MHO’s client facilities often ask for investigation of potential trends based on their perceptions shaped by real-world observations. These inquiries are essential – they help facilities explore and respond to emerging trends within their own facilities, challenge our assumptions about patient needs and care, and facilitate MHO’s support of changing facility needs.
Recently, we have heard increased chatter around a rise in impulsive behavior among patients. Impulsivity – acting on urges without enough thought – is a hallmark of many mental health conditions, making it critical to monitor closely.
To test these claims broadly, we compared three metrics in facilities with 100+ inpatient discharges in both 2020 and 2024:
- Diagnosed impulse disorders (ICD-10 category): a slight decline. Contrary to expectations, there was no increase in impulse disorders. Instead, there was a minor drop in patients with these primary or secondary diagnoses in inpatient mental health and substance use programs (~0.8% to 0.55% and ~0.25% to 0.10% respectively).
- ADHD diagnoses: a notable increase. ADHD primary or secondary diagnoses rose by 5-7% in child and adolescent inpatient groups. Since impulsivity is a key symptom of ADHD, this could explain some of the perceived increase in impulsive behaviors.
- Patient self-reported impulsivity: no change. The rate at which patients report the highest level of impulsivity captured by outcomes tools [1][2] was unchanged. While ADHD diagnoses are rising, the severity of impulsivity symptoms in these and other patients remain stable.
Figure 1. (Interactive) Monthly trends in inpatient impulsivity metrics
While data do not fully support a broad increase in inpatient impulsiveness, the rise in ADHD diagnoses amongst younger inpatients is worth noting. It raises questions about whether we (patients and clinicians) are getting better at recognizing ADHD and are more likely to seek help, or whether the diagnosis criteria have been expanded [3]. Further research is needed to understand this trend fully.
Importantly, this analysis shows the value of using data to test perceptions and assumptions. Anecdotes can guide questions, but it is evidence that helps us to act. Afterall, data driven policies, procedures, and treatment planning are most ideal.
Let’s keep the conversation going. Share your insights, questions, and trends – we’re listening!
References
[1] Morin, AL., Miller, SJ., Smith, JR., & Johnson, KE. (2017). Reliability and Validity of the Child and Adolescent Behavior Assessment (CABA): A Brief Structured Scale. Child Psychiatry Hum Dev DOI, 48(2):200-213. 10.1007/s10578-016-0632-9
[2] BASIS-32: The Behavior and Symptom Identification Scale is a self-report measure of a patient’s functioning, rated on a scale of 0 “no difficulties” to 4 “extreme difficulties”. BASIS-32 © Mclean Hospital, used by licensee with permission from Mclean Hospital.
[3] Abdelnour, E., Jansen, M. O., & Gold, J. A. (2022). ADHD diagnostic trends: Increased recognition or overdiagnosis? Missouri Medicine, 119(5), 467–473.
