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Monthly NewsNote
April 2007
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An ADD Triad: Frustration - Impulse - Temper
It is well known that a low frustration tolerance and impulsiveness are part of ADD. Less well known is that there is a typical kind of ADD temper, and that frustration, impulse and temper often follow each other in short order. The reason it is important to realize that this is an ADD pattern is that it is a problem that can be worked on and not just accepted as a personality trait. Therefore, this NewsNote will discuss the problem with the hope it will help patients and therapists deal with it successfully.
Let me explain the ADD temper. When a non-ADD person loses their temper they generally stay angry for hours or even days. But the ADD temper is basically a spike; it comes on abruptly, rises to a peak and is gone. It leaves bodies strewn around as the temper spikes, but the ADD person is often puzzled about why this happens because they are back to calmness very quickly, even in a matter of minutes.
The "triad" I'm describing starts with low frustration tolerance. With ADD, it doesn't take much to bring on the feeling of frustration. For a young person it can be an inability to understand the math homework. For a mom it can be the child who doesn't put away their toys when told to do so.
Feeling frustrated is not comfortable, and without thinking might lead to impulsive behavior, the second part of our ADD triad. Words or behaviors without thought fit the category of impulse. And they are often detrimental to the individual. Tearing up homework might be such an impulse, as would mom breaking a toy because it wasn't put away.
Temper is a loss of control. It's not beneficial to the person who explodes, and is often hurtful to the objects of the anger. Most people with ADD who lose their temper are upset with themselves afterwards
Here are two cases. Tara, a mother with ADHD, has three children under the age of eight. Two are in school and one is home with her most of the time. She calls the hours from 5 to 8 the "time from hell". With all the responsibilities she becomes frustrated quickly when the children don't cooperate. She then impulsively says things to them that she later regrets, and on most nights finds herself angry and screaming at the kids.
Another case is Steve. He is a 13 year old boy. When he has trouble with homework he is not able to stay calm. He gets frustrated quickly, and as a first response tears up his work - an impulse. But it doesn't stop there. He can really "get into a temper" as he calls it, and he will then throw the book or even try to kick a hole in the wall.
These are fairly dramatic problems, and not everyone's are so severe. But poor frustration tolerance and impulsivity are very common, and temper increases problems at home and with peers. These are symptoms of ADD and need to be part of the comprehensive treatment approach.
How do we do that? Each case is individual, but it starts by reducing the cause of the frustration. I would suggest, for example, that the boy having difficulty with homework try special help at school or a tutor. The housewife under such stress might avoid her "time from hell" by having some extra help during those critical hours.
Medication is helpful, and when prescribed for these situations is often necessary seven days a week. But to fully fashion a workable solution, the problem areas need to be addressed in guidance sessions. This will give the individual different tools to use in handling these feelings and behaviors.
The frustration-impulse-temper triad is a significant problem for the ADD patient. It's important that this triad be identified and brought under control.
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