This inability to control urges can lead to impulsive and often inappropriate social behaviour. For example a previously shy person may become quite extroverted and talkative if the brain injury has led to mild Disinhibition. When this inability to control urges is more marked it may lead to a normally reserved, polite person making crude or sexually inappropriate comments to strangers following a brain injury.

When other people do not understand the reasons for this behaviour it often leads to rejection and criticism from others. Impulsivity can therefore lead to Social isolation as the person alienates existing friendships and cannot make new ones.

Common features of Impulsivity

Another common outcome from a frontal lobe injury is lack of awareness. This can make it difficult to analyse one’s own behaviour or to gauge other people’s reactions. This complicates the issue of impulsivity as the person may refuse to acknowledge that they have inappropriate behaviour. They may be unable to understand their own limitations or the consequences of their actions. A person lacking in insight will also be unable to understand other people’s behaviour or motives, unable to empathise or imagine how someone else is feeling.

How is impulsivity treated?

Specific treatment for impulsivity varies from person to person depending on the underlying cause. In most cases, several different treatment strategies may be used at the same time on one person. The most common treatment is medication, some people may also benefit from behavioural therapy, parent training and school based interventions (if a child). You should consult your rehabilitation specialist or GP to see if medication can assist.

Impulsivity often arises in situations where the person is confused or fearful. These can be minimised by a predictable daily schedule. Also any outbursts should not be automatically written off as impulsivity and ignored. It may be indicating a cause of fear or confusion that needs to be dealt with.
When lack of awareness is not an issue the person may apologise later. Try to be sensitive to this despite any lingering anger or annoyance on your part. Prolonged complaints about the behaviour afterward are not likely to help as usually their lack of control was not by choice on their part.

If the person engages in attention seeking behaviour such as yelling or interrupting, tell them this is not a good way to get your attention and advise on an alternative strategy.

One of the most difficult strategies on handling impulsivity is to recognise that any challenging behaviours have arisen from a physiological cause - the frontal lobe injury.

Try to remember it is the impulsivity that is at fault, not your loved one. Generally they will not be speaking or acting intentionally to annoy you or hurt your feelings. Separating the person from the behaviour can go a long way to coping with the situation.

In serious cases your local Brain Injury Association will be able to put you in touch with any specialists in behavioural issues who may exist in your State.