Philip is 5 years old. He was diagnosed with ADHD a few months ago. The boy has always been extremely active. He was constantly fidgeting, could not sit still, was constantly touching other people and objects. He very often climbed on furniture, which sometimes resulted in a fall and various injuries. On top of that, he was very impulsive.

Symptoms of ADHD

He repeatedly picked up objects and threw them without thinking. Occasionally he would hold his attention for long periods of time and sit quietly, especially when he was watching TV. However, this was usually too difficult for him. Recently, Philip’s parents became concerned about the escalation of aggression in the boy’s behaviour. From the kindergarten, parents were receiving information that “Philip was impossible to deal with”. He was aggressive towards his peers and disobeyed established rules.

In kindergarten and at home, it was noted that Philip was relatively better behaved in one-to-one contact. However, recent outbursts of aggression both at home (especially towards his sister, who was two years younger) and in the kindergarten (where, by his behaviour, he basically had no playmates) had become a serious problem. The boy was clearly unable to cope with the demands formulated by adults and other children to self-regulate his emotions.

Philip’s case illustrates the problems that often occur in children with ADHD. In addition to the characteristic symptoms of hyperactivity and attention deficits, excessive impulsivity is clearly outlined. Philip presents a whole repertoire of behaviours that disrupt his environment. At the same time, he has significant problems in relationships with peers and in interactions with adults. These are characteristic complications of ADHD symptoms.

The aforementioned excessive impulsivity is sometimes associated with so-called impulsive aggression, characteristic of children with both ADHD and oppositional defiant disorder. This type of aggression is usually associated with difficulties in coping with a situation or high emotional tension.

It is characterised by sudden uncontrolled outbursts, often inappropriate to the strength of the stimulus. In doing so, they are usually not goal-directed and do not necessarily involve antisocial behaviour. Impulsive aggression associated with hyperactivity can also be directed against oneself, in which case we speak of self-aggressive behaviour.

Impulsive aggression

These can be behaviours in the form of active physical or verbal aggression towards oneself and others. We also speak of aggression towards objects (e.g. throwing objects, hitting a wall). Often these behaviours are accompanied by shouting and crying or making noise in other ways (e.g. by turning on very loud music).

Sometimes the problem of impulsive aggression requires seeking professional help. This occurs mainly when we are unable to ensure the safety of the child and its environment. In other cases, we can try to use methods to control the child’s impulsive behaviour ourselves.

Anger in ADHD

It is worth noting here that anger and other strong emotions are not bad in themselves. They are information for us – a signal that something important (positive or negative for us) is happening. Everyone feels anger and – consequently – has the need to express it. It is just a matter of in what form. Therefore, the child should not suffer the consequences of experiencing anger, but of unacceptable behaviour, e.g. hitting someone, throwing objects, insulting, yelling. It is very important that the child is instead given an alternative repertoire of anger-discharging behaviours that are acceptable. This could include hitting a pillow or other designated object, crying, drawing anger, tearing and crumpling newspapers.

Prevention in ADHD

Preventive measures, taken before a crisis even occurs, are very important. The key here is to spot the signals of an impending outburst. At the level of physiological and behavioural signs, certain characteristic ‘alarm signals’ can be distinguished. These include a change in facial expression, gesticulation and posture, increased muscle tension, clenched fists, increased liveliness, change in tone of voice, increased mobility, distractibility, denial of everything, malaise in behaviour.

In addition, we can distinguish conditions that are conducive to the emergence of an outburst of aggression. Such circumstances include, for example: fatigue, the experience of failure or other accumulated annoyances, situations that are very emotionally moving (pleasant and unpleasant), that cause a sense of injustice, disregard, frustration of needs. These are not factors specific to children with ADHD. They are typical external conditions of feeling strong emotions, especially anger. Accumulated emotions in the moment can be attempted to be discharged by distraction, e.g. taking the child on your lap, putting on relaxing music, offering to do something pleasant, making them laugh, etc. So if we recognise the warning signs of an impending outburst and help the child to vent his or her anger in an acceptable way, we have a chance of avoiding a crisis. This requires, on the one hand, acceptance of the child’s emotions and, on the other hand, clear boundaries regarding the child’s behaviour.

However, if the aggression has already erupted and we decide that there is no need to call for help, we basically have two choices. We can pay no attention and not intervene. This is difficult for both parents and the child. However, it avoids increasing the child’s nervousness and tension. This is the method to use if the answer to the question “Is the child and his/her environment safe?” is yes. The second method is to keep the child safe by restraining him or her. This must not be done by shouting, let alone hitting! This can be done by hugging the child firmly, putting your arms around him, standing behind him or holding him on the floor.

Responding to a child’s outburst of anger

As with other undesirable behaviour, it is very important to apply the consequences appropriately, e.g. sending the child to another room, cleaning up after him or her or apologising. It is important that the child knows that the consequences only apply to his/her behaviour – he/she, as a person experiencing different emotions, is accepted.

Impulsive aggression is a big difficulty for those around him because it carries a big emotional load. It is not uncommon for parents of children with ADHD to need support not only in responding to aggression themselves, but also in dealing with their own emotions in relation to their child’s outbursts of anger.