Ask the Experts

ADHD or Just Hyperactive?

Hyperactivity is a hallmark symptom of ADHD, but it’s not the only symptom. If your child can’t sit still — but she can focus, pay attention, manage time, and organize her thoughts — then the diagnosis may not be attention deficit hyperactivity disorder.

Q: “My six-year-old was diagnosed with ADHD, but I’m not sure she has all the traits. She can pay attention and gets very good grades – she just cannot sit still in class. Is there such a thing as just ‘hyperactivity disorder’?”

A: The Diagnostic and Statistical Manual of Mental Disorders recognizes three types of ADHD: primarily inattentive, primarily hyperactive or impulsive, and combined type. People with primarily hyperactive or impulsive ADHD act “as if driven by a motor” with little impulse control — moving, squirming, and talking at even the most inappropriate times. They are impulsive, impatient, and interrupt others. Symptoms of ADHD hyperactivity include the following:

  • Often fidgets with or taps hands or feet or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
  • Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
  • Often unable to play or engage in leisure activities quietly.
  • Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
  • Often has difficulty waiting his or her turn (e.g., while waiting in line).
  • Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).”

They key is that these symptoms must be present in at least two settings — for example, at school and at home — and they must interfere with the child’s functioning or development. ADHD cannot be the diagnosis if the only behavior is hyperactivity, especially if the hyperactivity occurs during specific situations.

If she’s only hyperactive during class, this might be due to anxiety, or perhaps she’s not being challenged by the work and gets bored. I’d discuss your concern with the doctor, and look for other causes of the hyperactivity.

ADHD Hyperactivity: Next Steps

  1. Take the Self-Test: Hyperactive or Impulsive ADHD in Children
  2. Take the Self-Test: Generalized Anxiety Disorder in Children
  3. Read: What ADHD Looks Like in Girls