Got ADHD? Here's how to prime inhibition.

Contending with ADHD as an adult reminds me of trying to figure out mystery medical illnesses: You may go a long time with a sense that something is wrong, but not knowing what it is. You may wait a long time to see a doctor—if you can get in to see one at all. You might do myriad tests, or meet with specialists, but still not have a clear road to getting help.

In both cases, you’ll likely wind up curating your own resources and modes of assistance. This can be a little daunting and time-consuming. It’s what compels me to write about ADHD and other issues: My hope as a psychologist and embodiment guide is that something I share with you here will be useful to you or someone you care about.  

In July, I wrote a piece on an embodied tool to support working memory in ADHD.

Today, I’d like to offer an embodied tool to address disinhibition, another key challenge in ADHD. The term refers to difficulty inhibiting impulsive thoughts, emotions, and actions.  

But first, here’s a quick recap on ADHD.

What ADHD Is + How It Challenges Us

ADHD is a developmental disorder seen in children, adolescents, and adults. It spans multiple domains of self-regulation, including:

• cognitive challenges which manifest as difficulties in executive functioning

• challenges with working memory, including the ability to remember an idea you had moments ago, or what you went into the kitchen for, or who you grabbed your phone to call

• difficulty with emotional regulation

• disinhibition

• cognitive, emotional, and physical impulsivity

• challenges with sustained attention and distraction control (secondary to inhibition issues)

So much focus in research and therapy addresses working memory and emotional regulation. Today, let’s hone in on inhibition and impulsivity.

Inhibition Issues in ADHD:

According to psychologist Russell Barkley, the first sign in the development of ADHD is difficulty not with attention, but inhibition.

This manifests as a child or adult being unable to suppress behaviors. They experience an uptick in motor (movement) and verbal activity (it’s called “motor mouth” for a reason). They have cognitive impulsiveness, an immediate thinking about and following through on the first thing that come to mind. (I’d add that the “following through” part makes this not just cognitive, but cognitive-motor.)

Emotionally, we may have low frustration tolerance and be quick to anger. We may be easily excitable and reactive. (Even with a long practice of yoga, mindfulness, meditation, and movement.) We tend to broadcast thoughts and emotions more clearly than others, which can rub them the wrong way.

The hyperactivity aspect of ADHD declines throughout childhood and gets internalized by the time we’re adults. It expresses itself in a strong pressure to be busy, to multitask. Frequent and intense restlessness. A pressured busy-ness of thought. A maelstrom of ideas. Random impulses galore. Quick physical reactions—before the mind picks up on the intention to move.

This spells trouble for inhibition.

The Importance of Dopamine to Inhibition

There’s a paradox here. Despite impulsivity, people with ADHD often have chronically under-aroused brains and a low balance of the neuromodulator dopamine, which regulates reward, movement, and inhibition.

A hypo-aroused brain spurs someone to look for new stimulation. Hypo-arousal can cause acute sensitivity to the environment, particularly to ambient sounds. It can lead to chronic and rapid attention-switching and pleasure-seeking. This happens instantaneously. Before we realize it, we’ve shuttled away to something else to get that little hit of dopamine.

If you’ve ever used tools like dopaminergic medication, moderate use of caffeine or sugar, or cold exposure to increase dopamine, you’ll know that after you do, it can feel like someone “let the horse out of the barn.” If you don’t direct the horse—the surge of dopaminergic excitement—toward your desired pursuit and inhibit any others, you can end up sucked into an impulsivity vortex. (Think getting trapped in a 5-hour search into how trees communicate, a long dive down the Instagram rabbit hole, or a quest for the ideal warm gray for when you next paint your bedroom wall.)

In ADHD, impulsivity and disinhibition come at a cost. They ignite a cascade of downstream effects on the mind, brain, and body. They compromise an already challenged working memory. They dissipate our creative energy, the works of art we make, the novel ideas we have in the service of self-determination, and our potential contributions to humanity.  

Enhancing Inhibition in ADHD: What Experts Advise

For me, the frustrating part about ADHD research is how much attention goes to working memory and emotional regulation, and how little to developing inhibition.

ADHD psychologists might have you build in rewards for inhibition and consequences for impulsivity. (My take: At least for adults, the negative consequences of disinhibition are so apparent that one hardly needs to amplify them.)

And then there are the experts on habit formation. I’m a huge fan of well-written books about building better habits, like James Clear’s Atomic Habits or Charles Duhigg’s The Power of Habit. I love to add positive habits into my routine, like taking a walk after dinner, building dynamic rest practices into my day, or fine-tuning my pre-bed routine.

Most habit formation programs give you clear steps to build a good habit. S.J. Scott, B.J. Fogg, and James Clear all discuss the notion of habit stacking, in which you identify a positive habit you already do and use it as a cue for one you don’t.

Say, for example, you wash the dishes after every meal—but you’d like to start cleaning off the counter too, and build in a short gratitude practice. You “stack” the habits: Each time you wash the dishes, you add in cleaning the counter to “pair” the two together. And when the counter is clean, you get out your journal and write down one thing you’re grateful for.

For many people with ADHD, forming positive behaviors is less challenging. Yet inhibiting negative ones is nearly impossible.  

To extinguish a bad habit, experts often tell us to essentially reverse-engineer the process of building a good one. But this doesn’t take into account the intensity of disinhibition in ADHD.

But there one idea from the psychology of habits has potential for people with ADHD.

Embodied Approaches to Inhibition

In many ways, to call ADHD a disorder of attention is to overlook one of its most obvious aspects. ADHD is an anomaly of agency, the sense that we can have an intention and mobilize ourselves to achieve it. Agency enables us to act in a way that matches our intention, and view the effects of our actions in the world. But ADHD compromises agency: Often, we have the best of intentions. But disinhibition channels our intentions, lightning-quick, into other enterprises. This further degrades our sense of agency, as well as our energy and life force.  

Inspired by the idea of habit stacking, I’ve been working with a tool I think of as agency binding. You pick a behavior you’d like to inhibit, and bind it to one you already inhibit well.

Here’s an example from my own life. I’ve wrestled with IBS, and used to indulge in what some call “extreme snacking.” In order to keep my gut microbiome stable and rest it between meals, I had to stop snacking between meals. It took a week or two to stop, but now “inhibition of snacking” is part of my routine; I have a sense of agency around it. (A caveat: For anyone with disordered eating, I do not recommend inhibitory or regulatory behaviors related to food. Please check with your treating professionals if you also have IBS.)

Because “not snacking” is an inhibitory success, I can scaffold its agency in support of a more challenging form of inhibition: say, not checking email. Now the agency I want to build around not checking email can ride on the autonomy I have in not snacking between meals.

There is a side effect of successful inhibition. My secret theory is that underneath the impulsivity dwells a giant “agitation monster.” When you build your inhibitory capacity, you poke the sleeping dragon. It comes roaring awake. You may face intense restlessness, a sense of being about to jump out of your skin. On top of that, you may feel immersed in a low dopamine, scanning-for-reward state.

You can employ your favorite practices here to tame the dragon enough to function. For me, breathing slowly and deeply, going upside down over the ottoman, self-applied neck traction, and dynamic rest practices work well. And labeling the agitation out loud and talking to myself for a moment in a supportive way helps me navigate the agitation enough to go deeper into whatever task I’m struggling with, and the challenge that made me want to bail in the first place.

It’s tricky, this inhibition thing. Without careful tending, it can make us walk too much in the garden of “no.” It can grow desiccated, a little blackened and decayed. It helps to juice up inhibition, to add a little life to it.

Here’s an idea adapted from a brilliant scientist and contemplative practitioner I know.

Imagine that each form or instance of inhibition is an origami bird that you’ve just created. (You can, of course, make them by hand, as she does, using them to build the outline of a thesis.)

And imagine that each time you employ inhibitory agency, you bring another origami bird into the world. In time, you can build a flock. There may be days when you’re out of agency juice, when you can’t feed and care for one of the birds. Or days when it seems the whole flock has migrated to more temperate climates.   

But time allows you to build a healthy relationship with your flock of inhibitory bird-virtues: Ingenuity. Perseverance. Divergence from norms. Courage. Humor. And critically, it does so in the service of creative flight, of grounded self and integrated community.