Impulsivity

• What is impulsivity?
• Features of impulsivity
• Common causes of impulsivity
• When to approach your health care professional
• Questions your health care professional may ask
• Examinations/tests your health care professional may perform
• How is impulsivity treated?
• What can families, parents and teachers do to help?

What is impulsivity?

Impulsive individuals tend to act without forethought. They may react rapidly and without planning, often without regard to the consequences on themselves or others.

Features of impulsivity

Some examples of impulsive behaviours include:

• Engaging in dangerous activities without considering possible consequences
• Difficulty waiting turns
• Calling out in class
• Intruding in on or interrupting conversations or games
• Blurting out answers before questions have been completed

Common causes of impulsivity

• Attention deficit hyperactivity disorder (ADHD)
• Alcohol or drug abuse
• Delirium
• Dementia
• Head injury
• Mood disorders
• Psychotic disorders
• Conduct disorder
• Antisocial personality disorder
• Borderline personality disorder
• Bulimia nervosa, anorexia nervosa
• Intermittent explosive disorder
• Adjustment disorder

When to approach your health care professional

Some degree of impulsivity is considered normal in most people. Impulsive behaviour becomes significant when it is persistent, severe, and affects performance at work, in school or in social relationships. This may be due to one or more of the underlying conditions.

In children, disorders like ADHD often begin before preschool age, but for most children it goes unnoticed until they land into trouble at school. Occasionally teachers may be first to recognise that the child has a problem. The first port of call is often the family general practitioner or school psychologist, who will assess the patient and initiate appropriate management or referrals.

Questions your health care professional may ask

During the consultation, the health care professional may ask you to describe the symptoms, including their onset and development. He/she may also ask about the patient’s past illnesses or injuries, current medications (prescribed and over the counter), and family history, particularly of psychiatric disorders.

In children, also important are the details of the pregnancy, delivery, and the developmental milestones, including risk factors such as maternal smoking, alcohol, drug use and major illness. The healthcare professional may also ask about your family’s social life and the presence of any stressful events.

Examinations/tests your health care professional may perform

The doctor may perform the following examinations:

• Observation of mental status
• Height, weight, head circumference measurements (children)
• Blood pressure and pulse
• Hearing and vision testing
• Developmental assessment
• Nutritional status assessment
• Examination of the nervous system

Often, other tests may be required, which may consist of:

• Questionnaires to be filled out by the parents and school teacher
• Tests of intelligence, individual subject areas, language skills, attention and executive functioning
• Blood tests and imaging may sometimes be required

 

How is impulsivity treated?

Specific treatment for impulsivity varies from patient to patient depending on the underlying cause. In most cases, several different treatment strategies may be used at the same time on one patient. In addition to using medicines, some patients may benefit from behavioural therapy, parent training and school based interventions.

What can families, parents and teachers do to help?

The treatment for conditions with impulsivity may involve medications and/or behavioural therapies. Families and parents can help by learning about the diagnosis, causes, features and treatment, in order to help manage the condition and understand what the patient is going through.

In children with ADHD, good behavioural management principles and strategies are important in managing impulsive behaviours. Some centers offer parent training, which has been shown to be an effective intervention. Teachers can help improve school behaviour and academic achievement by implementing school-based interventions (e.g. token economy systems).

Useful information

For more information on childhood ADHD and its symptoms and treatments, as well as some useful tools and animations, see Childhood ADHD.

For more information on ADHD in adults and its treatments, as well as some useful tools and animations, see Adult ADHD.

References

1. Soanes C, Stevenson A [Eds]. Impulsive adjective. In: The Oxford Dictionary of English (revised edition). Oxford University Press. 2003.
2. Moeller F, Barratt E, Dougherty, D, Schimitz J, Swann A. Psychiatric aspects of impulsivity. American Journal of Psychiatry. 2001; 158(11): 1783-93.
3. Sadock B, Sadock V. Chapter 39: Attention deficit disorders. In: Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 8^th ed. Lippincott Williams & Wilkins, Philadelphia. 2005.
4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM-IV-TR, 4^th ed. American Psychiatric Association, Washington DC. 2000.
5. First M, Frances A, Pincus H. DSM-IV-TR Handbook of Differential Diagnosis. American Psychiatric Publishing, Arlington. 2002.
6. Schweitzer J, Cummins T, Kant C. Attention-deficit/hyperactivity disorder. Medical Clinics of North America. 2001; 85(3): 757-77.
7. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry. 1999; 56(12): 1073-86.

Other symptoms related to Impulsivity:

• Hyperactivity
• Inattention