DEFINING IMPULSIVITY

Impulsivity involves the individual reacting rapidly to internal or external stimuli without planning, forethought or regard to the consequences to the self or others (Kanten, 2018; Moeller, 2001).

IMPULSIVITY AS PART OF NORMAL DEVELOPMENT

As part of normal development, most children have times when they act or say something or do something without thinking. It is important to note that depending on the circumstance, impulsive behaviour can be beneficial or detrimental (Winstanley, Eagle & Robbins, 2006). For example, Ingrid is a fifteen-year-old teenager. She arrived at her friend’s birthday pool party with her backpack containing her phone, her friend’s birthday present and a change of clothes. Before she could even put her backpack down she noticed her friend’s younger sister struggling in the pool. Without even thinking about her belongings in the backpack she straightaway jumped into the pool with her backpack to rescue the little girl. Whilst all the items in her backpack were soaked, this example highlights how her impulsive action resulted in a positive outcome.

WHEN IMPULSIVITY BECOMES OF CONCERN

Whilst most children over time learn how to calm their body when instructed to,  or are required to stop As children mature, they develop a range of skills and abilities supported by adult guidance which help them develop how to better control their impulses. However, for some children the various abilities that contribute to the development of impulse control are compromised which results in high levels of impulsivity persisting.

High levels of impulsivity are associated with Attention Deficit Hyperactivity Disorder (ADHD), Traumatic Brain Injury, Fragile-X syndrome, substance use disorder, oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania, pyromania and eating disorders (APA, 2013; Lozano-Madrid et al, 2020; Luman, Tripp & Scheres, 2010; Robbins et al., 2012; Weafer, Michell & de Wit, 2015; White et al., 1994).

IMPACT OF IMPULSIVITY

When impulsive behaviour becomes persistent, severe and chronic, it can cause negative consequences for the child and everyone else involved. Dealing with the consequences of the child constantly behaving and communicating without thinking tests everyone’s patience. It often results in people feeling frustrated, annoyed and stressed as the child does not appear to learn from consequences and no matter how many times they are given lectures it is as if it just goes out the other ear. The child’s impulsive behaviour can result in the child experiencing social rejection, failure and isolation. The climate of the context (e.g. childcare, preschool, kindergarten, school, disability support and youth service) can change dramatically. A considerable amount of time and energy can be spent on the child showing the impulsive behaviour, which can have a deleterious effect on the quality of the educational experience for all children. Research consistently shows that managing behaviour is linked to staff experiencing high levels of stress, burnout, and job dissatisfaction.

Hence, impulsive behaviour affects everyone involved and the child who is impulsive requires necessary help to learn positive ways of behaving and managing their emotions.

POSITIVE BEHAVIOUR SUPPORT AND IMPULSIVITY

Positive Behaviour Support (PBS) is an evidence-based approach that is used to eliminate or minimise the occurrence of challenging behaviours.

PBS recognises that there is no single cause for impulsive behaviour.  

Impulsive behaviour does not occur in a vacuum, but within a context. 

There are three main setting-related factors which impact the child and their behaviour:

  • environment
  • activity, and
  • interaction

These factors place different demands on the child and when any of these demands outweigh the child’s skills to cope with them, it can contribute to the child’s impulsive behaviour.

EXAMPLE

Ian is a four-year-old boy with ADHD who has been attending childcare for the last couple of years. He attends full time usually from 6:30am – 6pm. His parents have found it hard to develop a night time routine which means he often sleeps late and arrives at childcare tired.  The lack of sleep affects his behaviour. When his mum dropped him off at childcare she mentioned that Ian hadn’t slept well and maybe was coming down with a cold.

The children are participating in a group activity at childcare. The educator is standing at the front giving instructions about the upcoming spray-painting activity. As the instructions are being given Ian is looking around. He makes random comments about the window curtains, what other children are doing, laughs inappropriately as he plays with the shoelaces of the child sitting next to him. The educator ends the instructions by saying, ‘I am going to hand out spray cans. Remember not to press the button or I will take it back and you will miss out on the activity.’ She then proceeds to hand out the spray cans. The children do not press the button. As this has been happening, Ian has been arguing with the child next to him saying he wasn’t playing with his shoelaces, he was just tying them. Anyway, when the educator gives him the spray can, before she can even say his name, he proceeds to press the button. When she asks Ian to return the spray can he starts to scream and yell in frustration. The educator knows that Ian is quick to anger which means he goes 0 to a 100 in a split second, so to prevent the escalation the educator takes away the spray can, but then quickly guides him outside of the room with all the other children to start the spraying activity. All children are required to wait in a queue and take turns at spraying the tyres. The educator knows Ian cannot wait so she asks him to be second in line. However, Ian cannot wait so grabs the can from another child and starts spraying.  To not let the situation, escalate the educator lets him keep spraying. When it’s time for the next child to have a turn, she walks up to Ian. Ian pushes her and keeps spraying.

  • Communication skills – Does Ian understand the educator’s instructions? Does Ian have the skills to express his feelings (e.g. I’m feeling bored of sitting here for a long time) and his needs (e.g. I don’t understand what is being said; I don’t understand why she is taking my can.)
  • Emotional regulation – Can Ian regulate his emotions and stay calm?
  • Self-regulation skills – Is Ian aware of his behaviour? Can Ian control his impulse of wanting to press the button?
  • Social skills – Does Ian know how to wait? Does Ian know how to take turns?

As Ian does not have the skills needed to cope with the external triggers (e.g. having to wait for someone else to finish spraying, being given complex instructions) and the internal triggers (e.g. feeling tired and unwell), he resorts to exhibiting a range of challenging behaviours.

The example highlights that impulsive behaviour is not without purpose. It is important to investigate the external triggers as well as internal triggers that could be contributing to the occurrence of impulsive behaviour. It is never too late to address impulsive behaviour, even if it has been occurring for a while.

PBS provides a road map to address impulsive behaviour by using a holistic approach to develop a comprehensive and individualised PBS plan in three stages:

  • ASSESS: How to identify the reasons that contribute to the impulsive behaviour,
  • MANAGE: How to respond when impulsivity occurs, and
  • PREVENT: How to help the child learn positive ways of behaving and managing their emotions.

ASSESS STAGE

Assess Stage Aims

The Assess stage helps to identity:

  • Activities during which the impulsive behaviour occurs,
  • Environments in which the impulsive behaviour occurs, and
  • People dealing with the impulsive behaviour.

Assess Stage Checklist:

  • Child’s profile – Gather information about the child to create a comprehensive picture of the child, their abilities and needs.
  • Behaviour data collection forms – Record measurable details (e.g. frequency, intensity, duration) about the child’s impulsive behaviour.
  • Functional Behaviour Analysis (FBA)- Systematically reflect on an incident by analysing the antecedents (what preceded the impulsive behaviour), describing the impulsive behaviour, consequences (what happened after the impulsive behaviour).
  • Hypothesis – Determine the purpose (function) that the impulsive behaviour served.

MANAGE STAGE

Manage Stage Aims

The Manage Stage outlines how to effectively respond to the impulsive behaviour and after. Appropriate responses can help to safely defuse, redirect, and de-escalate the situation in the least disruptive manner.

Manage Stage Checklist:

  • Escalation stages – Help those supporting the child to recognise the number of stages the child exhibits as their emotion rises (i.e. mild escalation, moderate escalation, extreme escalation, and recovery stage).
  • Escalation profile– Help those supporting the child to recognise what non-verbal and/or verbal behaviours are exhibited in the different escalation stages, where the impulsive behaviour occurs in the escalation and how long it can last.
  • De-escalation plan – Help those supporting the child with guidelines on how to immediately respond when the behaviour occurs, safely defuse, and de-escalate the situation in the least disruptive manner.

PREVENT STAGE

Prevent Stage Aims

This stage aims to minimise the occurrence of the impulsive behaviour by reducing or avoiding the triggers that cause it and teach the child alternative behaviours.

Prevent Stage plan

The plan details strategies to minimise or avoid the triggers that contribute to the impulsive behaviours by providing the child with:

  • Supportive environments – Tailoring environment related aspects to minimise or avoid triggers that contribute to the occurrence of impulsive behaviour.
  • Supportive activities – Tailoring activity related aspects to minimise or avoid triggers that contribute to the occurrence of impulsive behaviour.
  • Supportive interactions – Tailoring interaction aspects to minimise or avoid triggers that contribute to the occurrence of impulsive behaviour, and
  • Teaching the child – Teaching the student positive ways of communicating their messages and managing their emotions and behaviours.

I FOR IMPULSIVITY: POSITIVE BEHAVIOUR SUPPORT GUIDE

Use the practical tools (checklists, forms, and strategies) in I for Impulsivity: Positive Behaviour Support guide to develop comprehensive PBS plans that can be used to support children of all ages consistently in all settings.

This invaluable guide is useful for parents, caregivers, educators in childcare, early childhood, primary and secondary schools, disability, mental health, allied health, and supervisory professionals. 

References

  • American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing.
  • Kanten, P. (2018). The Individual Antecedents of Impulsive Behavior. Journal of Business Research – Turk. 10, 732-746.
  • Lozano-Madrid M, Clark Bryan D, Granero R, Sánchez I, Riesco N, Mallorquí-Bagué N, Jiménez-Murcia S, Treasure J & Fernández-Aranda F. (2020). Impulsivity, Emotional Dysregulation and Executive Function Deficits Could Be Associated with Alcohol and Drug Abuse in Eating Disorders. Journal of Clinical Medicine, 21, 9, 1936.
  • Luman, M., Tripp, G., & Scheres, A. (2010). Identifying the neurobiology of altered reinforcement sensitivity in ADHD: a review and research agenda. Neuroscience & Biobehavioral Reviews, 34, 744-754
  • Moeller, F. G., Barratt, E. S., Dougherty, D. M., Schmitz, J. M. & Swann, A. C. (2001). Psychiatric aspects of impulsivity. American Journal of Psychiatry, 158, 1783–1793.
  • Robbins, T.W., Gillan, C.M., Smith, D.G., de Wit, S. & Ersche, K.D. (2012). Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry. Trends in Cognitive Sciences,16, 81–91.
  • Weafer, J., Mitchell, S.H. & de Wit H. (2015). Recent translational findings on impulsivity in relation to drug abuse. Current Addictions Report, 1, 289–300.
  • White, J. L., Moffitt, T. E., Caspi, A., Bartusch, D. J., Needles, D. J., & Stouthamer-Loeber, M. (1994). Measuring impulsivity and examining its relationship to delinquency. Journal of Abnormal Psychology, 103, 192–205.
  • Winstanley, C.A., Eagle, D.M. & Robbins, T.W. (2006). Behavioral models of impulsivity in relation to ADHD: translation between clinical and preclinical studies. Clinical Psychology Review, 26, 379-395.

 

 

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