Emotional Impulsivity – A Core Component of ADHD

June 6, 2010

Throughout history disorders of attention were described to include symptoms of emotional impulsivity, as seen in writings by Alexander Crichton (1798) and George Still (1902). Problems with regulating emotion were intially recognized as a core feature of ADHD. But during the 1960’s and 1970’s symptoms of emotional impulsivity/emotional self regulation were split off from the core criteria of ADHD as we know them today: inattention, hyperactivity, and impulsivity. Dr. Russell Barkley just published a wonderful discussion article in the Journal of ADHD and Related Disorders arguing that emotional impulsivity should be returned to its proper status as a core symptom of ADHD.

What do we mean by emotional impulsivity? Why does this matter? Examples of emotional impulsivity include impatience, quickness to anger, easily frustrated, over-reactive, and easily excited. These characteristics are frequently seen with ADHD, yet often unrecognized as a core part of the condition. Frighteningly, these folks may be misdiagnosed as having a mood problem such as depression or bipolar disorder instead of what is really going on – their ADHD!

Over the years in practice I have seen many ADHD kids mistakenly labeled as bipolar. Their over-reactive nature gives an impression of a mood problem when the child is instead struggling with self regulation of attention and behavior. They have difficulty putting on the brakes in their brain. Similarly adults with ADHD can be impatient or emotionally over-reactive, which could lead to misdiagnosis. Unrecognized and untreated these features of ADHD can lead to problems at work and home.

I should also mention ADHD frequently does co-exist with Depression, Anxiety, Sleep Disorders, Bipolar disorder,etc so it is indeed possible to have more than one condition. Making an accurate diagnosis can be tricky. If you are seeking an evaluation for ADHD, I encourage you to work with professionals who are specialized in this area. Getting an accurate diagnosis is essential to getting the right treatment.

Theresa Cerulli, M.D.

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