Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Impulsive Behaviour In A Person With ADHD
Question: Dear Doctor
I am from XXXXXXX Lanka (Colombo) and my son is 24 years. He was diagnosed with ADHD from the age of 8 and was been given Ritalin at that age. But right now he is taking Valparin and Risperidone on the need prescribed by his doctor. Also the dosages are as follows.
1000mg of Valporine (600 in the morning and 400 in the afternoon)
1mg Resperidone( in the evening) if the need arises we give him 2mgs.
The main problem we are facing right now is his impulsive behavior. For example: he gets the urge to kick parked vehicles when we take him out and tries to hit women , he does not touch women, he only wants to hit them two shots on the chest with that he stops, but not all the time. Suddenly he does this without any prior indication. He tells that its coming to him to behave that way. Is this true or is it a planned action? However he doesn't want to hit our own vehicle. He is not worried about this action. He is also happy at times after doing this. As a father I have told him several times of the consequences, but he is not bothered. Why is he doing this? Is there any problem for his erratic behavior? As a parent we are very worried about his future.
On the positive side he can read, write and he has completed his school education (Ordinary Level). And he can play the piano and guitar well, does swimming and cycling well. He also has a very good memory. He is very conscious of his figure and his belongings. He prays every day and does his other work in a satisfactory manner. He helps the mother in the kitchen and also helps in the house chores.
Now he is following a basic computer course at an institute.
The main problem he has is that he kicks parked vehicles (this habit started recently- 3 months) and having a tenancy to hit women occasionally.
This happens when he has a mood swing I believe. That is why he is under Valparin and Risperidone for his aggressiveness. Please advise us how we can overcome this problem so that he can lead a normal life. Also please tell us whether this happens because of his mood swings. If so how we could manage this problem.
Your kind co operation regarding this matter is greatly appreciated.
Thank you
Regards,
xxxxxxxx
I am from XXXXXXX Lanka (Colombo) and my son is 24 years. He was diagnosed with ADHD from the age of 8 and was been given Ritalin at that age. But right now he is taking Valparin and Risperidone on the need prescribed by his doctor. Also the dosages are as follows.
1000mg of Valporine (600 in the morning and 400 in the afternoon)
1mg Resperidone( in the evening) if the need arises we give him 2mgs.
The main problem we are facing right now is his impulsive behavior. For example: he gets the urge to kick parked vehicles when we take him out and tries to hit women , he does not touch women, he only wants to hit them two shots on the chest with that he stops, but not all the time. Suddenly he does this without any prior indication. He tells that its coming to him to behave that way. Is this true or is it a planned action? However he doesn't want to hit our own vehicle. He is not worried about this action. He is also happy at times after doing this. As a father I have told him several times of the consequences, but he is not bothered. Why is he doing this? Is there any problem for his erratic behavior? As a parent we are very worried about his future.
On the positive side he can read, write and he has completed his school education (Ordinary Level). And he can play the piano and guitar well, does swimming and cycling well. He also has a very good memory. He is very conscious of his figure and his belongings. He prays every day and does his other work in a satisfactory manner. He helps the mother in the kitchen and also helps in the house chores.
Now he is following a basic computer course at an institute.
The main problem he has is that he kicks parked vehicles (this habit started recently- 3 months) and having a tenancy to hit women occasionally.
This happens when he has a mood swing I believe. That is why he is under Valparin and Risperidone for his aggressiveness. Please advise us how we can overcome this problem so that he can lead a normal life. Also please tell us whether this happens because of his mood swings. If so how we could manage this problem.
Your kind co operation regarding this matter is greatly appreciated.
Thank you
Regards,
xxxxxxxx
Brief Answer:
It can not be planned
Detailed Answer:
Dear xxxxxxxx,
Thanks for using Healthcaremagic.
I read your query and understand your concerns.
Although it is difficult to determine without talking to your son whether it is intentional or impulsive but from the circumstantial evidence it seems that behavior is rather impulsive and not planned. His positive achievements in many spheres of life and his continual professional development indicates that he understands the consequences and such erratic behavior can not occur only on planned basis.
I understand your point that he never damages your own vehicle but from my clinical experience over years, I have an opinion that on most occasions selective sparing of normal behavior occurs. So on the basis that he damages others vehicle but not family vehicle could not be an indication for planned erratic behavior.
Now regarding management I feel that first a trial of appropriate dose of Valproic acid should be given. In impulsive behavior a dose of upto 30-35 mg per kg can be tried and I guess there is ample scope to increase the dose provided he tolerates.
In addition to this he should be taken for formal counselling (Cognitive Behavior Therapy) which is indicated for impulsive behavior. The counseling likely to be effective in both troubled domains which includes hitting vehicles as well as women. I must assure you that in expert hands it can help you for a large extent.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards
It can not be planned
Detailed Answer:
Dear xxxxxxxx,
Thanks for using Healthcaremagic.
I read your query and understand your concerns.
Although it is difficult to determine without talking to your son whether it is intentional or impulsive but from the circumstantial evidence it seems that behavior is rather impulsive and not planned. His positive achievements in many spheres of life and his continual professional development indicates that he understands the consequences and such erratic behavior can not occur only on planned basis.
I understand your point that he never damages your own vehicle but from my clinical experience over years, I have an opinion that on most occasions selective sparing of normal behavior occurs. So on the basis that he damages others vehicle but not family vehicle could not be an indication for planned erratic behavior.
Now regarding management I feel that first a trial of appropriate dose of Valproic acid should be given. In impulsive behavior a dose of upto 30-35 mg per kg can be tried and I guess there is ample scope to increase the dose provided he tolerates.
In addition to this he should be taken for formal counselling (Cognitive Behavior Therapy) which is indicated for impulsive behavior. The counseling likely to be effective in both troubled domains which includes hitting vehicles as well as women. I must assure you that in expert hands it can help you for a large extent.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Doctor
Can you please explain to us what is meant by Cognitive Behavior Therapy.
And also mentions dates on when he wants to do the damage. How ever sometimes he has done it and sometimes he doesn't.
He also takes Vegepa 1 a day (fish oil nutrition)
Should we avoid any particular types of food. specially red chilies?
Thank you
regards,
xxxxxxxx
Can you please explain to us what is meant by Cognitive Behavior Therapy.
And also mentions dates on when he wants to do the damage. How ever sometimes he has done it and sometimes he doesn't.
He also takes Vegepa 1 a day (fish oil nutrition)
Should we avoid any particular types of food. specially red chilies?
Thank you
regards,
xxxxxxxx
Brief Answer:
It is to do with changing behavior as well as thoughts
Detailed Answer:
Dear xxxxxxx,
Thanks for writing back to me.
As you know our every behavior is determined by our thoughts or our thinking process.
Cognitive behavior therapy attempts to change the thinking process to change behavior. When we encounter with certain situations not everyone thinks in similar line. B this therapy the alternative thoughts are encouraged to replace the destructive/erratic thoughts.
Although a detailed mental status examination is required to determine the reason for such behavior but as I said earlier my impression todate about such behavior is that most of time it is impulsive rather than intentional.
People with ADHD have repetitive thoughts and over time they fail to control particular behavior. That could be the reason for erratic behavior on specific dates and not on other days.
Regarding food as per my knowledge no normal food (Not substance of abuse) is associated with change in impulsive behavior and I do not think cutting down his chillies will help. I understand that people from our part of world are two much concerned with hot and cold foods but science has not proven any such foods.
I hope this helps you.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
It is to do with changing behavior as well as thoughts
Detailed Answer:
Dear xxxxxxx,
Thanks for writing back to me.
As you know our every behavior is determined by our thoughts or our thinking process.
Cognitive behavior therapy attempts to change the thinking process to change behavior. When we encounter with certain situations not everyone thinks in similar line. B this therapy the alternative thoughts are encouraged to replace the destructive/erratic thoughts.
Although a detailed mental status examination is required to determine the reason for such behavior but as I said earlier my impression todate about such behavior is that most of time it is impulsive rather than intentional.
People with ADHD have repetitive thoughts and over time they fail to control particular behavior. That could be the reason for erratic behavior on specific dates and not on other days.
Regarding food as per my knowledge no normal food (Not substance of abuse) is associated with change in impulsive behavior and I do not think cutting down his chillies will help. I understand that people from our part of world are two much concerned with hot and cold foods but science has not proven any such foods.
I hope this helps you.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
