Motivation and emotion/Book/2015/Impulsive behaviour in children

Overview
"Dishonesty, cowardice and duplicity are never impulsive."

-George. A. Knight

This chapter explains impulsive behaviour without an ADHD diagnosis from a psychological point of view. If know an impulsive child in your family, school, or neighbourhood you may be particularly motivated to better understand their behaviours.

Perhaps you are concerned if their behaviour continues on the trajectory you're currently witnessing, that it will lead to poor outcomes for the child as they pass into adulthood. After all, children's impulsivity at age six has been linked to deviancy, aggression, and criminal acts by age 14 to 16 years (Olsen, Schiller, & Bates, 1999). This chapter has been created to help you gain insight into why your child (or the child you know) can often:
 * behave without thinking and in a manner that marginalises themselves;
 * show little regard for consequence;
 * behave in a manner that impacts negatively on their academic outcome
 * which may eventually lead to a life of addiction, aggression, incarceration or worse.

By examining the brain structures involved with impulsivity coupled with theories which help explain mechanisms responsible for self-control and self-regulation and how they develop over time, we can start to unravel the motivational influences which lead to impulsive behaviour which more often than not develops into anti-social tendencies if left unchecked. Self-control failure due to nutrient deficiency will shed light on what is really happening to our children when they behave impulsively. However, understanding alone is not sufficient so this chapter also explains effective behaviour modification techniques that have practical application to everyday lives with impulsive children.

Children with impulsive tendencies can hopefully have people in their lives who understand their viewpoint and have the skills to respond to their behaviours in a way that supports autonomy and competence. This may help to strengthen relationships with their peers and family and hopefully in turn improve the well-being of impulsive children.

Keep these focus questions in mind as you read on:
 * What makes some children impulsive but not others?
 * How can we assist to modify their impulsivity toward a successful life?

Impulsivity
"Reason only controls individuals after emotion and impulse have lost their impetus"

- Carlton Simon

Let's begin with a quick test. Looking at Figure 1, which of the six butterflies is the identical match for the one on top?

[[File:ButterflyTest.jpg|thumbnail|left|Figure 1. Matching Familiar Families Test: used to assess impulsivity.

Source: Peterson, C. 2013]]

Did you find that your eyes scanned straight to the matching butterfly? Or did you meticulously check each one before making your decision? If you chose before looking at all the butterflies carefully, you may be an impulsive thinker. The faster your response, the more likely you are to make mistakes.

This example of a Matching Familiar Families Test (MFF) (Kagan, 1966) demonstrates how impulsive children operate. Impulsivity is a stable disposition, characterised by a lack of foresight, problems with delaying gratification, and inhibiting inappropriate responses (Patton, Stanford, & Barratt, 1995). It is a feature of patients with ADHD and conduct disorder and can result in Impulsive Control Disorder which encompasses adverse behavioural outcomes including substance abuse, gambling addiction, kleptomania, pyromania, problematic eating, and obesity in children/adults (Bennett, Blissett, Carroll, & Ginty, 2014). With so many future negative outcomes for children possessing an impulsive nature, it seems imperative that we nip impulsivity in the bud and guide impulsive children in the right direction to prevent them from ending up in one of the aforementioned categories. (See Figure 2).

[[File:Nick Kyrgios (18614670813).jpg|thumb|right|Figure 2: Tennis star, Nick Kyrgios.

At 19, his on court behaviour has been referred to as impulsive with calls to help curb his behaviour before his reputation is permanently damaged .]]

Impulsivity is multifaceted, meaning it has many aspects or features. It can be described in a variety of different ways, from lack of self-regulation or self-control, through to its involvement in Bi-Polar Disorder (Berlin, 2005). There are two main aspects of impulsivity that are measured. Firstly, inhibition or the inability to put on the brakes regarding inappropriate or adversive behaviour is measured using "go/ no-go" tasks, such as the MFF. Secondly, the inability to delay gratification, measured via self-control tasks, is seen as a preference for a small immediate reward and devaluing a delayed, larger reward (Bari & Robbins, 2013). Therefore, impulsivity is considered a problem due to disinhibition and the inability to delay gratification.

Impulsivity in children can manifest in the inability to sit still or wait to take their turn, constant interruption, blurting out answers, beginning tests without properly reading the questions or lashing out aggressively. Many researchers have explored the possible reasons behind the impulsive nature in certain children. Some believe modern distractions such as video games, computers, and iPhones are to blame for children who act without thinking and exhibit poor attention skills (Mayes, Gordon, Calhoun, & Bixler, 2014). However, in a study by Mayes and colleagues (2014) measured by the Gordon Diagnostic System, children were asked to earn points by pressing a button as fast as they could. During a pause they were instructed to refrain from button pressing as it would result in more points but they had no idea how long the pause would last. It was shown that on measures of inattention and impulsivity, children are no more impulsive or lacking attention than they were 20 years ago. This indicates that impulsivity is not symptomatic of modern technologies and lazy parenting- there is much more going on. To shed some light on what motivates impulsivity in children, let's begin with the brain.

Brain structures
"If you have an impulse from your brain, think about it.

If you have an impulse from your heart, act upon it."

- Anonymous

Dual-Process Model of Impulsivity
Whereas cortical brain regions, such as the PFC and OFC are concerned with self-control, resisting temptation and self-regulation, subcortical brain function is associated with basic urges and emotion-rich motivations such as hunger, thirst, sex, desire and reward (Reeve, 2015). During childhood, subcortical motivations such as hunger, thirst etc. tend to dominate the cortical brain and its reflective cognitive processes, because cortical brain structures are still developing and maturing during childhood. During adolescence children become increasingly able to control strong motivations and to delay immediate gratification for the benefit of long-term goals (Hirvonen, Piokkeus, Pakarinen, Lerkkanen, & Nurmi, 2015). The bidirectional forces of the affective subcortical and cognitive cortical brain are two help explain why impulsivity is more prevalent in young children.

Individual differences exist between people regarding impulsivity due their biological brain structure and is dependent on their brain's tendency to be active in either the right or left hemisphere of the PFC, in particular the OFC which is responsible for anticipating reward value and decision making. The maturity of the cortical brain structures will determine an individual's capacity to override basic motivational urges present in the subcortical brain which can be exhibited as impulsive behaviour.

In addition, when thinking and planning, those with sensitive left prefrontal lobes are vulnerable to optimism, emotionality and approach motivation. An active and sensitive left prefrontal lobe is usually associated with a sensitivity to Behavioural Activation System (BAS) output (Smillie, Dalgleish, & Jackson, 2007).

Behavioural Activation System (BAS) and Impulsivity


The BAS is one of two core features of Gray's Reinforcement Sensitivity Theory (RST). The second is a Behavioural Inhibition System (BIS). RST is a psycho-biological model stipulating that behaviour is a function of constitutional individual differences in sensitivity to reward and punishment, which can affect the positive and negative reinforcing properties of external stimuli such as drugs. (Lopez et al., 2012).

The RST was used to explain personality differences stating that the functioning of the BIS and BAS were involved in two major trait dimensions. Specifically, BIS-reactivity has been linked to trait anxiety whereas BAS-reactivity has been linked with trait impulsivity (Smillie et al., 2007). The theory posits that individuals are either sensitive to BIS or inhibition outputs and, therefore, are more sensitive to goal conflict or punishment or, conversely, they are sensitive to BAS outputs, resulting in a greater response to rewarding stimuli.

A study exploring alcohol expectancies and alcohol use in 10 to 12-year-old children found that those with a reported sensitivity to BAS outputs (i.e., high trait impulsivity) had greater alcohol use Lopez et al., 2012). This, once more, seems to point to the combination of neurobiological influences affecting parts of the brain associated with sensitivity to reward anticipation, resulting in individual differences in impulsivity and the resulting behaviour motivated by these reward systems, often addictive in nature (see Figure 5).

Executive Function
Executive Function is a collective term for the neurological processes concerned with mental control and self-regulation (Scope, Epson, & McHale, 2010). It is believed to develop in its complexity from infancy through to adulthood, and influences processes such as working memory, attention and inhibition control. Olsen et al. (1999) believes that Executive Function is also responsible for speed of response initiation, resistance to temptation and the ability to delay gratification which are all important subdimensions of impulsivity.

Considering how the processes involved in executive function continue to develop in complexity during child development and into adulthood, its influence has major implications for motivational causes regarding impulsive and self-regulatory behaviour in children. For example:

To help consolidate what you've learnt so far regarding impulsivity and the brain, here's a quick quiz to test your knowledge:

Self-regulation
"Our impulses are what reveal our character. What we are quick to do, we are quick to be."

- Kushand wizdom

Self-regulation can be thought of as the reverse of impulsivity, so it is important to discuss the concept here, along with self-control, because to understand how to improve self-regulation and increase self-control, we can go a long way in reducing children's impulsivity and, in turn, their long term outcomes. Self-regulation is often used interchangeably with self-control, however, it is best understood as the unconscious, automatic responses to behavioural impulses whereas self-control is the conscious, reflective and calculated response to impulses (Baumeister, Vohs, & Tice, 2007).

Self-regulation is critical for children's school readiness, successful adjustment and quality relationships with peers and teachers (Hirvoven et al., 2015). It manifests in children's ability to monitor, modulate and direct cognitive functions, attention, emotion and behaviour. Thus, self-regulation requires the self to exert cognitive, motivation and emotional effort to accomplish long-term goals.

In Olsen et al.'s (1999) longitudinal study into levels of impulsivity in children found that children's self regulatory processes increase markedly between ages 6 – 8 as did levels of overt impulsivity when children were offered incentives for task oriented performance. Interestingly, levels of impulsivity did not decrease over time during the non-incentive work task indicating the critical role motivational factors such as reward anticipation play in impulse control capabilites.

The domain of self-regulation most directly linked to impulsivity in children is behavioural regulation which has been defined as the ability to engage in inhibitory control, to sustain attention, and to form situationally appropriate responses (Hirvonen et al., 2015).

Behavioural regulation
Behavioural regulation requires the use of basic executive function including working memory, attention and inhibition control, to curb impulsive responses and inappropriate behaviour in children. Impulse control as a component of behavioural regulation develops on a continuum of phases which at first in infancy, sees behaviour and emotion controlled based on awareness and externally set demands and later manisfests without the need for external monitoring. Different components of regulation and executive function skill develop at different times. For example, by age three, children's working memory and their ability to shift attention show considerable development and inhibitory control shows great improvement between three and six years (Hirvonen et al., 2015)

Gains in children's ability to control behaviour and mental processes are involved with physiological maturation and growth of the PFC. In addition to these neurobiological advances, impulse control is also influenced by experiences and social interaction of the individual with the environment. Peers, parents, schools and teachers all have significant roles to play in developing solid self-regulation. According to Gottfredson and Hirshi (1990), responsible parents monitor children's behaviour, recognise and punish misbehaviour when it occurs and guide children toward alternative responses when their emotions are inappropriate thus fostering the development of self-regulation. However, teachers typically report less closeness and more conflict with in relationships with children who have problems with behavioural regulation (Hirvonen et al., 2015).

Social and environmental factors
Impulsivity and motivation can be seen as reciprocally linked to behavioural regulation failure in the academic context because in order to achieve learning goals that children strive for, students need to apply regulation skills (Hirvonen et al., 2015). Self-striving, interest and perceived choice all play major roles in the way a child will apply sufficient self-regulation to achieve a long-term goal. Without sufficient motivational forces implicit to a child's goal setting techniques, such as planning or goal setting, a child may defer to approach behaviour in the sense that they need to overcome their feelings of discordance with their environment. The approach behaviour is observed as impulsivity, such as acquiescence during a test, overriding any levels of self-regulation of self control required to adapt to the situation or negative feelings. For a summary motivational factors contributing to impulsivity, see Figure 6.

Self-control theory
Whilst self-regulation can be seen as a process of exerting and managing the self to accomplish a long-term goal, self- control is the capacity to suppress, restrain and even override an impulsive desire, urge, behaviour or tendency to pursue the long-term goal (Reeve, 2014). Here's a scenario to help get a feel for self-control:

Consider this: '''You are a four-year-old child sitting at a table and a delicious- looking, large, white marshmallow has been placed on the table in front of you by an adult. The adult then tells you that they are going to leave the room and will be back in 15 minutes but you are not to eat the marshmallow in that time and if you manage to not eat it, they will give you another delicious-looking, large, white marshmallow- and both are yours to keep.'''

What would you do? Watch Joachim de Posada's presentation on the Marshmallow Experiment.

Two out of three children eat the marshmallow before the fifteen minutes is up. They cannot override the impulsive urge to satisfy their immediate desire to eat the marshmallow in exchange for the long-term goal of receiving two. The famous Stanford marshmallow experiment developed by Walter Mischel in 1972 was replicated time and again with similar results (Baumeister & Vohs, 2007; Muraven & Scheli, 2006) indicating that impulsivity via inability to delay gratification was a problem for two thirds of children around the world.

Researchers further examined the paradigm and, in doing so, have identified the following seven underlying factors contributing to self-control.

Children who were able to successfully manage their control regarding these seven subsets tended to be calmer, less aggressive and irritable and received higher grades. Once they entered adolescence they were better able to handle the stress of exams and had higher SAT scores when applying for college (Muraven, Tice, & Baumeister, 1998). However, considering that self-control is said to establish by middle to late childhood (around 8 to 10 years) and, according to self-control theory, remains stable over time (Vazsonyi & Huang, 2010) this may account for the young children having little self control as their executive function and brain structures are still developing.

When researchers explored possible reasons behind self-control failure, it was shown that self-control is much like a muscle. It has an energy reserve that tires with excessive use and leaves it without the energy for future use (Baumesiter et al., 2007). This discovery lead to the development of the Limited Strength Model of self-control.

Limited strength model


The idea that self-control could be depleted by excessive use was based on multiple findings by researchers in trying to explain impulsive motivation. In one example, participants would first perform a self-control task (watching a sad movie while controlling the desire to cry), while others performed a similar, neutral task. In the second phase of the experiments, participants would preform a second unrelated self-control task (continually squeezing a handgrip), including the control group. If self-control was a limited resource, participants in the trial group would perform worse in the second task, which they did (Muraven, Tice, & Baumeister, 1998) (See Figure 8).

Once self-control was exerted in one domain of self-control, it's capacity was diminished in other, unrelated domains of self-control and therefore leave an individual vulnerable to their impulses. The "energy" that was said to be depleted is blood glucose which is converted by the brain into neurotransmitters for cognitive functioning. An experiment on depletion had participants engage in consecutive self-control tasks whereby they were asked to think hard and override impulses. Glucose was reduced significantly (Muraven, Shmeuli, & Burkley) and this state of diminishes resources via blood glucose following self-control exertion is referred to as Ego-depletion.

Ego-depletion
Ego-depletion temporarily reduces the self's capacity or willingness to engage in volitional action, including controlling the environment, controlling the self, making choices, and initiating action. However, ego-depletion does not seem to occur as the result of simply performing a difficult task. Performing difficult maths problems or memorising tasks that do not require self-control does not impair later attempts at self-control. Likewise, after exerting self-control participants performed worse only on those tasks requiring self-control (Baumeister, Galliot, DeWall, & Oaten, 2006). Therefore, the effects of ego-depletion seem particular to self-control tasks and not difficult or challenging tasks in general. Furthermore, the deleterious effects will be observed across different unrelated domains of self-control.

In the radish study (Baumeister, Bratslavsky, Muraven, & Tice, 1998), participants were first asked to fast for three hours and when they entered the laboratory, the smell of freshly baked cookies filled the air. In front of them were the cookies and a bowl of radishes. The experimental group were asked to eat the radishes instead of the cookies and the control group could eat the cookies. Five minutes later, both groups were given a geometric task that was impossible to solve. On average, participants who ate the cookie persisted for 19 minutes whereas the radish eaters lasted only 8 minutes- they did not have the same level of energy available to them to persist on the difficult task (See Figure 9).

When the brain's energy resource is depleted and it stops thinking, it becomes more impulsive and exerts less executive control. As one researcher puts it, "no glucose, no willpower" (Baumeister & Teirney, 2011). Knowing this, people could consume glucose, such as a sweet lemonade, before a challenging task and this has been found to be effective in keeping impulsivity at bay (Hagger, Wood, Stiff, & Chatzisarantiset, 2010). However, glucose depletion does not occur when people pursue long-term goals that satisfy the psychological needs of autonomy and competence (Baumeister et al., 2006). Considering that a main attribute of impulsivity is lacking the ability to override short-term urges to pursue long-term goals, it stands to reason that impulsive children are more prone to ego-depletion in the form of glucose reduction due to their preference for short-term rewards and devaluing long-term goals.

Aside from replenishment via glucose consumption, self-control and self-regulation can be enhanced through practice (Muraven, Baumeister, & Tice, 1999). In the next section we will look at several methods of behavioural modification that has shown great efficacy in reducing impulsivity in children.

Before we do that, let's test your knowledge on impulse control:

Effective Behaviour Modification
Looking back to the marshmallow study, the researchers waited until all the children were young adults and assessed how they were doing in terms of academic achievement, popularity, health, and proneness to addiction. The one-third of children who were able to resist the marshmallow during the 15 minutes were more academic, more popular, healthier and resistant to addictions than the two-thirds that couldn't help themselves (Baumeister et al., 1998). These results indicate that having strong self-control capacities is beneficial for a successful life. It also illustrates the perils of impulsivity.

So how do we modify impulsive behaviour in children and increase self-control strength? From what you have learnt so far, it is clear that impulsivity is neurobiological in nature and that parents and teachers can effect the severity in individuals. Knowing this, treatment focusing on cognitive behavioural change would be seen as the most appropriate for impulsivity. Cognitive Behavioural Modification (CBM) has been utilised with impulsive children and the results have been positive. In a meta-analysis of Cognitive and Behavioural treatment in children, it was shown that CBM improved impulsive tendencies by almost one standard deviation (Baer & Nietzel, 1991). Like any cognitive training treatment, it takes time but the results are worth it. Below are some helpful and practical examples that have been successful in the home and school environment (Baer & Nietzel, 1991; Martens & Witt, 2004).

Cognitive-behavioural strategies
Teachers would also benefit from implementing the strategies into classroom activities:

Physical exercise
As previously mentioned, self-control resembles a muscle that becomes tired after exertion. However, exercise can also result in strengthening muscles therefore it has been hypothesised that impulsivity can be reduced by improving self-control and self-regulation via exercise or practice (Muraven, Baumeister and Tice, 1999). Muraven et al. (1999) had 69 college students spend two weeks participating in one of three self-control exercises: monitoring and improving posture, regulating mood or monitoring eating. Compared with the no exercise control group, those who participated in self-control exercise showed significant improvement as measured by stamina on a handgrip test.

Whilst the "improving posture" experimental group showed the most significant improvement in self-control, improvements in the "regulating mood" group was negligible. However, the study still provided initial evidence that exercise improves self-regulation. Stronger evidence has shown that adhering to an exercise program for two months increased participant's self-control in other unrelated domains of self-control including the ability to reduce smoking, alcohol use and make healthier food choices (Oaten & Cheng, 2006). Therefore, if we can reduce impulsivity by creating a long-term physical exercise routine for children which exercises not only their bodies but their self-control, it seems that other areas of their lives which struggle with impulsive responses can be improved for the better.

Conclusion
Research can demonstrate that motivational causes of impulsivity in children have their origins in the Prefrontal brain area, namely the Orbitofrontal cortex. Dual-process interplay between subcortical motivational forces and cortical cognitive development within the OBF give rise to impulsivity in early years when executive control strength is still growing. A dominant Behavioural Activation System result in "go" approach and self-regulation failure due to reward sensitivity and low perceived value of long-term goals.

These neurobiological processes are effected both positively and negatively by environmental factors such as parents, teachers and social expectations which help to explain individual differences amongst impulsive children. Children who are required to submit to social or scholastic norms when they are sensitive to immediate gratification, may suffer from ego-depletion whereby their brains deplete glucose when working hard to control their inappropriate actions.

Impulsivity is a complex construct therefore treatment to reduce its negative effects on individuals needs to be multifaceted. Parents and teachers can benefit from introducing cognitive and behavioural modification which views self regulation and self-control as skills that can be enhanced via practice. Adhering to a physical exercise schedule has shown to be effective in transferring self-control strength to other unrelated areas thereby reducing impulsive responses across domains. Like any exercise, practice is required consistently over time before results are noticed but the results are worth the effort.

In review of impulsivity literature it seems a gap exists regarding impulsivity in children from differing socio-economic backgrounds or genetic prevalence in siblings. Future research would benefit from exploring these two topics to gain a deeper insight into the socio-biological factors effecting impulsivity in children.