Impulses are thoughts that inspire behavior. Whether or not you actually do the behavior depends on how much internal or external control there is. For example, if you have the impulse that you are hungry and want to eat something, you might just go eat something. However, if you are imposing some internal control on yourself in order to lose weight, you might decide not to eat until it is mealtime. If you have a sore throat, the anticipation of pain might serve as an internal control to guide you to select something soft to eat. If you go to the refrigerator and nothing appeals to you, an internal food preference is governing your behavior. If the refrigerator is empty, that is an external control that prevents you from eating. If you happen to be 2 years old and can’t open the refrigerator, that is also an external control. If you are 6 years old and know that you will get yelled at if you take food without asking, internal control might keep you from just taking food.
As humans, many of our impulses are towards bad behavior. That, in itself, is not a problem. The problem begins when there is not enough control to prevent us from engaging in behaviors that are harmful or socially unacceptable. Disorders of impulse control stem either from a lack of internal control or a lack of external control or both.
When external control is lacking, that’s the easiest to treat. We work first with the parents to establish external controls for their children, which turn into internal controls as the children mature. However, this is the form of treatment that parents hate the most because it means they pretty much have to do all the work. It also means that parents have to take responsibility for their children’s behavior and often this is not easy to do. We at Down To Earth recognize that most parents are kind, caring, well-intentioned people who are trying to do the best they can for their children. We try very hard to be educational, not critical.
When internal control is lacking, that’s a little more tricky because it can be hard to tell why internal control is missing. It could be a physical problem within the child. It could be an emotional problem within the child. It could be simply that external control wasn’t established and therefore, internal control wasn’t established yet, either.
Our approach at Down To Earth is to begin by making sure external controls are in place. If not, that’s where we focus first. If that fails, then we move to the theory that perhaps something is wrong within the child and we try to find out whether it is physical or emotional. If emotional, there may still be more work to do with the parents or with the child individually. If physical, psychiatric evaluation for the possible use of medication may be recommended.