View Full Version : Beyond Impulsivity: Behavioural Disinhibition in ADHD


drmshowraki
04-23-14, 12:33 PM
Impulsivity, acting or blurting without thinking or considering the consequences have been a major feature or symptom of ADHD. But impulsivity itself in ADHD is a part of larger group symptoms of "behavioural Disinhibition" that have not yet fully discussed in the literature!

In my practice, having seen many ADHD/ADD children and teenagers, over the years, I have been observing at least in a group of the patients, symptoms of "behavioural disinihibition", beyond just a single of impulsivity. I have found that these children and teenagers are in general and across a broad range of behaviours, disinhibited. In other words, this group of patients as early age as toddlers, lack control over their behaviours. Many of these symptoms are missing from most of diagnostic criteria or symptoms descriptions of ADHD, including DSM-IV and most recently DSM-5, that is the diagnostic bible of psychiatric disorders.

DSM-IV and 5, define Impulsivity as "often blurting out answers before questions have been finished/often having trouble waiting one's turn/ and often interrupting or intruding on others (e.g., butting into conversations or games). But "behavioural disinihibition" that impulsivity is a part of it is beyond these and can include many missing symptoms in our current diagnostic criteria, such as uncontrollable silly and clown like behaviours; giggling, laughing too much; bullying, mocking behaviours;risk taking behaviours including engagement in risky and careless driving, drug and substance abuse, sexual misconduct; other misconduct behaviours such as interest in prohibited actions and words, lying, etc; annoying others and causing disturbances at home, schools and other environments.

As one can see or have observed in oneself or others around him/her with ADHD, these symptoms could be the most costy and dangerous to the person, family and the society at large if left ignored and untreated. The common consequence of these disinhibited behaviours are vast and ranges from complications of bullying behaviours, common in schools, misconduct behaviours including anti-social acts and legal consequences, substance abuse and so on. Behavioural Disinhibition, is lack of restraint or control over one’s behaviour, including disregard for social convention, impulsivity and poor risk assessment. Disinhibition can affect motor behaviour, instinctual, emotional, cognitive and perceptual domains that anatomically in brain is linked to the frontal lobe, specially pre-frontal and orbitofrontal cortex dysfunctions.

Lrkemp
05-25-14, 12:06 AM
I am new to this forum. What I have read has been extremely helpful. I am especially happy to see someone pinpointing the dis-inhibited behavioral issues seen in some children with ADHD. My 6 yr. old grandson displays these symptoms. He was diagnosed with ADHD at 4 and has displayed aggression and inappropriate outburst since the age of 2. I'm curious how common these symptoms are seen in ADHD children. He is currently diagnosed further with ODD and mild OCD, but they all relate to the dis-inhibition in his behavior. It seems so odd that his impulsiveness is beyond even the "norm" for ADHD behavior. Even on medication he continues the unusual behavior for someone his young age. And to exacerbate things more, the medication makes him irritable and whiny. Can this be changed with therapy, behavior modification? What, if anything, can be done about this? It seems the education system and the area we live offer very little advise for all of this. He is only six and just graduating kinder and already I'm wondering what we can possibly do to fix or modify or change the direction this boy is heading. Any suggestions?

Dizfriz
05-25-14, 10:58 AM
drmshowraki This would fit well within Russell Barkley's theory of ADHD being an issue of the development of the executive functions resulting in defects of self control, self regulation.

Dizfriz

Dizfriz
05-25-14, 11:15 AM
Lrkemp.

Great questions. To keep this thread focused on drmshowraki's ideas and thoughts, I responded in another section of the forum http://www.addforums.com/forums/showthread.php?p=1651991#post1651991

Good luck and welcome.

Dizfriz

meadd823
05-26-14, 03:50 AM
Being ADD isn't the same as having conduct disorder or ODD but many seem to struggle to tell the difference. . . Some ADD people are sensitive to the emotions of other people Many of us do care how our actions impact others - We are more likely to be bullied than bullies ourselves - Violence is not some thing we come by naturally by way of simply having ADD but it is some thing some of us learned in order to survive in a violent abusive world.


People with ADD have variation in temperaments just like every one else - Some of us are easy going, emotionally balanced and slow to anger even those of us who tend toward the hyperactive side. Some hyperactive folks like myself are by nature pleasantly busy.

RobboW
05-26-14, 07:30 AM
One of my daughters (so it seems to me) displays dis-inhibited behaviours. She is also a chronic blurter and lies a lot. She gets it from me of course, but she seems much worse than me. When I do or say innapropriate things I tend to realise straight away and regret it, but she genuinely doesn't seem to get it. Frustration much.....

I think she really needs medication. No amount of talk has any lasting impact.

daveddd
05-26-14, 11:28 AM
Being ADD isn't the same as having conduct disorder or ODD but many seem to struggle to tell the difference. . . Some ADD people are sensitive to the emotions of other people Many of us do care how our actions impact others - We are more likely to be bullied than bullies ourselves - Violence is not some thing we come by naturally by way of simply having ADD but it is some thing some of us learned in order to survive in a violent abusive world.


People with ADD have variation in temperaments just like every one else - Some of us are easy going, emotionally balanced and slow to anger even those of us who tend toward the hyperactive side. Some hyperactive folks like myself are by nature pleasantly busy.

maybe some

but "quick to anger" i believe is found in more adhd adults than your classic symptoms

sometimes its inhibited , so harder to see

but at least barkley thinks it should be on the dx criteria

The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults.
Barkley RA1, Fischer M.
Author information

Abstract
OBJECTIVE:
Emotional impulsiveness (EI) may be a central feature of attention-deficit/hyperactivity disorder (ADHD) contributing impairment beyond the two ADHD dimensions of inattention and hyperactivity-impulsivity.
METHOD:
We evaluated EI in hyperactive (N = 135) and control (N = 75) children followed to adulthood (mean age 27 years). The hyperactive cases were subdivided into those individuals whose ADHD persisted (ADHD-P) and did not persist (ADHD-NP) to adulthood. We examined the additional contribution of EI apart from ADHD symptoms to global ratings of impairment in 10 major life activities, adverse occupational and educational outcomes, criminal and driving outcomes, and money management difficulties at ages 21 and 27.
RESULTS:
The ADHD-P group reported more EI symptoms than either the ADHD-NP or community control groups. EI uniquely contributed to seven of 10 major life domains and to overall impairment beyond ADHD symptoms. Severity of EI uniquely contributed to numerous impairments in occupational, educational, criminal, driving, and financial outcomes beyond ADHD symptoms.
CONCLUSIONS:
EI is as much a component of ADHD as are its two traditional dimensions and is associated with impairments beyond those contributed by the two traditional dimensions.

http://www.ncbi.nlm.nih.gov/pubmed/20431470