Impulse Control Damage Control

A lot is said about “impulse control” particularly in relation to neurodivergencies such as ADHD. Strategies for improving the ability to control reflex reactions and impulsive behaviours are taught, and hopefully implemented. Methods for pausing, urge surfing, and breathing through feelings are taught. CBT and DBT are learned. But what happens when you’re early in your journey and haven’t reached the step of being guided on this yet? When your child hasn’t found the approach that works for them? When spoons are being used on other things and the strategies are momentarily unavailable? In these situations, rather than allowing your child to feel guilty for what they may have done due to their difficulties with impulse control, you can instead focus on supporting them to repair.

IMPULSE CONTROL

Impulse Control Disorder (ICD) was first recognised as its own class of psychiatric disorders in the DSM-5 in 2013.

Many neurotypes, and psychological and psychiatric disorders, frequently include impulsivity as a trait, including ADHD, autism, foetal alcohol disorder, conditions related to substance abuse, and various personality and mood disorders.

While impulse control difficulties are a feature of other disorders, conditions considered to be Impulse Control Disorders – not classified in other categories – include internet addiction, sexual compulsion, compulsive shopping, pyromania, kleptomania, ODD, and intermittent explosive disorder. 

As neurodivergencies such as autism, ADHD, and Parkinson’s are increasingly understood to encompass a broader range of traits than previously believed, many theorise that most (if not all) of these are actually resultant of one of these neurotypes rather than independent conditions. ICDs do appear to be forms of dopamine-hunting and meltdowns. At present, research simply demonstrates a high correlation between the co-occurence of certain neurotypes and some form of ICD.

Most people who experience impulsivity are aware that their actions are not appropriate / acceptable. 

STRATEGIES

Treatment of ICDs, and of impulsivity as a trait of neurotypes, is the same, and is divided into two areas: pharmacological, and psychosocial.

Pharmacological

A range of SSRIs (selective serotonin reuptake inhibitors) including fluoxetine, fluvoxamine, paroetine, and escitalopram, have been used to treat different ICDs with varying results. Similarly, use of TCA (tricyclic antidepressant) clomipramine has been beneficial in the treatment of other ICDs. No one SSRI or TCA has been shown to assist in the control of impulsive behaviours across the board.

Naltrexone can be used when craving or addiction is a key factor in the ICD.

People medicated to assist with management of ADHD often find that when their meds are at a beneficial level, this includes improving impulsivity.

Psychosocial

Cognitive Behaviour Therapy (CBT) and Dialectical Behaviour Therapy (DBT) are both used in the management of ICDs and impulsivity as a trait of neurodivergence. Techniques within these that are often employed include urge surfing, recognising the need to pause, self-regulation and preventative tolerance methods, and more.

When it comes to children experiencing impulsivity, and in the early stages of learning strategies (or yet to discover their preferred approach), parental engagement is crucial. Parents can assist in reducing impulsive behaviours by:

• Removing violent (physical, emotional, and mental) discipline
• Minimising acknowledgement (positive or negative reinforcement) of impulsive behaviours
• Promoting and recognising empathy, kindness, self-regulation, and other positive behaviours
• Being consistent in parenting approaches to strengthen predictability
• Co-regulating
• Avoiding criticism and blame when reflecting on impulsive acts
• Ensuring these reflections are:
  • Brief: a long chat may lead to additional dysregulation. Be clear with what you want to share or reinforce, deliver without criticism, ask the child to validate or repeat back the hope you have for next time, allow the child to speak or ask questions, and try to end with connection such as a hug or joint activity.
  • Isolated: the parent isn’t “a bit cross” with the child for an extended period, and lets go of behaviours that express negativity once the issue is addressed. The incident isn’t repeatedly referred back to.
  • Constructive: avoid simply venting to your child that what they did was wrong, and the negative consequences of it. Instead approach with the intention of sharing how you felt when the child did the action in question, and what you would like as a result (see REPAIR below). 

BEFORE STRATEGIES ARE KNOWN

A person with a trait that causes hurt does not need to reach a point of eradicating that trait before they can partially fix the situation, and feel understood and loved. 

Simply recognising that a person has an ICD, or that impulsivity is a feature of their neurotype, is not going to stop it from happening. Medicating or utilising strategies are also not going to definitely prevent impulse control from being an issue. 

Almost like an inverse presentation to executive function difficulties, a person who struggles with impulsivity is not naturally adept at controlling their reflexive behaviours; and when they do, it is likely to require conscious thought and hard work, at least initially. As such, exhaustion, hunger, stress, menstruation, hormonal fluctuations, or simply losing focus, may lead to impulsivity reappearing even once a person has become quite skilled at adopting strategies.

As many people with impulse control difficulties do wish they had greater abilities in this area, and frequently do care about the people are affected, a negative incident of impulisivity can lead to:

• Guilt
• Shame
• Defensiveness
• Low self-esteem
• Anger
• Self-harm
• Dysregulation

All of which can increase the likelihood of impulsivity!

These can be alleviated, or even prevented, with active skills in repair.

REPAIR

Offering repair is beneficial to both the people who have been hurt by impulsive behaviours, and the person enacting them, particularly when regarding a child. It goes beyond saying sorry, and works towards fixing the problem – both the cause (in this case, impulsivity) and the incident itself.

Good ol’ Daniel Tiger – and the wonderful human he is based on, Mr Rogers – has the right idea when it comes to apologising and repairing, particularly in ways that are child-friendly and neuroaffirming in that there is no sense of apologising for who you are or what you’re like.

The Simple Repair Approach

If your child is young, finds communication difficult, or is not emotionally and cognitively equipped to tackle a detailed repair, encourage a simple five step:

1. Find calm
2. Say sorry
3. Say what you’re sorry for
4. Say you won’t do it again (even a vague, “I’ll try not to…” is fine!)
5. Ask what you can do to help fix it

This might sound like,

“I’m sorry I hit you. I won’t hit you again. How can I help?”

Detailed Repair

If your older child is prone to impulsive behaviours, consider sharing these steps with them. Even print them out for reference in the aftermath of an impulsive episode.

1. Work for calm first
2. Sorry
3. Take responsibility
4. Explain briefly, and add a feeling
5. Next time
6. Stay on the path
7. How Can I Help?

Work for calm first

• Note this is not wait for calm. Waiting until you feel ready to repair prolongs escalation and dysregulation, negative thought patterns, and painful feelings. Utilise CBT and DBT strategies, self-soothe, box or candle breathe, ask for help such as coregulation, and return to a state of feeling calm again. This is often referred to as the “wise mind”, where the emotional and rational entwine, and the person is at their most reasonable and logical without being cold or detached. While some strategies suggest distraction therapy, in people prone to impulsivity this can be too distracting, and simply bottle up the feelings around the incident; this means when it’s time to discuss it, all the old negative dysregulated feelings are still there ready to fly!
• Take the time that is needed. “That’s close enough” is likely to lead to additional hurt. Communicate if you need more time that people seem to be offering.
• The calm is important to ensure that any apology or repair is outward, rather than inward. Apologising when calm sounds genuine. Apologising when distressed often presents as shameful, self-pitying, self-loathing, etc. This can inadvertently ask for more from the person who is deserving of an apology, as they will want to reassure and offer love to alleviate these negative feelings, despite still not receiving this themselves.

Sorry

• “I’m sorry” suffices. A simple apology is fine! It is clear and genuine and is difficult to misinterpret.
• Mean it. Say it because you want the other person to know you’re sorry. Because you want them to feel better. Because you want them to know they don’t deserve it. Because they deserve an apology for what they received or experienced.
• Avoid making it about you. Don’t apologise with the intention of communicating how much you’re hurting because of what you’ve done. Though you can do this later.

Take Responsibility

• Even if it feels a bit silly, clearly state what you did. Begin with, “I…”. For example, “I shouted at you when you asked if I’d seen your handbag.”
• Do not explain (yet!) why, or what you were feeling.
• Add recognition that this wasn’t the right thing to do.

Explain Briefly, and Add A Feeling

• If you know why you were impulsive, say so. Use sentences starting with “I…” to avoid blaming the person you’re apologising to. In this example, it might be, “I thought you were implying that you thought I’d stolen your handbag.”
  1. If you don’t know why you were impulsive (in children, in the early days of therapy and strategising, and/or combined with communication differences or conditions such as alexithymia, it happens!), simply say, “I do not know why I did it.”
• Add a feeling or two, but avoid adding a “because” afterwards. For example, “I felt defensive and angry”; not “I feel defensive because you always accuse me of…”

Next Time

• Share what you’d like to do differently next time. Don’t express whether you think this is likely or possible or difficult. Simply demonstrate that you know what would have been a preferable option for both parties.
  • “Next time, if I think you’re blaming me for something I’m going to just answer your question,” or 
  • “Next time I feel like you’re accusing me of something, I’ll ask if you think I’ve done something wrong,” or 
  • “Next time I feel that anger bubbling up I’m going to sit down and box breathe,” or 
  • “Next time I feel defensive I’ll double check if what I feel you’ve said is the same as what you actually said,” or
  • “Next time I feel angry I’ll let you know I need a moment. Then I’ll come back to reply to your question.”

Stay on the Path

• Recognise that overcoming impulsivity issues is a journey, and one you’re currently on. Forgive yourself for the hiccup – however significant – and assure the person you’re apologising to that you’re still on that journey. Something like, “I will keep working on urge surfing with my psych,” or “I’m going to do some exercises in my DBT book tomorrow”.
• Know it’s okay to ask for help if there’s anything you need to do your best.

How Can I Help?

• Offer a means of helping, but accept that this may be rejected and that it would not be okay to respond negatively to this, or
• Ask how you can help repair things

While obviously not expecting a small child to be eloquent and organised, in theory all of this might sound like,

”I am so sorry. I stole a game from the shop. I saw it, wanted it, and knew I didn’t have the money for it, so I just took it. I really wanted to play it and was focused on that. Next time I won’t steal the game, and even if I can’t shake that feeling of really wanting it, I’ll phone you and ask if I can buy it if I do jobs on the weekends to pay you back. I will work with you on a plan. I’m going to talk to my psych about this, and be honest about what I did. Could you please come with me to take the game back to the shop because I don’t think I can do that alone; I feel scared and embarrassed. How can I help make this better for you?”

SELF FORGIVENESS

While, if you are dealing with the consequences of your child’s impulsivity (either external issues, or your own feelings), it can be difficult to be generous, it is important to recognise how damaging impulse control difficulties can be upon the child themselves.

Feelings of worthlessness, guilt, shame, fear, self-loathing, and negative assumptions of others’ opinions of them, can be debilitating and lead to low self-esteem, anxiety, low mood, and self-harm.

When you are also in your Wise Mind, assure your child that you love them. That their actions when they don’t think first are only a tiny part of who they are, not everything. That you are on their side tackling the problem of impulsivity, and that you are not trying to change them by fixing it; you are trying to protect them, and help them to have a happier and safer life. That you are there to talk to, and that if there is something you can do to help them avoid impulsive issues you are keen to support them.

Work with your child, and their psychologist or occupational therapist if useful, to develop healthy self-esteem, skills in self-forgiveness, and an ability to accept their differences if when they’re differences they’re choosing to work on minimising.

COMMUNICATION DIFFERENCES

Obviously in the context of neurodivergencies and co-occurring conditions, this degree of communication, self-awareness, and control, cannot be assumed. All suggestions and advice can be tailored to suit your child.

For example:

• Perhaps a child without awareness of impact on others, or ability to recnogise others’ feelings, will need to be told what they could be apologising for, or why you feel it likely occurred
• A child who uses AAC might not be able to elaborate to the most impactful level, but your receipt of their apology can account for this and be as grateful
• Certain children might not be capable of following all steps, but will manage some. For example, you might not receive an active apology, but they might start cleaning up something they’ve broken. Or draw you a picture unexpectedly later. Or be unusually keen for hugs.
• Remember to meet your child where they are at, and actively receive the best they are offering with grace and gratitude

EMPOWERMENT OVER SHAME

When we deal with the consequences of a child’s impulsivity, it can be difficult to focus anywhere other than the damage done. The hurt. The problem solving. The future prevention.

But in that moment, rather than allowing your child to feel guilty for who they are, help them feel empowered to repair any damage done, and proud of taking responsibility for their differences.

Repair comes in many forms, and at different stages. Praise it, even reward it, and you might even find that your own perspective shifts and living with impulsivity doesn’t always feel so hard.

And when the scale and consequences make this impossible, or you are struggling with your own experience, always ask for more help from your support network, medical professional, or More Than Quirky.