For some people, one of the most challenging aspects of adult ADHD is the tendency to engage in risky and impulsive behaviours. I have seen this cause substantial problems for some of my clients, especially when it comes to drug and alcohol use and the behaviours that are performed while the person is intoxicated. This can include accumulating driving and assault convictions. Recent illicit drug use may also mean a person will not be prescribed stimulant medication, which is a real shame as this is usually the best treatment for ADHD and is likely to help reduce the rate of future impulsive behaviour.
Impulsivity is a core symptom of ADHD, characterised by a tendency to act quickly without considering the consequences. This can manifest in various ways, including difficulty waiting one's turn, interrupting others, oversharing personal information, and engaging in risky behaviours.
Common Examples of Risky and Impulsive Behaviours in Adult ADHD are:
Reckless driving: As a group, adults with ADHD are more likely to engage in dangerous driving, such as speeding, tailgating, or running red lights. This can increase the risk of accidents and traffic violations. ADHD medication can significantly reduce impulsive and aggressive behaviour in a driving context, and is a pretty good reason all on its own for treating ADHD.
Substance abuse: Adults with untreated ADHD have higher levels of substance abuse than the wider community. Substance use disorders are the third most common comorbid mental health disorder in adults with ADHD. Thankfully, stimulant medication for ADHD can reduce levels of substance abuse to the average rate in the community, and can aid in the reduction of abuse of other substances. I think that's pretty impressive.
Unprotected sex: Impulsivity can contribute to engaging in unprotected sex, as well as more promiscuity, increasing the risk of sexually transmitted infections and unplanned pregnancies.
Gambling: The thrill-seeking nature of gambling can be particularly appealing to adults with ADHD, leading to impulsive and risky financial decisions.
Overspending: Difficulty with impulse control can result in excessive spending and financial instability. This can make it difficult to save money and mean that people can miss out on important things like home ownership or saving for retirement, as well as causing difficulties in relationships.
Frequent job changes or quitting without a backup plan: Impulsive decision-making can lead to hasty career moves, resulting in employment instability and potential financial difficulties. This can limit job progression and contribute to lower socio-economic status. I have had several clients with ADHD who have impulsively quit jobs, sometimes for no other reason than they woke up not feeling like going to work that day.
Overeating or unhealthy eating habits: Impulsivity can contribute to poor food choices and overeating, which can negatively impact overall health and well-being. People with ADHD, especially women, have higher rates of eating disorders, and more so ones that include binge eating. I see this regularly in my assessment and therapy clients, and I have seen big reductions in binge eating and food focus when people have started stimulant medication. I have many clients with issues with chronic snacking on high-carbohydrate foods. This can be accompanied by a feeling of loss of control. As a group, adults with ADHD have higher rates of obesity than community averages.
Managing Risky and Impulsive Behaviour in Adult ADHD
While impulsivity can be a challenging aspect of adult ADHD, there are strategies to help manage these behaviours:
Medication: I feel it really goes without saying at this point, but medication should be optimised to treat ADHD symptoms as well as possible. Stimulant medication can decrease impulsivity, although it will not completely get rid of it. When the medication wears off every afternoon/evening, and in the morning before the first dose, a person will be back to their normal levels of impulsivity. Refining medication to the right dose for enough hours of the day will likely be the biggest help with impulsivity.
Seek professional help: A clinical psychologist or therapist specialising in adult ADHD can provide guidance and support in managing impulsivity.
Create structure: Establish routines and daily schedules to help stay on track and minimise the opportunities for impulsive decisions.
Set realistic goals: Setting attainable and realistic goals can help manage expectations and reduce the risk of impulsive actions. A goal to stop all snacking is not realistic. A goal to reduce snacking by 50% is much more likely to be reached and is still a sizeable achievement.
In summary, risky and impulsive behaviours are common challenges for adults with ADHD. By understanding the connection between ADHD and impulsivity, individuals can take steps to manage these behaviours and improve their overall quality of life.
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