g.Beyond Impulsivity: Behavioural Disinhibition in ADHD

Impulsivity, acting or blurting without thinking or considering the consequences have been a major feature or symptom of ADHD. But impulsivity itself in ADHD is a part of larger group symptoms of “behavioural Disinhibition” that have not yet fully discussed in the literature!

The children and teenagers of hyperactivity type of ADHD are in general and across a broad range of behaviours, disinhibited. In other words, this group of patients as early age as toddlers, lack control over their behaviours. Many of these symptoms are missing from most of diagnostic criteria or symptoms descriptions of ADHD, including DSM-IV and most recently DSM-5, that is the diagnostic bible of psychiatric disorders.    

DSM-IV and 5, define Impulsivity as “often blurting out answers before questions have been finished/often having trouble waiting one’s turn/ and often interrupting or intruding on others (e.g., butting into conversations or games). But “behavioural disinihibition” that impulsivity is a part of it is beyond these and can include many missing symptoms in our current diagnostic criteria, such as uncontrollable silly and clown like behaviours; giggling, laughing too much; bullying, mocking behaviours;risk taking behaviours including engagement in risky and careless driving, drug and substance abuse, sexual misconduct; other misconduct behaviours such as interest in prohibited actions and words, lying, etc; annoying others and causing disturbances at home, schools and other environments.

As one can see or have observed in oneself or others around him/her with ADHD, these symptoms could be the most costy and dangerous to the person, family and the society at large if left ignored and untreated. The common consequence of these disinhibited behaviours are vast and ranges from complications of bullying behaviours, common in schools, misconduct behaviours including anti-social acts and legal consequences, substance abuse and so on. Behavioural Disinhibition, is lack of restraint or control over one’s behaviour, including disregard for social convention, impulsivity and poor risk assessment. Disinhibition can affect motor behaviour, instinctual, emotional, cognitive and perceptual domains that anatomically in brain is linked to the frontal lobe, specially pre-frontal and orbitofrontal cortex dysfunctions.

Read more in the book “ADHD:Revisited” at Amazon, Kindle e-books.