ph.D. “The child with ADHD needs 20-30 milliseconds longer warning [to correct course], which is an eternity when it comes to behavior control.”

In other words, this is not simply rudeness or lack of self-discipline. It is a function of the interior signaling system of the brain.

[ Free Expert Resource: Unraveling the Mysteries of Your ADHD Brain ]

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ADHD & Impulsivity: Understanding the Connection

Author: Arelie Estevez, LMHC

Arelie Estevez LMHC, LPC

Arelie is a bilingual counselor focusing on cultural impacts on behavior, addressing trauma, anxiety, and depression through diverse therapies aimed at underserved populations.

Heidi Moawad MD

Heidi Moawad, MD is a neurologist with 20+ years of experience focusing on mental health disorders, behavioral health issues, neurological disease, migraines, pain, stroke, cognitive impairment, multiple sclerosis, and more.

Impulsivity and ADHD are closely related; sometimes they are co-occurring, and sometimes you can have impulsivity without also having ADHD and vice versa. Impulsivity in someone diagnosed with ADHD usually shows up as actions without thinking or planning. This person may speak over you or out of turn, make poor decisions, and/or take unnecessary risks. Sometimes impulsivity can be a good thing, like when you need to think fast and come up with a quick solution to a problem, but for the most part, impulsive behaviors can put you in unnecessary risky situations.

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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
• Feelings of inadequacy
• Poor decision making

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.

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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:

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

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For Further Reading

• Complete Guide to ADHD Medications – Child Mind Institute
• Effectiveness of Day Treatment for Disruptive Behaviour Disorders: What is the Long-term Clinical Outcome for Children?
• How to Find a Neurodiversity-Affirming Therapist
• ADHD Benefits: 13 Things to Love About Your ADHD
• Is ADHD a Learning Disability? Qualifications & Benefits

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Centers for Disease Control and Prevention. (2023, March 30). Learn about attention-deficit / hyperactivity disorder (ADHD) . Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/index.html 

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Sheffler ZM, Reddy V, Pillarisetty LS. Physiology, Neurotransmitters. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539894/

Arnsten AF. Stress signaling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci. 2009 Jun;10(6):410-22. doi: 10.1038/nrn2648. PMID: 19455173; PMCID: PMC2907136.

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Psychological Treatments for Hyperactivity and Impulsivity in Children with ADHD: A Narrative Review

Shayan sadr-salek.

1 Service Psychologique, Solidarité Jeunes asbl—Haus 13, 48, rue Victor Hugo, L-4140 Esch-sur-Alzette, Luxembourg; [email protected]

Andreia P. Costa

2 Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Campus Belval, MSH, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg; [email protected]

Georges Steffgen

Associated data.

Not applicable.

Treatment of the ADHD types (hyperactive-impulsive, inattentive, and combined) in children has rarely been studied separately, although their prognostic courses differ widely. In addition, data show that improvements in hyperactivity/impulsivity are hard to achieve. Thus, we focused on treatments tailored to hyperactivity/impulsivity. We examined meta-analyses and systematic reviews within the inter- and intra-individual treatments and found that psychoeducation and training for parents, school-based interventions, reinforcement strategies, and neurofeedback consistently showed small to moderate effect sizes in reducing hyperactivity/impulsivity in children. Conversely, emotional self-regulation, social skills, and cognitive trainings showed unsatisfactory results. In summary, we found that the quality of usual care can be surpassed when the designated interventions are purposefully combined into a multimodal treatment program.

1. Introduction

1.1. clinical picture.

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood [ 1 , 2 ]. ADHD is characterized by the three core symptoms of inattention and/or hyperactivity and impulsivity. In short, these symptoms are present at an abnormal level (in relation to age and developmental stage), occur across situations, and cause significant distress and/or limitations in social, educational, or occupational functioning [ 3 , 4 ]:

• Inattention is defined by forgetfulness, distractibility, and careless mistakes. Moreover, concerned persons commonly seem to have difficulties listening when they are spoken to, finishing what they started, and organizing themselves as expected. They also often avoid or refuse to do their homework and frequently lose their toys and belongings;
• Hyperactivity is characterized as fidgeting and not being able to sit still, respectively, by running and climbing around in inadequate situations. Moreover, hyperactive children may not be able to play in a quiet way or, at least not over an extended time span. Moreover, excessive motor activity often cannot be managed by the social environment and direct orders;
• Impulsivity is regarded as interrupting others or not being able to hold back answers, thus bursting into other people’s conversations. Impulsive children talk excessively and often change the conversation subject. Consequently, these children are very impatient, and they find it difficult to wait their turn.

1.2. Epidemiology/Prevalence

The prevalence of ADHD is age-dependent and varies with the diagnostic criteria and sources of information used to assess symptomatology. In childhood and adolescence, the prevalence found in international epidemiological studies is around 5.3% worldwide, with no significant differences internationally [ 5 ]. For instance, in Germany, the frequency of parent-reported diagnoses of ADHD is about 5%, according to the KiGGS study of the Robert Koch Institute [ 6 ]. For adulthood, a prevalence of 2.5% was found in a meta-analysis of six studies based on the DSM-IV criteria [ 7 ]. Moreover, Polanczyk et al. [ 8 ] could illustrate that the prevalence has not changed over the last three decades on a worldwide basis.

In population samples, the prevalence ratio between boys and girls varies around 3:1, whereas in clinical samples, the prevalence ratio between boys and girls varies around 6:1 [ 9 ]. Scahill and Schwab-Stone [ 10 ] found, between the ages of 4 to 16 years, a prevalence rate of 9% for boys and 3% for girls. In the same way, girls are less likely to have comorbid aggressive symptoms [ 9 ]. In addition, Schlack et al. [ 6 ] showed that higher prevalence rates of ADHD are correlated with lower socioeconomic status and that living in big cities is linked with higher prevalence rates of ADHD compared to living in the countryside.

Moreover, prevalence estimates for ADHD types vary considerably across studies, and no consensus has yet been found on which type is more prevalent. Depending on the study, the prevalence rates for the hyperactive and impulsive type range from 0.7% to 2.77%, while the prevalence rates for the inattentive type range from 0.3% to 3.2% [ 11 , 12 , 13 , 14 ]. Concerning comorbidities, 30–50% of all ADHD cases meet the criteria for oppositional defiant disorder, 20–30% for learning disabilities, 20% for anxiety disorders, 15% for depressive disorder, and 10–20% for tic disorder [ 9 ].

1.3. Etiology

The conditions for the development of ADHD are extremely diverse as multiple interacting factors are involved in the pathogenesis of ADHD. Genetic predispositions and pre-, peri-, and early-postnatal environmental influences that affect structural and functional brain development play a central role [ 15 ].

Research on molecular genetics has shown that particularly dopamine and serotonin seem to be involved in the pathogenesis of ADHD. Heightened dopamine transporter concentration and reduced dopamine concentration in the synaptic gap have been found to be associated with ADHD symptoms [ 16 ]. Furthermore, findings from both behavioral and molecular genetic studies indicate that genetic as well as non-genetic factors contribute to the development of ADHD. Faraone et al. [ 17 ] provide a review of family, twin, and adoption studies and found convincing evidence that genes play an important role in transmitting vulnerability to ADHD. This is most apparent in twin studies, which value the heritability of ADHD at 0.76. Moreover, Fortier et al. [ 18 ] present genetic evidence for the implication of the hypothalamic–pituitary–adrenal axis in ADHD, which may serve as an important mediator in the pathogenesis of the disorder. Furthermore, the severity of ADHD was found to be higher in children with parents affected by ADHD than in children whose parents were non-affected [ 19 ].

In addition, parental ADHD was linked to a higher likelihood of being diagnosed with the combined ADHD type and a lower chance of being diagnosed with the inattentive type alone [ 19 ]. Apart from this finding, there is only scarce evidence on the different backgrounds of the ADHD types [ 4 ].

Intriguingly, Tully et al. [ 20 ] have found that early births or low birthweight significantly increase the risk for later development of ADHD. They also found that maternal warmth served as a protective factor, counteracting birthweight or birth time as risk factors. Furthermore, infections, toxins, head traumas, and diet need to be further studied in the multifactorial pathogenesis of ADHD [ 4 , 9 ].

Moreover, ADHD is frequently paired with cognitive and executive deficits that are related to diffuse brain abnormalities. The anterior cingulate gyrus and the dorsolateral prefrontal cortex are significantly smaller in ADHD patients. These changes are thought to explain deficits in purposeful behavior. In addition, activity in the frontostriatal region is similarly impaired in these individuals, as shown by fMRI measurements. An understanding of these pathophysiological mechanisms is crucial so that interventions can be targeted to them [ 21 , 22 ].

Additionally, a range of psychosocial factors are commonly discussed in the literature, which have been shown to moderate the intensity of children’s hyperactive and impulsive behaviors. In general, a genetic disposition is considered the main causative variable of ADHD. However, unfavorable conditions in the family and school can lead to an increase in negative interactions in the environment, which, in turn, can amplify symptoms of ADHD. Moreover, the family is the first environment in which children learn rules and boundaries. In families where this process is not successful, the adoption of rules becomes progressively more problematic throughout life and leads to increasingly harsher consequences [ 4 ]. In this regard, Fenesy et al. [ 23 ] examined childhood ADHD symptoms and negative parenting styles as predictors of prospective changes in social problems over a four-year period. Initially, families of children with and without ADHD were closely examined, encompassing observed positive and negative parenting styles, youth ADHD symptoms, and multiple modal ratings of youth social problems. Along with other research, their findings suggest that psychosocial and educational factors (e.g., authoritarian parenting style, reinforcement through inconsequent parenting, absence of consistent rules, shortage of concrete action plans for parents and children, lack of school interventions, inadequate social skills, poor cognitive stimulations, imbalance of reward and punishment, etc.) are highly implicated in the underlying vicious circle that feeds hyperactive and impulsive symptoms in particular and moderates the severity of the disorder over the developmental period in children [ 3 , 4 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].

1.4. Diagnostic

The criteria of the ICD-11 or the DSM-5 classification systems must be fulfilled to diagnose ADHD. Both classification systems specify three types, namely the predominantly inattentive type, the predominantly hyperactive/impulsive type, and the combined type. According to the American Psychiatric Association [ 1 ], diagnosis of the inattentive type is made if the sub-points for the hyperactive and impulsive characteristics are not fulfilled; diagnosis of the hyperactive/impulsive type is made if all criteria are met except the sub-points for the inattentive type. Diagnosis of the combined type is given if all diagnostic criteria are met.

The diagnosis also requires the presence of at least moderate functional impairments. The symptoms of inattention or hyperactivity and impulsivity and the resulting functional impairments should occur in several areas of life, usually before the age of 12 [ 21 ]. If the symptoms only occur in one area of life (e.g., only at school/work, only in the family), this may be an indication of another mental disorder (e.g., adjustment disorders due to stress in the family or at school) that should be clarified by differential diagnosis [ 4 ]. Thus, ADHD diagnostics should always be multidimensional. This means that the affected persons themselves, relatives, or close persons should be interviewed. It also means that a variety of examination methods should be used, such as clinical interviews, questionnaires, behavioral observations, and objective tests [ 4 ]. An anamnesis should help to understand the history of the person and to consider critical life events. Differential diagnostics should consider especially oppositional defiant disorder and learning disabilities [ 9 ]. In addition, an intelligence test can further clarify the strengths and weaknesses of the person, and intervention methods can be adapted to the present intelligence profile, especially since 50% of ADHD patients have noticeable executive dysfunctions [ 31 , 32 ]. To complete the diagnostic evaluation, medical and neurological examinations are necessary to assess the underlying brain activity and functioning [ 33 ]. ADHD may take different manifestations depending on the person’s age, which can reflect differences in brain regulatory systems [ 34 , 35 , 36 ]. Therefore, an overarching assessment of the child’s functional maturity is needed to correctly diagnose ADHD and define a treatment plan [ 37 ].

1.5. Prognosis

The prognosis of ADHD varies according to the age of the person concerned. ADHD symptoms are found to persist into adolescence and can affect social and academic areas of life. A total of 40% of patients continue to show symptoms into adolescence, while 25% are diagnosed with an anti-social disorder at the same time, and recent research points to an apparent trend in the increase in the prevalence of ADHD among adults [ 38 , 39 ]. Nevertheless, there is also an important long-term trend in which ADHD patients’ symptoms decrease by about 50% in adulthood. Typically, 50% of patients “outgrow” ADHD, including through treatment, and 25% do not require treatment until they reach adulthood. Commonly, two theories are discussed to explain these developments. First, stimulants help improve frontal lobe development over time, and second, adults with ADHD often choose occupations that do not require sustained attention. As adults, these patients are then able to achieve their educational and occupational goals [ 40 ].

ADHD treatment, on the one hand, has been found to be effective in improving the symptoms of oppositional defiant disorder and conduct disorder. Likewise, the risk of substance use has been shown to be considerably reduced. Untreated ADHD, on the other hand, can lead to persistent dysfunction and devastating consequences, including long-term disability, a heightened risk of substance abuse, and an increase in car accidents [ 21 , 41 , 42 , 43 , 44 ]. In this regard, the symptom of inattentiveness, which can hinder the full understanding of the consequences of numerous actions, is hypothesized to be partly responsible for various crimes, such as theft, drug use and sale, robbery, and even burglary [ 45 ]. In contrast, individuals suffering from the hyperactive/impulsive type of ADHD tend to disrupt their routines, lose touch with their friends and families, and engage in risky behaviors even if they understand the consequences of their actions better than those suffering purely from inattentiveness. Those with the hyperactive/impulsive type, conversely, commit reckless crimes that lead to arrests and convictions to a higher degree than those with the inattentive type. These crimes relate to theft and especially assault, but not drug trafficking, as the latter, presumably, requires forethought [ 46 ]. Thus, there are clear predictors of the differences in the prognosis, which become apparent by evaluating the crimes committed by people suffering from the different types of ADHD alone [ 46 ].

1.6. Negative Consequences of ADHD over the Life Span

Children with ADHD suffer significantly from their disorder and face various consequences throughout their school years and beyond [ 46 , 47 ]. First, the school curriculum poses a challenge that children cannot follow due to their hyperactivity/impulsivity, which is often accompanied by oppositional behavior or due to their inattention and absent-mindedness [ 9 ]. This often leads to poor school grades and/or a conflictual school environment, which not infrequently results in the affected children beginning to devalue the school itself [ 48 ]. As a result, defiant and stubborn behavior toward any kind of schooling repeatedly occurs, leading to children performing significantly worse in school compared to their peers [ 47 , 48 ].

Thereafter, transitioning to puberty with ADHD is a major task. Classic developmental tasks such as detachment from the parental home or the special importance of identity development are influenced by ADHD and place a particular burden on adolescents with the disorder [ 49 ]. The influence of family members and peers should also be mentioned at this point. For example, a negative parenting style can further increase the risk of developing an affective disorder [ 50 , 51 ]. This should be prevented and addressed by activating resources within the family. In addition, peers may predispose adolescents with ADHD to develop strong externalizing behavior disorders (e.g., aggression, dissocial behavior) and substance abuse, as they are prone to these behaviors from the beginning. These behaviors are also associated with the early onset of conduct disorders, which, in turn, points to the need for early intervention in children [ 46 ].

Ultimately, in adulthood, the likelihood of being unemployed, addicted to drugs, implicated in accidents, or involved in crimes and punished by the justice system is much higher [ 1 , 43 , 44 , 46 , 52 ], which also places a significant economic burden on the public sector [ 53 ]. These negative developments represent a major loss for those affected, their families, and society. Social integration plays a critical role throughout the course of the disorder and poses a considerable psychological strain on all other areas of life [ 46 ]. Although many interventions attempt to alleviate the symptoms of ADHD, no major breakthroughs have been made in this field to proactively reduce prevalence rates and/or to address the underlying neuropathological mechanisms [ 52 ].

Although the ADHD literature focuses almost exclusively on evidence and interventions of the ADHD inattentive and hyperactive/impulsive types combined, the current paper sets itself apart by considering the conceptual gap that the diagnosis of ADHD entails, as there are substantial differences between the types. In short, the inattentive type is defined by distractibility, carelessness, frequent daydreaming, and forgetfulness, while the hyperactive/impulsive type stands out with restlessness and fidgetiness during any calm activities, interruptions, and disturbances of other people and often getting into trouble [ 54 ]. These differences within this psychopathology commonly lead to divergent developments and consequences and, hence, require an individually tailored and modular treatment plan. The distinction between the two types and their implication for treatment is especially important for children, for whom there is a clear distinction between the presentation of the inattentive type and the hyperactive/impulsive type, while in adults, this distinction has been found to be less clear [ 55 ]. Moreover, recent advances in psychotherapy as a field are also considering modular therapeutic approaches to treat the individual patient’s needs rather than relying only on predetermined tools that are used in a general way to treat a given diagnosis [ 56 , 57 ]. Therewith, this paper challenges not the diagnostic conception of ADHD but rather examines the implications for psychological treatment. Specifically, this paper seeks to highlight the hyperactive/impulsive pathway since this pathway differs too much from the inattentive one, and addressing both exceeds the scope of this work [ 45 , 46 ]. Additionally, as the expression can vary significantly between the ADHD types, practitioners can benefit from more explicit guidance on best practices depending on the different types. This aspect, however, has only been addressed very sparsely within the ADHD literature.

Consequently, the main purpose of the present review is to critically examine the current state of knowledge concerning the psychological treatments of the hyperactivity and impulsivity dimension of ADHD in children and adolescents. For this purpose, after having explained the clinical picture, epidemiology, etiology, diagnostics, prognosis, and negative consequences of ADHD, we will continue by describing the interventions for hyperactivity and impulsivity in children with ADHD and the associated results.

2.1. Search Strategy

Boolean search with combinations of “ADHD”, “attention deficit and hyperactivity disorder”, “hyperactivity”, “impulsivity”, “psychological treatment”, and “pharmacotherapy” was performed in the electronic databases PubMed, PSYNDEX, and Google Scholar between 1967 and 2022. The cross-references of the articles were also checked. Additionally, the filter options with meta-analysis, randomized controlled trials, or systematic reviews were chosen depending on the availability of the research junction and the area of interest.

2.2. Study Selection

Peer-reviewed studies carried out in children with ADHD and published in English or German were selected for the current review. Case reports and animal studies were excluded from the current selection.

2.3. Data Extraction

The studies were extracted using the above-stated criteria and were categorized into different themes such as clinical description, epidemiology, etiology, diagnostics, prognosis, and interventions. Moreover, because of the focus of this paper on the hyperactive/impulsive type, the effects of the discussed treatments on inattention in children with ADHD were not considered and are thus not reported in the following sections.

3. Interventions

Numerous interventions attempt to alleviate ADHD symptoms. These interventions range mainly from psychosocial therapies to bio- and neurofeedback therapies, nutritional and herbal therapies, and psychopharmacotherapy [ 2 , 58 , 59 , 60 ]. In this regard, this review mainly investigates the state-of-the-art psychological treatments for hyperactivity and impulsivity in children with ADHD and, hence, focuses on the psychosocial intervention techniques, including neurofeedback, while drawing comparisons with psychopharmacotherapy. Moreover, the reported psychosocial intervention techniques can be subdivided into the inter-individual versus the intra-individual domains. This enables the present review to classify the indicated techniques concisely into essential subcategories, which furthermore provide information about the basis on which the interventions operate, either in the social setting or on the individual child. Moreover, this paper aims to provide an integrated and modular treatment overview. Thus, the following sections will focus specifically on parent training, psychoeducation, school interventions, and social skills trainings as inter-individual therapeutic modules and on cognitive skills, emotional self-regulation, and neurofeedback as intra-individual therapeutic modules with the aim of increasing children’s hyperactivity and impulse control. This selection has also been drawn in accordance with the work of van der Burg et al. [ 42 ], who have systematically analyzed the most relevant therapeutic components and distilled further evidence in which ways these components can be improved to increase the quality of ADHD therapy.

3.1. Inter-Individual Interventions

3.1.1. parent psychoeducation and parent skills trainings.

Psychoeducation is a therapeutic element that mainly teaches information about psychological disorders and their treatment. The aim of these psychoeducational approaches is to promote symptom recognition, ensure treatment participation, improve treatment adherence in both psychosocial and pharmacological domains, and teach coping skills to patients and their families [ 61 ]. Accordingly, in some studies, sessions include didactic presentations, discussions, detailed written instructions or programs, as well as guidance and skills training for parents [ 61 , 62 ]. Additionally, psychoeducation has frequently been proposed in combination with behavioral interventions, such as self-control learning [ 63 ], classroom management techniques [ 64 ], or parent and family counseling [ 65 ]. Research has also shown that pharmacotherapy with psychoeducation leads to greater improvements in symptoms and family relationships, among other outcomes, compared to pharmacotherapy alone [ 66 , 67 ].

Ferrin et al. [ 68 ] developed a comprehensive 12-session long psychoeducation program for families of children and adolescents with ADHD and used this program in a randomized controlled trial. The program content ranged from an overview of core symptoms, etiological factors, comorbidities, prognosis, pharmacological treatments, cognitive behavioral therapies, and neurofeedback to several sessions addressing problematic everyday situations. The psychoeducation group consisted of 7 to 10 families who attended six two-hour sessions per week. During the last three sessions, they were briefly introduced to a range of behavioral strategies to manage ADHD symptoms and reduce challenging behaviors. For the control group, treatment was continued with their usual medical doctor. In their study, Ferrin et al. [ 68 ] found statistically significant treatment–time interactions for total ADHD symptoms and a significant reduction in parent-reported hyperactivity/impulsivity with a medium effect size compared to treatment as usual. Consequently, comprehensive psychoeducation programs should be considered as a valid and complementary approach in the treatment of ADHD. Thus, clinical guidelines for the treatment of hyperactivity/impulsivity in children with ADHD suggest that treatment should include psychoeducation as an important component [ 69 , 70 ].

In contrast to psychoeducation, parent skills trainings are psychosocial interventions that train parents in cognitive and behavioral techniques that they can use to manage their children’s difficult behavior. The programs vary in their nature and content, but usually, they are manual-based and may include discussion sessions and the use of videos and role-playing. In addition, ADHD parent training generally includes psychoeducational components about ADHD and explains how the presence of ADHD affects a child’s functioning and behavior. Typically, programs are conducted in groups of parents and comprise 10 to 20 weekly sessions lasting one to two hours. They cover a range of topics, including the nature of ADHD, positive reinforcement skills (e.g., paying careful attention to appropriate behavior and ignoring undesirable behavior), reward systems, stimulus control techniques, the use of time-outs, working with teachers, and planning ahead for problems [ 71 ].

Zwi et al. [ 30 ] described in their meta-analysis evidence that parent skills training has a positive impact on the general behavior of children with ADHD. Similarly, the researchers discovered that it reduced parental stress and increased parental confidence. However, they did not find statistically significant improvements in the child’s hyperactive/impulsive behavior. Similarly, van der Oord and Tripp [ 72 ] found that parent training is moderately effective in reducing oppositional behavior and improving parenting practices, but it did not reduce ratings of ADHD symptoms, including hyperactive/impulsive behaviors, when independent evaluators were blinded. Moreover, the training effects appear to disperse in long-term follow-up evaluations. Nonetheless, van der Oord and Tripp [ 72 ] recommend parent and teacher training as a psychosocial, evidence-based treatment for school-aged children.

In summary, extensive psychoeducation programs are comparable to parent training programs and can even outperform parent trainings when the chosen content within the programs provides a comprehensive treatment rationale for the hyperactive/impulsive symptoms of children with ADHD.

3.1.2. School Interventions

Teachers of children with ADHD are often in challenging positions. They must demand from the concerned child a behavior that is particularly difficult for the child, i.e., to sit quietly for a long period and to concentrate on the content of the lesson. Moreover, there are often several problematic children in the same class. Hence, teachers frequently find themselves in a vicious circle when trying to meet the individual needs of children with ADHD. The teacher blames the child, ends up getting angry, and does not know what to do. However, if the child occasionally manages to comply with the teacher’s demands, the teacher is pleased that he or she can continue with the lesson undisturbed and does not take the opportunity to praise the child’s behavior. This exemplifies how schooling can be exceptionally stressful for children with ADHD, their teachers, and the whole class [ 28 , 64 ].

Therefore, Miranda et al. [ 64 ] studied the effectiveness of a multicomponent program that was taught to teachers and implemented by them in a classroom. The program included components such as general information about ADHD, learning principles, positive reinforcement, the Premack principle, and cognitive behavioral techniques such as self-control and self-instructional procedures. Dependent measures included neuropsychological tasks, behavior rating scales for parents and teachers, direct observation of classroom behavior, and academic records of children with ADHD. Teachers were trained in the use of behavior modification techniques, cognitive behavioral strategies, and classroom management strategies for 29 children. The remaining 21 children formed the control group of a total of 50 children who participated in the study. Parent and teacher ratings showed improvements in the primary symptoms of hyperactivity/impulsivity and behavioral difficulties associated with ADHD. The results also show that academic performance and classroom behavior observations improved and that teachers were more familiar with strategies they could use to meet the educational needs of the children more effectively.

Moreover, Richardson et al. [ 28 ] examined the effectiveness of non-pharmacological school-based interventions for students with ADHD and the conditions that may augment or limit their effectiveness. In their systematic review, 54 controlled trials met the inclusion criteria. Positive significant effects for various symptoms and school outcomes were observed in 36 of 39 meta-analyzed randomized controlled trials. Mean weighted effect sizes ranged from very small to large for improving hyperactive and impulsive behavior; thus, considerable heterogeneity in effect size estimates was found between studies. Furthermore, moderator analyses could not clarify which intervention characteristics were associated with which degree of effectiveness.

In conclusion, DuPaul et al. [ 73 ] argue that school-based interventions are essential components of a well-integrated treatment plan for children with ADHD. Such interventions are effective complements to pharmacotherapy and family-based interventions, particularly regarding direct effects on academic and behavioral outcomes in the school classroom. Moreover, DuPaul et al. [ 73 ] state that therapy plans should include a balanced combination of proactive (i.e., antecedent-based) and reactive (i.e., consequence-based) behavioral interventions to best manage hyperactive and impulsive outbursts.

3.1.3. Social Skills Trainings

Social skills are made up of complex relationships involving multiple aspects of cognition, emotion, and behavior. Social skills trainings, designed specifically to address the characteristics of ADHD, intend to improve inter-individual and communication skills and reduce social difficulties [ 74 ].

Children who display impulsive-aggressive behaviors often have problems expressing their needs and wishes appropriately and subsequently end up with social difficulties. They also often resort to inappropriate problem-solving strategies or do not take the time to think about a suitable solution. Not infrequently, dysfunctional communication and action patterns lead to a reinforcement of inter-individual problems and existing conflicts. As a result, children and adolescents with aggressive behaviors experience rejection, which, in turn, reinforces their own mistrust and the perception that others are hostile toward them. An important component in the psychotherapeutic treatment of children and adolescents with hyperactive and impulsive issues is, therefore, the development of social skills. By building socially appropriate assertiveness and adaptive skills, children learn alternative and socially appropriate strategies for communication and interaction situations in which conflicts often arise [ 27 ].

To train these situations, it is recommended to practice concrete solutions by means of role-play in addition to exercises and games that explain social situations and improve children’s theory of mind. This also provides the opportunity to jointly analyze and, if necessary, improve practical implementations using video recordings. The transfer of skills for children with hyperactive and impulsive issues into everyday life is mainly achievable by extending the setting. For instance, by training in a group setting, integrating people from everyday life (e.g., through the participation of siblings in individual sessions), and educating and informing educators or teachers about certain strategies practiced in therapy so that they can also observe, support, and give feedback on the corresponding implementation in everyday life [ 72 ].

Social skills programs focus on varying facets but typically on problem solving, emotion control, and verbal and non-verbal communication. Generally, these training programs concentrate on helping children learn how to read the subtle hints in social interactions, such as learning how to wait for their turn, recognizing when to change the subject during a discussion, and being able to detect the emotional expressions of others. Children can be shown how to practice matching their verbal and non-verbal behavior in their social exchanges. Such trainings could also include efforts to change children’s cognitive evaluation of the social world. Thus, social skills trainings also include knowledge about the social norms, social rules, and expectations of others [ 74 ].

Social skills trainings are often conducted in groups and are comparatively short-term programs. The trainings usually span between 8 and 12 weeks, while each group session usually lasts between one hour and 90 min. Therapy sessions can range in frequency from a couple of times a month to several times a week [ 74 ].

Despite all of the aforementioned research, Evans et al. [ 75 ] reported that even though social skills trainings are a common intervention approach, their findings suggest that social skills trainings have limited effectiveness in reducing hyperactive and impulsive behavior, at least when delivered in traditional clinical settings. Mikami et al. [ 27 ] accentuate these findings by highlighting two promising directions in which social skills trainings can be adapted to enhance their effectiveness for hyperactivity/impulsivity. First, social skills trainings should entail stronger reinforcement and reminders of appropriate social behavior in real-life peer situations, which also requires that such reminders can be accepted prior to a potential outbreak. Second, the intervention effects increase when the peers are engaged to be more socially inclusive and supportive of the affected children with ADHD. However, to date, this pathway has been under-researched in the literature.

3.2. Intra-Individual Interventions

3.2.1. cognitive trainings.

ADHD, particularly the hyperactive/impulsive type, is associated with an increased tendency to react impulsively to strong emotions, which, in turn, is closely associated with deficits in cognitive control. To counteract this, cognitive trainings can be delivered through user-friendly and evidence-based PC programs. Such programs have been developed with the aim of improving mental performance. Cognitive functions such as attention, concentration, memory, visuomotor coordination, reaction and information processing speed, and impulse control are common targets of these trainings. Some trainings also claim to promote stress tolerance and mental resilience [ 76 ]. Peckham and Johnson [ 76 ] could also show significant improvements in the trained areas of working memory and inhibition tasks, as well as improvements in an inhibition transfer task. Overall, their results support the effectiveness of cognitive training interventions as a mean of reducing emotion-related impulsivity in adults.

In children with ADHD, Paul-Jordanov et al. [ 77 ] found that the effects of cognitive control through if-then plans (see [ 78 ]) modulate the event-related potential component P300 measured with a high-density electroencephalogram (EEG) and also facilitate response inhibition using a combined classification and Go/No-Go task paradigm. Moreover, this effect was comparable to the effects of methylphenidate treatment. Furthermore, methylphenidate, as well as if-then plans, modulated the P300 and improved inhibition of an adverse response in a Go/No-Go task to the same level as in children without ADHD. Thus, Paul-Jordanov et al. [ 77 ] found evidence to support their hypothesis that an impaired function of the prefrontal cortex, anterior cingulate cortex, and a respectively reduced P300 are linked to deficits in executive functions in children with ADHD and further concluded that self-regulatory strategies are a valuable alternative to drug treatment in children with ADHD. In this sense, self-regulation strategies strengthen the inhibition of unwanted reactions and help actively control hyperactive and impulsive behaviors.

Cortese et al. [ 25 ] conducted a meta-analysis of randomized controlled trials to determine the effects of cognitive trainings on ADHD symptoms, neuropsychological impairments, and school performance in children or adolescents with ADHD. Several databases were searched, and 16 studies were finally analyzed. By considering all types of trainings combined, a significant effect on overall ADHD symptoms was found. However, the score decreased significantly when evaluators were blinded. Moreover, the effects on hyperactivity/impulsivity and academic performance were not statistically significant. Hence, despite improvements in working memory, cognitive training had limited effects on hyperactivity/impulsivity, especially when assessed by blinded measures. Approaches targeting multiple neuropsychological processes could optimize the translation of the effects from cognitive deficits to everyday clinical symptoms [ 25 ].

3.2.2. Emotional Self-Regulation

In everyday life, emotional self-regulation, i.e., the child’s ability to manage, direct, express, and control their emotions, is especially important when it comes to completing tasks that have unpleasant or negative connotations. Self-regulation enables the planning of actions, the concentration on these actions, and the consistent pursuit of action-oriented goals and is especially important when hindrances appear. Children who suffer from ADHD have great difficulties performing these tasks, as these children do not regulate their impulses and emotions adequately, which leaves them with a severely limited ability to self-regulate [ 79 ].

In general, the ability to self-regulate is an important predictor of a suitable level of functioning in social situations [ 80 ]. Moreover, self-observation enables children and adolescents to acquire knowledge about their own feelings and behavioral reactions and to gain insight into the motives of their personal actions. Such self-assessments are then compared with internal standards, ambitions, and expectations, which, in turn, set the basis for affective and cognitive responses [ 79 ]. Thus, deficits in self-awareness are related to poorer self-regulation and allow impulsive-aggressive behavior to manifest itself more repeatedly. Therefore, an essential component in the treatment of children and adolescents with impulsive-aggressive behavior is the sharpening of their perception of their own feelings and moods while simultaneously eliminating distractions. Ultimately, recognizing one’s own impulses and emotions is the first step in learning to control them in a competent way and further acquiring strategies for dealing adeptly with conflictual situations [ 81 ].

Moreover, Guderjahn et al. [ 79 ] showed that a teacher-led intervention with goal setting and if-then plans promoted self-regulation skills in children with ADHD. Herein, teachers reported significantly lower ADHD symptoms and improved self-regulation when goal intention was paired with if-then plans. However, the effects only lasted until the end of the intervention and only when the introduction of if-then plans preceded the school implementation tightly. In addition, and contrary to what was hypothesized, self-monitoring tools alone did not seem to contribute to the effects of the intervention. Nonetheless, if-then plans are an easy-to-create tool for promoting the everyday behavior of children with ADHD in the classroom and represent a promising pathway for supporting impulse control and self-regulation [ 79 ].

Complementary therewith and in accordance with most evaluations, the application of reinforcement, for which rewards and punishments are applied to redirect children’s behavior, has one of the greatest effects of all educational and psychosocial interventions [ 26 , 74 , 82 ]. In this regard, most studies directed at identifying cognitive and motivational factors involved in ADHD have examined cognitive control theories and reinforcement effects separately. Recently, the interplay between these two factors has been increasingly investigated. For this reason, Ma et al. [ 26 ] conducted a systematic and in-depth review of behavioral and neuroimaging studies that have analyzed the effects of reinforcement on inhibitory control in ADHD. The results of their meta-analyses demonstrated that reinforcement could restore inhibitory control to baseline levels in children and adolescents with ADHD, which actively contributes to controlling hyperactive and impulsive behavior. Additionally, the findings indicate that reinforcement enhances inhibitory control to a larger degree in children with ADHD compared to the controls [ 26 ]. Moreover, Storebø et al. [ 74 ] reason that emotional self-regulation is an integral aspect of resilience and that contingency management can help children effectively learn coping strategies to respond appropriately to disappointments, losses, and other distressing events.

3.2.3. Neurofeedback

Neurofeedback is a computer-assisted form of behavioral therapy and a proven method for digital mental training. In neurofeedback interventions, unconsciously occurring neurophysiological processes are made perceptible to the person through feedback, and the patient can learn to control and influence the normally involuntary activities of the brain. Similar to learning to ride a bike or walk as a small child and gradually automating the movements, neurofeedback can help internalize how to behave in order to create an attentive and relaxed state [ 58 ].

On this subject, Geladé et al. [ 83 ] performed a randomized controlled trial (RCT) in which they compared the effects of neurofeedback on neurocognition with methylphenidate and physical activity as control groups. In a three-way parallel group RCT design, 7- to 13-year-old children with ADHD were randomly assigned to neurofeedback, methylphenidate, or physical activity groups over a 10 to 12-week period. Neurofeedback included theta/beta training measured at the sensorimotor cortex. The physical activity sessions were matched in time and frequency with the neurofeedback sessions. Methylphenidate was administered with a double-blind and placebo-controlled procedure. Neurocognitive performance was rated by parameters from the auditory oddball, stop signal, and visual–spatial working memory tasks. In sum, stimulants showed a better effect than neurofeedback in improving neurocognitive functions. As such, the results do not support the utilization of theta/beta training as an exclusive intervention for children with ADHD, specifically because intent-to-treat analysis of the methylphenidate group showed significantly enhanced inhibition and reduced impulsivity compared to the neurofeedback and physical activity groups. This effect was demonstrated by the increased response times and lowered error rates during the stop signal task. Regardless of the treatment, all groups showed a significant improvement in working memory.

Comparably, Van Doren et al. [ 29 ] examined the robustness of neurofeedback and control treatment effects by considering randomized controlled trials with follow-up (2–12 months) in children with ADHD. Ten studies met the inclusion criteria for their meta-analysis. Standardized mean differences in parent behavioral ratings within and between groups were calculated and analyzed. Significant medium intra-group effects of neurofeedback on hyperactivity/impulsivity were found after treatment and at follow-up. However, the non-active control conditions did not result in any significant effect size at follow-up. In contrast, active treatments (mainly methylphenidate) showed a significant medium effect size for hyperactivity/impulsivity after treatment and at follow-up. Between-group analyses also showed a little advantage of neurofeedback over non-active controls in terms of hyperactivity/impulsivity after treatment and at follow-up. Thus, compared to the non-active control treatments, neurofeedback appears to have more durable treatment effects, lasting at least six months after treatment. Overall, these studies provide a rationale for the current role of neurofeedback as an adjunct in the treatment of children diagnosed with ADHD [ 84 ].

4. Discussion

This review examined a range of psychosocial intervention techniques that are commonly used to treat the hyperactive/impulsive type of ADHD in children. The focus on this ADHD type allows for a straightforward analysis of the state-of-the-art intervention’s techniques without the disturbance of adapting the interventions to other symptoms that are linked, however, conceptually different, to the symptoms of interest within this paper. This sharp line further assists in reaching conclusions beyond diagnosis and prognosis and conveys a deeper understanding of treating this type specifically within the clinical practice. Furthermore, this paper incites to differentiate more between and delve into the ADHD types in the clinical setting.

The intervention techniques that have been investigated are divided into the inter-individual and intra-individual domains, containing parent psychoeducation, parent skills trainings, school interventions, and social skills trainings for the inter-individual domain and cognitive training, emotional self-regulation, and neurofeedback for the intra-individual domain.

Overall, the evidence for the discussed interventions varies considerably in terms of their effectiveness in reducing the levels of hyperactivity and impulsivity in children. In summary, both the inter-individual and intra-individual approaches appear to have positive effects on reducing symptoms of the hyperactive/impulsive ADHD type. However, within these approaches, some interventions have been found to be more beneficial than others. In the inter-individual domain, psychoeducation and training programs for parents appear to be effective in unblinded evaluations but lose much of their effectiveness when assessed by blinded evaluators. The effect sizes of the school-based interventions were found to be significant but varied between low and high in the different studies. As for social skills trainings, there is currently limited evidence of effectiveness in reducing hyperactivity and impulsivity in children. In the intra-individual domain, cognitive trainings had no transferable effects on hyperactivity and impulsivity in everyday life, but the results show a significant reduction in emotional impulsivity. Emotional self-regulation through an if-then schedule failed to maintain significant effects beyond the study period, but the effects of reinforcement strategies were strong and were able to provide comparable or even better self-regulation levels in the affected children compared to children without ADHD. In addition, neurofeedback showed medium effect sizes compared to non-active control groups in reducing impulsive and hyperactive behavior, but unlike psychopharmaceuticals, neurofeedback did not achieve the same magnitude of symptom reduction.

An additional part of the heterogeneity in results can be explained by the fact that the response to treatment depends on the intensity and quality of the treatment itself. In addition, effect sizes are compared with different control groups, which vary in all studies. However, the results also provide indications of which psychosocial interventions seem more suitable. Apart from the fact that each method offers a unique therapeutic benefit for the treated children, the interventions outlined could be combined into a multimodal treatment program and thus offer the potential to surpass the quality of treatment as usual by a considerable degree (see [ 63 , 66 ]).

Moreover, to complete the view of a multimodal approach in the following subsection, the transcendent effect of goal setting is discussed. Naturally, this effect needs to be subtracted from the positive impact of any other applied method. Furthermore, the combination of some effective methods will not result in an arithmetic addition of all effect sizes but rather in a slight increase in the overall effect since all methods operate largely on similar mechanisms and patterns and, hence, possess an overlying effect. Nonetheless, the general scientific evidence provides a clear consensus on the fact that a multimodal treatment approach to hyperactivity/impulsivity symptoms in ADHD represents the procedure of choice (see [ 63 , 66 ]).

4.1. Goal Setting

Setting up therapy goals represents a key element of behavior change interventions, yet it remains unclear when goal setting is optimally effective. In this regard, Epton et al. [ 85 ] have performed a meta-analysis and found a significant effect of goal setting across a range of behaviors. In their moderator analyses, goal setting was especially effective when goals were challenging, publicly specified, and/or set as a group goal. In contrast, goal setting was weaker when it involved monitoring behavior and outcomes by others without feedback.

Rostain et al. [ 86 ] found that 88% of the publications that they analyzed contained predefined criteria for treatment response. Unfortunately, predefined criteria for normalization, remission, and/or relapse were only presented in 5%, 13%, and 4% of studies, respectively. In addition, there was a clear lack of consistency between the instruments used to measure these outcomes, as well as the criteria used to define treatment response, normalization, remission, and relapse. In this respect, therapeutic goals in treating ADHD should surpass modest reductions of ADHD symptoms to include functional remission and approach optimal treatment outcomes.

Kersting et al. [ 87 ] found that children suffering from ADHD and their primary caregivers consistently focused on the improvement in problem areas, such as the reduction in school problems, better concentration, and reduced impulsivity. Consistent with other studies, Podeswik et al. [ 88 ] indicated that school is the primary setting in which improvements are sought, and medication-related problems were of secondary importance, even though 48% of patients were receiving medication. Still, Kersting et al. [ 87 ] found that in 62% of the cases, the goals of the patients and their primary caregivers differed. Therefore, it turns out to be essential in therapy to uncover and reconcile these differences between the goals of the patient, the family, and the school.

Fiks et al. [ 89 ] demonstrated that assessing parents’ preferences and goals is useful for clinicians in understanding which treatment parents are likely to initiate for their children. Additionally, these results insinuate that, at least for achieving academic and behavioral goals, treatment initiation may be more important than the specific treatment selected in helping parents address their goals for their children. Overall, these findings further support the process of pairing parents and children with treatment that they are likely to begin and that achieve goals that are relevant for the family.

4.2. Critical Analysis

The evidence presented in this review is largely based on meta-analyses as well as on some comprehensive studies that evaluated the effects of therapeutic methods for treating children suffering from the hyperactive and impulsive type of ADHD. The methods studied were divided into inter- and intra-individual interventions, depending on whether the children themselves or their psychosocial environment were the main target of the intervention.

The strength of this paper is the robustness of the underlying methodology of the reviewed studies, which have been mostly based on randomized controlled trial designs. This step ensures a bias reduction that may, in turn, affect the interpretation of results. However, there exists a range of limitations within this review that must be addressed. First, only a minority of studies included drew their conclusions from blinded ratings, which uniformly revealed smaller effect sizes compared to the results of non-blinded studies. Second, treatment as usual has frequently been used as a control group, which does not allow for the same comparative value as against a multimodal approach as a control group. In this regard, the control groups of the cited studies have been very heterogeneous, hence impeding the comparison between study results. Third, many studies have computed their results from limited group sizes, which, in turn, decreases the power of the applied tests substantially. Fourth, many studies reported an overrepresentation of comorbidities within their samples, which, in turn, possesses an undermining effect on the evaluated effect sizes. Fifth, the transferability of the effects to everyday life is unclear; this shortcoming is particularly apparent in the case of cognitive training. Besides these points, all studies suffer to some extent from a selection of information bias. However, the studies included in this review do not show any signs of a lowered quality in this regard compared to the general standards within psychosocial research (see [ 72 ]). Especially since the replication of previous treatment effects as well as the agreement of the cited meta-analyses with previous scientific findings was satisfactory.

4.3. Practical Implications

First and foremost, this review takes a unique stand on the diagnosis of ADHD by segregating the predominantly inattentive and predominantly hyperactive/impulsive types of ADHD in terms of treatment implementation. Even though the types have their rightful place within the overarching diagnosis of ADHD, this review draws attention to their diverse developmental trajectories. Consequently, these types should be conceptually considered differently in the clinical practice and require specific and distinctive treatment plans. Furthermore, this review provides solid arguments that an adaptive, integrative, and modular treatment approach represents the state-of-the-art treatment paradigm for the management of the ADHD hyperactive and impulsive type. Moreover, inter-individual and intra-individual interventions are considered as equally important. Beyond that, this paper mainly focuses on the effects of psychosocial interventions on the dimensions of hyperactivity and impulsivity in children.

Moreover, it is noteworthy that psychopharmaceutical treatments for the impulsivity dimension of ADHD have their rightful place and can serve as stand-alone treatments. In short, psychopharmaceuticals can also complement, enhance, or enable psychosocial treatments [ 59 ]. Santosh et al. [ 54 ] reported the superiority of medication over psychosocial treatment, as the advantageous effects of medication were greater in severe cases of children suffering from the hyperactive and impulsive type. These findings support the legitimacy of medication for this type and imply that treatment with stimulants is a primary treatment in severe cases. In contrast, other findings indicate that children with ADHD do not necessarily have a better response to medication than to psychosocial treatments and that the guidelines should, therefore, broaden their indications [ 90 ]. However, although the literature predominantly suggests that medication for ADHD ranks higher above all other psychosocial interventions in terms of behavior change, a number of reasons exist for preferring psychosocial interventions instead of medications, as the medications can bear unknown long-term effects and often possess low response rates in the clinical setting [ 30 , 54 ]. In addition, some children develop an intolerance to their medications, interactions with other medications are still quite unknown, and there are substantial moral and other barriers to the use of medication in young children [ 69 ]. Hence, many parents refuse to go down the pharmaceutical path, fear the emergence of side effects, or regard the medications as a means to turn their children into civilized, well-mannered children without tackling or correcting any underlying cause. These reasons highlight the fact that psychosocial approaches, even alongside pharmaceutical therapy, are necessary to help children who suffer from hyperactivity and impulsivity and to help parents and teachers in raising and educating children [ 30 ].

Consequently, more attention has been focused in recent years on the establishment of an evidence base for effective psychosocial treatments for ADHD [ 91 ]. Back in 1998, Pelham and colleagues [ 92 ] conducted a review of the relevant literature and concluded that behavioral parent training narrowly met the criteria for an established treatment but did meet the criteria for a probably effective treatment. A decade later, in 2008, Pelham and Fabiano [ 91 ] refreshed this review, pointing out that their findings extended the earlier review and revealed that behavioral interventions, including behavioral parent training, behavioral classroom management, and intensive summer program-based peer interventions, are backed up as evidence-based treatments for ADHD. Moreover, clinical psychological research has further demonstrated that intra-individual interventions, such as emotional self-regulation and neurofeedback, have extensive effects in reducing hyperactive and impulsive behaviors in children. These interventions have been shown to help affected children to more appropriately deal with their own feelings and moods. Additionally, their deficit in pursuing their needs in a goal-oriented way and their struggle to subordinate short-term desires to longer-term needs and goals have been lessened with the aforementioned interventions [ 49 ].

Furthermore, children with a diagnosis of ADHD tend to have multiple comorbid conditions, such as anxiety, depression, and oppositional defiant behavior, as well as relationship difficulties, so a multimodal treatment approach appears to be the most beneficial and fitting. Thus, in children with milder symptoms, behavioral interventions seem to be the first line of choice, especially for safety and user preference reasons [ 69 , 93 ].

Overall, our findings are consistent with clinical guidelines that recommend treating more severe hyperactivity and impulsivity in children with psychostimulants while offering multimodal psychosocial treatment to the children, their parents, and teachers. In contrast, for low to moderate symptom severity, a predominantly multimodal psychosocial treatment approach should be offered, using psychostimulants only when interventions do not result in clinically significant symptom reductions [ 9 , 30 , 69 , 93 ].

5. Conclusions

Clinical practice guidelines widely recommend that children and adolescents with mild to moderate hyperactivity and impulsivity should primarily be offered psychosocial treatment, while the parents should be provided with a group-based parent training program [ 9 , 30 ]. In the event that the symptoms do not alleviate adequately with this approach, pharmacological treatment can further be added to the psychosocial interventions [ 93 ]. In contrast, for children who present with severe symptoms, pharmacological treatment should be offered primarily [ 9 , 69 ]. Nevertheless, pharmacological treatment in children should at all times be part of a multimodal treatment plan that unequivocally includes a variety of interventions of the biopsychosocial model [ 93 ]. This means that participation in a parent training program in conjunction with psychological treatment for the children, such as emotional self-regulation strategies and neurofeedback, would be ideal in any case. Moreover, teachers should optimally be trained in managing hyperactivity and impulsivity in the classroom. In accordance with van der Burg et al. [ 42 ] and Evans et al. [ 75 ], this review has found that the family and school environment are prominent areas that influence ADHD characteristics within the inter-individual approach, while emotional self-regulation and neurofeedback produce promising outcomes on impulse control within the intra-individual approach. Currently, medication and/or psychological or behavioral interventions are the most prevalent advances in treating hyperactivity and impulsivity in children, whereas the proportionality of the interventions diverges extensively across treatment centers and more so across countries [ 94 ].

First, the evidence suggests that purely psychosocial interventions for hyperactivity/impulsivity symptoms in ADHD can have positive effects in children, although considerable heterogeneity in effect sizes was found between studies. The clinical significance and the transfer of the effects into everyday life are also still unclear, as the available data often contradict each other. On that account, steps need to be taken to continuously improve psychosocial treatment outcomes for ADHD. To ensure this, emotion regulation processes such as reward and punishment and the balance between proactive and reactive behavioral interventions need to be more prominent and closely linked to the instrumental processes of psychosocial treatment. In this context, future research should investigate further into what works, for whom, and in which circumstances (see [ 72 ]).

Second, considering that this review is essentially about the treatment of hyperactivity and impulsivity in the scope of ADHD disorder, a review of current treatment options for inattention would be the work of choice to complement the present paper. Another way to complement the current gap in this research is to further explore the efficacy and effectiveness of state-of-the-art treatment options for adults. Ideally, these include the development and testing of standardized instruments to describe interventions, agreements on gold standard outcome measures to assess ADHD behavior, and the testing of a range of potential moderators alongside intervention studies (see [ 28 ]).

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, S.S.-S. and G.S.; methodology, S.S.-S.; formal analysis, S.S.-S.; writing—original draft preparation, S.S.-S.; writing—review and editing, A.P.C. and G.S.; supervision, G.S. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

The science of impulsivity in ADHD

Self-control requires a child to manage their impulses, their emotions and their movements to achieve a goal and meet external expectations., need to know.

Do you have a child with ADHD who makes impulsive decisions or reacts without thinking? Then you probably have a few extra grey hairs from worrying about whether they will break a bone from all the risky climbing or from regularly mopping up a flooded bathroom!

Not everyone with ADHD experiences the same levels of impulsivity, hyperactivity, and distractibility, and to reflect that, an ADHD diagnosis is now categorised into three different presentations: predominantly inattentive; predominantly hyperactive-impulsive; and combined.

In all ADHD presentations, it is believed that parts of the brain work and look differently from typical brains. There is evidence to support that inattentive and hyperactive/impulsive presentations are each connected to different parts of the brain and influenced by different neurotransmitters (chemicals messengers that carry signals in your brain): impulsive/hyperactive type is affected specifically by dopamine and inattentive type by noradrenaline/norepinephrine. This discovery, along with evidence that shows stimulant medication is more effective for children with impulsive/hyperactive or combined type, is useful when evaluating the best treatments for your child

Scientists agree that ADHD impacts vital brain functions including attention, planning & organisation, mental flexibility, inhibition (impulse control), abstract reasoning, self-monitoring, and working memory. Our ability to meet daily and long-term goals is predicated on all these functions working well together to accomplish tasks. 

Inhibition, or inhibitory control, is defined as “the ability to control one’s attention, behaviour, thoughts, and/or emotions to override a strong internal predisposition or external lure, and instead do what is more appropriate or needed” .  

Scientists believe that inhibition can be broken down into two components that develop differently:

• Response inhibition – This relates to what you know as self-control and our ability to resist temptation (like wanting to eat another cupcake) and our capacity to resist acting impulsively (like retaliating physically or verbally immediately after we perceive we have been attacked); and
• Interference control – This refers to our ability to direct our attention where it is needed at a particular time in order to accomplish a task and not letting unnecessary or unwanted thoughts or memories bother us.

Research on inhibition control is evolving with various theories on the mechanics of inhibition control in children with ADHD. The key themes still being explored by researchers include: 

Difficulties processing information – Children with ADHD have been shown to have less capacity to process relevant environmental information which impacts their executive functioning and their ability to control impulses. 

Emotional control – Negative emotional situations, particularly those that trigger anger and frustration, have been shown to have a greater impact on children’s ability to control their responses. It’s thought that this is because emotional processing consumes mental resources, and potentially changes the dopamine response needed for self control. 

Processing emotional content – Some studies have looked specifically at a child’s ability to accurately infer how someone feels based on their face or non-verbal context clues. Not all scientists agree that children with ADHD struggle with recognising other people’s non-verbal emotion signals.

Delay aversion, working memory and hyperactivity – Children with ADHD often try to avoid waiting for things, and prefer for instance a small reward immediately than waiting to get something bigger later. When children have no choice but to wait, they might act quickly without thinking or become really active to make the waiting time feel shorter. Increased hyperactivity has been proposed as a self-stimulation strategy used by children to deal with periods of waiting for a reward and in situations that require high cognitive demand, like learning.

Difference in ADHD presentations – In recent times, scientists have been interested in looking more deeply into the brain differences and impact on individual executive functions like inhibition, to inform treatments. There is enough evidence to show that children with inattentive presentation differ from hyperactive/impulsive and combined presentations and therefore could benefit from different interventions.

Why it’s important

Self-control requires a child to manage their impulses, their emotions and their movements to achieve a goal and meet external expectations. The consequences of having an impaired ability to manage impulses can be profound:

• Academic challenges –  Impulse control difficulties can hinder a child’s ability to focus in class, complete assignments, and follow instructions.
• Social struggles – Impulsivity can affect a child’s relationships. Children with low inhibition may have trouble taking turns, listening during conversations, or considering the feelings of others.
• Emotional regulation –  Impulse control issues are associated with emotional dysregulation. Children with ADHD may be more prone to frustration, anger outbursts, and difficulty coping with stress.
• Risk taking –  Studies have found that children with ADHD are more likely to take risks that can culminate in addiction, accidents and injury.

There are some positives to having impaired inhibition including creativity and entrepreneurship. Famous entrepreneurs have spoken about and credited their ADHD for their successes in business, including Richard Branson who said “Instead of allowing my diagnosis to limit my abilities, I overcame the stigma attached to ADHD and built a seven-figure business in just two years — and I’m not alone.”

All the research tells us that there are many elements that affect a child’s ability to control their impulses. The combination of factors like ADHD presentation, level of executive dysfunction, emotion regulation, situational context, etc, all contribute to your child making decisions without thinking.

What does all of this mean? From a parent’s perspective, it’s important to know that the evidence from years of research confirms that impulse control is a real and measurable trait of ADHD that can vary depending on what presentation your child has been diagnosed with. 

This knowledge can help you better assess situations when your child has done or said something that doesn’t meet your expectations, and guide you on how to respond and support them for better future outcomes. 

Tips & strategies

Be careful not to shame – For many children, an impulsive decision is quickly followed by intense shame as a result of their action. Watching your child hate themselves is heartbreaking, but it’s in this moment that you need to find a way to respond so the focus is on repair and problem solving.

Focus on building self-confidence – A child with ADHD receives 20,000 more negative messages than their peers by the age of 10. It is vital that you prioritise the things that will build your child’s self-confidence so they have the capacity to deal with negative situations.

Get a cognitive performance profile – Cognitive assessments are the only way to obtain an accurate picture of your child’s cognitive performance under standard conditions. The results are useful in clarifying the relationship between their cognitive functioning and behavioural symptoms so that you can create an individually tailored treatment plan.

Explore and decide on the appropriate treatment – Becoming intimately familiar with your child’s struggles is key to identifying the right treatments. Use the Keywell app to record your observations and share with your child’s health care team. A multimodal approach using a combination of treatments has shown to have the best outcomes. 

Medication – Methylphenidate is the most common and successful medication for ADHD, with years of evidence that show it reduces symptoms of inattention, hyperactivity, and impulsivity as well as improving executive functions. Keep in mind though, approximately 30 percent of children do not respond well to this treatment, have no long-term benefits, and experience side effects. There are other types of medications that are better tolerated by those who don’t respond to standard stimulant medications,

Psychosocial treatments – the following 3 have significant evidence supporting their use:

• Behaviour management interventions   – these include parent training, classroom interventions (advocate for your child to have an Individual Learning/Education Plan so that they are supported), and peer-based interventions.
• Training interventions – these include cognitive training, neurofeedback, organisation skills, cognitive behaviour therapy (CBT).
• Physiological treatments – physical activity like organised sport.

Non-pharmacological interventions – There is small to medium clinical effectiveness supporting these measures:

• Dietary interventions – This includes adding vitamins ( Vitamin D, Magnesium, and omega-3 fatty acids) and nutritional interventions like removing certain foods.
• Transcranial Direct Current Stimulation – A weak electrical current is applied directly and non-invasively to change how brain neurons work. 
• Mind-body interventions – These include meditation-based therapies like mindfulness and some yoga practices.
• Executive Functions | Annual Review of Psychology
• ADHD and Injuries: Accidental and Self-Inflicted | The ADHD Report
• Attention Deficit Hyperactivity Disorder and Increased Risk of Injury
• Full article: The association between hyperactive behaviour and cognitive inhibition impairments in young children
• The Maturation of Interference Suppression and Response Inhibition: ERP Analysis of a Cued Go/Nogo Task – PMC
• Double-dissociation between the mechanism leading to impulsivity and inattention in Attention Deficit Hyperactivity Disorder: A resting-state functional connectivity study – ScienceDirect
• Deficits in Response Inhibition in Patients with Attention-Deficit/Hyperactivity Disorder: The Impaired Self-Protection System Hypothesis – PMC
• Is Emotion Recognition Related to Core Symptoms of Childhood ADHD? – PMC
• Visual attention deficits contribute to impaired facial emotion recognition in boys with attention-deficit/hyperactivity disorder
• Evidence Against Emotion Inference Deficits in Children with ADHD – PMC
• Hot executive control and response to a stimulant in a double-blind randomized trial in children with ADHD | European Archives of Psychiatry and Clinical Neuroscience
• Hemodynamic response of children with attention-deficit and hyperactive disorder (ADHD) to emotional facial expressions – ScienceDirect
• Are Emotion Recognition Abilities Intact in Pediatric ADHD? – PMC
• Emotional dysregulation and Attention-Deficit/Hyperactivity Disorder – PMC
• Cortical Dopamine Release During a Behavioral Response Inhibition Task – PMC
• Inhibitory Functioning across ADHD Subtypes: Recent Findings, Clinical Implications and Future Directions – PMC
• Deficits in Conditional Discrimination Learning in Children with ADHD Are Independent of Delay Aversion and Working Memory
• The 5 Superpowers People With ADHD Can Use to Be Better Entrepreneurs
• ADHD-Related Neurodiversity and the Entrepreneurial Mindset – Curt B. Moore, Nancy H. McIntyre, Stephen E. Lanivich, 2021
• Subclinical symptoms of attention-deficit/hyperactivity disorder (ADHD) are associated with specific creative processes – ScienceDirect
• Diet and food in attention-deficit hyperactivity disorder – ScienceDirect
• Eating Patterns and Dietary Interventions in ADHD: A Narrative Review – PMC
• Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review – PMC
• How do stimulant treatments for ADHD work? Evidence for mediation by improved cognition – PMC
• Methylphenidate is more effective to improve inhibitory control and working memory compared to tDCS in children and adolescents with attention deficit/hyperactivity disorder: a proof-of-concept study – PMC
• ADHD: Current Concepts and Treatments in Children and Adolescents – PMC
• Long-term effects of repeated multitarget high-definition transcranial direct current stimulation combined with cognitive training on response inhibition gains
• Inhibitory Control and Information Processing in ADHD: Comparing the Dual Task and Performance Adjustment Hypotheses – PMC
• Inhibitory deficits and symptoms of attention‐deficit hyperactivity disorder: How are they related to effortful control? – Kostyrka‐Allchorne – 2023 – British Journal of Developmental Psychology – Wiley Online Library
• A unified framework for inhibitory control – PMC
• Emotional foundations of cognitive control – PMC

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• Impulsivity in ADHD

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The Neurobiology of Impulses and Impulse Control

• Why It's Difficult
• Tips to Improve Impulse Control

ADHD Symptom Spotlight is a series that dives deep into a hallmark or overlooked symptom of ADHD each week. This series is written by experts who also share their tips on managing these symptoms based on firsthand experience and research-backed insights.

Both inattentive and hyperactive subtypes of ADHD are prone to impulse control problems. This impulsivity can come in handy in rare situations where they need to think on their feet, but it generally puts them at risk of making poor choices and taking unnecessary risks.

To understand why impulsivity is a characteristic of ADHD, it’s important to understand the science behind how impulses happen and how the brain typically controls them.

The human brain uses a complex system of “happy” hormones to make decisions about what to do. These hormones reinforce behaviors that make you feel good, but they each function in slightly different ways, triggering different kinds of responses.

When it comes to impulses, the science so far suggests two happy hormones, in particular, are at play: dopamine and serotonin .

In extremely oversimplified terms, dopamine is the “go” signal. It’s the motivational coach in your head encouraging you to do certain activities and to keep going. Meanwhile, serotonin is the “no go” signal. It’s the Zen monk in your head, letting you know when you’ve done enough and it’s time to stop and enjoy the state of contentment you’ve achieved.

In a healthy brain, the balance between the two is relatively stable, where the person gets just enough motivational dopamine to do what they need to do and a healthy amount of serotonin to make them feel satisfied with what they’ve accomplished and avoid making rash decisions.

Then, when the occasion calls for it, each hormone has the ability to override the either. When dopamine overrides serotonin, it’s pushing you to indulge in an impulse and ignore the “no go” signal serotonin is sending you. When serotonin overrides dopamine, it’s practicing impulse control, telling you to ignore that “go” signal the dopamine is giving you.

Both processes have their function. The ability to resist impulses can save you from taking unnecessary risks or making bad choices. Meanwhile, the ability to have and act on impulses can be useful in extreme situations where you need to react quickly and make snap decisions.

Dopamine and Serotonin Imbalances in ADHD Make Impulse Control Difficult

For people with ADHD, that balance is nonexistent. During ordinary tasks, a low number of dopamine receptors in the brain prevent people with ADHD from getting that “go” signal. This lack of motivation means they’re liable to procrastinate , struggle with making decisions , and find it hard to make themselves start or stay on task.

In one study on impulsivity, low activity levels in dopamine receptors were linked to increased impulsive behavior. The reason is that when dopamine release was stimulated, it triggered even higher amounts of the hormone in these normally dopamine-deficient brains than it did in the less impulsive group.

In those unpredictable moments when dopamine release is stimulated, then, a flood of the motivational hormone leaves the person feeling overwhelmed with the need to do the thing that triggered the dopamine flood.

ADHD brains may also have low numbers of serotonin receptors, impairing their ability to resist an impulse. So when those impulses happen, they’re stronger than usual and occur in a brain with a weakened impulse control mechanism.

While the research on exactly how those floods of dopamine are triggered is still scarce, one recent study found a possible link to emotional escalation. Events that trigger sudden and intense emotions—like panic, anger, or euphoria—may trigger higher amounts of dopamine.

What Does Impulsivity Look Like in ADHD?

ADHD-related impulsivity takes a lot of forms, with some impulsive behavior more obvious than others. Some of the most common ways impulsivity manifests in ADHD include:

• Spur-of-the-moment decision-making
• Interrupting people during conversations
• Acting or speaking without thinking first
• Starting tasks without planning first
• Racing thoughts that are hard to control
• Lack of patience
• Difficulty saving money (or generally working toward long-term goals)
• Risky, self-destructive behavior

Impulsiveness feels like this intense, fiery drive to do something. There’s no time to wait, no time to plan, no time to consider whether you actually should do the thing. You just have to go do it. Trying to resist it is like standing in the middle of a bonfire and trying not to leap out of it. The urge is too intense and you feel like you will burn up if you don’t indulge it.

Sometimes, you have the foresight to know the impulse is a bad one, but most of the time you aren’t even really thinking about whether it’s a good or bad idea until after the fact.

Over the long term, your more self-destructive impulses can leave you with heavy guilt and regret. But even the milder forms of impulsivity, like blurting out statements, can strain your friendships, get you in trouble at work, and make it hard to maintain positive, stable relationships in all areas of life.

How to Improve Impulse Control When You Have ADHD

ADHD might make impulses feel stronger and reduce your ability to control them, but with practice, you can get better at managing your impulses. The key is to distinguish between good and bad impulses, and focus most of your energy on resisting the bad ones. Here are a few strategies that can help.

Exercise Regularly

Studies show that regular aerobic exercise can help reduce all symptoms of ADHD, including impulsivity. Find fun activities that get your heart rate up and try to spend around 30 minutes to an hour each day doing those.

This won’t cure your impulse control problems but it can help lessen the intensity so that it’s a little easier to resist.

Do a Personal Inventory to Reflect on Past Impulsive Behavior

Reflect on past moments of impulsivity to figure out what your triggers might be and how you might have acted differently to handle the situation better. It can be tough to think about, but reflecting on past experiences is one of the best ways to figure out a plan for avoiding those mistakes in the future.

Do this regularly until you’ve identified your most problematic impulsive behaviors and grasped some idea of when you’re most likely to become impulsive. This increased self-awareness can help you anticipate high-risk situations and figure out personalized strategies for diffusing those impulses.

Train Your Impulse Endurance

With ADHD, an impaired impulse control mechanism makes resisting impulses feel impossible. But, with practice, you can build up some tolerance. A mental trick you can try is telling yourself that you can act on the impulse but first, you want to see how long you can hold off. Knowing that you can give in when it becomes overwhelming can make it less daunting to try to delay the impulse .

Meanwhile, the more you practice at least delaying those impulses, the better you get at controlling them. Eventually, you’ll be able to use that delay to consider whether this is even an impulse worth indulging. If not, thinking about the consequences can help decrease the desire to do it, eventually allowing the impulse to pass.

Complicate Your Impulse Decisions

ADHD brains often avoid complex or delayed-reward tasks because the motivation isn’t strong enough . So you can leverage one ADHD symptom against the other by making impulsive behaviors harder to execute, thereby forcing your impulsiveness to battle your executive dysfunction for dominance. Here are some ways to do that:

• Enforce a cooling-off period . If you want to buy a new outfit, leave it on the rack for now. Tell yourself you can come back in, say, a week if you still want it.
• Add extra steps . Instead of buying junk food while doing your normal grocery shopping, leave it for when you have the craving. Sure, you can have ice cream. But you have to go all the way back to the store to get it (if possible, enforce a rule that you have to walk instead of drive).
• Bring cash only on nights out . If you tend to overspend when you go out with friends, leave your cards at home and just bring the amount you’ve budgeted for the night in cash.
• Bring a notebook to meetings . If you’re prone to blurting things out in meetings, write those things down in your notes first. That way, you’ll have them there to bring up later when you can speak without interrupting someone. Similarly, in text conversations, you can write out your responses to friends in a notetaking app first during more sensitive or difficult conversations where you don’t want to carelessly hit send before considering how your words will impact the other person.

For each of the impulsive behaviors you identified during that personal inventory, think of similar strategies for complicating them to give you more time to consider your actions.

Accept Some Degree of Impulsivity

To some degree, impulsivity can be healthy, exciting, and productive. There’s nothing wrong with being the spontaneous friend who wants to try new activities or the coworker who proposes a creative change to ineffective processes at work.

The key is learning to recognize good and bad impulses—and doing that requires some honest and thorough self-reflection on your past behavior. When did your impulsiveness lead to good outcomes and when was it disastrous?

Focus your energy on controlling the disastrous impulses and let the positive or neutral ones slide.

Channel Your Impulsivity

Finding ways to let impulsivity exist in life is important for ADHD brains instead of trying to always lessen or "cure" it. You may even be able to use those impromptu actions to your advantage—what's referred to as functional impulsivity. Some hobbies or activities where that functional impulsivity can be an advantage include:

• Gymnastics . In addition to getting you up and moving, gymnastics is an activity that requires the kind of quick and decisive action that someone who’s naturally more impulsive would be good at. You can’t do a backflip in slow motion. You just have to leap into it. If gymnastics doesn’t appeal to you, you could also try martial arts, pole dancing, or figure skating.
• Tennis . Like gymnastics, tennis requires a lot of quick and decisive movements because you’re darting from point to point on the court to strike the ball. Matches are also relatively fast-paced and short, which is good for people who struggle with losing interest in activities too easily. You can play a match or two and then head home for the day before you get bored. Other racket sports like squash, badminton, or table tennis are good options for the same reasons.
• Tabletop role-playing games . For a less physically-demanding option, tabletop RPGs (like the popular Dungeons & Dragons) are great. I really enjoy them because they put you into a fictional world with a constant series of ever-changing high-stakes scenarios (the kind of scenarios ADHD brains thrive in): fighting hordes of angry goblins, negotiating a peace treaty with orcs, or navigating a booby-trapped cave in search of treasures. Often, success hinges on being able to make spur-of-the-moment decisions and adapting quickly when your plans go awry. But even when your impulses lead you astray, the consequences are all in-game, so no real-world harm is done. There are online groups you can join, but you can also check your local hobby shops for regular in-person meetups.
• Arts and crafts. Painting, drawing, woodworking, ceramics, jewelry-making, the list goes on. Any creative hobby you can think of is a great way to channel your impulsivity because you can make what you want, with whatever materials you want, in whatever timeframe you want. Because you’re doing it as a hobby, there are also no external demands or constraints on what you make. You can draw a hyper-realistic cityscape or throw paint wildly at a canvas. Carefully craft a matching set of bowls or free-hand an abstract sculpture. Creative hobbies let you turn impulses into works of art.

Incorporating one of these or a similar hobby into your life is a good way to practice embracing your impulsiveness and learn to recognize how and when it can be beneficial. 

Volkow ND, Wang GJ, Kollins SH, et al. Evaluating dopamine reward pathway in adhd: clinical implications . JAMA . 2009;302(10):1084. doi:10.1001/jama.2009.1308

Buckholtz JW, Treadway MT, Cowan RL, et al. Dopaminergic network differences in human impulsivity . Science . 2010;329(5991):532-532. doi:10.1126/science.1185778

Quist JF, Barr CL, Schachar R, et al. The serotonin 5-HT1B receptor gene and attention deficit hyperactivity disorder . Mol Psychiatry . 2003;8(1):98-102. doi:10.1038/sj.mp.4001244

Monopoli WJ, Evans SW, Benson K, et al. Assessment of a conceptually informed measure of emotion dysregulation: Evidence of construct validity vis a vis impulsivity and internalizing symptoms in adolescents with ADHD . Int J Methods Psychiatr Res . 2020;29(4):1-14. doi:10.1002/mpr.1826

Waldera R, Deutsch J. Adhd and physical activity . TPE . 2021;78(6). doi:10.18666/TPE-2021-V78-I6-10563

Thorell LB. Do delay aversion and executive function deficits make distinct contributions to the functional impact of ADHD symptoms? A study of early academic skill deficits . J Child Psychol & Psychiat . 2007;48(11):1061-1070. doi:10.1111/j.1469-7610.2007.01777.x

Dickman SJ. Functional and dysfunctional impulsivity: personality and cognitive correlates .  J Pers Soc Psychol . 1990;58(1):95-102. doi:10.1037/0022-3514.58.1.95

By Rachael Green Rachael is a New York-based writer and freelance writer for Verywell Mind, where she leverages her decades of personal experience with and research on mental illness—particularly ADHD and depression—to help readers better understand how their mind works and how to manage their mental health.

• Medication & Treatment
• ADDA Library

Exploring Therapy for Adults With ADHD: 11 Options & How They Work

• Posted by ADDA Editorial Team
• Categories Medication & Treatment
• Date August 23, 2023
• Comments 0 comment

Around 30% of adults don’t respond well enough to standard drug treatment for ADHD. [1]

This is where ADHD therapy comes into the picture as an alternative management option. Or an additional, evidence-backed treatment, even when medication is working as intended.

Studies have shown that a combination of drug and behavioral therapy for ADHD can lead to significant improvements in symptoms in adult ADHD . [2]

These therapies enhance treatment by helping people build the structures, skills, and habits they need to thrive and succeed.

Through ADHD therapy, you can work on key areas, such as communication, focus, emotional regulation, and time management.

Exploring Different Science-Backed Therapies for Adult ADHD

While medications are effective for many, adults with ADHD can also manage their symptoms through other methods, such as behavioral therapy, ADHD coaching , and support groups.

There are a few behavioral therapies for ADHD, including:

• Mindfulness-based cognitive therapy
• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy
• Neurofeedback

You might be wondering what type of therapy best treats ADHD in adults . Well, it boils down to your personal preference and individual response to treatment.

While CBT has the most scientific evidence proving its efficacy, other therapies might work better for you. How well your treatment works also depends on your symptoms and their severity, as well as your therapist’s expertise and experience level.

The good news is you don’t have to stick to just one form of therapy. Some people find that combining two types of ADHD therapies helps them control their symptoms more effectively.

Let’s take a deeper look at how these different forms of therapy help manage ADHD.

Cognitive Behavioral Therapy (CBT) for ADHD

CBT is a goal-oriented, short-term psychotherapy that helps you pinpoint unhealthy thinking and behavioral patterns. Research has found that CBT can help adult ADHDers manage their symptoms and boost their self-esteem. [3]

One example of an unhealthy thought pattern that CBT addresses is the all-or-nothing mindset. This way of thinking causes you to procrastinate or avoid tasks you think cannot be done “perfectly.” Other examples include comparing yourself to others, magnifying your mistakes, and downplaying your achievements.

Through CBT, you’ll learn how to dismantle these unhelpful beliefs and habits and replace them with new, beneficial ones.

Apart from changing how you perceive yourself and your capabilities, this adult ADHD therapy can also help you work on different skills and areas. They include the following: [4]

• Relationships and friendships
• Organization and planning
• Focus and attention
• Problem-solving
• Procrastination

Your therapist will help you devise practical strategies to overcome your ADHD-related challenges. For instance, they may guide you in building a system, such as a calendar, task list, or finding an app to help you stay on track and complete your tasks on time.

Mindfulness-Based Therapy for ADHD

Mindfulness-based cognitive therapy (MBCT) is a treatment approach that combines both CBT and mindfulness meditation. Through this form of therapy, you’ll gain a deeper understanding of ADHD and its symptoms .

The CBT portion of this treatment helps you identify and modify problematic thought patterns. [5]

You’ll also engage in mindfulness meditation under this program. Mindfulness meditation is a type of mental training thought to enhance the function of brain regions altered by ADHD. [5]

Based on research studies, MCBT has been shown to improve the following areas:

• Attention and focus: Mindfulness trains a person to pay attention in a particular way. The aim is to purposefully focus on the present moment without judgemental thoughts. Because of this, mindfulness may help improve concentration in those with ADHD. [6]
• Emotional reasoning: This ADHD treatment for adults teaches individuals to regulate how they experience and express emotions. For example, participants will learn to view emotional states as temporary, passing events – helping them control their emotions better. [5]
• Impulse control: MBCT can sharpen a person’s self-awareness and emotional regulation, thus improving impulse control.
• Executive functioning: Mindfulness meditation training enhances executive function. [4] This refers to the mental skills that allow you to plan, organize, focus, and juggle multiple tasks.
• Mental health: Research has found that MBCT can help reduce anxiety, depression, and stress. [7]

Based on current evidence, MCBT can be offered in addition to medication or as an alternative management option for ADHDers who don’t respond well to drug treatment.

Dialectical Behavioral Therapy (DBT) for ADHD

DBT is a form of talk therapy that teaches a person to manage their emotions and behaviors. It is one means of treating ADHD at home and can be conducted in various ways, such as through group, individual, or phone sessions.

The goal of DBT is to help a person build essential skills to cope with day-to-day activities and replace unhelpful behaviors with positive ones.

DBT focuses on the following four main components: [8]

• Mindfulness: As discussed earlier, mindfulness helps an individual focus on the present moment in a calm and non-judgemental manner.
• Emotional regulation: This component can teach you how to express your emotions and change your response to various situations. You’ll learn to manage difficult feelings and be less vulnerable to negative emotions.
• Interpersonal effectiveness: In DBT, you’ll also find out how you can culture positive relationships, build proper boundaries, and end unhealthy friendships. You’ll work on your communication skills, listening skills, and self-respect.
• Distress tolerance: This form of training teaches you how to apply various self-soothing techniques when facing difficult situations. You’ll learn to develop healthy coping mechanisms to overcome tough times and challenges.

During therapy sessions, your therapist will teach you how to apply these skills to your daily life. They might also provide homework assignments that encourage you to practice them in your day-to-day life.

Based on research studies, DBT can reduce the severity of ADHD symptoms, depression, and feelings of hopelessness, as well as improve mindfulness. It may also enhance social skills, decrease impulsivity, and boost the overall quality of life of adults with ADHD. [9]

Therefore, researchers concluded that this therapy might be helpful if you don’t respond well to drug treatment. [9] 

Neurofeedback for ADHD

Neurofeedback is a type of brain training that involves measuring brain activity. It uses an electroencephalogram (EEG), a non-invasive test that measures your brain’s activity.

The measured activity is then translated into sounds or visual cues presented to you in real time. This feedback allows you to learn to control and modulate your brain activity to achieve specific goals through trial and error. [10]

Neurofeedback therapy generally involves the following steps:

• You’re given a simple task, like reading, while having the device hooked up to you.
• The EEG measures your brain waves and activity.
• Feedback is provided in real-time.
• When you achieve optimal brain activity, the feedback provided may be as simple as a beep you hear or something more complex like moving a character in a video game.
• Whenever you get distracted or lose focus, the feedback changes. For instance, your character might stop moving in the game.

Some research has found that neurofeedback can be a promising treatment option for ADHD. In fact, one scientific analysis showed that neurofeedback might be as effective as stimulant medications in as little as 35 sessions. [11]

Holistic Approaches to Complement Adult ADHD Therapy

Different non-medical approaches can address symptoms of ADHD along with co-occurring issues, such as depression, anxiety, interpersonal conflict, and low self-esteem.

If you’re looking for a holistic way to manage your symptoms of ADHD, you may consider asking your healthcare provider about the following options:

• Music therapy: Music therapy can be active, where you’ll play an instrument, or passive, which involves listening to music. Some research has found that active music therapy may help improve social skills and reduce aggression or impulsivity. Passive music therapy was found to enhance attention and academic skills. [12]
• Pet therapy: Animal-assisted therapy typically involves a trained pet and an owner with a diagnosed condition, such as ADHD. A service dog, for instance, can help an ADHDer release excess energy and reduce anxiety or distress.
• Art therapy: This type of therapy can help ADHDers enhance their problem-solving skills and focus, as well as increase relaxation and reduce stress. During art therapy, you’ll work with a professional to create works of art that can help you express and work through your thoughts and emotions.
• Interpersonal therapy: Interpersonal therapy helps you process and resolve any issues or conflicts that might have developed between you and others due to ADHD-related behaviors. It can also help address personal issues, low self-esteem, and feelings of failure. [13]
• Occupational therapy: This therapy guides ADHDers in building the skills needed to adapt well to their environment. It helps people identify barriers to success in their workplace, school, or home and find solutions to overcome them.
• ADHD coaching: An ADHD coach will collaborate with you to set up structures that bring you closer to your goals. They’ll teach you skills and strategies to improve your time management, organization, and focus.
• Support Groups: ADHD support groups offer a safe place for ADHDers to connect with people on the same journey. You’ll be able to exchange advice and gain support and a sense of belonging in a non-judgemental community.

The best management option for your ADHD depends on your symptoms, struggles, and goals.

For instance, someone who wants to build meaningful relationships and resolve conflict might benefit from interpersonal therapy. Meanwhile, a person who wishes to understand and regulate their emotions better might opt for art therapy.

Leveraging the Power of Therapy to Manage ADHD

Medications are effective for a large group of people. However, they may not improve all symptoms of adult ADHD . Plus, they affect different people in different ways.

Because of this, the best treatment approach is to combine medication, therapy, and other management options, such as counseling and coaching. This enables you to create a holistic treatment plan that addresses all ADHD-related challenges in your career, academics, or relationships.

Remember that seeking therapy, coaching, or counseling isn’t a sign of weakness. Quite the opposite, acknowledging and tackling your struggles head-on is a brave step in the right direction.

With the skills, structures, and strategies you build through therapy, you’ll be in the best position to achieve your biggest goals and ambitions.

Check out ADDA+ for more expert-driven resources that will help you thrive as an adult with ADHD. You can also visit our virtual support groups , where you can seek advice and encouragement from those who have walked in your shoes.

[1] Basiri, N., & Hadianfard, H. (2023). Adult ADHD Treatment Based on Combination of Dialectical Behavior Therapy (DBT) and Transcranial Direct Current Stimulation (tDCS) as Measured by Subjective and Objective Scales. Journal of attention disorders, 27(1), 57–66. https://doi.org/10.1177/10870547221118527

[2] Knouse, L. E., & Safren, S. A. (2010). Current status of cognitive behavioral therapy for adult attention-deficit hyperactivity disorder. The Psychiatric Clinics of North America , 33(3), 497–509. https://doi.org/10.1016/j.psc.2010.04.001

[3] Antshel, K. M., Hargrave, T. M., Simonescu, M., Kaul, P., Hendricks, K., & Faraone, S. V. (2011). Advances in understanding and treating ADHD. BMC medicine , 9, 72. https://doi.org/10.1186/1741-7015-9-72

[4] Sprich, S. E., Knouse, L. E., Cooper-Vince, C., Burbridge, J., & Safren, S. A. (2012). Description and Demonstration of CBT for ADHD in Adults. Cognitive and behavioral practice , 17(1), 10.1016/j.cbpra.2009.09.002. https://doi.org/10.1016/j.cbpra.2009.09.002

[5] Bachmann, K., Lam, A. P., & Philipsen, A. (2016). Mindfulness-Based Cognitive Therapy and the Adult ADHD Brain: A Neuropsychotherapeutic Perspective. Frontiers in psychiatry , 7, 117. https://doi.org/10.3389/fpsyt.2016.00117

[6] Janssen, L., Kan, C. C., Carpentier, P. J., Sizoo, B., Hepark, S., Grutters, J., Donders, R., Buitelaar, J. K., & Speckens, A. E. M. (2015). Mindfulness based cognitive therapy versus treatment as usual in adults with attention deficit hyperactivity disorder (ADHD). BMC Psychiatry , 15(1). https://doi.org/10.1186/s12888-015-0591-x

[7] Aadil, M., Cosme, R. M., & Chernaik, J. (2017). Mindfulness-Based Cognitive Behavioral Therapy as an Adjunct Treatment of Attention Deficit Hyperactivity Disorder in Young Adults: A Literature Review. Cureus , 9(5). https://doi.org/10.7759/cureus.1269

[8] Linehan, M. M., & Wilks, C. R. (2015). The Course and Evolution of Dialectical Behavior Therapy. American Journal of Psychotherapy , 69(2), 97–110. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.97

[9] Cole, P., Weibel, S., Nicastro, R., Hasler, R., Dayer, A., Aubry, J. M., Prada, P., & Perroud, N. (2016). CBT/DBT skills training for adults with attention deficit hyperactivity disorder (ADHD). Psychiatria Danubina, 28(Suppl-1), 103–107.

[10] McGough, J. J. (2022). Neurofeedback for ADHD: Time to Call It Quits? American Journal of Psychiatry , 179(12), 888–889. https://doi.org/10.1176/appi.ajp.20220861

[11] Enriquez-Geppert, S., Smit, D., Pimenta, M. G., & Arns, M. (2019). Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice. Current psychiatry reports , 21(6), 46. https://doi.org/10.1007/s11920-019-1021-4

[12] Martin-Moratinos, M., Bella-Fernández, M., & Blasco-Fontecilla, H. (2023). Effects of Music on Attention-Deficit/Hyperactivity Disorder (ADHD) and Potential Application in Serious Video Games: Systematic Review. Journal of medical Internet research , 25, e37742. https://doi.org/10.2196/37742

[13] Gentile, J. P., & Atiq, R. (2006). Psychotherapy for the patient with adult ADHD. Psychiatry (Edgmont (Pa. : Township)) , 3(8), 31–35.

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ADHD Impulsivity: Its Types, Effects, and Management Tips

• Updated: 01.09.2023

ADHD is a diverse cognitive condition that manifests behaviorally in many ways, including impulsivity. It is a common symptom among those adults diagnosed with predominantly hyperactive ADHD . Even though the prevalence of hyperactivity in adults is lower since it tends to decline with age, it can still occur.

It’s vital to carefully assess if you have this symptom because ADHD impulsivity can affect the functionality and the quality of your life in different ways. Read on to learn more.

Over the course of your life, your symptoms of ADHD may change. Consult a professional for ADHD treatment online .

What Does Impulsiveness Mean?

Impulsivity is the tendency to act without thought or planning and without considering the potential consequences. Impulsivity reveals itself in a range of behaviors in children and adults with attention-deficit/hyperactivity disorder (ADHD).

Of course, some people may experience impulsiveness more severely than others, particularly if they are more likely to have the hyperactive-impulsive subtype of the disorder than the inattentive subtype.

Types of Impulsivity

ADHD impulse control issues can be divided into four main types depending on how the action develops and the motivations behind the impulsive activity. Here is a little explanation to give you some background information on this:

• Motor impulsivity . This kind is connected to an individual’s unexpected acts or outbursts. People with this type are restless and need help sitting still or frequently perform behaviors that are likely to draw attention.
• Emotional impulsivity . Individuals do this when they base a choice on their feelings. This kind of impulsivity increases one’s tendency to be impatient, irritable, or easily angered. Emotional dysregulation, one of the symptoms of ADHD , should be addressed in this case.
• Sensory impulsivity . Individuals struggle to digest information when dealing with this type of impulsivity. They need help sifting through unimportant information and need to be more focused .
• Cognitive impulsivity. It typically entails a lack of clarity of thought or attention to detail. It also makes a person more likely to act hastily, act without thinking, or forget things , all of which might lead to future issues.

Adult ADHD and Impulse Control Issues: The Connection Explained

The thalamus region [1*] of the brain regulates response inhibition. It functions like a gate, providing signals to permit or prohibit certain behaviors. The limbic-hippocampal connections of the brain transmit a warning from the thalamus to the frontal cortex when it notices a red flag. That is the part of the brain that regulates problem-solving and emotional expression.

This thalamus gate might be impaired in people with ADHD. As a result, a person can find it difficult to restrain short-term urges, such as the desire to eat an extra candy or spend more money than planned.

ADHD comes in many forms. Consider getting professional help if you want to manage the symptoms effectively.

How Impulsivity Can Impact One's Life

Symptoms of impulsive ADHD issues in adults might include but are not limited to actions like:

• Making impulsive decisions
• Pursuing dangerous activities
• Requiring immediate fulfillment of needs
• Being loud in voice or actions
• Having a generally rowdy behavior, possibly even destructive
• Willing to finish tasks and projects before moving on to other ones

Beneficial outcomes do not always follow impulsive actions. Regular and recurrent impulsivity is frequently seen as a sign of a more serious problem, especially when it results in injury to oneself or others.

As a result of impulsive behavior, the following effects are most frequently observed:

• Uncontrollable urges. Impulsive behavior can result in an inability to control an urge, temptation, or desire. It can also occur in the form of an obsessive need to engage in a particular action damaging to oneself or others.
• Heightened stress. ADHD and impulse control problems can lead to stress. Before conducting the act, impulsivity can heighten the sense of arousal.
• Antisocial personality. According to research [2*] , impulsivity is linked to antisocial personality. It can also increase the risk of developing an antisocial personality disorder. This disorder is characterized by a total disregard for the consequences of one’s actions and the feelings of other people.
• Temperament issues. Impulsive people are sometimes characterized as hot-headed, rash, and unstable. The feelings of inadequacy that surface with unstable emotions, behaviors, and relationships can be difficult for impulsive people to deal with. They could be quick to react angrily to perceived injustices and frequently fail to realize when their feelings are unjustified or exaggerated.
• Unacceptable behaviors. Adults with poor impulse control may be prone to exhibit behaviors such as unrestricted gaming, the compulsion to shop, pyromania (an impulse to set fires without considering consequences), internet addiction, or hypersexuality.
• Bipolar disorder
• Obsessive-compulsive disorder (OCD)
• Substance abuse

Consult a competent doctor in your area to receive a personalized treatment plan.

Managing Impulsivity

Although impulsivity can be difficult to control sometimes, it is manageable with the correct tools and some effort. You can learn how to recognize your triggers and how to control impulsivity caused by ADHD by using the following tactics:

• Recognize and accept your impulsiveness.
• Develop your self-awareness.
• Limit or prevent risks.
• Communicate more with loved ones.
• Notice your impulsive behaviors to change them.
• Consult a professional.

Final Words

Even though it can occasionally seem quite difficult, controlling ADHD impulsivity is possible. Seeking the assistance of a mental health professional who can help you develop a treatment plan is the first step to managing your impulses. The ADHD specialists at MEDvidi are at your convenience at any time.

• Thalamic inhibition: diverse sources, diverse scales. (2016) Source link
• The Role of Impulsivity in Antisocial and Violent Behavior and Personality Disorders Among Incarcerated Women. (2007) Source link

Consult a healthcare professional online and receive a treatment plan tailored to your needs.

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When Is Impulsivity a Problem?

Risk factors.

• In Children
• When It's a Problem

Impulsive behavior is not a disorder, but it can be a symptom of a condition like ADHD or bipolar disorder. 

Impulsivity is the tendency to act without thinking about the consequences. For some people, impulsivity is simply a character trait—a preference for spontaneity. For others, it can be a symptom of a significant disorder. Some medications and illegal drugs can also lead to impulsive behaviors.

Learn when impulsivity is a problem and what steps to take if you’re concerned.

mixetto / Getty Images

Signs of Impulsivity

There are many different definitions of impulsivity. All of them describe it as an antisocial or negative type of behavior. According to one definition, there are four factors involved with impulsivity:

• Lack of premeditation : Acting before thinking about the potential consequences
• Sensation seeking : Seeking out new and exciting experiences, often with the added element of risk for its own sake
• Lack of perseverance : Quitting a challenging activity or job before it’s done
• Urgency : Taking negative actions during an emotional outburst

Another way to think about impulsivity is to describe it in terms of how it is expressed. Some researchers describe three different types of impulsiveness:

• Motor impulsivity : Acting without thinking, which can include anything from hitting and shouting to simply jumping up and pacing
• Cognitive impulsivity : Quick decision-making without thought of consequences
• Non-planning : Acting without thought for the future

Compulsive vs. Impulsive

Impulsivity and compulsivity are both behavioral problems that have to do with a lack of control. However, people with compulsivity are unable to stop behaving in inappropriate or harmful ways, while people with impulsivity aren’t able to stop themselves from initiating inappropriate or harmful behavior.

Causes of Impulsivity

The prefrontal cortex is the part of the brain responsible for impulse control. There are several regions within the prefrontal cortex. These interact with neurochemicals such as serotonin to control functions like selective attention, response selection, motivational control, and behavioral inhibition.

Substances that can cause impulsivity include recreational drugs such as cocaine and methamphetamine, but can also include medications such as levodopa (used to treat Parkinson’s disease) and Abilify (aripiprazole).

Everyone behaves impulsively from time to time, but excessive impulsivity can be a sign of an underlying problem. Certain disorders or environmental influences can put a person at higher risk for impulsive behavior. For example:

• Genetic predisposition
• Growing up in an environment where adults behave impulsively
• Experiencing childhood trauma
• Experiencing a brain injury
• Having brain differences or a mental health condition

Impulsivity in Children

It is common for children to behave impulsively, even if they don’t have a disorder associated with impulsivity. Some examples of normal impulsive behavior in children include:

• Grabbing something they want without asking first
• Interrupting conversations between others or interrupting someone who is talking to them
• Screaming or tantruming when disappointed or angry
• Putting themselves in dangerous situations, like petting a growling dog or walking into a busy street

All children are impulsive sometimes, and it can be difficult to distinguish normal impulsivity from impulsivity pointing to a problem. If you notice excessive impulsivity in your child or impulsive behavior that is inappropriate for the child’s age, talk to their healthcare provider.

When Is Impulsive Behavior an Issue?

There is a fine line between spontaneity and impulsivity. A spontaneous decision to take the day off and go to the beach can be a reasonable choice; an impulsive decision to tell off the boss and quit your job can be disastrous.

The difference between impulsivity and spontaneity is that impulsive behavior is usually negative and often has the potential to be harmful to the individual or the people around them.

While spontaneous people may enjoy doing things on the spur of the moment, impulsive people are more likely to act out or take unreasonable risks. For example, impulsivity is closely associated with:

• Pyromania (the impulse to start fires)
• Gambling disorders
• Kleptomania (the impulse to steal)
• Recreational drug use, which can lead to substance use disorders

Impulsive behavior is a problem (or a potential problem) when:

• It appears suddenly, as it can be associated with a drug-related issue or with the onset of a physical or mental disorder.
• It is associated with an unreasonable level of risk that is likely to harm the person or others.
• It has a negative impact on the person’s ability to succeed in ordinary aspects of daily life (for example, they are often fired from or quit jobs, are unable to make friends or keep relationships, etc.).
• It causes harm to others. (Impulsive behavior can result in aggression toward others or unreasonable financial or physical harm.)

Conditions Associated With Impulsivity

Impulsivity is usually associated with a physical, psychological, or developmental disorder. It may also be caused by medications or recreational drugs. The most common disorders associated with impulsivity include:

• Attention deficit hyperactivity disorder (ADHD), a medical condition that affects your ability to sit still, control your behavior, and organize your thoughts
• Bipolar disorder , a mental health condition that causes extreme mood swings
• Antisocial personality disorder , a behavior disorder in which a person doesn’t care about other people’s needs or feelings and behaves in hurtful and manipulative ways
• Borderline personality disorder , a mental health condition that can cause emotional disturbances and make it difficult to form and keep relationships
• Autism , a developmental disorder that can make it difficult to interact socially, plan your actions, or control your emotions and behaviors
• Post-traumatic stress disorder (PTSD), a mental health condition that results from a traumatic event and may include recurrent problems with anxiety, attention, emotional regulation, and behavior
• Intermittent explosive disorder, a mental health condition that causes extreme emotional outbursts and violence
• Parkinson’s disease , a progressive neurological condition that can cause movement problems as well as sudden, uncontrollable urges to act in certain ways

Treating Impulsivity

Impulsivity may be treated with cognitive behavioral therapy , a type of psychotherapy (talk therapy), and medications. The choice of treatment depends, of course, on the cause of the impulsive behavior. In some cases, simply withdrawing or changing a drug or medication can make all the difference.

Treatment may start with a diagnosis of an underlying issue such as ADHD or bipolar disorder. Once the underlying issue is diagnosed, treatment may include appropriate medication. It may also include both behavioral and cognitive therapy.

In other cases, when impulsive behavior is associated with related issues such as uncontrolled gambling, 12-step programs can be very helpful. These are often recommended along with behavioral and cognitive therapy.

Medications for Impulsivity

Certain groups of medications may help treat impulsivity. These include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Selective noradrenergic reuptake inhibitors (SNRIs)
• Opioid antagonists
• Glutamatergic agents
• Atypical antipsychotics
• Stimulant medication

Cognitive and Behavioral Therapy for Impulsivity

Cognitive therapy is traditional talk therapy, which explores inaccurate perceptions or thoughts that drive impulsive behaviors. Behavioral therapy teaches the person to substitute new behaviors for problematic behaviors.

Cognitive behavioral therapy combines elements of both therapeutic techniques to help people think through and manage problematic behaviors. Therapists may also use techniques such as biofeedback (techniques to gain control of involuntary processes) to help people manage issues such as anxiety, which can lead to impulsive behaviors.

Impulsivity describes behaviors that are associated with a lack of control, such as acting without considering consequences and sensation seeking. Impulsive behavior can be a symptom of a condition like ADHD or bipolar disorder. 

Impulsivity is common in children, but excessive impulsivity or impulsivity that is inappropriate for their age should be discussed with a healthcare provider.

The conditions that are associated with impulsivity can be treated with medication, therapy, or a combination of both.

Dugré JR, Giguére CÉ, Percie du Sert O, Potvin S, Dumais A; Consortium Signature. The psychometric properties of a short UPPS-P impulsive behavior scale among psychiatric patients evaluated in an emergency setting . Front Psychiatry . 2019;10:139. doi:10.3389/fpsyt.2019.00139

Venkatesan S, Lokesh L. Impulsivity in students with specific learning disabilities . Int J Indian Psychol . 2019;7(4):37-47. doi:10.25215/0704.005

Ersche KD, Ward LHE, Lim TV, et al. Impulsivity and compulsivity are differentially associated with automaticity and routine on the Creature of Habit Scale . Pers Individ Dif . 2019;150:109493. doi:10.1016/j.paid.2019.07.003

Friedman NP, Robbins TW. The role of prefrontal cortex in cognitive control and executive function . Neuropsychopharmacology . 2022;47(1):72-89. doi:10.1038/s41386-021-01132-0

Food and Drug Administration. FDA warns about new impulse-control problems associated with mental health drug aripiprazole (Abilify, Abilify Maintena, aristada) .

Garcia-Ruiz PJ. Impulse control disorders and dopamine-related creativity: pathogenesis and mechanism, short review, and hypothesis . Front Neurol . 2018;9:1041. doi:10.3389/fneur.2018.01041

Gustavson DE, Friedman NP, Fontanillas P, et al. The latent genetic structure of impulsivity and its relation to internalizing psychopathology . Psychol Sci . 2020;31(8):1025-1035. doi:10.1177/0956797620938160

Kim JH, Choi JY. Influence of childhood trauma and post-traumatic stress symptoms on impulsivity: focusing on differences according to the dimensions of impulsivity . Eur J Psychotraumatol . 2020;11(1):1796276. doi:10.1080/20008198.2020.1796276

Fullerton AF, Jackson NJ, Tuvblad C, Raine A, Baker LA. Early childhood head injury attenuates declines in impulsivity and aggression across adolescent development in twins . Neuropsychology . 2019;33(8):1035-1044. doi:10.1037/neu0000570

Chen HY, Meng LF, Yu Y, et al. Developmental traits of impulse control behavior in school children under controlled attention, motor function, and perception . Children (Basel) . 20216;8(10):922. doi:10.3390/children8100922

Herman AM, Critchley HD, Duka T. Risk-taking and impulsivity: the role of mood states and interoception . Front Psychol . 2018;9:1625. doi:10.3389/fpsyg.2018.01625

Grant JE, Chamberlain SR. Psychopharmacological options for treating impulsivity . Psychiatric Times . 2015;32(8).

Ahuja T, Gupta P. Regulating impulse control using cognitive behavior strategies with Eye to I model for children with autism spectrum disorder . International Journal Indian Psychol . 2022;10(3). doi:10.25215/1003.049

Texas A&M University Central Texas. Impulse control disorders .

By Lisa Jo Rudy Rudy is a writer, consultant, author, and advocate who specializes in autism. Her work has appeared in The New York Times and Autism Parenting Magazine.

How to Manage Impulsive Behaviours in Kids with ADHD

Impulse control is a critical skill to develop because all other skills, behaviours, and even learning depend on it. This skill takes time and effort to develop, which is why kids need help to manage in the meantime. To help you get started, here is the most important information you need to know to manage impulsive behaviours in kids with ADHD.

Understanding

As with anything, you need to first understand ADHD . Their brains make it hard for them to self-regulate. Therefore, they need adult support longer than other kids to manage impulsive behaviours. So, by understanding the nature of ADHD allows you to practice patience, which is critical for success.

Next, you need to understand impulse control . Again, this is a critical skill for kids to develop. Without it, no other skills activate. A child can’t practice paying attention if he’s already become distracted. A child can’t learn to problem solve if she has already freaked out in an emotional outburst.

Set them up for success

For anything to work, kids need to experience success. Therefore, set kids up for success . Although they still need to learn to control their behaviours, their success is greatly affected by the structure, support, learning opportunities, modelling, and reinforcement they are exposed to; especially at first. There are several ways to help promote their success.

Get their buy-in and motivate

If kids are not motivated to work on developing skills to manage impulsive behaviours, they will have a hard time putting forth the effort needed to do it. For some kids, the natural consequences can be enough:

Pull other kids’ hair? They are not going to want to be friends.

If you share, other kids will want to play with you.

However, kids with ADHD have a hard time remembering what they need to do when they need to do it and why it is important. Therefore, they often need extra reinforcement and reminders to stay on track.

Unfortunately, kids with ADHD (and especially those who have a hard time managing impulsive behaviours) often get a lot of negative feedback and don’t feel they can do anything right anyway, so why bother? Or, they start to feel defeated and try to defend themselves.

All kids want to do good. And guess what: all kids ARE doing at least some good things throughout their day. It is a matter of being sure to recognize those times. Maybe Sally is off-task, chatting with her friend when she should be working. But look! She pulled her book out and gathered all of the materials she needs. That is praise worthy. If kids are praised throughout their day for what they are doing good, they will be motivated to keep doing good.

While praise may be enough for some, more tangible rewards like tokens to earn extra screen-time or activity can be more motivating.

Be a good role model

It is important you model expected behaviours too. If you are stressed and lose control by yelling at your kids, they are going to have a tough time keeping their cool too. Or learning how to handle situations calmly.

Talking through how you make decisions can be good learning opportunities too. You can talk through the steps on how you decide what to make for dinner with fewer ingredients than you expected. Or how to manage a stressful situation you are in. Or processing a rude remark someone made to you earlier in the day. All of this shows kids how to manage.

Create an ADHD-friendly environment

The best way to help manage impulsive behaviours in kids with ADHD, at least to start, is creating an ADHD friendly environment. We all know structure, patience, support, and safety are helpful. Other things also include:

Minimize risk

Reducing the opportunity for impulsive behaviours to occur in the first place is helpful. For example, if Johnny cannot help pull girls’ ponytails, then make sure he does not sit behind a girl with long hair.

Increase supervision

Kids with ADHD do best with a “minute manager;” ongoing supervision in which an adult frequently checks in on kids’, especially during problem times. If Suzie cannot play without hitting her younger brother when left on their own, then only allow them to play when you can be close by. If Tommy cannot complete his math worksheet on his own, then having someone sit next to him can be helpful.

Be explicit!

Often, we are too vague in telling kids how to behave. Explain exactly what behaviours you want to see. What does being nice mean? Or being respectful? Being good? Playing nicely?

Also be sure to state behaviours in the positive. That is, tell kids exactly what behaviour you DO want to see and not what you don’t want to see. Often we will say things like “no hitting!” Ironically, our brain will focus on the behaviour we are not supposed to do (so hitting is still likely to occur). Besides, kids might not know what they should do instead of hit, so always state what you do want to see happen so everyone is on the same page.

Collaborate

Kids are empowered and more likely to follow through if they are part of the rule making process.

Make it visual

Post the expectations somewhere where everyone can see it to help them remember the rules. For some kids, having an extra visual cue – even a little sticker on the edge of their desk or at their coat hook is enough of a reminder of what they need to do.

Give lots of breaks

Physical activity is important to help minimize and manage impulsive behaviours. Be sure kids get lots of time outside, exercise, and movement breaks throughout the day.

Behaviour Strategies to Manage Impulsive Behaviours

Of course, we cannot always manipulate the environment to manage and avoid impulsive behaviours. And we’re not always around to catch kids being good.   Kids need to learn skills to manage their behaviours too, which we can do through behavioural approaches. The key to success is practicing new behaviours (rather than being nagged about them all the time). Kids with ADHD have trouble with the point of performance , which means they know what they are and are not supposed to do. Which is why nagging doesn’t help – they already know it! The problem is actually doing what they need to do when they need to do it.

Explicit consequences

Just as it is important to be explicit about what behaviours are expected for a child, it is also important to tell kids exactly what will happen if the rules are or are not followed. Have kids help brainstorm what appropriate consequences could be – kids usually have some great ideas that are meaningful for them.

Consistent follow through

Once kids know the expectations and what will happen depending on their behaviour, be sure to consistently follow through. If you are unreliable in follow through, behaviour change is not likely to happen as effectively (if at all). And being reliable is even more important when it comes to praise and reinforcement; otherwise, kids have no reason to put in the effort they need to.

We all know consistency is important. However, here is one thing you may not have considered. Consistency is especially important to manage impulsive behaviours because kids learn two things: 1. it is WORTH practicing self control and 2. I CAN practice self control.

Researchers have shown that, developing self-control is greatly affected by kids’ environment. Having a reliable environment in which adults respond consistently, even for just a few minutes, greatly shaped kids behaviours.

Swift follow through

Just as consistency is important, so too is immediacy. If too long of a delay happens between their behaviour and the imposed consequence, kids have a harder time learning from their behaviour.

And consequences don’t just mean punishment. They can include reinforcement and praise as well. It is critically important to catch them being good when they are doing what you expect of them to reinforce more of those behaviours as well.

Having the consequences listed can be helpful too – especially if things go sideways and you have to implement consequences and kids are thinking you’re not being fair. You can go back to the visual with the child and review together what happens if a behaviour occurs.

Practice delayed gratification

We now know that delayed gratification – waiting to get what we want – is tied to long-term success (you can read more studies here and here ). Teaching kids delayed gratification is important to manage impulsive behaviours.

The kids who were successful in waiting for what they wanted found something else to do as they waited. Therefore, teaching appropriate replacement behaviours (e.g., things they can do instead of problem behaviour) is helpful. The more FUN and engaging the replacement behaviour, the more effective it will be.

Practice makes perfect!

Practicing is important, which you would first do in a structured situation in which they will experience success to get started.

If, for example, kids have trouble keeping their cool at the grocery store because they want the chocolate bar, you could outline the expectations and together come up with something they could do to wait for the chocolate bar. Perhaps they can flip through an Archie comic while waiting in line. If you think they can only wait for 1 minute in line before getting antsy, then set your timer for 30 seconds (remember, we want to set them up for success) and if they can stand calmly until the timer goes off, then they can have the chocolate right away. Once they achieve success, you can slowly increase expectations.

Read more about how to teach delayed gratification .

Teach self-talk

Kids with ADHD don’t have a strong internal voice that helps guide their behaviour to do good, which makes it really hard for them to manage impulsive behaviours. So, we need to teach how to create scripts for themselves to guide their behaviour.

For example, if Billy has trouble waiting in line without touching someone, a script he can repeat to himself might be, “Both feet on the ground, hands in my pocket. Both feet on the ground, hands in my pocket.” And then practice in a structured situation (e.g., with only one other child in front of him for 10 seconds with adult supervision), reward him for being successful, and slowly increase expectations until he can stand in line without any problems.

Teach self awareness

To manage impulsive behaviours, kids need to be aware that they are even behaving impulsively. Kids with ADHD have a hard time with this and need to develop self awareness. Teaching them think about what they are doing whenever they hear a key phrase, such as  “Stop and think!”  can be helpful. They can think about what they are supposed to be doing and what they are actually doing.

Reward for accurate responding (even if they are off-task) so that they learn to be honest; otherwise, kids will always say they are doing what they are supposed to be doing to avoid punishment and fail to develop awareness at all. If they are praised for accurate responding vs. behaviour initially, they will be better at monitoring their behaviours.

Make the link between behaviours and outcomes

Learning about their behaviour choices and whichever choice they make is directly related to the outcome (vs. you being mean when you go to consequence). For example, my girls know that whining and yelling do not get me to listen to them. In the moment I might say, “You can keep your cool and we can chat about what to do next over hot chocolate or you can continue to yell at me and I will leave you alone until you calm. Up to you kiddo.”

It can be helpful kids start by predicting what would happen if they __________ (e.g., screamed at their teacher if she said they couldn’t go out for recess). Or what they could do to ______________ (e.g., get their teacher to smile at them). And then have them experiment with the positive things they can do to earn a specific positive response!

Teach them to problem solve

To start, use those predictable times when impulsive behaviours tend to show up. When kids have to stand in line. When they go out for recess. When they are left alone in the kitchen. For these situations, brainstorm ideas with your child about what they can do instead of the problem behaviour. Find those replacement behaviours. And then, go practice.

First, brainstorm all the things kids can do if someone comes and steals their toy. Generate as many ideas as possible – this is important for problem solving because our first idea is not always the best idea so kids need to learn there are lots of alternatives.

Once you have your list, identify the goods and bad of each choice. Then choose two to three options to practice. Our first plan does not always pan out how we expect, so it is important to have a back-up plan too.

Set up a situation where a child (purposefully!) grabs the toy from the other, who has to practice the replacement behaviours for screaming/hitting (e.g., perhaps offering another toy) while you are there to help them be successful. Or, have kids practice calmly transitioning off their video game to go do something else.

If they are successful, be sure there is a pay-off that makes it worth it to keep practicing and using the new skills. Maybe it is giving them access to another super fun toy they normally would not have access to. Maybe they can go back to the video game with more time later. We definitely want them to be successful, so help them so that they can be immediately reinforced and see good things can come their way.

When kids are not successful, understand why. Perhaps the first strategy was not effective, so experiment with a different idea.

Additional resources

To get kids into the habit of problem solving for themselves, use this problem solving template to help get them started. You may also be interested in the steps for video modelling to help kids become more aware of their behaviours.

Looking for other things to read? Here are two of my personal favourites when it comes to managing behaviours:

• Taking Charge of ADHD, Third Edition: The Complete, Authoritative Guide for Parents (Russell Barkley)
• The Explosive Child (Ross Greene)

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Learn to Rewire Your ADHD Brain to Improve Cognitive Skills

How neuroplasticity helps to improve adhd symptoms..

Posted May 13, 2024 | Reviewed by Monica Vilhauer

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• Neuroplasticity is when the brain can rewire itself based on our daily experiences.
• Novel environments can improve executive function skills in individuals with ADHD.
• Exercise, artistic expression, and even playing video games can boost cognitive functioning.

My ADHD son loves to play puzzle-based video games. They are challenging, require problem-solving, and navigating novel environments. While my son enjoys playing these games, they are secretly improving his cognitive abilities and how his brain works. This is due to neuroplasticity—how our brains change in response to our environment and daily experiences.

Neuroplasticity and ADHD

Neuroplasticity is at work in your child when they learn a new concept in school, learn to ride a bike, or play an instrument. In recent years, research has focused on the benefit of neuroplasticity in improving executive function skills in children and adults with ADHD. When a cognitive training program, including planning, attention, memory , and problem-solving was assessed daily in ADHD children over a two-week period, volumetric increases in gray matter (neuronal cell bodies) were observed in brain areas commonly associated with ADHD. In other words, it’s possible that “brain training” can lead to an improvement in the executive function deficits prevalent in ADHD.

Summer vacation, when your child is away from the stressors of school, may be a good time to practice some skills to help your child rewire their ADHD brain for success.

Get outdoors and explore

My son has a self-balancing electric skateboard, and he had to learn to navigate alternate routes to the busy streets around his college campus. Exploring a new environment can enhance cognitive functioning through problem-solving, planning, and memory.

• Consider having your child find a new route to a friend’s house, whether by walking, biking, or driving.
• Visit a park and explore hiking trails or waterways.
• Another way to “explore” is by trying to do things with your non-dominant hand.

Practice balancing and get some exercise

Within the past two decades, scientists have realized a connection between the cerebellum and other higher functioning brain regions (e.g. prefrontal cortex) responsible for cognitive functions like learning and memory. The cerebellum has a large concentration of dopamine neurons and is primarily responsible for motor control. Based on connections between the cerebellum and the prefrontal cortex, strengthening the cerebellum through balance exercises has been shown to improve executive function skills. ADHD experts Drs. Edward Hallowell and John Ratey suggest doing simple balance exercises like these:

• Standing on one leg for a minute, or until you fall over
• Standing on one leg for a minute with your eyes closed, or until you fall over
• Taking your socks off and putting them on without sitting
• Learning to juggle, then spending 3-5 minutes juggling

Other activities like martial arts, skiing and skateboarding (all activities my son likes to do) are also good for practicing balance.

According to Dr. Ratey, exercise can help regulate emotional control and fidgetiness, and increase attention. More complicated exercises, such as martial arts, gymnastics, or mountain biking, have the greatest effect on improving focus and concentration, since you need to learn the skills for these technical and challenging activities (e.g. you don’t want to fall off your bicycle while riding on dangerous terrain).

Get creative

Diffuse attention contributes to highly creative ADHD brains. Research studies suggest children with ADHD may be better at music and art. For my son, there was mandatory participation in either band or choir beginning in elementary school, and he chose to play the trumpet and stuck with it through high school (he also played piano). Music and art can help with important executive function skills like concentration, focus, memory, motor coordination (cerebellum-prefrontal cortex link), expressing emotions, and communicating.

• Have your child dust off their instrument during summer break and encourage them to learn a new song. It may be fun for them to choose a favorite tune.
• If your child loves to draw or paint, creating an art piece can help with brain plasticity.

Play video games

If you are like me then you spend an exorbitant amount of time trying to get your ADHD child to STOP playing video games. However, playing video games can help teach your brain new skills through focus, problem-solving, navigating challenging situations, recovering from failure ( emotional regulation ), and motor coordination (cerebellum-prefrontal cortex link). The FDA has even approved a video game for the treatment of ADHD. Compliance won’t be an issue since most kids love gaming, just like my son who I am sure I would find playing one of his puzzle games if I went up to his bedroom. Just be sure to monitor playing time so there’s time left in the day to increase neuroplasticity in other ways too!

Hoekzema E, Carmona S, Ramos-Quiroga JA, Barba E, Bielsa A, Tremols V, Rovira M, Soliva JC, Casas M, Bulbena A, Tobeña A, Vilarroya O. Training-induced neuroanatomical plasticity in ADHD: a tensor-based morphometric study. Hum Brain Mapp. 2011 Oct;32(10):1741-9.

Hallowell, E. & Ratey, J. (2021). ADHD 2.0: New science and essential strategies for thriving with distraction—from childhood through adulthood. New York, NY: Ballantine Books.

Rapoport, J., Gogtay, N. Brain Neuroplasticity in Healthy, Hyperactive and Psychotic Children: Insights from Neuroimaging. Neuropsychopharmacol 33, 181–197 (2008).

Ratey, J.J., & Hagerman, E. (2013). Spark: The revolutionary new science of exercise and the brain . Little, Brown.

Rawson, K. (n.d.) Balance Exercises: An Alternative Treatment for ADHD. Coachbit. https://coachbit.com/cb-parents/balance-exercises-an-alternative-treatm… .

Raypole, C. (2020, June 17). 6 Ways to Rewire Your Brain. Healthline https://www.healthline.com/health/rewiring-your-brain .

Kristin Wilcox, Ph.D. , is the author of Andrew's Awesome Adventures with His ADHD Brain . She has studied ADHD medications and drug abuse behavior at Emory University and Johns Hopkins University School of Medicine.

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