ADHD Impulsive Behavior and Risk of the Choking Game


ADHD impulsive behavior increases the risk of teens playing the choking game and what parents and teachers should watch for….

Impulsivity is one of the key symptoms of attention deficit hyperactivity disorder as most of us who deal with children and teens with ADHD can readily attest.

Sometimes, ADHD impulsive behavior can be of great benefit both for the person who is ADHD and for others around him or her. It’s often said that without impulsivity the world would have no great military leaders, no outstanding sports heroes, no successful entrepreneurs and maybe even a lot fewer doctors. 

The reason is simple: Most of the great discoveries, most of the best inventions, most military endeavors, and most of the world’s most successful surgeons have one trait in common. They are risk takers and on top of it all, they are impulsive extreme risk takers. So, in some cases, impulsivity and risk taking behavior may benefit us all.

Unfortunately though, not all risk takers are striving for advancement or betterment. Some impulsive boys and girls are engaging in risk taking behavior just for the sake of a quick high.

The choking game played by preteens and teens is one such example of this type of behavior. Ok…I heard that. You mentally said; “My child wouldn’t do something so stupid.” Are you sure? Have you been watching for signs that your son or daughter might be using controlled choking to “fit in with his or her friends”?

The reason we should be concerned about the choking game in ADHD teens and pre-teens is obvious. ADHD kids and teenagers are much more likely to participate in impulsive behaviors that produce immediate reward or a high…and the choking game is one such behavior.

Other impulsive behaviors that give instant rewards include:

  • Speeding and racing cars
  • Stealing and shoplifting
  • Unprotected sex
  • Illegal drug use
  • Playing violent video games
  • Street gang related activities
  • Tattooing and body piercings.

If your ADHD child or teen has been caught doing any of these things, then you should look closely for signs they have been joining in the choking game with or even without their friends.

Recent medical research has shown children were more likely to participate in the choking game if:

  • They engaged in high risk or unprotected sexual practices-both homosexual and heterosexual
  • They were exposed to paternal violence and had a father in prison
  • They had a mother with illegal drug addiction or mental illness
  • They were poorly nourished or suffered from malnutrition
  • They had poor self-esteem or body image problems (I believe victims of child abuse and childhood bullying fall into this group)
  • They engaged in gambling and high risk legal behaviors

Here’s what happens in the choking game or the practice of strangulation entertainment:

  • A ligature of some type (belt, scarf, tie, tie-downs, bed sheet, pillowcase, backpack strap, towel or piece of cloth) are tied around the neck
  • The ligature is progressively tightened by hanging from a support such as a clothing rack, shower curtain rod or hook on a door; or by another person who assists in “the choke”
  • Pressure on the child’s or teen’s neck cuts off most of the blood flow to the brain to the point of almost passing out from lack of oxygen
  • The ligature is abruptly released, which rapidly returns blood flow and oxygen to the brain producing an intense “high”.

Some of the symptoms of or signs you might see if your child or teen has been playing the choking game include unexplained bruising or red marks on the neck, little red or blue hemorrhages about the eyes (petechiae occur from increased facial pressure and forced blood flow) and frequent complaints of headache and neck pain.

Many more issues surrounding the choking game and signs and symptoms of the game can be found in my previous article on this topic found on

Beware the Choking Game

As parents and doctors of ADHD kids and teens, we should all be on the outlook for symptoms and signs of dangerous risk taking and impulsive behavior. The best way to do so is to be sure we interact frequently and communicate well with our young charges.  Just simply discussing the risks and long-term side effects of a popular behavior might be enough to make your ADHD child or teen to think twice before following the lead of others. Talk to your kids and learn about what’s important in their lives.

Frank Barnhill, MD


Risk behaviors can indicate participation in the "choking game"


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