Hyperactive-Impulsive ADHD Type: Symptoms, Causes, & Treatment

What Is Hyperactive-Impulsive ADHD Type?

Hyperactive-impulsive ADHD is a type of attention-deficit/hyperactivity disorder (ADHD) that mainly presents as hyperactivity and impulsivity. Hyperactivity involves feeling restless and constantly “on the move,” while impulsivity means acting on immediate urges without considering the possible complications.

Hyperactive-impulsive ADHD mainly affects children with ADHD but can persist into adulthood.¹ Some research suggests this type affects about 7% of those diagnosed with ADHD, compared to 31% with inattentive type and 62% with combined type ADHD.² Hyperactivity and impulsivity are also more common in boys (13%) than girls with ADHD (6%).³

Hyperactive-Impulsive ADHD Vs. Other Types of ADHD

While inattentive ADHD primarily involves difficulty focusing and organizing tasks, hyperactive-impulsive ADHD showcases heightened restlessness and impulsive behaviors.

Many times, adults can more easily recognize hyperactive-impulsive ADHD because symptoms are more observable in nature. However, these differences do not simplify the diagnostic process, as other factors impact symptom manifestation. In terms of prevalence, hyperactive-impulsive ADHD is considered less common than the inattentive or combined types.

Hyperactive-Impulsive ADHD Symptoms

Individuals with ADHD hyperactive-impulsive type may struggle to control impulses, act without thinking, and exhibit an ongoing need for movement. However, symptoms vary from person to person, with some individuals experiencing milder symptoms while others face more noticeable challenges. Symptoms may change over time and overlap with other types of ADHD.

Symptoms of Hyperactive-Impulsive ADHD in Children & Adolescents

Hyperactive-impulsive ADHD symptoms typically emerge in early childhood, becoming noticeable between the ages of three and six.¹ Children and adolescents with this ADHD subtype often display excessive restlessness, impulsive behaviors, and difficulty staying focused. These symptoms can significantly impact various aspects of their lives.

In school, kids may struggle with staying attentive and completing tasks, potentially affecting academic performance. In relationships, impulsive interruptions and restlessness can lead to conflict and strain. Symptoms can also disrupt daily routines at home, and parents may find managing the high energy levels challenging.

Symptoms of hyperactive-impulsive ADHD in children and adolescents include:

• Fidgeting or squirming: Children may tap their feet or move excessively, even when inappropriate.
• Trouble staying seated: Children and teens may struggle with sitting through tasks or activities, disrupting classroom settings or quiet environments.
• Impulsive interruptions: Children with hyperactive-impulsive ADHD frequently interrupt conversations or activities, struggling to wait for their turn to speak or engage in group tasks.
• Excessive talking: Some kids tend to talk excessively, sometimes blurting out answers or comments without waiting for others to finish speaking.
• Difficulty playing quietly: Hyperactive-impulsive ADHD can also create challenges in maintaining quiet, focused play, with kids preferring high-energy activities that involve constant movement.
• Risk-taking behavior: Impulsivity may lead to risky activities without considering potential consequences, such as climbing on dangerous structures or running into the street.
• Forgetfulness in daily activities: Forgetfulness in ADHD is common, with kids often forgetting to bring necessary materials or failing to follow instructions.
• Difficulty waiting: Some kids with hyperactive-impulsive ADHD may become impatient and frustrated when waiting their turn for a game or meal.

Symptoms of Hyperactive-Impulsive ADHD in Adults

Hyperactive-impulsive ADHD symptoms can persist into adulthood, though they may present differently from childhood. Adults with this subtype often struggle with impulsivity, making quick decisions without careful consideration. ADHD masking is also common in adulthood, with many hiding their symptoms. Hyperactivity may be less overt, presenting as inner restlessness or a constant need for stimulation.

Challenges in maintaining focus and completing tasks can affect work performance, leading to difficulties in professional settings. In relationships, poor impulse control may contribute to interpersonal challenges and, in the case of marriage, ADHD spouse burnout. 

Symptoms of hyperactive-impulsive ADHD in adults include:

• Low frustration tolerance: Adults with ADHD may be prone to angry outbursts and mood swings due to impulsive reactions to minor setbacks or obstacles. This behavior can affect relationships and work dynamics.
• Racing thoughts: ADHD-induced racing thoughts can make focusing on one task difficult. Additionally, restless thoughts can contribute to ADHD insomnia.
• Impulsivity in relationships: Adults may struggle with impulsive reactions in social interactions, such as interrupting others, making hasty decisions without consultation, or difficulty listening attentively. 
• Restlessness: As an adult, restlessness often occurs internally as a constant need for activity. This tendency can make relaxing or engaging in tasks requiring sustained attention challenging.
• Difficulty organizing tasks: Adults may struggle with organizing and prioritizing tasks, potentially leading to forgetfulness, missed deadlines, and ADHD paralysis.
• Workplace challenges: Impulsivity and difficulties sustaining attention may impact job performance, with adults facing challenges in maintaining focus, completing tasks, and managing time effectively.
• Procrastination: Individuals with hyperactive-impulsive ADHD are prone to procrastination. They may delay tasks or decisions often due to difficulty initiating and sustaining effort.
• Risk-taking behavior: Adults with hyperactive-impulsive ADHD may engage in risky behaviors, such as reckless driving, without fully considering the potential consequences.

What Causes Hyperactive-Impulsive ADHD Type?

The exact cause of hyperactive-impulsive ADHD is complex, involving a combination of genetics and environmental factors. Research shows a genetic component to ADHD, but evidence on the heritability of each subtype is limited.¹ Genetics is just one factor, and environmental influences also contribute to the development of ADHD.

Possible causes of hyperactive-impulsive ADHD include:

• Genetics
• Prenatal factors
• Birth-related factors
• Brain structure and function
• Environmental factors

Can I Have Just Hyperactive or Impulsive ADHD?

Predominantly exhibiting either hyperactive or impulsive symptoms is possible, but a diagnosis of hyperactive-impulsive ADHD implies the presence of both features. In clinical practice, a person could receive an ADHD diagnosis with the specifier “hyperactive-impulsive presentation” if they primarily demonstrate hyperactivity and impulsivity without significant inattentiveness.

However, professionals rarely give a diagnosis solely for hyperactivity or impulsivity without elements of the other category. The combined presentation, which includes symptoms from both inattention and hyperactivity-impulsivity, is the most common form of ADHD.

How Is Hyperactive-Impulsive ADHD Diagnosed?

The DSM-5 outlines specific criteria requiring the presence of at least six symptoms related to hyperactivity and impulsivity for a hyperactive-impulsive type diagnosis.⁴ These symptoms must be present across different settings, such as home, school, or work, for at least six months.

Diagnosis often begins with a thorough assessment by a qualified healthcare professional, which may include a psychiatrist, psychologist, or a specialized ADHD clinic. Assessments typically involve interviews, behavior rating scales, and a review of individual developmental history.

To prepare for a diagnosis, individuals or parents of children seeking an assessment should gather relevant information about the observed behaviors, including when they started and how they impact daily life. Any relevant family history, educational reports, or previous assessments are important. While the criteria for diagnosis are generally similar for children and adults, the specific manifestations of symptoms may vary across age groups, increasing the importance of age-appropriate assessments.

The diagnostic process for hyperactive-impulsive ADHD may include:

• Medical history review
• Psychiatric evaluations
• Behavioral observations
• Clinical interviews
• Behavior rating scales

Treatment for Hyperactive-Impulsive ADHD

Treatment for hyperactive-impulsive ADHD aims to alleviate symptoms and enhance daily functioning. A combination of behavioral therapy and medication is beneficial, but the choice between methods ultimately depends on individual needs and preferences. Treatment plans for children and adults may differ based on developmental and lifestyle considerations, but the core principles of addressing hyperactivity and impulsivity remain consistent across age groups.

Therapy focuses on developing coping strategies, organizational skills, and symptom management techniques. ADHD medications can help regulate neurotransmitters in the brain associated with attention and impulse control. Non-stimulant ADHD medications, such as Strattera, may be considered if stimulants are unsuitable. While symptoms may naturally improve with age, proper treatment can significantly enhance this progress.

Treatment for Children & Adolescents

Treating hyperactive-impulsive ADHD in children and adolescents involves a tailored approach to address symptoms at home, in school, and other contexts. A key component is behavioral therapy, which teaches strategies to manage impulsivity and hyperactivity. Professionals may also recommend medication if symptoms significantly impact daily functioning. 

Parental involvement is crucial, and educating parents about ADHD and how to support their child is often an integral part of the overall strategy. Teachers and parents collaborate to implement behavioral interventions and provide necessary academic accommodations in the educational setting. Fostering a supportive and structured environment at home and school contributes significantly to the success of ADHD treatment for children and adolescents with hyperactive-impulsive ADHD.

Treatment options for hyperactive-impulsive ADHD in children and adolescents include:

• Behavioral therapies: Behavioral therapies teach children and teens specific skills to manage their behavior, impulses, and attention. Cognitive behavioral therapy (CBT) for ADHD focuses on identifying and changing negative thought patterns and behaviors associated with ADHD.
• Parental coaching: Parents play a crucial role in supporting their child with ADHD. Parental coaching programs guide effective parenting strategies, behavior management techniques, and creating a structured and supportive home environment to address the unique challenges of hyperactive-impulsive ADHD in children and teens.
• Medication: Stimulant medications are the most commonly prescribed ADHD medication for children. They help regulate neurotransmitters in the brain, improving attention and impulse control in children with hyperactive-impulsive ADHD. Parents should monitor medication effectiveness and potential adverse effects carefully.
• School interventions: Collaborating with teachers and school staff is vital. Educational interventions may include specialized teaching strategies, classroom accommodations, and individualized education programs (IEPs) to support academic success and address behavioral challenges in the school setting. Legally, ADHD is considered a disability, and schools are required to accommodate a child’s needs.
• Mindfulness and relaxation techniques: Incorporating mindfulness for kids can help manage stress, improve self-awareness, and enhance impulse control. These techniques can contribute to overall symptom management and well-being.

Treatment for Adults

Treating hyperactive-impulsive ADHD in adults involves a comprehensive approach tailored to address symptoms at home, work, and in relationships. As with children, a well-rounded ADHD treatment plan for adults may include behavioral therapy and medication. 

Additionally, fostering a structured environment at home and work and incorporating stress-management practices can significantly contribute to success. Therapy can help adults with hyperactive-impulsive ADHD navigate challenges like managing professional responsibilities and maintaining relationships.

Treatment options for hyperactive-impulsive ADHD in adults include:

• Behavioral therapy: This involves adults learning practical strategies to manage their impulsivity, improve time management, and enhance organizational skills. Therapy sessions may focus on setting achievable goals and implementing structure in daily routines.
• Medication for adult ADHD: The most commonly prescribed medication for adults with ADHD is stimulants. Medications for impulsivity and hyperactivity can help adults practice positive symptom management. Careful monitoring and dosage adjustments are essential.
• Coaching and support groups: Coaching services and support groups tailored to adults with ADHD provide a platform for sharing experiences and learning coping strategies. This supportive environment can be instrumental in addressing common challenges faced by adults with hyperactive-impulsive ADHD. Online support groups are available as well.
• Cognitive remediation programs: These programs focus on improving cognitive functions such as memory, attention, and executive functions through targeted exercises and training. They aim to enhance the overall cognitive abilities that ADHD may impact.
• Mindfulness-based interventions: Mindfulness practices, including meditation for ADHD and mindful breathing, can help adults manage stress, improve focus, and prevent ADHD-induced emotional dysregulation. These techniques contribute to overall symptom management and well-being.
• Environmental modifications: Creating an organized and structured environment at home and in the workplace can significantly benefit adults with hyperactive-impulsive ADHD. This may involve implementing systems to reduce distractions and improve time management.
• Natural remedies for ADHD: Some adults explore natural remedies to treat their ADHD. These techniques may include dietary adjustments, exercise, and mindfulness practices to complement traditional treatments. Without replacing evidence-based interventions, these approaches may contribute to overall well-being.

When to Seek Professional Support

Adults with hyperactive-impulsive ADHD should consider seeking professional help when their symptoms significantly impact daily functioning, relationships, or work performance. Consulting a mental health professional is crucial if impulsivity, hyperactivity, or attention difficulties interfere with personal goals and well-being.

Finding a neurodiversity-affirming therapist who understands and respects neurodiversity can be important for a positive therapy experience. Online therapist directories or online therapy platforms specializing in ADHD treatment can be useful in locating such professionals. If considering medication management, finding a psychiatrist is advisable. Online psychiatrist options offer accessibility and convenience while ensuring proper evaluation and monitoring.