Cultivating Response Inhibition in Children

Response inhibition (RI) is the ability to voluntarily control a response; to think before you act. It is one of many executive functions that exist in the frontal cortex of the brain.

If you have an out-of-the box child who has a diagnosis of ADHD, or ADHD with a co morbid condition , then there could definitely be a deficit in this area. Many studies of childhood ADHD have shown an impaired RI. (1)

What??

As a parent, I want to understand how RI affects my child, and how to best remediate this problem. While the neuropsychology behind it is fascinating, it is difficult!

My job, then, is to break it down.

This executive function is one of the earlier skills to develop; beginning in infancy.

As the authors of the book, Smart but Scattered , share, “It is a fundamental skill that enables all other executive skills to develop. A child at the mercy of his impulses can’t initiate, sustain attention, plan, organize or problem solve effectively.”

Our LCSW (therapist) Emily explained it to our daughter this way: When you get angry or upset, your animal instinct kicks in. It’s that instinct that makes you want to fly off the handle, say something rash, cry, get angry, or do something you regret later.

Our ability to move from animal thinking back to rational thinking is where response inhibition takes place. It is the ability to keep cool and THINK in an emotionally charged situation.

Fortunately there are many ways to build and strengthen this area of weakness in ourselves and our children. Once again, to understand these topics, read the book, Smart but Scattered.

I’d love to call it a neuropsychology primer for moms and dads!

Neurological Pruning

Follow the link on neurological pruning for a complete explanation of this fascinating process. However, for our purposes, think of it as getting rid of all the extra branches on a tree so that the ones left can grow stronger.

As your child hits pruning stages in life, and there are several, his or her brain will begin to strengthen the remaining connectors in the brain. This is good news for response inhibition because it allows “reason” to enter into our instinctive animal-like state!

Before those connections are in place, children will struggle with their reactions, just as they will struggle with impulse control .

Some children can even exhibit an intermittent explosive disorder, which is characterized exactly how it sounds: intermittent times of explosive behavior.

The underlying cause??? Poor impulse control and response inhibition.

Always Assume "No"

If in doubt, always assume that your child does not have strong response inhibition or impulse control.

Just because a child is smart doesn’t mean they have strong executive functions. Sometimes we forget that. There is a lot of competition for their impulses!

We can introduce them to impulse control in a variety of ways; all of which result in response inhibition. Techniques include setting limits, learning to delay gratification, making them earn a reward, and establishing routines.

Organized Carrot Dangling

The first/and then schedule is a great teacher. Think of it as organized carrot dangling. It is NOT threat based!! There is no punishment if the task is not completed.

It is a way to teach your child to delay gratification which will in turn teach response inhibition. You can begin at any age, and it can start small. For example:

1. First put your toys away, and then you can watch TV.

2. First complete your reading assignment, and then you can play on the computer for 10 minutes.

3. First save up your money, and then I will take you to pick out your ___________________.

Role Playing

Role playing is an important social piece involved in executive function. If you know your child is going to be in a situation that requires impulse control, practice the possible scenarios that could arise in that situation ahead of time.

This serves two purposes: social regulation and response inhibition. Your child may not know how to respond socially, and they may not know how to remain “rational” in the heat of the moment. By reviewing and role-playing the situation, you effectively kill two birds with one stone.

The Power of Rewards

Here’s some food for thought. There is a study published in the Journal of Child Neuropsychology that studied response inhibition in children with DSM-IV subtypes of AD/HD and related disruptive disorders.

They were looking at the role of reward.

They were exploring whether poor response inhibition in children with ADHD was a core problem or an underlying problem that could be related to reward, and what was the role of reward in these kids.

Using a stop paradigm (a test of executive function and response) they found that there was no difference in the SPEED of response inhibition (RI).

However, when rewards for RI was introduced, the children who had ADHD slowed down more dramatically than the norm group!(2)

The bottom line?

Rewards, used correctly, can be powerful. And you can even say there’s research to prove it!

What About Medications?

In another study published by the Society of Biological Psychiatry an experiment involving response inhibition was done on a group of adults with ADHD. They used a stop-signal to measure reaction time for adults who had ADHD, but were either medicated with methylphenidates (stimulant drugs) or not.

The findings?

The reaction time was significantly slowed in unmedicated adults with ADHD, and the deficit was significantly improved by medication. (3)

This tells us is that there is some research that supports the use of methylphenidates to improve some of the specific issues associated with ADHD. Of course, there are all kinds of other issues associated with the use of stimulant medication too.

Your doctor should sort them out with you.

Response Inhibition is a building block for success. If you decide your child has a deficiency in this area, find people who can help you to fill in those missing pieces!

1. Biol Psychiatry 2003;54: 1465–1468 © 2003 Society of Biological Psychiatry

2. Child Neuropsychology 0929-7049/01/0703-172, 2001, Vol. 7, No. 3, pp. 172±189 # Swets & Zeitlinger

3. Biol Psychiatry 2003;54: 1465–1468 © 2003 Society of Biological Psychiatry