Have you ever wondered how we can do things such as:
- stay quiet when we have something we would really like to say but know we shouldn’t;
- resist the urge to scratch a mosquito bite;
- pull ourselves out of negative thought patterns and self-talk so as not to dwell on them;
- not interrupt someone when they are talking to us; and
- stay focused on a task even though there are several distractions all around us?
These are all examples of inhibitory control. We use it many times a day to stop ourselves from doing things without really being aware of it.
What is Inhibitory Control?
Inhibitory control is a core executive function. It involves controlling our automatic urges (attention, behaviour, thoughts, and emotions) by pausing, then using attention and reasoning to respond appropriately. Inhibitory control involves our ability to think before we react. It allows us to think about past experiences and then consider what the future consequences might be in a particular situation.
How do we Develop Inhibitory Control (Inhibition)?
Inhibition is one of the prefrontal cortex functions in the brain, which has also been referred to in previous articles as the “upstairs brain”. Inhibitory control begins to develop at the end of the first year of life. It continues to develop quickly until the age of 6 years. Over the next 20-30 years, inhibitory control will continue to develop and then will begin to decline in older age.
What are the different types of Inhibitory Control?
Inhibitory control involves inhibition at the cognitive, behavioural, emotional and motor levels:
- Cognitive inhibitory control is the ability to control our focus and attention while having several distracting stimuli all around us.
- Behavioural inhibitory control is the ability to control our urges to react and respond to situations when we know it would not be appropriate to do so.
- Emotional inhibitory control is the ability to control or regulate our emotions.
- Motor inhibitory control is the ability to control our motor behaviour, such as staying in our seat in class even though we feel bored.
Interestingly, low cognitive inhibitory control results in distractibility and inattention, low behavioural inhibition results in impulsivity, and low motor inhibition looks like hyperactivity. These are all the main characteristics of an individual diagnosed with ADHD (combined presentation). Challenges related to emotional regulation are also common. In other words, low inhibitory control is very much part of the presentation of children who are diagnosed with ADHD.
Inhibitory Control and ADHD
ADHD has been described as a developmental disorder of inhibitory control. Children and adults with ADHD are less able to inhibit their thoughts and behaviours and control their responses to situations. Research has shown that children and adults with ADHD have a prefrontal cortex that is not as mature or active as that of people without ADHD. In other words, children with ADHD are not willingly defying rules in the classroom and social rules and norms. Rather, they have lower inhibitory control than those without ADHD.
Impulsivity occurs as a result of low behavioural inhibitory control where the person with ADHD struggles to resist urges to respond in ways that would be considered inappropriate. Examples of this include:
- becoming easily frustrated;
- easily losing their temper;
- being impatient;
- having difficulty waiting their turn;
- making hasty decisions; and
- interrupting conversations or speaking out in class when it is time for instruction.
Hyperactivity is a result of low motor inhibitory control in people with ADHD. This looks like:
- not being able to slow down;
- talking constantly;
- fidgeting;
- difficulty staying on task; and
- constantly jumping up out of their seat.
Distractibility occurs due to low cognitive inhibitory control in children with ADHD. This looks like:
- being unable to block out unimportant distractions or visual distractions in order to focus; and
- making careless mistakes in schoolwork as they fail to pay close attention to detail.
- Emotional Dysregulation occurs due to low emotional inhibitory control in people with ADHD. This looks like:
- an emotional reaction that seems bigger than the problem. This could include overexcitement, lashing out in anger, or a big anxious reaction ending in a panic attack.
- difficulty calming after experiencing a big emotional reaction.
- severe depression, suicidal thoughts, and/or self-harm.
Why is Inhibitory Control Important?
Our ability to stop and think before reacting helps us to follow the rules and social norms. It also allows us to take time to make responsible decisions when we are in difficult situations. The concern is that people who do not have well-developed inhibitory control have an increased chance of engaging in high risk behaviours such as alcohol and drug use, sexual activity, violence and self-harm. Children with low inhibitory control are at risk of experiencing more externalizing behaviour problems such as aggression, hyperactivity and impulsivity. It can also result in delinquent behaviours such as theft, vandalism and assault.
How Parents can Support their Children with Low Inhibitory Control
Executive functions can be improved with practice. Neuroplasticity is a term that describes how our brain is malleable and able to change, adapt and reorganize itself to form new connections. Parents can support their children with low inhibitory control by implementing behavioural interventions.
Behavioural Interventions and Accommodations
Parents will need to remind themselves that their children with ADHD really struggle with executive functioning and as a result a parent/adult will need to be the “brain boss” for their child until they can do this more independently. It is often helpful to use visual cues and reminders to externalize their ‘brain boss’. It encourages the child’s independence while also helping them with the reminders they need. The following are just a few examples of behavioural interventions and accommodations that can be made for children with ADHD to support their impulse control development:
- Teach your child the “Stop Think Act” Method. This method allows them to pause before responding. They think about the problem and potential solutions before proceeding with the best option.
- Play games like Simon Says where the child has to inhibit doing what is asked of them if they don’t hear Simon Says first.
- Give the child some warning when the activity is about to change, and practice with them what things will look like when the transition occurs.
- Make accommodations and create a learning environment that is free of distractions. Allow the child to use noise-cancelling headphones.
- Use positive reinforcement to encourage your child to do more of what you expect of them.
- Play games that encourage your child to wait their turn. You can use a visual timer to remind the child how much longer they need to wait before they can do what they want to do next.
- Use cues that remind the child that it is time to stop and take a break. Have a plan with them ahead of time to know what their options are and what helps them self-regulate when they need a break. The cues can be verbal or non-verbal, such as a hand signal with a specific meaning between the child and parent.
- Teach and model to your child strategies of self-regulation. They can take breaks when they become dysregulated or do some deep breathing when they feel frustrated or angry
Stimulant Medications
If low inhibitory control becomes a real problem and starts to impact children’s learning and relationships in school and at home, stimulant medication can help. Stimulant medications are often prescribed to people who are experiencing challenges with symptoms related to ADHD, such as inattention, hyperactivity and impulsivity. Stimulant medications are not for everyone, but they can provide the support children with ADHD need to have more success managing their symptoms in school. These medications reduce symptoms of hyperactivity and impulsivity, which then increases a child’s ability to focus and concentrate. This treatment option should be discussed with a doctor to evaluate both the benefits and the risks.
Summary
ADHD can be described as a developmental disorder of inhibitory control. Children with ADHD struggle with low inhibitory control which we know because impulsivity, hyperactivity, and inattention or distractibility are the defining characteristics of ADHD. We must try to support children with ADHD to improve inhibitory control, as low inhibition may result in more risky behaviours as children get older. Parents can support their children by using behavioural strategies and, stimulant medication when prescribed by a doctor, pediatrician or psychiatrist.
Resources
Websites:
- Child Mind Institute https://childmind.org
- Understood https://www.understood.org
- Cognifit
- Life Skills Advocate
Books:
Barkley, R.A. (2013). Taking Charge of ADHD: The Complete, Authoritative Guide for Parents. The Guilford Press.