Impulsivity in children with ADHD

 By Kissel Goldman, PhD, BCBA-D and Catherine Baker, PhD, BCBA-D

 Impulsivity is one of many diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD). Impulsivity is when a person engages in behaviors to get small, immediate rewards instead of behaviors that result in larger, more delayed rewards. For example, a person who chooses to eat fried foods for the taste over healthier options like fruits and vegetables might be said to be “impulsive”.  A reward or punishment is less effective the farther away in the time it is, or the less likely it is to happen. Essentially, if you won’t experience the effects of your choices right away, your choices are less affected by those consequences. In research, we call this “discounting”, because there is less value placed on far away or less likely consequences. For example, if someone is given the choice between $75 now or $100 in a month and chooses the $75, then we would say that the person values $100 in one month at less than $75. Children with ADHD have difficulty choosing what we might call the “right” decisions because they discount consequences that are far away and less likely than most people do.  

People make countless decisions every day and may not even be aware of most of them. Whether to look at a smartphone, write sloppy or neatly, and talk or stay quiet are all decisions. Choosing to do something almost always means choosing to not do something else. This is what is called “opportunity cost”. For example, a child writing sloppily may be doing so to finish their work as quickly as possible. Writing sloppily leads to a quick escape from work almost 100% of the time but may also lead to them being asked to redo the work or receiving a bad grade. However, redoing work and getting a bad grade are consequences farther away in time and have a less than 100% likelihood of happening. Therefore, children are likely to “discount” those consequences. 

Although we adults, and certainly children, are not doing math equations to calculate delays and probabilities every time they make a choice, all people do behave in ways that get us things we value. The difference in children with ADHD is that they value certain consequences slightly differently. That said, there are some techniques that can be used to help people value delayed or less likely consequences. One is to make sure that the person can experience the outcome if possible. If a child rarely receives a good outcome from waiting or self-managing, then we would not expect them to wait or self-manage. For example, a child who fidgets might be told to stop fidgeting. However, nothing good happens when they do stop fidgeting, except maybe the person who told them to stop goes away. A person telling them to stop is not going to happen all the time, so that consequence is discounted as well. A more useful way of reducing fidgeting would be to provide some sort of praise or reward when the child shows self-control. That way, the child can begin to experience the benefits of not fidgeting all the time. Another method is to practice what is called Future Episodic Thinking. In Future Episodic Thinking, a parent or therapist presents a real or made-up scenario in which immediate and delayed rewards are available and helps guide the child through the positive outcomes associated with waiting. As an exercise, this can be a little difficult, but the continued practice has been shown to reduce impulsivity in children. Finally, you can improve or help develop a child’s sense of time. Children with ADHD often estimate time inaccurately. Children unable to estimate the passage of time are more likely to discount far-off consequences. If the passing of 5 minutes feels like 20 minutes, then a person is going to feel like it takes 20 minutes to get something when it only takes 5. We will discuss this more in-depth in the next blog on Time Estimation in Children with ADHD.   

All people make countless choices a day. Impulsivity and discounting help describe how these choices are made. Being consistent, practicing, and helping children make contact with the consequences of waiting and self-management are all ways that might improve impulsive behaviors in children with ADHD. 

REFERENCES

https://www.cdc.gov/ncbddd/adhd/diagnosis.html 

https://www.sciencedirect.com/science/article/pii/S1471015315000380?casa_token=osmDbTlLm-4AAAAA:v1Kv8ezzTBr8dj4cnRbc8hJlH8GHoT6Bp16c8AsGVQ-exMnE3-4luyR6pHSqK4XAOMgT2wRb_Q 

https://www.tandfonline.com/doi/pdf/10.1080/09297049.2020.1712347?casa_token=wIt79TOvVT0AAAAA:QsA5C5UH_9g4ofVIlRWVxoTmedFGMfXoAihTQ69GJW760Ma_CX84wbmEleBNKa5NpbMDASk5BdPQ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856320/ 

Menu