Some children grab something they shouldn’t or might yell, scream or jump. While this can be often seen as part of development, sometimes there is more to these impulsive behaviors.
“We say a child is impulsive when they do the first thing that comes to mind,” says Timothy Shawn Sullivan, Ph.D, program director at Cleveland Clinic Children’s Learning Evaluation Clinic. “We depend on response inhibition to keep ourselves from acting impulsively.”
However, he says impulsivity is a symptom for kids who have attention-deficit/hyperactivity disorder (ADHD) and other disorders such as language or communication problems, children with anxiety, those who are oversensitive or undersensitive, or children with autism.
“ADHD affects 8-10 percent of all children between ages 3 and 1,” he says. “Children with ADHD don’t stop and think about consequences — they just do. Further, many children with autism have sensory processing issues, which can lead to agitation and impulsive behavior.”
Sullivan helps us understand impulsivity in children, and offers some best practices for parents whose kids are struggling with impulse control.
Q: How do I know if my child has issues with impulsivity?
A: It’s not always easy to identify problems of response inhibition in children. Rebecca Branstetter, Ph.D., of the Cleveland Clinic, recommends parents ask themselves the following questions to determine if their child has trouble with impulsivity:
- Has my child always acted impulsively, from a very early age?
- Does my child tend to “jump first and think later,” doing the first thing that comes to mind?
- Is it very difficult for my child to think about and follow “if-then” contingencies (e.g., If I finish my homework now, then I can go play)?
- Am I constantly reminding my child to turn off screens (e.g., phones, computers, tablets, TV) when she is supposed to be working on homework?
- Is it hard for my child to think about the consequences of his behavior?
- Is my child impulsive in her work, making careless mistakes?
If you answered yes to three or more of these questions, your child likely has difficulty with response inhibition.
Q: What can I do to help my child who struggles with impulsivity?
Exercise helps control impulsivity. Parents can think about signing their child up for a sports team, such as basketball, baseball, soccer or lacrosse. Playing a sport not only gives children exercise, but also teaches them to follow rules and take turns.
You can build up your young child’s response inhibition by playing games like Simon Says and Red Light, Green Light, which require children to stop and think before acting. Older children might benefit from playing games like Trouble or Monopoly, which require turn taking and waiting for an outcome.
Impulsive children often show warning signs before they act. A parent can look for these signs, such as increasing frustration, agitation or overexcitement. These feelings can lead to impulsive behavior. When you see the warning signs, you can redirect, prompt, remove the child from the situation, and/or encourage calming strategies. Your job is to step in just before the impulsive act and intervene. Eventually, you’ll want to teach your child to recognize her own signs so she can regulate her own behavior.
Teach Replacement Behaviors
Some children with response inhibition challenges will act impulsively because they haven’t practiced behaviors. For example, if your child grabs your things without asking, you can stop him and say, “Let’s try this again. Can you ask me to use it?” Then, when your child asks, you give him the object to reinforce the asking behavior. If he isn’t allowed the object, you can redirect him to an object he can use.
Catch them Being Good
Children with impulsivity problems are often caught in a negative-feedback cycle. Most interactions with adults involve having their behavior corrected. One way to counter this is to be on the lookout for desired behaviors. Catch your child being good, label what it is she is doing well, and praise her. For example, if you see your child waiting patiently, be sure to comment on how much you appreciate her patience. It is important to be specific and sincere. Take the time to notice when your child is being in control, resisting temptation or showing restraint.
Q: When should a parent seek professional help?
A: Sometimes children’s response inhibition is delayed and with targeted help from caregivers, they catch up to their peers. At other times, a child’s impulsivity is so severe that assessment is needed to uncover the causes. A psychologist, psychiatrist or developmental pediatrician can provide a thorough evaluation of your child’s response inhibition.
Behaviors that signal the need for immediate professional help include:
- Extreme overreaction to frustration, disappointment, mistakes and criticism
- Physical aggression directed toward peers and family members
- Reckless and dangerous behavior (e.g., children: running into the street, climbing out of windows, and hiding in public places; adolescents: use of illegal substances, sexual acting out, shoplifting, and vandalism)
Q: How is impulsivity treated?
A: Impulsivity is typically treated with behavioral therapy and/or medication. The goals of behavioral therapy are to strengthen positive behaviors, like response inhibition, and eliminate unwanted or problem behaviors, like impulsivity. Behavioral therapy can include parent management training, parent-child interaction therapy, and behavior support plans.
Dads Give Strategies
Michael Walker, the father of a 13-year- old son, and Mark Gurko, who has a 9-year-old son, both live in the Cleveland area and provide some strategies on how to manage this impulsive behavior for parents who have children with ADHD or who are on the autism spectrum.
Walker says creating a consistent plan for your child can be a big help.
“Don’t have a lot of unstructured activities,” he says, adding that you do have to map out time to allow them to also be creative and do things their own way.
He adds to learn what is best for your child. As a parent, learning about what works can be difficult and you might have to be open to new ideas. “You have to be very self-reflective, have to be willing to change your strategy in a moment’s notice,” he says.
Gurko says some strategies used in his family are clinical, while others are practical. He keeps a journal about his son’s daily activities.
“It’s so important to spend time to write it down,” he says. “The more data I have, the more I know my son and I can patternize things so I can know how the day is going to go or techniques to help mediate when impulses are coming.”
He says his family talks a lot about the behaviors with their son after using calming methods or redirection.
“We do a lot of occupational therapy, music therapy, an oil diffuser (and more) to calm his system,” he says, adding there’s not a one-size-fits-all approach and parents should try different strategies that best fit their child.
The Cleveland Clinic’s ADHD Center for Evaluation and Treatment (ACET) provides comprehensive care for children struggling with impulsivity. ACET provides behavioral treatment for ADHD and related concerns. The center emphasizes cooperation between home and school. Further, if caregivers want to pursue pharmacological management of their child’s impulsivity, ACET offers access to programs using a systematic, scientific approach to finding the right medication at the right dosage. Visit my.clevelandclinic.org for more information.