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3. Impulsivity / inhibition problems in ADHD


3. Impulsivity / inhibition problems in ADHD

Impulsivity is generally defined as spontaneous reactions to internal impulses or external stimuli, without consideration of even obvious consequences. The behavior is perceived by third parties as inappropriate to the situation, uncontrolled or thoughtless. Excessive impulsivity is referred to as impulse control disorder (inhibition). Impulsivity has advantages in certain life situations where rapid focus and quick decisions are required and appears to be primarily dopaminergically controlled.1

3.1. Impulse control problems / inhibition problems as ADHD symptoms

On the neurophysiological causes of impulsivity and inhibition problems The neurophysiological correlates of inhibition and impulse control problems.

3.1.1. Manifestations of inhibition problems in children

  • Frequently blurts out answers before the question is finished (DSM IV/5)
  • Frequently interrupts and disturbs others (e.g., bursts into others’ conversations or games) (DSM IV/5)
  • Has difficulty waiting for his/her turn (DSM IV/5)
    Having difficulty waiting for one’s turn is not only an impulsivity problem, but also a problem of aversion to inactivity.

3.1.2. Manifestations of inhibition problems in adults

  • Spontaneous, rash decisions
    This is one of the 9 most accurate symptoms of ADHD in adults, but2 is also found in acute (hypo)manic sufferers or some Axis II problems
    • Spontaneous purchases
      • Buy something without needing it
      • Buy something without reflection whether the money is enough for it
    • spontaneous acceptance / termination of a job
    • spontaneous beginning / spontaneous termination of a relationship
    • Unconcern in dangerous situations Whether this is really an inhibition problem or rather a question of attention control is an open question. In ADHD, according to this understanding, the directing of attention follows the dictates of the stress maxim that there is a (survival-)threatening, uncontrollable danger. This can lead to significantly different judgments about what is dangerous and what is not.
  • Exuberant ideas need to be communicated quickly before they are in danger of being forgotten3
  • Excessive cell phone use correlated with impulsivity4 and affected 20.1% of participating student subjects
    • Excessive cell phone use further correlated with higher levels of
      • Alcohol consumption
      • Sexual activity
      • PTSD/PTBS
      • Anxiety disorders
      • Depression
  • Impulsivity in ADHD and elevated BMI share genetic and neurophysiologic correlates5
  • Speech is often experienced as aggressive by the environment

Impulsivity alone is not a compelling indicator of ADHD. In a study of impulsive subjects with and without ADHD, ADHD subjects showed a greater lack of interpersonal interaction, more indecisive decision-making, and lower motor skills than the non-ADHD subjects with and without impulsivity. Impulsivity without ADHDS showed good motor skills, good 1:1 social interactions, good decision making in spatial orientation tasks, and more versatile laterality in the lower limbs.6

3.2. Impulse control problems as symptoms of stress

Typical stress symptoms are known to be:

  • Impulsivity7
  • Riskier decisions8
  • Decision-making problems7910

  1. Toschi, Hervig, Moazen, Parker, Dalley, Gether, Robbins (2021): Adaptive aspects of impulsivity and interactions with effects of catecholaminergic agents in the 5-choice serial reaction time task: implications for ADHD. Psychopharmacology (Berl). 2021 Jun 9. doi: 10.1007/s00213-021-05883-y. PMID: 34104987.

  2. Barkley, Benton (2010): Das große Handbuch für Erwachsene mit ADH, Seite 22

  3. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 61

  4. Grant, Lust, Chamberlain (2019): Problematic smartphone use associated with greater alcohol consumption, mental health issues, poorer academic performance, and impulsivity. J Behav Addict. 2019 Jun 1;8(2):335-342. doi: 10.1556/2006.8.2019.32. n = 3.425

  5. Barker, Ing, Biondo, Jia, Pingault, Du Rietz, Zhang, Ruggeri, Banaschewski, Hohmann, Bokde, Bromberg, Büchel, Quinlan, Sonuga-Barke, Bowling, Desrivières, Flor, Frouin, Garavan, Asherson, Gowland, Heinz, Ittermann, Martinot, Martinot, Nees, Papadopoulos-Orfanos, Poustka, Smolka, Vetter, Walter, Whelan, Schumann, IMAGEN Consortium (2019): Do ADHD-impulsivity and BMI have shared polygenic and neural correlates? Mol Psychiatry. 2019 Jun 21. doi: 10.1038/s41380-019-0444-y.

  6. Prat, Andueza, Echávarri, Camerino, Fernandes, Castañer (2019): A Mixed Methods Design to Detect Adolescent and Young Adults’ Impulsiveness on Decision-Making and Motor Performance. Front Psychol. 2019 May 24;10:1072. doi: 10.3389/fpsyg.2019.01072. eCollection 2019.

  7. Buhusi, Olsen, Yang, Buhusi (2016): Stress-Induced Executive Dysfunction in GDNF-Deficient Mice, A Mouse Model of Parkinsonism. Front Behav Neurosci. 2016 Jun 21;10:114. doi: 10.3389/fnbeh.2016.00114. eCollection 2016

  8. Wang, Li, Sawmiller, Fan, Ma, Tan, Ren, Li (2013): Chronic mild stress-induced changes of risk assessment behaviors in mice are prevented by chronic treatment with fluoxetine but not diazepam. Pharmacol Biochem Behav. 2014 Jan;116:116-28. doi: 10.1016/j.pbb.2013.11.028

  9. Dias-Ferreira, Sousa, Melo, Morgado, Mesquita, Cerqueira, Costa, Sousa (2009): Chronic stress causes frontostriatal reorganization and affects decision-making. Science. 2009 Jul 31;325(5940):621-5. doi: 10.1126/science.1171203

  10. George, Koob (2010): Individual Differences in Prefrontal Cortex Function and the Transition from Drug Use to Drug Dependence; Neurosci Biobehav Rev. 2010 Nov; 35(2): 232–247; doi: 10.1016/j.neubiorev.2010.05.002; PMCID: PMC2955797; NIHMSID: NIHMS212204

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