What Does Hyperactive ADHD Look Like?

Understanding the symptoms of hyperactive/impulsive type ADHD can be difficult, even more so in adults than children. It is tempting for us as nurses to armchair-diagnose the disorder in our coworkers, our neighbors, celebrities, even in our patients. However, ADHD symptoms aren’t widely understood and the condition is often stigmatized. This article is the second in a series that I hope will shatter some misconceptions and bring the facts of ADHD out into the open.

  1. What myths have you heard about ADHD ?

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      People who have ADHD are stupid or lazy - they never amount to anything
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      ADHD is over-diagnosed
    • 6
      Television and red food dye cause ADHD
    • 11
      ADHD isn't real
    • 1
      Something else, I'll leave it in a comment

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What Does Hyperactive ADHD Look Like?

FACTS: Hyperactive/impulsive behaviors

Unable To Be Completely Still

Children often fiddle with pencils/crayons in class, fidget, tap their fingers or their toes, take overshirts or jackets off and put them back on, toy with their clothing or with fasteners, click pens, etc.

Teens and adults tend to bounce their knees, doodle, take excessive notes, pass notes in class, flip through textbooks, read and reread agendas or other meeting documents, flip through reports, twirl pens, tap pens, change positions frequently, and so forth.

Have A Hard Time Remaining Seated

Children will get up frequently in class, ask to use the bathroom frequently, find excuses to get up and look out the windows, get up while eating, get on the floor while supposed to be sitting, and get up for frequent snacks and bathroom breaks while doing homework.

Teens and adults will offer to do tasks that require standing or walking, claim that sitting hurts their back and stand against the wall, shift position frequently, leave to get beverages or snacks. They may also take frequent bathroom breaks, get up and down for extras during dinner, clean or do several other tasks while watching television, and stand or walk around while talking on the telephone.

Tend To Run Around Or Climb Inappropriately

Children will often display these behaviors while participating in sports or other structured activities; to the child with ADHD, the world is often a fascinating obstacle course.

Teens and adults have usually learned to stop doing this, but are often restless. This behavior can be exaggerated in situations where it is appropriate, such as while participating in sports or outdoor activities. Patients will often search out opportunities to be physically active, like participating in martial arts, taking self-defense classes, running obstacle courses and marathons, or sports.

Tend To Get Loud While Participating In Quiet Activities

Children can be loud, argumentative, and confrontational during structured quiet time.

Teens and adults often show this while watching sports or television by talking to or yelling at the screen, as well as by becoming overly competitive and loud while playing board or card games.

Seem Unable To Stop And Rest

Children may be unable to stop themselves from an enjoyable activity, or may complete one activity and dive straight into the next; this is characterized as acting as though they are "driven by a motor."

Teens and adults may display "driven" behaviors towards school, work, or leisure activities. This can be mistaken for commitment, but is similar to short-term obsession. The teen and adult with ADHD are frequently enthusiastic to the extreme about a new project, video game, garage band, concept for entrepreneurship, and so on. Teens may stay up all night playing music or games even though they have class the next day. Adults may be unable to stop work in the middle of a task and continue on to finish it even though it takes hours and affects sleep patterns. Artists and craftspeople may work without sleeping until exhausted or until a project is complete. In teens and adults, this symptom can be mistaken for mania. Another term for this symptom is hyperfocus.

Talk When It Is Inappropriate

Children may talk excessively in class or during activities, tell stories constantly, socialize during class time, and may be characterized as a "motormouth."

Teens and adults may dominate conversations, especially when excited, or talk over others.

Tend To Blurt

Children do not wait to be called on and shout out answers in class or at home even before the question is finished, say whatever they are thinking without thought to the consequences, and change subjects in the middle of sentences.

Teens and adults answer questions before they are finished, make uncensored comments, say hurtful things without meaning to, and have trouble staying on topic.

Doesn't Want To Take Turns

Children have a hard time waiting for their turn, preferring for it to be their turn all the time. They may become frustrated and tearful when it is another child's turn.

Teens and adults may lose interest in long games and look for a more exciting activity, break in line, or get frustrated while waiting in line and leave.

Butts In

ADHDers often miss social cues that indicate an intrusion is not welcome and will do things such as interrupt speakers, interject during movies, walk through a photo op, barge into rooms, and break into other's conversations. These patients may be labeled as a "busy-body."

Impulsive

For ADHD children, action is often synonymous with thought; an affected child will chase after something it sees that it wants, change direction mid-stride, break into running, slide to a stop, grab for things without being careful, snatch toys, hit other children, scream suddenly, or throw things when frustrated.

Teens and adults often make poorly thought out decisions, such as choosing a college because their friend got in, taking the first job offered, spontaneous road trips, sudden turns while driving, making expensive purchases on a whim. These patients may be described as "flighty."

FICTION:

"Only boys are hyperactive." Females are diagnosed with hyperactive/impulsive type ADHD, as well as combined type. In females, the trait displays more as excessive talking and hyper-social behavior.

"There's nothing wrong with that child except a lack of discipline." While discipline and structure can help a child mitigate behavioral symptoms, the underlying ADHD is not cured.

"Boys will be boys!" The often out-of-control behavior that is typical of males with hyperactive/impulsive symptoms is not a normal manifestation of maleness. These children often need help to learn how to regulate their behavior.

"There's nothing wrong with that girl except too much pent-up energy." While getting enough exercise is an important element in treating ADHD, it is only part of a complete treatment plan.

"That's just a bad kid." Children with ADHD are not inherently bad. With proper treatment, they can be very successful.

First article in the series: Stupid, lazy, or ADHD?

References

American Psychiatric Association (APA), "What is ADHD?"

What Is ADHD?

National Institute of Mental Health (NIMH), "Attention Deficit Hyperactivity Disorder"

NIMH >> Attention Deficit Hyperactivity Disorder

The Centers for Disease Control and Prevention (CDC), "Symptoms and Diagnosis"

Symptoms and Diagnosis | ADHD | NCBDDD | CDC

Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) The National Resource on ADHD, "About ADHD:

About ADHD | CHADD

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canigraduate

About canigraduate

I have been a nurse since 2012. I have worked in four different hospitals in several services and am currently an agency/travel nurse.

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Any myths I've heard I've tried to counteract with research and facts, and tried to treat each child as an individual.

Great article.

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I have it. Albeit a very mild case. Diagnosed as a child. My parents were told it was to mild to *edit* I mean medicate.

I asked for medication at one point because I was having trouble focusing.

I was told it wasn't possible because of depression.

So I have to force myself to become interested.

When I do ussually it's great I can get mountains of work done in a short stretch.

When I get to ahead though I have trouble getting focussed again, and that causes problems.

Its a mild case, so it could be quite different from others. My patrents told me. I don't remeber the diagnoses.

I find I need to enjoy the topic, or it probably won't end well for me.

I was like that as a kid. Sometimes I would excel, but then I would become disinterested because I knew I had time.

Well sooner, or later time runs out, and while at times I would excel at others I wouldn't nearly live up to my perceived potential.

Of course every one always telling

Because I could do mountains of work I started relying on it, and that wasn't healthy.

I still do it though. I know if I don't force myself to enjoy a topic I will fail. I do well at times when I am riding high. Bumps I don't handle so well. Because I have been down that road so many times. So either I pack it in when I am still in a good position, or I overcompensate.

Its probably not relatable to other people's experiences. As it's supposed to be a very mild case, but I do love being on my feet. Frequently I volunteer for high movement jobs. Just so I can stay active.

I enjoy distractions. So I try to translate my work into a pastime, so I never fail to stay engaged.

Sooner, or later though my mind starts to wander again. Especially when I feel like I am not at my best.

Which lately has been all the time. I try to distance myself from any distractions, but either that leads to me working to much, or having no work to do at points.

Which leads ads me to wander back to distractions I know I should avoid. Because they just become to frequent to try to keep up with. Because everything interests me, and that's why sometimes it's hard to focus on the things that should be focused on.

It ussually ends up leading to all work and no play, or all play and no work.

I think I need a focused hobby for this. As keeping my attention on something tends to keep me out of trouble.

Its weird I don't like relaxing things, except sleep. So hobby

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Any myths I've heard I've tried to counteract with research and facts, and tried to treat each child as an individual.

Great article.

Thank you! School nurses rock.

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Gavin, hobbies are good things for those of us with ADHD. Not so much for the people around us, though, as we tend to leave projects unfinished and laying around the house. I find that I do better with two or three different projects at a time. That way I can rotate when I get bored and I have a better chance of finishing.

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Dint critic me spelling!

That was a joke. I couldn't edit my original post.

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Specializes in adult psych, LTC/SNF, child psych.

I have ADHD, inattentive type and boy does it make nursing hard sometimes. I work in child psych and sometimes I'm as bad as the kids if I've missed my medication when it comes to blurting out an answer without thinking.

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Great article! As someone with RBADD (Really Bad :-) I've come to appreciate that it is not really a deficit but rather a surplus of attention that we are blessed with. We try to pay attention to too many things all at once and get overwhelmed. That is why Thom Hartmann in his work said we are hunters not farmers, and why we make great entrepreneurs (we are very good at starting things) but are not so good as managers (we're not so good at maintaining things). Sometimes the problems people with ADD and ADHD experience have less to do with the individual and more to do with the context.

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I was recently diagnosed with adult ADHD in May of this year. I'm 32 years old, and I have to recognize that despite all of the resources available, I was completely ignorant about ADHD. I refused to believe that there was something wrong about me, I thought I was just different from others and that my quirkiness made me somewhat special. I was very upset when I received the diagnosis and I felt inadequate when I had to start therapy along with medication. I took pride at never filling my body with unnecessary medications, and staying healthy. I always thought that if I went down that road, I was going to be labeled as "weak" and somehow my worth as a person, a professional, and a student was no longer going to be "enough."

I really struggled trying to cope with the changes in medications, and finally accepting that there was something "wrong" with me and that I needed help. I became depressed and upset at the diagnosis, it has been a long road to acceptance of myself and my new ways to cope with ADHD, I don't tell anyone of my condition, people can be so hurtful to others when they perceive a weakness. I have tried really hard to make my peace with it, but I feel less than when I start realizing that my anxiety and my ADHD are affecting my school and my work.

My hope is for one day to have more awareness about disorders like ADD and ADHD, just because you don't see it it doesn't mean is not there.

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Gavin, hobbies are good things for those of us with ADHD. Not so much for the people around us, though, as we tend to leave projects unfinished and laying around the house. I find that I do better with two or three different projects at a time. That way I can rotate when I get bored and I have a better chance of finishing.

I thought I was the only ones who does this! I've been diagnosed with hyperactive ADHD since I was a young child and I've found that the only way I can stay focused is to have more than one thing to do at once. I find it too difficult to try and put all my attention towards one thing (unless I'm in one of those hyper-focus moods then nothing can pull me from that project lol)

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If you haven't already read the books by Ned Hallowell: Driven to Distraction, Driven to Distraction at Work, and Delivered from Distraction. Also recommended is his book Worry.

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I remember my supervisor making a comment to me that I seemed to have ADHD when she noticed that I am used to move frequently during my classes. For the first time, I got defensive and said I am just changing my position to make myself comfortable. But watching me over and again, she became obsessed that I certainly have this ADHD and started recommending me some medications which I found funny. I always thought only children have this problem until I started to know more about its symptoms. More I learnt about it, more it made sense to all the activities I perform with no initial thinking. I felt like I have so many symptoms in common. But until now, I feel I have no problems with my daily living because of it and I haven't made any effort to get treated medically. I don't know if it's really that severe to get pharmacological treatment. I tried to learn meditation on my own but I have problem concentrating while doing it. I rather find working physically more interesting than doing something being seated somewhere i.e. reading. I would be glad to know what-else can be recommended to people with ADHD to become less distracting and more focused.

Anyway, thank you for the nice article.

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