ABCs of Mental Health > Parent Resource > The Child with Attention Problems > Impulsive Behaviours

The Child with Attention Problems - Impulsive Behaviours

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Section	Age	Indicator
Action	Early Childhood	Green
Belief	Middle Childhood	Yellow
Course	Early Adolescence	Red
	Adolescence

Impulsivity is defined as acting without thinking or the inability to wait. People who are impulsive appear to do things suddenly, without any planning ahead or considering the effects of their actions. In children, severe impulsivity includes not being able to wait before answering a question, or even before it is completed; often interrupting or intruding on others; running out into the street without stopping and looking, and being unable to wait for things that they may desire. Another way of thinking about impulsivity is as the lack of what psychologists call “inhibitory control”.

Defining and explaining impulsivity within the research community is difficult. There is no agreement about impulsivity. It appears to be a complex behaviour. Two common models used to explain impulsivity are:

People who have a hard time holding back. They act suddenly, without thinking or planning. There is no self-monitoring of their behaviour. This group is often described as lacking “inhibitory control”. That is, they lack the ability to put the brakes on motor actions, verbal actions or thought processes.

People who cannot delay gratification. These are people who may know that waiting or doing something that they may not desire (like homework) is best, but they can’t repress their desires for the immediate reward (going out with friends). This group is often described as being reward dependent or stimulation seeking. Often, children who have difficulty delaying gratification as observed in their behaviour, also have problems regulating (controlling) their emotions.

The other thing to keep in mind is that the behaviours associated with impulsivity change over time as children move to new stages of development. This will be evident in the different age groups in this resource.

The ability to control impulsive behaviour is associated with executive functions. As children mature, they develop skills and knowledge to control and regulate their desires and emotions. There appear to be two developmental points where there is an evident disjoint between emotional drives and executive control. The first developmental stage is early childhood when emotions drive behaviour. The second stage is early adolescence, when the brain is reorganizing itself in preparation for adulthood. During both these stages, adults generally have two responsibilities; one is to be understanding of this disjoint and the other is help in the development of regulatory skills to reduce it. Some children and youth may, because of neurodevelopmental problems, insults to the brain or mental health disorders, have a harder time regulating emotions and may appear impulsive as a result.

Parents need to be able to understand what is driving impulsive behaviours in order to address these behaviours at home and to help teachers working with their children.

If we look at babies, one sees behaviours that are purely “stimulus controlled” and “impulsive”. Babies do not act, they react to either internal (hunger, discomfort or fatigue) or external (a familiar face) stimulation. As infants enter their first year of life, things begin to change. They become wilful or goal directed. They are no longer just reactive. There are certain things that they want, such as a favourite toy, and they will insist on having it. Often, they are able to resist simple distractions or alternatives, when they want something. Parents may feel that their child is still impulsive, but the child is actually beginning to regulate their own behaviour and control their impulsivity.

With the development of language in year two, things begin to change rapidly. Children now begin to learn to express what they want and also what they can and can’t do. They learn to plan and to judge the consequences of their behaviour. They are learning “conscious control” of their behaviour. This ability to consciously control one’s behaviour through goal setting, planning and reflecting is often called the beginnings of “executive control” or “executive functions”. This process will continue to develop throughout their childhood and into adult life.
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During early childhood, impulsive behaviour can be very common in many children. Part of the learning processes is developing both physical and emotional control. They learn, first at home, through parental instructions and later at school, through teacher lead activities, how to regulate themselves. Generally, boys will appear to be more active than girls. On the other hand, girls may appear more talkative than boys. This distinction has to do with different developmental trajectories in childhood. Girls develop language at a more rapid rate than boys, whereas boys develop gross motor skills sooner.

Both at home and in school, adults should not be overly concerned about either energetic activity or excessive talking in children alone. Instead, they should be concerned when as child is not able to respond to commands, is unable to learn and practice rules or is at risk for hurting themselves.

Parents may wish to use the following domains of development to help them understand the emergence of expected behaviours:

Social Domain:

Making friends: Children should be able to play co-operatively with another child. They should be able to seek out another child for play. They should be able to share materials and toys. They should be able exchange ideas and roles in play dyads. They should be able to sustain play with others.
Conflict resolution: They should be able to express what they want. They should begin to regulate their feelings. They should begin to listen to what other children want. They should begin to work towards solutions when there are conflicting goals. They should begin to recognize consequences and accept solutions.
Peer group skills: They should observe before entering play. They should offer relevant ideas, roles and materials for play. They should be willing to accept available roles in play situations.
Cooperative skills: They should be able to identify emotions of others. They should be able to regulate their own emotions & behaviours according to the needs of others. They should begin to show respect for the belongings of other children. They should begin to listen, think and respond appropriately when others speak during group activities.

Emotional Domain

Recognizing emotions: They should begin to recognize their different emotions and give them names. They should be able to increase and decrease emotional energy in keeping with the situation. They should be able to express negative emotions in a way that doesn’t harm others.
Regulating emotions & related behaviours: They should be able to delay gratification. They should be able to persist when frustrated. They should be able to use language to express needs and regulate their emotions. They should be able to use strategies for self-calming. They should be increasing their ability to cope with challenges and disappointments.
Developing positive attitudes: They should be able to persevere as social demands and parental expectations increase, but only within a reasonable range of their ability. They should be able to accept defeats and mistakes. They should be able to ask for and accept help. They should be able to express satisfaction when accomplishing a task.

Communication and Language Domain

Conversing with peers & adults: They should be able to learn to adjust language use that is appropriate for cultural, age appropriate, social status and sex of listener. They should be able to have longer interactions. They should feel comfortable speaking in front of groups.
Listening to others: They should be able to listen to others, without distraction or interruption, for longer stretches of time. They should be able to practice appropriate turn taking. They should be able to understand and follow instructions up to three steps.

Cognitive Domain:

They should be using language to regulate their behaviours. Self-talk should be a possible regulatory strategy.
They should be able to monitor their own behaviour.
They should be able to identify problems, plan ahead, share in solutions, recognize consequences and take responsibility for actions.
They should be able to see the other point-of-view.

Physical Domain:

This is a time of increased levels of physical activity. Children are rapidly developing gross motor skills. They are increasing coordination, speed and endurance. At the same time they should be developing the ability to regulate these activities according to appropriate situations. On the other hand, teacher should schedule appropriate opportunities for the expression of physical activities. This is especially necessary for boys, whose gross motor skills are rapidly developing during this time.

Children who have problems with impulsivity and related hyperactivity often have problems specific to the following developmental domains:
Social Domain:

Making friends: They have a hard time making friends or retaining a best friend for very long
Conflict resolution: Impulsivity often precipitates conflict, so it is not uncommon to be involved in fights, especially among boys.
Peer play: Often this group of children are not openly accepted by their peers
Cooperative skills: These are very weak in this group of children. Often they appear immature when compared to their peer group

Emotional Domain:

Recognizing emotions: They may appear delayed compared to their peers. They may have a hard time managing their emotional energy. Their responses to events, both positive and negative may be more extreme
Regulating emotions & related behaviours: They have problems with delayed gratification and this can result in wanting rewards before completing tasks. This may result in emotional outbursts..[How is this different from “outbursts”]
Developing positive emotions: Constant criticism for inappropriate behaviour from adults and peer rejection can undermine the development of positive emotional skills and undermine the ability to accept setbacks and defeats. It can make a child less resilient.

Communication and Language Domain:

Conversation with peers and adults: They have a hard time staying on topic or being able to clearly state a point. Their conversations may drift off on a tangent before returning to the topic at hand. They have problems with voice modulation, which may appear as speaking too loud for the situation.
Listening to others: They often appear to speak out of turn or interject information that may be unrelated to the conversation.

Cognitive Domain:

They lack strategies to regulate their behaviour, such as self-talk.
They may not be able to see long term consequences of their behaviours.

They may not understand another person’s point of view.

Physical Domain:

They are highly accident prone. This has more to do with impulsive actions and hyperactivity, and less to do with gross motor development.

Children who have problems with impulsivity and related hyperactivity will often act without thinking. They may begin activities before you finish giving instructions. They may answer questions before you finish your instructions. They may break rules without thinking. In the playground they may speak out of turn or not be able to wait their turn when playing games. Overall, these children are at a higher risk for being accident prone. They tend to not stop and think before they act. In some case they gravitate to risky behaviour, which further compounds the danger of serious accidents.

They often appear to have a high degree of unnecessary movements such as restlessness, being fidgety or constantly squirming. Usually they will fidget with their hands and feet or squirm in their seats.

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Behaviours associated with impulsivity and related hyperactivity, that do not seem to be age appropriate, that are identified by their teachers as disruptive, that occur in a variety of settings, that affect learning in the classroom, that persist for at least 6 months and that cannot be attributed to either cultural or other external events should be of concern to parents.

Impulsive behaviours will include:

Children who can’t wait their turn
Children who blurt out comments
Children who interrupt and intrude into conversations

Hyperactive behaviours will include:

Children who constantly fidget and squirm
Children who are constantly running around and climbing objects
Children who constantly get up and leave their seat
Children who are constantly on the go
Children who can’t play quietly
Children who talk excessively

If a child exhibits at least 6 of the above problems behaviours, parents have their child referred to a paediatrician, psychologist, psychological associate or psychiatrist for assessment and to determine whether they have a diagnosable attention deficit/hyperactivity disorder. (please see Beliefs subchapter for information about ADHD)

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During early childhood and into middle childhood there seems to be a strong link between impulsivity and motor activity. Impulsive children appear to be very active and very talkative. They appear to be always on the go. They have a hard time sitting still and are often seen fidgeting and squirming when seated. They will acknowledge that it is painful for them to sit still. They also are very talkative and in many cases have a hard time modulating their speech. As a result, they may speak too loudly. It must be remembered that speech is a motor activity, so if a child has difficulty regulating motor function, it will affect the way they speak.

As children enter into middle childhood they should be developing skills that help them to regulate both impulsive behaviours and emotions. High energy, especially in boys is natural, but they should be aware of appropriate contexts for the expression of physical activities. Parents should also be sensitive to the needs of all children to exercise physical drives, but they should be concerned about children who appear to be impulsive in their behaviours or have a hard time regulating their physical behaviours when expected.

Parents may wish to use the following domains of development to help them understand the emergence of expected behaviours:

Social Domain:

Making friends: Children should have a best friend. They should be able to play group games. They should be able to interact with more pro-social skills. There should be a decline in aggressive behaviour both overt physical behaviour and covert language based aggression. They should show an interest in acting appropriately for adults.
Conflict resolution: they should understand the importance of following rules. They should look towards finding solutions to problems that take into account the other’s perspective. They should be developing a sense of right and wrong. They should understand the connection between actions and consequences.
Cooperation: They should be developing the ability to understand the point of view of others. This should be a building block for developing empathy. They should be increasing their to help others. They should participate in co-operative and sharing behaviours.

Emotional Domain:

Recognizing emotions: Children should continue to increase their understanding of the sources of their emotional states, especially complex emotions like pride, gratitude, jealousy and anxiety. They should be improving their ability to articulate these emotions. They should also be improving their ability to regulate emotions through private speech, perspective taking and empathy. When they struggle with emotions like anger, fear and anxiety, they should be able to learn and apply strategies to regulate these emotions. They should be developing positive attitudes to learning, persistence and engagement.

Communication & Language Domain:

Conversing with peers and adults: They should be developing their ability to adapt messages to the needs of the listener. They should be fully versed in appropriate turn taking and listening skills. They should be able to modulate their voice according to the situation.

Cognitive Domain:

Self-regulation: Children should be able to regulate attention, block out distractions and focus on tasks at hand.
Problem solving: Children should not be reactive to obstacles, but develop problem solving skills. They should be able to access, develop a plan and proceed to solution. They should be able to monitor their behaviour.

Children who have problems with impulsivity and related hyperactivity will often act without thinking. They may begin school activities before instructions are finished. They may answer questions before you have finished speaking. They may break house rules without thinking. In the playground they may speak out of turn or not be able to wait their turn when playing games. Overall, these children are at a higher risk for being accident prone. They tend to not stop and think before they act. In some case they gravitate to risky behaviour which further compounds the danger of serious accidents.

Children with problems with impulsivity and related hyperactivity will often appear to have a high degree of unnecessary movements such as restlessness, being fidgety or constantly squirming. Usually they will fidget with their hands and feet or squirm in their seats.

They have a hard time engaging in quiet activities. They often appear to talk too much or too loud. They have a difficult time not intruding into other people’s conversations or activities. Sometimes they make inappropriate comments because they say whatever pops into their heads.

They often have problems specific to the following developmental domains:
Social Domain:

Making friends: They have a hard time making friends or retaining a best friend for very long
Conflict resolution: Impulsivity often precipitates conflict, so it is not uncommon to be involved in fights, especially among boys.
Peer play: Often this group of children are not openly accepted by their peers
Cooperative skills: These are very weak in this group of children. Often they appear immature when compared to their peer group

Emotional Domain:

Recognizing emotions: They may appear delayed compared to their peers. They may have a hard managing their emotional energy. Their responses to events, both positive and negative may be more extreme
Regulating emotions & related behaviours: They have problems with delayed gratification and this can result in wanting rewards before completing tasks. This may result in emotional outbursts. As well, poor inhibitory control can also lead to problems regulating feelings.
Developing positive emotions: Constant criticism for inappropriate behaviour from adults and peer rejection can undermine the development of positive emotional skills and the ability to accept setbacks and defeats. It can make a child less resilient.

Communication and Language Domain:

Conversation with peers and adults: They have a hard time staying on topic or being able to clearly state a point. Their conversations may drift off on a tangent before returning to the topic at hand. They have problems with voice modulation, which may appear as speaking too loud for the situation.
Listening to others: They often appear to speak out of turn or interject information that may be unrelated to the conversation.

Cognitive Domain:

They lack strategies to regulate their behaviour, such as self-talk.
They may not be able to see long term consequences of their behaviours.
They may not understand another person’s point of view.

Physical Domain:

They are highly accident prone. This has more to do with impulsive actions and hyperactivity, and less to do with gross motor development.

Behaviours associated with impulsivity and related hyperactivity that do not seem to be age appropriate, that are identified by teachers as disruptive, that occur in a variety of settings, that affect learning in the classroom, that persist for at least 6 months and that cannot be attributed to either cultural or other external events should be of concern to parents.

Impulsive behaviours will include:

Children who can’t wait their turn
Children who blurt out comments
Children who interrupt and intrude into conversations

Hyperactive behaviours will include:

Children who constantly fidget and squirm
Children who are constantly running around and climbing objects
Children who constantly get up and leave their seat
Children who are constantly on the go
Children who can’t play quietly
Children who talk excessively

If a child exhibits at least 6 of the above problems behaviours, parents are encouraged to have their child referred to a paediatrician, psychologist, psychological associate or psychiatrist for assessment and to determine whether they have a diagnosable attention deficit/hyperactivity disorder. (please see Beliefs subchapter for information about ADHD)

ADHD rarely appears by itself. Many children with ADHD, also have language and learning problems and mental health problems. Learning problems include problems with reading fluency and comprehension, as well as problems with writing. To a lesser degree some children also have problems with math. Mental health problems most commonly include anxiety and mood disorders. As well, some children have oppositional behaviour problems.

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As children enter adolescence, their impulsivity begins to take on a different profile. Motor activity begins to become more internalized. Teenagers appear more restless. They often describe the need to be somewhere else. They often talk about being bored. Researchers talk about the link between impulsivity, poor delayed gratification and motivation. Teenagers who are impulsive have a hard time staying focused on one activity. They may begin with the best of intentions, but when the task no longer gives immediate reward, they lose interest by announcing “this is boring”. In fact, they crave immediate reward for their activity, so they move onto something else and usually repeat their loss of interest. Activities, like computer games attract this group of teens because they offer immediate rewards as they play. Activities that have delayed rewards (gratification) cannot hold these teenagers.

The level of impulsivity children and teenagers display is on a continuum. It is fair to say that during early childhood, almost all children will show some degree of impulsivity. As they learn to be mobile they will want to move around, as they develop language they will want to talk and as they learn to like things, they will develop desires. One of the roles of parenting is to teach children to be able to manage these behaviours appropriately. Through educating, modelling and setting limits on behaviour, parents begin to teach both appropriate behaviour and the control of impulsive tendencies. In some cases, children still struggle at managing their impulsive drives. These children may have poor “inhibitory control”.

As children move into early adolescence they begin to experience physical, emotional and cognitive changes. This is a time when they begin to mature beyond the more vulnerable state of childhood, yet they lack the competencies of adulthood. This is a time when they begin to separate from their parents, identify more with their peer group and become more aware of themselves, initially their physical self. It is also a time of developmental disjoint between their emotional development and their self-regulatory ability. As a result, they often over-react emotionally. Also, they appear to be attracted to activities with high levels of arousal. They often look for things that are exciting. This often shows itself in risk-taking behaviours or getting easily bored by activities that do not hold either a high reward for them or do not have a high level of excitement.

Parents may wish to use the following domains of development to help them understand the emergence of expected behaviours:

Social Domain:

Friendships: In early adolescence, peer group friendships become very important. Students are redefining their identities in groups, clubs and even gangs. Girls, who are developing faster than boys may also begin to explore romantic pairing. There may be the risk of attraction to older boys who are further along in development.
Conflict resolution: Young adolescents may have difficulty with conflict resolution because they may react with high intense feelings to situations. This may appear as very quick emotional responses to conflict situations. As well, problem solving during heightened arousal may not work.
Cooperation – young adolescence should be learning to work with their peers during this time and to develop appropriate social engagement skills with adults. Yet, they may tend to exclude their parents from this process.

Emotional Domain:

Regulating emotions: In some teenagers, during the early stages of adolescence some emotional feelings may be easily triggered. This is because emotions may be experienced at a heightened level relative to childhood. As a result, regulating feelings in the middle of a heightened situation may be challenging. For most teens, this is not a risk situation.
Recognizing emotions: This a time for students to learn more about the changes that are taking place within themselves and to develop an understanding of the changes taking place within their emotions.

Physical Domain:

Physical changes: In early adolescence, students will begin to experience physical changes. This is the time for the onset of puberty. Their bodies begin to change. Most evident is the beginning of the development of physical sexual traits. Girls usually begin this process before boys. In boys, this process may produce physical awkwardness, as well as self-consciousness, usually around the changing of their voice and possible facial blemishes. Girls may also be self-conscious of initial changes.
Physical behaviour: There are often changes associated with sleep patterns and appetite. Teens become more nocturnal and have a hard time getting to bed on time and getting up in the morning. They require at least 8-10 hrs of sleep. Teachers may experience students with poor arousal regulation in their classes.

Communication & Language Domain:

Conversing with peers: There may be some awkwardness across genders. Boys may feel especially self-conscious speaking out in class, especially around topics dealing with emotions and relationships. Boys may also be self–conscious around their changing voices. Though performing communication skills may appear to be poor, competencies are in place and students should be able to converse appropriately when they feel safe.
Talking to adults: appropriate skills should be in place.

Cognitive Domain:

Self-regulation – children should be able to regulate attention, block out distractions and focus on tasks at hand.
Problem solving – children should not be reactive to obstacles, but develop problem solving skills. They should be able to access, develop a plan and proceed to solution. They should be able to monitor their behaviour.

Some adolescents have a hard time regulating both their emotions and their behaviours. Development during this time of life is not consistent. For some teenagers with poor regulatory skills, they will continue to present as hyperactive. For others with poor regulatory skills, their hyperactivity will be replaced by feelings of inner restlessness. In both cases, impulsive behaviours will continue. Problems with delayed gratification, with acting without thinking, and reacting with strong emotional responses will still be evident. These behaviours can in turn lead to poor decision making and risk taking.

Young adolescents who have problems with hyperactivity and impulsivity also often have problems specific to the following developmental domains:
Social Domain:

Making friends: They may gravitate to a peer group that is also looking for high levels of stimulation. Risky behaviour and substance abuse are possible
Conflict resolution: Impulsivity often precipitates conflict, so it is not uncommon to be involved in fights, especially among boys.

Emotional Domain:

Recognizing emotions: They may appear delayed in recognizing emotions in themselves and others compared to their peers. They may have a hard managing their emotional energy. Their responses to events, both positive and negative may be more extreme
Regulating emotions & related behaviours: They have problems with delayed gratification and this can result in wanting rewards before completing tasks. This may result in emotional outbursts. As well, poor inhibitory control can lead to problems regulating feelings.
Developing positive emotions: Adolescents with poor regulatory skills have higher rates of negative ideation and emotion expression

Communication and Language Domain:

Conversation with peers and adults – They have a hard time staying on topic or being able to clearly state a point. Their conversations may drift off on a tangent before returning to the topic at hand. They have problems with voice modulation, which may appear as speaking too loud for the situation.
Listening to others- They often appear to speak out of turn or interject information that may be unrelated to the conversation.

Cognitive Domain:

They lack strategies to regulate their behaviour, such as self-talk.
They may not be able to see long term consequences of their behaviours.
They may not understand another person’s point of view.

Physical Domain:

They are highly accident prone. This should also be kept in mind when they reach the age where they can drive.

Behaviours associated with impulsivity and related hyperactivity, that do not seem to be age appropriate, that are identified by teachers as disruptive, that occur in a variety of settings, that affect learning in the classroom, that persist for at least 6 months and that cannot be attributed to either cultural or other external events should be of concern to parents.

Impulsive behaviours will include:

can’t wait their turn (appears to very impatient)
blurts out comments
interrupts and intrude into conversations

Hyperactive behaviours will include:

constantly fidget and squirm
full of inner restlessness
constantly needs to be somewhere else (often feels bored)
constantly on the go
can’t play/work quietly
talks excessively

If a teen exhibits at least 6 of the above problems behaviours, parents should have their child referred to a paediatrician, psychologist, psychological associate or psychiatrist for assessment and to determine whether they have a diagnosable attention deficit

ADHD rarely appears by itself. Many children with ADHD, also have learning problems and mental health problems. Learning problems include problems with language, reading fluency and comprehension, as well as problems with writing. To a lesser degree some children also have problems with math. Mental health problems include anxiety and mood disorders. As well, some children have oppositional behaviour problems.
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Adolescence is a time for establishing one’s independence from the family. It is a time to begin to explore the role of becoming an adult, usually without all the responsibilities of adulthood. Slowly, society allows adolescents some responsibilities. The right not to have a curfew and the right to drive a car are responsibilities initiated by age 16. And slowly, the list increases. The assumption is that with each year, teenagers become more responsible- better at regulating their behaviours and the emotions that drive the behaviours. Most teenagers handle the acquisition of adult responsibilities with very little difficulty.

Parents may wish to use the following domains of development to help them understand the emergence of expected behaviours:

Social Domain:

Friendships: As adolescents mature, they still retain a high regard for their peer groups, but they also begin to explore romantic relationships with single partners.
Conflict resolution: Adolescents are still experiencing heightened arousal and strong emotions during this time of development. As a result, it may be a challenge to resolve conflicts in such a heightened state, but they also should be developing good insight into human nature. As a result, conflict resolution should be possible, once emotions have subsided.
Cooperation: Adolescence is often described as a time of idealism and, with good directions, adolescents should have all the skills necessary to work cooperatively with adults.

Emotional Domain:

Regulating emotions: This should be a time for developing abilities to regulate feelings and put the brakes on behaviours driven by intense feelings. Remember, this is a work in process.
Recognizing emotions: This a time for students to learn more about the changes that are taking place within themselves and to develop an understanding of the changes taking place within their emotions.

Physical domain:

This is a time of transition to full adulthood. Physical coordination and strength should be almost fully developed.

Communication & Language Domain:

Earlier awkwardness associated with conversations with the opposite sex should be subsiding. There should also be a comfort level associated with talking to adults.

Cognitive Domain:

Self-regulation – The disjoint between emotional development and cognitive control will still be there, but should show signs of decreasing.
Problem solving – The ability to recognize a variety of problem solving skills, including understanding alternative points-of-view should be in place.

Adolescent behaviours associated with impulsivity and related hyperactivity appeardifferent in teenagers. There may be a cluster of related behaviours that also occur. These may include:

Indecisiveness: The inability to make clear thought out decisions may be coupled with impulsive decision making
Low frustration tolerance: The tendency to quickly get bored and irritated
Difficulty managing emotions: Self regulation of emotions may be linked to problems with delayed gratification
Poor self motivation: This may be tied into difficulty sustaining focus, without being distracted by internal emotional feelings of frustration or irritation around task at hand, especially if it lacks any immediate reward.
Difficulty accepting responsibility: This may be linked to emotional immaturity or a history of poor outcomes
Low self-esteem: this may be related to poor social skills and a history of poor outcomes

can’t wait their turn (appears to be very impatient)
blurt out comments
interrupt and intrude into conversations

Hyperactive behaviours will include:

constantly fidget and squirm
full of inner restlessness
constantly needs to be somewhere else (often feels bored)
constantly on the go
can’t play/work quietly
talk excessively

If your teenager exhibits at least 6 of the above problems behaviours, parents are encouraged to have their child referred to a paediatrician, psychologist, psychological associate or psychiatrist for assessment and to determine whether they have a diagnosable attention deficit

ADHD rarely appears by itself. Many children with ADHD, also have learning problems and mental health problems. Learning problems include problems with language, reading fluency and comprehension, as well as problems with writing. To a lesser degree some children also have problems with math. Mental health problems include anxiety and mood disorders. As well, some children have oppositional behaviour problems.
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Poor inhibitory control is believed to be one of two underlying process deficits in Attention Deficit Hyperactivity Disorder (ADHD). The other is poor working memory. ADHD is a common neurobiological disorder. It is a chronic and lifelong disorder. It affects about 5% to 7% of the population. This translates into 1 or 2 students per class. ADHD interferes with an individual’s capacity to self-regulate their activity level (hyperactivity & restlessness), to inhibit behaviour (impulsivity) and to attend to the task at hand in an age appropriate way (attention).

Inhibitory control is a seen as a psychological process responsible for symptoms (behaviours) associated with the hyperactive/impulsive dimension of ADHD.
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Many children and youth with problems regulating impulsive behaviours and hyperactivity may in fact have a neuro-developmental disorder like ADHD or be born with congenital health problem like Foetal Alcohol Syndrome (FASD). Back to top

Children who come from families where family life is less structured or rule based may initially enter school with behaviour that appears hyperactive and impulsive. Back to top

Poor impulse control and hyperactivity are also associated with other disabilities than ADHD. It is often associated with Foetal Alcohol Syndrome (FASD). Children with autism will also have impulsive behaviours, though the link with hyperactivity is not there. Any delay in development of the prefrontal cortex or any affront to the prefrontal cortex may also result in impulsive behaviour. Back to top

Some children are described as very energetic and/or quick to process information. Often, these children are incorrectly identified as having impulse control problems when they may just be under stimulated. Back to top

Different cultures have different approaches to early child rearing. Some cultures allow for more independence in young children, whereas other cultures may require more defined behaviours. Teachers should pay close attention to the cultural expectations associated with child rearing in the early years. This may have a bearing on the level of school readiness once a child enters the classroom. The type of learning intervention necessary for a child whose impulsive behaviour may be learned is different from impulsivity that is organic. Back to top

Children who have experienced emotional trauma or come from turbulent environments may respond differently to classroom situations. They may respond immediately to both internal stimulation (a thought of danger) or to external stimulation (an experience that may rekindle memories of danger). Their immediate response may run counter to classroom expectations and thus be seen as impulsive behaviours. These children should be referred to counselling services immediately. Back to top

As children prepare for pre-school programs and kindergarten, they should be developing self-regulatory skills as part of their school readiness. Parents can promote self-regulation by:

Promoting the extensive use of language in play activities
Teaching intention and planning through play
Encouraging social role-playing during game activities
Introducing structured programs, with defined time-frames for activities
Slowly introducing appropriate social rules
Using any conflict or infraction of rules as a teachable moment for their child

At this age, it is hard to distinguish normal children’s behaviour from children who have difficulty with impulsive behaviours and hyperactivity. Children who appear to show these behaviours in excess of their peers and who appear less mature than their peers should be closely monitored. They may be at higher risk for accidents at home and at play.

These children benefit best from a well structured and predicable home life.

Parents should be highly prosocial and positive. They should explicitly model, explain and coach appropriate social skills on a daily basis.

Children who are impulsive and hyperactive will likely have poor attention skills as well. As a result, they may have trouble following instructions. When giving instructions, parents should make eye contact with the child. They should speak clearly and paced. Use short sentences and visual cues if possible. Pause between sentences.

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Children who struggle with impulsivity and related hyperactivity may be at risk for mental health or learning problems. Parents may wish to have their children referred to a paediatrician, psychologist, psychological associate or psychiatrist for assessment to determine whether they have diagnosable attention deficit/hyperactivity disorder.

Medications

There are two main types of medication that have been officially approved by Health Canada for the treatment of ADHD in children, adolescents and adults. These are stimulant medications and non-stimulant medications. The stimulants are methylphenidate-based like Ritalin and Concerta and amphetamine-based like Dexedrine and Adderall. The non-stimulant medications include a new class of drugs known as atomoxetine hydrochloride. Atomoxetine is sold under the trade name of Strattera.

Medications can also be differentiated based on how long they last. Stimulants can be classified as short lasting (3-4 hours) and longer lasting (6-14 hours). Effects of non-stimulant medications can last up to 24 hours.

Medications are found to improve core symptoms of impulsivity, hyperactivity and inattention. In the classroom, children may be less fidgety, less emotional and better able to concentrate. At home there may less conflict, more quiet play and better transition at bedtime.

Like all medications, stimulants and non-stimulants come with side effects. The following side effects occur in about 5% of children with ADHD. They include stomach discomfort, insomnia, nervousness, mild increase in pulse and blood pressure, irritability and mild sadness. Often, these symptoms clear up within 30 minutes and will disappear completely in 24 hours if the medication is stopped. Controversies, such as growth deficits and substance abuse are unfounded.

Two key points to keep in mind are that these medications do not cure ADHD symptoms. They simply give relief to the core symptoms associated with ADHD. The second point is that it is a challenge to get compliance for using these medications from children and youth. Children are more compliant that teenagers. Teenagers argue that they feel like they are not themselves when on the medications. Since peer relationships are important to teenagers, they resist the use of these medications. Ironically, young adults who are in post-secondary settings are much more compliant. They see the medications as a means towards success in school.

Psychosocial & Bbehavioural Interventions

Parent training: These programs help parents to understand ADHD behaviours as well as learning methods for coping with and accommodating children’s behavioural and learning difficulties. Parent training programs usually cover anywhere from 6 to 12 sessions. Evidence shows that they do reduce stress at home, improve parental self-esteem and improve child compliance.

Social skills training: A high percentage of children and teenagers with ADHD have poor social skills. These can range from children with aggressive behaviours to children who have difficulty reading social cues and modulating their social interactions. Generally, these programs work best when they are presented in learning contexts (classrooms) and they use a universal approach (include all classroom students).

Cognitive-Behaviour therapies: – These programs use behaviour management strategies, problem solving and self-monitoring strategies. The goal of these programs is to improve self-control.

Behavioural therapies and management – the goal of these programs is to reduce unwanted programs and to encourage wanted behaviours. These programs can be divided into two broad categories; programs & strategies that are antecedent focused and programs & strategies that are consequence focused.

Antecedent focused behaviour management strategies try to identify the events that immediately preceded the problematic behaviours. Once the trigger for the behaviour is identified, the goal is to eliminate the trigger with an intervention that will promote positive outcomes. The intervention can be either environmental (i.e., changing a student’s seating) or accommodations (i.e., altering the structure and length of class assignments).
Consequent focused behaviour management strategies are used to reinforce appropriate behaviour or punish inappropriate behaviour. Programs that provide immediate and consistent rewards for appropriate behaviour are found to be effective in reducing the severity of symptoms associated with ADHD. Common consequence behaviour programs include the use of token economy management systems and behaviour contracts. Often, self-monitoring strategies, such as checklists to monitor desired behaviour are built into these programs. Students are still rewarded when they achieve a certain level of performance, but at the same time they are taught to think about their behaviour.

Multimodal Interventions

The combination of medication, parent training and school based behavioural and education interventions has been shown to have the best outcomes for children with ADHD when the school based interventions are consistent and continued for at least 2 or 3 years.

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During middle childhood, children should be developing appropriate self-regulatory skills in the classroom as part of their normal development. See Actions Observed for Middle Childhood for benchmarks of development. Parents can promote these domains of development by modeling appropriate social behaviours, by encouraging reflective thinking and by promoting a positive learning experiences. Back to top

Children who act without thinking may show the following behaviours:

They may begin a task before instructions are finished
They may impulsively break rules
They may speak out of turn
They may talk back (need to have the final say)
They may take shortcuts when doing their work

Parents can use a variety of strategies to manage impulsive behaviours. These can include:

Creating a structured home environment. Set up a predicable routine at home. Establish rules around expectations. Make sure that you consistently enforce the rules.
Managing transitions. Allow time for transitions such as dinner time or going to bed. You may want to use a timer to set-up a countdown to transitions. When out in the community try to avoid rapid changes. Discuss expected behaviours for any change in situation. For example, if you are entering a shopping mall, review expected behaviours before entering the mall. You may want to ask your child to repeat what you expect and then have them confirm that they are OK with the rules.
Reduce temptations for poor self-regulation. Pay attention to overstimulation. Judge what settings may trigger unwanted behaviours, and either avoid them or rehearse your expected behaviours for your child before entering such a situation.
Use positive discipline. Whenever you get a chance, complement your child for appropriate behaviour. For example, if they are in a public setting and are able to regulate their behaviour, let them know that your are proud of their accomplishment.
Teach, model and practice. Talk to your child about what you expect. Explain why it is important to behave in a certain way. Model the expected behaviour and practice it consistently.
You may wish to use a reward system to promote specific behaviours. See the section on token economies for strategies.
Coping with unwanted behaviours. Avoid power struggles. Point out unwanted behaviours, and impose agreed consequences. If your child is losing their control, acknowledge that they are upset, you should remain calm and offer them a chance to regain composure. Offer them a choice, “you can either….. or ……..”. Do not get into a power struggle.
Teach your child problem solving strategies. Self-talk, breathing exercises or specific behaviour management programs can help.

Children who struggle with impulsivity and related hyperactivity, whether the cause is ADHD or other factors are at a disadvantage at school and in the community. It is not primarily the outward behaviour that puts them at risk, but rather the lost opportunity to learn and to make friends. As well, in the majority of cases the externalizing behaviour that one associates with impulsivity/hyperactivity is only the tip of the iceberg. Underneath, there are probably a number of cognitive processes that are affecting learning and socialization. So, parents should not assume that once the hyperactivity and impulsivity are managed, that learning will take place.

That said, there are a variety of interventions that can help reduce the frequency of impulsivity and hyperactivity. These include behaviour management, supporting academic success at school, strategy training and medication. The best outcomes occur through a multimodal approach.

Behaviour Management

In its most general sense, there are two components involved in behaviour management. First, there is the teaching of rules. These rules define behaviour that is allowed and behaviour that is not allowed. Second, there is the consequence for the student’s behaviour. The consequence can be a reward for practicing behaviours that are allowed and punishment for practicing a behaviour that is not allowed.

Behaviour management has some challenges when being applied to children with ADHD. Children with ADHD have diminished reactions to delayed consequences, whether those consequences are rewards or punishments. Also, children with ADHD have weak sensitivity to both rules and consequences, which means they have a hard time remembering or being motivated to engage in both components of behaviour management programs. Therefore, parents need to express rules frequently and to use heightened reinforcements.

With the aforementioned challenges in mind, Dr. Russell Barkley has suggested eight principles to think about when trying to manage impulsivity and hyperactivity:

Use more immediate feedback and consequences: Children with ADHD respond better to immediate feedback for behaviour. This should include immediate feedback for both obeying rules and for breaking rules. If possible, parents should use more positive than negative consequences.
Use more frequent feedback and consequences: Children with ADHD benefit from more reminders and most children. Feedback does not have to be just consequential to inappropriate behaviour. It can preface transitions or tasks. It also does not have to always be verbal. Strategies using token economies and self-monitoring can be used to promote frequent feedback.
Stronger consequences: Children with ADHD have reduced sensitivity to consequences, whether they are rewards or punishments. Parents need to increase the level of consequences. Generally, this works best for rewards, since increased negative consequences can in fact undermine the motivation to participate in schooling. Dr. Barkley suggests that in addition to praise, parents may wish to develop a reward system for children with ADHD (see token economy)
Use positive over negative: All children respond better rewards than they do to punishment. First, the parent should identify the behaviour they wish to change. Next, the parent should observe their child waiting to see when the child uses this desired behaviour in place of the unwanted behaviour. Rewarding the desired behaviour immediately. Only after the new behaviour has consistently been rewarded for a week, should the parent evaluate whether to also introduce punishment for undesired behaviour. If they choose to introduce punishment to mange misbehaviour, it should be mild.
Be consistent: It is important for parents to be consistent with expectations and enforcement of rules for all children, across time, place and situations.
Anticipate problems: It is important for parents to be proactive, rather than reactive. This involves being aware of triggers that may set off unwanted behaviour. Plan ahead and reduce unwanted behaviours.
Keep a perspective: It is important to remember that children with ADHD have a hard time regulating behaviour and remembering rules. Unwanted behaviour is often not intentional, so parents should not personalize or become enraged when the behaviour is recurrent. Losing your cool does not help the situation. Parents may want to develop an internal strategy to help them step back from the immediate situation, stay calm and then engage with the understanding that you are working with a child with a disability.
Practice forgiveness: Dr. Barkley identifies three components to this process. First, forgive the child for their transgressions. They struggle with a disability that may be hard for you to really understand. Two, forgive those around the child, who misunderstand the child’s inappropriate behaviour. Finally, forgive yourself, for your own missteps in managing the child’s behaviour. ADHD children at times have the ability to challenge the patience of the best of us. Recognize that you may at times fall short of the expectations you have set for yourself as a parent, and set out to improve your own ability to regulate your emotions and actions.

For children who have a diagnosis of ADHD, the best approach is a multimodal approach. At school, it is important for parents to make sure that all the components are in place. This includes the teacher based classroom strategies, a psycho-educational program for the child, which will teach them about their disorder and how to self-advocate and finally medication. But, it is important for teachers to remember that medication will not address the problems associated with learning. Only, a good academic assessment, appropriate instructional practices and monitoring of the students learning will promote school success.

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Children who are impulsive and hyperactive may be diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). Parents should know the following about treatment approaches for these children.
Treatment for ADHD includes medications, psychosocial, and multimodal interventions.
Medications:
There are two main types of medication that have been officially approved by Health Canada for the treatment of ADHD in children, adolescents and adults. These are stimulant medications and non-stimulant medications. The stimulants are methylphenidate-based like Ritalin and Concerta and amphetamine-based like Dexedrine and Adderall. The non-stimulant medications include a new class of drugs known as atomoxetine hydrochloride. Atomoxetine is sold under the trade name of Strattera.

Medications can also be differentiated based on how long they last. Stimulants can be classified as short lasting (3-4 hours) and longer lasting (6-14 hours). Effects of non-stimulant medications can last up to 24 hours.

Medications are found to improve core symptoms of impulsivity, hyperactivity and inattention. In the classroom, children may be less fidgety, less emotional and better able to concentrate. At home there may less conflict, more quiet play and better transition at bedtime.

Like all medications, stimulants and non-stimulants come with side effects. The following side effects occur in about 5% of children with ADHD. They include stomach discomfort, insomnia, nervousness, mild increase in pulse and blood pressure, irritability and mild sadness. Often, these symptoms clear up within 30 minutes and will disappear completely in 24 hours if the medication is stopped. Controversies, such as growth deficits and substance abuse are unfounded.

Two key points to keep in mind are that these medications do not cure ADHD symptoms. They simply give relief to the core symptoms associated with ADHD. The second point is that it is a challenge to get compliance for using these medications from children and youth. Children are more compliant that teenagers. Teenagers argue that they feel like they are not themselves when on the medications. Since peer relationships are important to teenagers, they resist the use of these medications. Ironically, young adults who are in post-secondary settings are much more compliant. They see the medications as a means towards success in school.

Psychosocial & behavioural Interventions

Parent training: These programs help parents to understand ADHD behaviours as well as learning methods for coping with and accommodating children’s behavioural and learning difficulties. Parent training programs usually cover anywhere from 6 to 12 sessions. Evidence shows that they do reduce stress at home, improve parental self-esteem and improve child compliance.

Social skills training: A high percentage of children and teenagers with ADHD have poor social skills. These can range from children with aggressive behaviours to children who have difficulty reading social cues and modulating their social interactions. Generally, these programs work best when they are presented in learning contexts (classrooms) and they use a universal approach (include all classroom students).

Cognitive-Behaviour therapies: – These programs use behaviour management strategies, problem solving and self-monitoring strategies. The goal of these programs is to improve self-control.

Behavioural therapies and management – the goal of these programs is to reduce unwanted programs and to encourage wanted behaviours. These programs can be divided into two broad categories; programs & strategies that are antecedent focused and programs & strategies that are consequence focused.

Antecedent focused behaviour management strategies try to identify the events that immediately preceded the problematic behaviours. Once the trigger for the behaviour is identified, the goal is to eliminate the trigger with an intervention that will promote positive outcomes. The intervention can be either environmental (i.e., changing a student’s seating) or accommodations (i.e., altering the structure and length of class assignments).
Consequent focused behaviour management strategies are used to reinforce appropriate behaviour or punish inappropriate behaviour. Programs that provide immediate and consistent rewards for appropriate behaviour are found to be effective in reducing the severity of symptoms associated with ADHD. Common consequence behaviour programs include the use of token economy management systems and behaviour contracts. Often, self-monitoring strategies, such as checklists to monitor desired behaviour are built into these programs. Students are still rewarded when they achieve a certain level of performance, but at the same time they are taught to think about their behaviour.

Multimodal Interventions

The combination of medication, parent training and school based behavioural and education interventions has been shown to have the best outcomes for children with ADHD when the school based interventions are consistent and continued for at least 2 or 3 years.

Back to top

During early adolescence, children should be developing appropriate self-regulatory skills in the classroom as part of their normal development. See Actions Observed for early adolescence for benchmarks of development. Parents can promote these domains of development by modeling appropriate social behaviours, by encouraging reflective thinking and by promoting a positive learning experiences. Back to top

Children who act without thinking may show the following behaviours:

They may begin a task before instructions are finished
They may impulsively break rules
They may speak out of turn
They may talk back (need to have the final say)
They may take shortcuts when doing their work

Parents can use a variety of strategies to manage impulsive behaviours. These can include:

Creating a structured home environment. Set up a predicable routine at home. Establish rules around expectations. Make sure that you consistently enforce the rules.
Managing transitions. Allow time for transitions such as dinner time or going to bed. You may want to use a timer to set-up a countdown to transitions. When out in the community try to avoid rapid changes. Discuss expected behaviours for any change in situation. For example, if you are entering a shopping mall, review expected behaviours before entering the mall. You may want to ask your child to repeat what you expect and then have them confirm that they are OK with the rules.
Reduce temptations for poor self-regulation. Pay attention to overstimulation. Judge what settings may trigger unwanted behaviours, and either avoid them or rehearse your expected behaviours for your child before entering such a situation.
Use positive discipline. Whenever you get a chance, complement your child for appropriate behaviour. For example, if they are in a public setting and are able to regulate their behaviour, let them know that your are proud of their accomplishment.
Teach, model and practice. Talk to your child about what you expect. Explain why it is important to behave in a certain way. Model the expected behaviour and practice it consistently.
You may wish to use a reward system to promote specific behaviours. See the section on token economies for strategies.
Coping with unwanted behaviours. Avoid power struggles. Point out unwanted behaviours, and impose agreed consequences. If your child is losing their control, acknowledge that they are upset, you should remain calm and offer them a chance to regain composure. Offer them a choice, “you can either….. or ……..”. Do not get into a power struggle.
Teach your child problem solving strategies. Self-talk, breathing exercises or specific behaviour management programs can help.

Behaviour Management

Use more immediate feedback and consequences: Children with ADHD respond better to immediate feedback for behaviour. This should include immediate feedback for both obeying rules and for breaking rules. If possible, parents should use more positive than negative consequences.
Use more frequent feedback and consequences: Children with ADHD benefit from more reminders and most children. Feedback does not have to be just consequential to inappropriate behaviour. It can preface transitions or tasks. It also does not have to always be verbal. Strategies using token economies and self-monitoring can be used to promote frequent feedback.
Stronger consequences: Children with ADHD have reduced sensitivity to consequences, whether they are rewards or punishments. Parents need to increase the level of consequences. Generally, this works best for rewards, since increased negative consequences can in fact undermine the motivation to participate in schooling. Dr. Barkley suggests that in addition to praise, parents may wish to develop a reward system for children with ADHD (see token economy)
Use positive over negative: All children respond better rewards than they do to punishment. First, the parent should identify the behaviour they wish to change. Next, the parent should observe their child waiting to see when the child uses this desired behaviour in place of the unwanted behaviour. Rewarding the desired behaviour immediately. Only after the new behaviour has consistently been rewarded for a week, should the parent evaluate whether to also introduce punishment for undesired behaviour. If they choose to introduce punishment to mange misbehaviour, it should be mild.
Be consistent: It is important for parents to be consistent with expectations and enforcement of rules for all children, across time, place and situations.
Anticipate problems: It is important for parents to be proactive, rather than reactive. This involves being aware of triggers that may set off unwanted behaviour. Plan ahead and reduce unwanted behaviours.
Keep a perspective: It is important to remember that children with ADHD have a hard time regulating behaviour and remembering rules. Unwanted behaviour is often not intentional, so parents should not personalize or become enraged when the behaviour is recurrent. Losing your cool does not help the situation. Parents may want to develop an internal strategy to help them step back from the immediate situation, stay calm and then engage with the understanding that you are working with a child with a disability.
Practice forgiveness: Dr. Barkley identifies three components to this process. First, forgive the child for their transgressions. They struggle with a disability that may be hard for you to really understand. Two, forgive those around the child, who misunderstand the child’s inappropriate behaviour. Finally, forgive yourself, for your own missteps in managing the child’s behaviour. ADHD children at times have the ability to challenge the patience of the best of us. Recognize that you may at times fall short of the expectations you have set for yourself as a parent, and set out to improve your own ability to regulate your emotions and actions.

Psychosocial & Behavioural Interventions

Antecedent focused behaviour management strategies try to identify the events that immediately preceded the problematic behaviours. Once the trigger for the behaviour is identified, the goal is to eliminate the trigger with an intervention that will promote positive outcomes. The intervention can be either environmental (i.e., changing a student’s seating) or accommodations (i.e., altering the structure and length of class assignments).
Consequent focused behaviour management strategies are used to reinforce appropriate behaviour or punish inappropriate behaviour. Programs that provide immediate and consistent rewards for appropriate behaviour are found to be effective in reducing the severity of symptoms associated with ADHD. Common consequence behaviour programs include the use of token economy management systems and behaviour contracts. Often, self-monitoring strategies, such as checklists to monitor desired behaviour are built into these programs. Students are still rewarded when they achieve a certain level of performance, but at the same time they are taught to think about their behaviour.

Multimodal Interventions

During adolescence, teenagers are expected to be developing skills necessary for self-control and independence. The later years of high school are intended to promote self-control and independence in preparation for post-secondary education, the workplace and adult life.

The challenge for parents of teenagers is to continue to raise a healthy and well adjusted teenager without being too restrictive or too lenient. Defined rules and articulated expectations are important. But, be open to negotiations. Teenagers should learn to articulate what they believe and should feel safe engaging in conversation with their parents. Learn to be an active listener. The more your teen is able to talk with you the healthier your relationship will be.

Remember that teenagers are highly energetic, driven towards peer approval and open to risk taking. It is important to link responsible behaviour to incentives. Establish rules, and be consistent. Activities, like driving or staying out late, should be defined as privileges that can be revoked when not handled responsibly.

Promote positive feedback. Look for the good and acknowledge it. Try to avoid negative interactions. Ignore minor problems. Avoid power struggles. If there is a conflict, refer to established and agreed on rules. If possible, avoid saying “no”. Simply refer to the agreed to rules and ask why they should be changed at this time.

Remember that teenagers begins to explore their independence and to define who they are, your role is to create a safe space for them in their journey.

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Teenagers who appear to be impulsive and who may be impatient and bored (these behaviours appear to replace hyperactivity in adolescence and early adulthood) benefit from the interventions suggested in C-8. Parents should be aware of the age differential, but should implement the suggestions as they see appropriate. Back to top

Teenagers who are functionally at risk because of impulsivity and who appear often impatient and bored (these behaviours appear to replace hyperactivity in adolescence and adulthood) should be encouraged to seek a psychoeducational assessment. This can be done by a qualified psychologist and psychological assistant.

Parents will probably need to act as advocates with their child’s school. They should make sure that the school is prepared to integrate recommended teaching and classroom strategies for students recommended in the psycho-educational assessment. Most recommendations at this level involve accommodations and should be implemented by all subject teachers.
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