What is hyperactive-impulsive ADHD?

Hyperactive-impulsive ADHD is thought to be the least common subtype of attention-deficit hyperactivity disorder (ADHD). Estimates suggest that about 7% of people with ADHD are diagnosed with this type. People with hyperactive-impulsive ADHD experience symptoms like excessive activity and impulsivity, without the more common signs of inattention and distractibility. 

Young boys are the most likely to experience symptoms of hyperactive-impulsive ADHD. Many children will notice a reduction in their symptoms before adolescence, particularly in terms of physical hyperactivity — but impulsivity may continue into adulthood for some.

Fortunately, every type of ADHD can be treated. With the right support, you can learn to not only manage disruptive symptoms but also learn to accept and love your brain as it is.

Signs of hyperactive-impulsive ADHD

Hyperactive-impulsive ADHD is the least common type of this condition. It’s diagnosed when someone only presents with symptoms of hyperactivity, without major signs of inattention or distractibility. Some research suggests that around 7% of people with ADHD have hyperactive-impulsive symptoms only.

According to the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR), the symptoms of hyperactive-impulsive ADHD include:

• Fidgeting with hands or feet or squirming when seated
• Running or climbing in inappropriate situations
• Finding it hard to stay seated in situations where it’s expected, like in class or at work
• Feeling restless, as if being driven by a motor — often getting up or moving around in situations where it’s not appropriate
• Being unable to play or engage in activities quietly
• Always feeling “on the go,” as if you’re constantly in motion
• Talking excessively
• Blurting out answers before questions have been fully asked or completing other people’s sentences
• Interrupting or intruding on others — like jumping into conversations, games, or activities without being invited

To meet the full diagnostic criteria for hyperactive-impulsive ADHD, children must experience at least six of these symptoms, and adults must experience at least five.

Research shows that hyperactive-impulsive ADHD is more common in children younger than 12 and that they tend to outgrow hyperactivity by adolescence. However, some adults with ADHD continue to experience symptoms of hyperactivity.

In adults, symptoms of hyperactive-impulsive ADHD could look like:

• Feeling restless or constantly needing to move (even if it’s just tapping a foot or shifting in your seat)
• Leaving meetings or having trouble sitting through situations that require sustained attention (like long lectures)
• Feeling fidgety or restless or being unable to relax in calm situations 
• Having trouble engaging in leisurely activities quietly or calmly
• Feeling internally restless, always needing to be on the move or multitasking
• Talking excessively, often interrupting others or dominating conversations
• Making hasty decisions or acting on impulse (like buying things without considering the consequences)
• Having difficulty waiting in lines or waiting for things like food orders

How is hyperactive-impulsive ADHD different from other types?

In addition to hyperactive-impulsive ADHD, there are two other subtypes of this condition: predominantly inattentive ADHD and combined-type ADHD.

Inattentive type ADHD

People with predominantly inattentive ADHD experience symptoms like lack of focus, difficulty paying attention to detail, making careless mistakes, and frequently losing or forgetting important items. They may not experience any hyperactivity at all. 

From the outside, they can show vastly different symptoms from people with hyperactive-impulsive ADHD. While people with hyperactive-impulsive ADHD often behave as though they’re driven by a motor, those with predominantly inattentive ADHD may appear “spacey” or distracted.

Inattentive ADHD is more common than hyperactive-impulsive ADHD, with reports showing that around one-third of people with ADHD are diagnosed with inattentive symptoms only.  

Combined type ADHD

People with combined type ADHD show symptoms of both inattentive type and hyperactive-impulsive type ADHD. This is the most common type of ADHD, which means that a vast majority of people who are diagnosed with ADHD live with both inattention and hyperactivity/impulsivity. 

In fact, in one study, even adults who were diagnosed with hyperactive-impulsive type ADHD presented with symptoms of inattention that were comparable to people who were diagnosed with inattentive or combined type ADHD. This supports the findings that children with ADHD tend to outgrow hyperactivity symptoms but inattention continues to be a problem for adults as well. 

The authors of the study concluded that ADHD with hyperactive-impulsive symptoms only — as it presents in children — is relatively rare in adults. 

What causes hyperactivity and impulsivity?

We’re still trying to understand the specific reasons why people with ADHD can become hyperactive and impulsive. Part of the explanation lies in the way ADHD affects the brain’s prefrontal cortex. Studies have shown that people with ADHD have differences in the activity and structure of this part of their brains. 

Among other things, the prefrontal cortex is responsible for executive functioning skills, which are a complex set of cognitive abilities that include self-control, emotion management, and planning. Because people with ADHD have differences in this area of the brain, they have a harder time with these skills — which can lead to symptoms like hyperactivity and problems with impulse control.

The causes of ADHD as a condition, regardless of the type, are still not completely understood. ADHD is a neurodevelopmental condition, which means it starts affecting people during childhood while their brains are developing.  

So far, scientists have found that genetics play a large role; research has found that ADHD is up to 80% hereditary. So if you have a close relative with ADHD, you’re more likely to have it yourself.

Many myths surround hyperactive-impulsive ADHD, especially for children. ADHD-related hyperactivity isn’t caused by too much sugar, poor parenting, or immunizations. It’s also not an attention-seeking behavior. It’s a symptom of ADHD — a lifelong neurodevelopmental condition that we’re still trying to understand more thoroughly.

What can hyperactive-impulsive type ADHD lead to?

Hyperactive-impulsive ADHD can be very disruptive to your life, regardless of your age. It can not only make it difficult to succeed at school or at work, but it can also lead to negative impacts on your relationships.

In many ways, hyperactive-impulsive symptoms are more visible than symptoms of inattention. This is especially true in children. Children who present with hyperactive-impulsive symptoms may be seen as more “disruptive” in the classroom. Their behaviors, like interrupting the teachers or getting out of their seats at inappropriate times, may create a situation where intervention feels more immediately necessary.

The visibility of symptoms can be a double-edged sword. In many ways, it can be positive. This is because children with more externally “disruptive” symptoms are more likely to be referred for assessment and diagnosis. This means they may receive an ADHD diagnosis earlier in life, which can help them learn how to manage their symptoms and get education and support as they grow.

The flip side is that because hyperactive-impulsive type ADHD’s symptoms are often so noticeable, people — especially children — who have it may face social rejection. They may be labeled as “problematic,” even if people know that they have ADHD. This may lead to mental health and self-esteem issues later in life. People with hyperactive-impulsive ADHD may also be diagnosed with co-occurring conditions like conduct disorder. 

It’s worth noting that people assigned male at birth are more likely to have hyperactivity symptoms than female people, who are more likely to present with inattentive symptoms. Unfortunately, this often leads to females, especially children, being less likely to get referred for diagnosis and treatment.

How is hyperactive-impulsive ADHD managed?

Hyperactive-impulsive ADHD is a neurodevelopmental condition, which means that it can’t be “cured” or go away completely. But with the right treatment and support, you can better manage the difficult parts of living with ADHD to focus on the unique strengths that can also come along with this condition.

The most effective treatments for ADHD are medication, therapy (specifically cognitive behavioral therapy), or a combination of both.

A therapist can help you learn new tools, like stress management techniques, to better control your impulses and change behaviors that might be causing trouble in your life. Additionally, they can help you learn how to accept yourself for the full spectrum of who you are, including your neurodivergent brain. You can learn how to stop blaming yourself for your symptoms and internalizing negative labels, which can be a common experience.

In addition to professional ADHD treatment, some lifestyle changes that can help include:

• Exercise: Physical activity is known to be one of the most effective non-medical strategies for managing ADHD. Regular exercise can help reduce impulsivity, improve mood, and boost concentration. It does this by increasing the production of neurotransmitters like dopamine and norepinephrine — the same brain chemicals targeted by ADHD medications.
• Community support: Building a strong support network of friends, family, or ADHD-specific support groups can significantly help. Connecting with people who understand your challenges can provide a sense of belonging and encouragement, as well as practical advice.
• Mindfulness: Mindfulness practices, like meditation or mindful breathing, have been shown to improve self-regulation and reduce impulsive behaviors in people with ADHD. Regular mindfulness exercises can help you become more aware of your thoughts and actions and make it easier to manage symptoms like distractibility, impulsivity, and emotional reactivity.
• Sleep: Getting quality sleep every night is crucial for managing ADHD symptoms. Sleep deprivation can make symptoms like hyperactivity and impulsivity worse and make it even more challenging to cope with ADHD during the day. Prioritize restful sleep by establishing a consistent sleep routine, reducing screen time before bed, and creating a relaxing sleep environment.

Find care with Rula

Hyperactive-impulsive ADHD can have a significant impact on your mental health and well-being. But treatment can help you strengthen your impulse control, learn new skills, and practice self-acceptance. 

That’s where Rula comes in. We boast a network of 10,000+ licensed therapists with expertise in 80 different clinical specialties, including ADHD. Best of all, you can get an appointment as soon as tomorrow. Don’t wait to start learning how to manage your ADHD.

Find a therapist with Rula