Impulsiveness, the most dangerous trait of ADHD

Who cares about ADHD? It’s just for boys in grade school who can’t sit still–right?

Wrong. 

This stereotype of the hyperactive boy disrupting class severely underplays the real risks inherent for children, teens, and adults with ADHD.

What are the most severe outcomes for those with ADHD?

According to research presented by CHADD (Children and Adults with Attention-Deficit / Hyperactivity Disorder), in each of the following categories a person with ADHD is far more likely to suffer than someone without ADHD:

• Accidental Injuries, including car accidents (1.5 - 3x)
• Teenage pregnancy (8-10x)
• Sexually transmitted disease (4x)
• Drug addiction (20-30% of those with ADHD may qualify for a substance abuse disorder)
• Suicide (3-5x)

In other words, people with ADHD have a serious predisposition to get into trouble. Big trouble.

(By the way, that is a pretty good laundry list of a parent’s worst nightmares.)

Why does ADHD lead to higher percentage negative outcomes in those categories?

First, let’s get a better understanding of what ADHD is. 

ADHD (Attention Deficit Hyperactivity Disorder)--notice that ADHD is actually named after its primary traits or symptoms instead of what is happening inside of the brain. 

Some of the primary traits are difficulty focusing, poor working memory, hyperactivity, and impulsivity, although not all of those traits are present in every person who suffers from ADHD. 

For example, many girls and women do not exhibit hyperactivity. Instead they have heightened inattention and lack of focus. Because of this discrepancy, girls are about half as likely as boys to be diagnosed with ADHD. 

I personally am familiar with this narrative as I have predominantly inattentive type ADHD and went undiagnosed. My son, on the other hand, has hyperactive ADHD and was diagnosed immediately. It was through his diagnoses that I began to study ADHD and its symptoms, before realizing that I too had it. 

In school, I hardly ever paid attention and was always disorganized and daydreaming, but I didn’t disrupt class. My son, however, when he stopped paying attention might simply leave his chair and walk out of class!

Let’s go in deeper.

What causes those ADHD symptoms to happen?

A better definition of ADHD is that it is a neurological disorder characterized by executive dysfunction and emotional dysregulation. These problems in the brain and nervous system lead to difficulty focusing, hyperactivity, impulsivity, etc.

The executive part of your brain manages your thoughts, emotions, and reactions. Specifically, it controls inhibition control, long term planning, and goal achievement. In other words, someone with executive dysfunction has difficulty staying on track and thinking long term.

The other half of the definition, emotional dysregulation, refers to someone exploding or giving up due to a minor problem or setback. This person could also easily feel severely frustrated or overwhelmed. 

My understanding is that someone with emotional dysregulation does not feel emotions that the rest of us lack. However, they react to and demonstrate those emotions in a big way, while a person with typical emotional regulation might hide the emotion or only demonstrate it in a small or socially acceptable way.

For example, Jane and Tom both work in McDonald’s. They have an overbearing manager who constantly changes their schedules without warning. One day, they both walk in to see that they have been scheduled to work that weekend. 

Tom, who properly regulates his emotions, feels angry, but he gets his anger under control. He suppresses it. When he sees his manager, he asks about the schedule change. When the manager does not give a reasonable response, Tom nods, goes back to work, and tells himself as soon as he gets off this shift he’s going to start sending job applications to other establishments.

Jane, on the other hand, has ADHD characterized by emotional dysregulation. When she sees that her schedule has been changed, she feels angry. In fact, the anger takes her over. She goes and finds the manager, tells him he is an insensitive idiot, and he yells back at her (because, of course, when you attack people they act in kind). Then she quits and walks out. 

In both cases, Jane and Tom felt angry, but only Jane acted fully on her anger.

This story highlights a few important points about ADHD. Without emotion, there is no action. If Jane didn’t care that her schedule was changed, she would not have hunted down her boss and took him to task. 

Lack of emotional regulation leads to acting on an emotion to the hilt–whereas an individual with well regulated emotions may still act on the emotion, but is more likely to do so in a socially acceptable manner. 

Also, the well regulated individual might keep long term goals in mind. For example, Tom reasoned that he needed a job to pay his bills, and he would also need his manager’s referral when he found a job to replace the current one. Keeping the larger situation in mind helped him to not blow up at his manager. He played the game.

These definitions and overview bring us to the one ADHD trait that may cause the most harm: impulsivity.

The APA Dictionary of Psychology defines impulsivity as “displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences of an action.”

Based on what we have already investigated, I would like to add to the above definition that impulsivity is acting immediately on an emotion.

I called impulsivity possibly the most dangerous trait to ADHD as it can be easily connected to some of the negative outcomes listed earlier:

• Accidental Injuries, including car accidents
• Teenage pregnancy
• Sexually transmitted disease
• Drug addiction
• Suicide

Many of us may feel sexual attraction to someone, but the impulsive person may immediately have unprotected sex. Many of us may feel anger at someone, but the impulsive person may physically or verbally attack. Finally, many of us may feel depressed, but the impulsive person may choose to end his or her life. 

Clinical Psychologist and ADHD specialist Dr. Russell A. Barkley also emphasizes the importance of social isolation to the personal suffering of those with ADHD, and he directly links social isolation to impulsive behavior. 

He states that peers and friends of those with ADHD often do not really care about hyperactivity, forgetfulness, or lack of attention. Those traits will not put off a friend. However, when one of these peers is attacked verbally or physically by someone with ADHD, they will not forgive that and likely break off the friendship. That attack against a peer is likely driven by impulsiveness and poor emotional regulation leading to lack of self control.

So now that we have a thorough understanding of the importance of getting impulsiveness under control for an adult with ADHD, how can we learn to control impulsiveness?

Next week, I would like to get into some useful tactics to tap the brakes on impulsiveness and learn to regulate emotions. Check out the blog post titled: 3 Tactics to Tap the Brakes on Impulsivity