The ADHD hyperactive-impulsive type is characterized by significant hyperactive and impulsive symptoms such as being restless, fidgeting, and having impulsive thoughts and decision-making.
The absence of significant inattentive symptoms distinguishes it from the inattentive type of ADHD and the combined types of ADHD.
The hyperactive-impulsive type is thought to be the rarest subtype among those with ADHD although it is often diagnosed early in childhood due to physical signs being more obvious.
Signs of ADHD Hyperactive-Impulsive Type
Below are some of the signs associated with the hyperactive-impulsive type of ADHD:
Hyperactivity:
- Constantly fidgeting or being unable to sit still
- Children may run about or climb at ‘inappropriate’ times
- Always ‘on the go’ and full of energy
- Talking a lot and jumping around topics
- Difficulty engaging in quiet activities
- Racing/hyperactive thoughts
Impulsivity:
- Making decisions without thinking through the consequences
- Interrupting others or answering before hearing the full question
- Intruding on others’ activities without intending to be rude
- Difficulty waiting turns or waiting in lines
- Risky behaviors without consideration
- Emotional outbursts in conversation
These signs are also present in the combined subtype of ADHD, which includes both inattentive and hyperactive/impulsive symptoms.
Studies have shown that the frequency of hyperactive-impulsive signs tends to diminish with age in individuals with ADHD.
Those diagnosed with hyperactive-impulsive ADHD in childhood are likely to be later diagnosed with the combined subtype as demands for attention increase with age.
It could be that hyperactivity and impulsivity are managed better or are better masked (or camouflaged) in adulthood.
How does this compare with the inattentive type?
The hyperactive-impulsive type of ADHD is characterized by restlessness, interrupting, and difficulty waiting turns.
This contrasts with the inattentive type of ADHD, which is characterized by persistent inattention, difficulty sustaining focus, and forgetfulness.
The main cognitive difference in the hyperactive/impulsive type is impaired response inhibition. They may struggle socially due to impulsive, disruptive behaviors and difficulty following social rules.
While the inattentive type is often underdiagnosed, especially in girls, the hyperactive/impulsive type is more commonly identified.
Treatment for the inattentive type focuses on improving organization and attention to detail, while hyperactive/impulsive interventions target impulse control and self-regulation.
An accurate diagnosis by a professional is key, as there can be symptom overlap between subtypes.
Click here for a full breakdown of the general signs of ADHD.
Impact of ADHD hyperactive-impulsive type
Below are some of the potential impacts of having hyperactive-impulsive ADHD:
Social difficulties
Frequently interrupting others in conversations and making impulsive comments without consideration can lead to misunderstandings and might be perceived as disrespectful to others.
‘Eric’ who has ADHD describes how he is not able to control his impulses and is not aware of them:
“It’s a person shouting behind thick glass in the back of my head.”
He explains how he may impulsively respond to someone and then regret it later on:
“Reflection comes later and it’s very painful.”
Many people with hyperactive-impulsive ADHD might have difficulty making friends which can lead to feelings of loneliness.
Work and school challenges
During school, a child with hyperactive-impulsive ADHD may find it difficult to sit still and focus in class.
They may struggle to stay seated and may be disruptive due to their restlessness which could result in getting into trouble with the teacher.
Adults may find it difficult to concentrate at work during meetings or with completing tasks.
Projects may be started enthusiastically but the struggle comes with following through and finishing them due to their impulsive nature.
Emotional challenges
People with ADHD can be aware of their emotional reactions but still struggle to control them in the moment, highlighting the impulsive nature of these emotional responses.
“I can feel it come over me, I am then in my head telling myself to stop yet unable to. It is like the controls of my body have been hijacked by someone else… I know it’s going to hurt, there is going to be catastrophic damage but all I can do is sit by and pray I survive.”
‘Margot’
This reduced ability to self-regulate strong emotions can lead to breakdowns in relationships and could diminish self-worth:
“I feel like a monster… I’m so tired of being this helpless mess.” (‘Cleo’)
Financial difficulties
Impulsivity can transfer to impulsive spending, as ‘Nik’ explains:
“It’s like I don’t have that thought process of no you can’t afford this you have more important thing to pay for! It’s so impulsive by the time I’m home from being out I’m filled with regret and dread!”
Difficulties with controlling impulses could lead to financial stress and shame. It could result in many getting into debt, having a lot of unused items, and overall anxiety about money management.
“I decided I wanted to try yoga whilst I was out shopping then went on to buy a yoga outfit a yoga matt and a matching water bottle! I’ve not even tried yoga yet so why of earth have I done this?!”
‘Maria’
Note that because the hyperactive-impulsive type of ADHD is less common in adults, these personal experiences describe hyperactivity and impulsivity in ADHD in general.
Managing hyperactive-impulsive ADHD
Mindfulness techniques
Mindfulness involves paying attention to the present moment without judgment and can increase self-awareness for more conscious choices.
While this might seem counterintuitive for managing a condition characterized by distractibility and restlessness, when adapted for ADHD, mindfulness can be a powerful way to center focus and manage impulsivity.
Foster self-compassion
ADHD coach Dr. Doug emphasizes the importance of self-compassion. This involves treating oneself with kindness and understanding and recognizing ADHD as a neurological difference rather than a personal failing.
Cultivating self-compassion can help you overcome the self-criticism and shame often associated with ADHD, promoting a more positive and accepting self-image.
Seek professional guidance
Consulting with professionals, such as therapists, coaches, or psychiatrists, can provide you with tailored strategies and support for managing hyperactive and impulsive signs of ADHD.
These professionals can help to develop coping mechanisms, explore medication options, and work through the emotional and social challenges associated with ADHD.
Channel energy and focus
Engaging in activities or passions that can help to channel hyperactive energy into something positive and fun.
Examples include Michael Phelps, whose hyperactivity found an outlet in swimming, and Dr. Edward (Ned) Hallowell, a renowned ADHD expert known for his energetic lecturing style, who has successfully managed his ADHD without medication.
This can be a way to manage impulsivity while still embracing the energy that comes with hyperactive-impulsive ADHD.
Seek accommodations
In workplaces or educational settings, advocating for accommodations, like extended deadlines or quiet workspaces, can make a significant difference.
However, the availability and acceptance of such accommodations can vary widely, depending on the specific context.
You may have to be prepared to advocate for your needs and seek environments that are supportive and understanding of ADHD.
Hobbies as a form of fidgeting
Try engaging in detail-oriented hobbies like knitting, crochet, or drawing to manage the restlessness associated with hyperactivity.
These hobbies offer a socially acceptable way to fidget, providing an outlet for excess energy while also producing tangible results.
Use medication when appropriate
Dr. Thomas Brown, a clinical psychologist, highlights the importance of finding the right medication and dosage for each individual, as responses to stimulant medication can vary significantly.
Working closely with a qualified medical professional is essential to determine whether medication is an appropriate option to carefully monitor potential side effects and adjust dosages as needed.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Gallagher, R., & Rosenblatt, J. L. (2013). Attention-deficit/hyperactivity disorder predominantly inattentive type. In L. A. Reddy, A. S. Weissman, & J. B. Hale (Eds.), Neuropsychological assessment and intervention for youth: An evidence-based approach to emotional and behavioral disorders (pp. 155–176). American Psychological Association. https://doi.org/10.1037/14091-007
Gibbins, C., Weiss, M. D., Goodman, D. W., Hodgkins, P. S., Landgraf, J. M., & Faraone, S. V. (2010). ADHD-hyperactive/impulsive subtype in adults. Mental Illness, 2(1), 41-45. https://doi.org/10.4081/mi.2010.e9
Limberg, B., Peña, R. M., Davidson, B., & Yeagley, C. B. (2018). F90.0 Attention-deficit hyperactivity disorder. In J. B. Schaffer & E. Rodolfa (Eds.), An ICD–10–CM casebook and workbook for students: Psychological and behavioral conditions (pp. 203–215). American Psychological Association. https://doi.org/10.1037/0000069-017
Soto, E. F., Black, K., & Kofler, M. J. (2024). Is hyperactivity in children with attention deficit/hyperactivity disorder (ADHD) a functional response to demands on specific executive functions or cognitive demands in general? Neuropsychology, 38(8), 699–713.
Stanton, K., Forbes, M. K., & Zimmerman, M. (2018). Distinct dimensions defining the Adult ADHD Self-Report Scale: Implications for assessing inattentive and hyperactive/impulsive symptoms. Psychological Assessment, 30(12), 1549. https://doi.org/10.1037/pas0000604
