Content

ADHD Hyperactive-Impulsive Type

Dorianne Green
Written by:
Dorianne Green
Medical Writer
Dr. Henry Bradford
Medical Reviewer:
Dr. Henry Bradford
MD

Highlights

  • Attention deficit hyperactivity disorder (ADHD) has three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined.
  • Predominantly hyperactive-impulsive ADHD is generally the rarest subtype in adults.
  • Hyperactive-impulsive symptoms are usually more subtle in adults than in children with ADHD.

When you think of ADHD in adults, you most likely think of attention deficit symptoms: someone who has difficulty paying attention and struggles to focus; their desk may be a mess, they’re forgetful, always late, or rarely meet deadlines. 

On the other hand, the younger children with ADHD you’ve come across often appear hyperactive. Running around screaming, climbing on furniture, and writing on walls, they appear naughty and out of control.

It might surprise you that adult ADHD hyperactivity symptoms exist; they just present differently. 

Let’s explore the symptoms, diagnosis, and management of hyperactive-impulsive ADHD in detail.

Get assessed for ADHD online by a licensed medical provider. Have a video consultation in 24 hours.

What Is Hyperactive-Impulsive ADHD?

Worldwide, attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed mental health condition. As the name suggests, there are two broad symptom groups: low attention and high energy (hyperactivity). But there are also symptoms indicating low impulse control (impulsivity).

In fact, in ADHD, hyperactivity and impulsivity go hand in hand. In 2013, ADHD diagnosis was no longer a ‘one description fits all’ condition, and three subtypes of ADHD were recognized:

  1. Predominantly inattentive subtype
  2. Predominantly hyperactive-impulsive subtype
  3. Combined (combination of the above)

Hyperactive-impulsive ADHD (ADHD-HI) is diagnosed when people with ADHD have high energy and low impulse control, which causes more life disruption than low attention.

"Predominantly hyperactive-impulsive ADHD is the least common subtype diagnosed in adults. While adults often internalize hyperactivity and develop coping strategies to manage impulsivity, these symptoms can still lead to significant internal stress which may be alleviated through ADHD treatment."
Dr. Henry Bradford, MD
Medical provider at MEDvidi

Next, let’s look at why people develop ADHD; the reasons are the same for inattentive and hyperactive-impulsive ADHD subtypes.

Causes and Risk Factors of Hyperactive-Impulsive ADHD

ADHD is one of the neurodevelopmental conditions, and usually starts in early childhood. These conditions happen when a trigger affects brain development and function, impacting learning, communication, behavior, and motor skills. Other examples include autism spectrum disorder (ASD) and specific learning disorders. 

So what are the triggers? They are usually genetic or non-genetic (environmental factors).

  1. DNA plays a significant role[1] , ADHD is highly heritable and often runs in families.
  2. Triggers in the person’s environment[2] might impact the brain, and these can happen before or after birth. Here are a few examples:
  • Alcohol, cigarette, or drug use during pregnancy.
  • Low birth weight.
  • Premature birth.
  • Exposure to chemicals or heavy metals like pesticides, lead, or mercury.
  • Longstanding issues with sleep quality.
  • Traumatic brain injury.
  • Stroke.

You might have heard that poor parenting, too much screen time, too few micronutrients, or too much sugar causes ADHD, but these are likely myths, as there is no clear evidence.

It is widely accepted that ADHD affects 3 to 6% of adults[3] , but a new article reports that 14.6% of US adults[4] may meet criteria for ADHD. So, if you’re reading this and thinking you might have ADHD, you’re not alone, and it’s not your fault.

Next, we’ll chat about how doctors make the diagnosis.

How Hyperactive-Impulsive ADHD Is Diagnosed

Healthcare professionals use the DSM-5[5] (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) to diagnose the predominantly hyperactive-impulsive subtype of ADHD.

What they are looking for in adults is:

  1. At least five symptoms in the following list:
    1. Moving hands and feet, rocking on chairs, or swiveling on chairs, clicking or tapping pens.
    2. Feels uncomfortable sitting for a normal time: at the dinner table, in a restaurant, in a meeting.
    3. A general feeling of restlessness; difficulty relaxing.
    4. Is generally loud.
    5. Always on the go, like a motor is driving them; other people can’t keep up.
    6. Talks a lot.
    7. Interrupts conversations, completes other people’s sentences.
    8. Extreme frustration and difficulty waiting in queues or traffic.
    9. Intrudes on others: takes over tasks or uses things without permission.
  2. Some of the symptoms were present before age 12.
  3. Some symptoms are present in two or more settings, such as at home and work.
  4. They are affecting the quality of life and causing poor functioning.
  5. No other mental health condition is causing the symptoms.

The hyperactive impulsive subtype makes up about 6% and 8%[6] of children with ADHD, and because hyperactivity symptoms decrease with age, the hyperactive-impulsive type in adults is far less common[6] .

Do you think you may have ADHD? Get assessed by a qualified medical provider online.

Inattentive ADHD Subtype vs. Hyperactive-Impulsive ADHD Subtype

A person with predominantly inattentive symptoms may experience difficulty concentrating, struggle to focus, be easily distracted. They may also make careless mistakes, be forgetful, frequently lose things, and have poor time management, resulting in being late for appointments and missing deadlines.

If you’re recognizing inattentive and hyperactive-impulsive symptoms in yourself, you might have combined ADHD. Why not take this free, 5-minute screening test to analyze your symptoms in more detail?

What Hyperactive-Impulsive ADHD Feels Like

If you ask a person with hyperactive-impulsive ADHD how they feel, this is how they may respond; let’s see if you relate to any of the answers.

Non-physical symptoms that the person with ADHD is experiencing internally: 

  1. “My mind races all the time, jumping from one thought to the next.”
  2. “Queues frustrate me; I’d rather leave or push in than wait my turn.”
  3. “It feels like there’s always something to do.”
  4. “I have trouble sitting for long because I feel trapped and uncomfortable.”
  5. “There’s a constant feeling of restlessness in my mind and body, and I struggle to relax.”
  6. “I feel like I’m constantly overworking, but I can’t stop.”
  7. “I feel like I’m losing my mind; I do unexpected things, like spending my whole salary, or drinking way too much, which I never do.”
  8. “I’m constantly disappointed in myself because of impulsive decisions that I regret; I have no self-control, like when I quit my job or the time I cheated on my partner.”

Physical symptoms of hyperactivity in ADHD can be seen and impact other people:

  1. “People think I’m rude when I take over tasks or use things without asking, but it’s because I feel like I need to get things done.”
  2. “I talk so fast that people miss half of what I’m saying.”
  3. “I can’t handle traffic and drive like I’m in a hurry, even when there’s no need. I think that’s why people don’t want to drive with me; and I’ve had accidents.”
  4. “I constantly fidget without even realizing it: tapping my fingers, bouncing my knee, clicking pens, rocking back and forth in chairs, picking at my skin, and pulling at my hair; it irritates those around me.”
  5. “I tend to be louder than others around me, even when I don’t mean to be; sometimes I’m the life of the party, and sometimes it’s inappropriate, and upsets people.”
  6. “I feel an urge to speak, so I interrupt people and even finish their sentences.”
  7. “I can’t handle incompetence, and I’ll cause a scene to prove a point; this embarrasses my family.”
  8. “At times, I feel like I can’t control my feelings, and I’ll just blurt something out, so people are always commenting about my mood swings.”
"While hyperactive symptoms in adults may be related to ADHD, they can also stem from anxiety, trauma, personality traits, or medical conditions. A thorough initial assessment is essential to identify the underlying cause and determine whether ADHD treatment is appropriate."
Dr. Henry Bradford, MD
Medical provider at MEDvidi

How Hyperactive-Impulsive ADHD Affects Daily Life

The physical or behavioral hyperactive and impulsive ADHD symptoms can be very disruptive in everyday life, affecting interpersonal relationships at work and within the family. They may also influence work quality, self-esteem, and even physical and mental health.

Colleagues, family, and friends may grow impatient with the inappropriate, loud, or high-risk behaviours described above, even though the person with ADHD has little control over the situation.

This affects the individual with ADHD-HI’s self-esteem, leading to them developing co-existing mental health conditions, such as depression, anxiety, and sometimes, both.

With the right treatment, it’s possible to avoid the significant impact of ADHD on daily life. Talk to a medical provider in 24 hours.

Hyperactive-Impulsive ADHD Treatment

The good news is that ADHD-HI is manageable with a combination of self-help strategies and a personalized treatment plan from a mental health professional. Let’s start with a few tips you can use at work and at home.

Coping Strategies and Self-Help Tips

  • Use fidget toys, stress balls, or chew gum: Satisfy your need to move in less obvious ways.
  • Empty your brain: When you feel your mind is overwhelmed with racing thoughts, write them all down and pick out what’s relevant.
  • Reduce stress and anxiety: The stress response triggers a surge in adrenaline, which can lead to increased hyperactivity and impulsivity. So, calm yourself with deep breathing exercises and mindfulness[7] , which involves intentionally recognizing your feelings without judgment.
  • Stay physically active: Not only will exercise decrease anxiety[8] , but it will satisfy your need to move.
  • Sleep more: High-quality sleep helps reduce ADHD symptoms[9] .
  • Ask someone to check your behavior: If you’re getting loud, annoying people, or appearing rude, they can gently pull you aside and make you aware.
  • Avoid traffic and queues: Plan your appointments and visit banks or attend meetings at quieter times of the day.

Medication

Medication is the pillar[1] of ADHD treatment and falls into two categories: stimulants and non-stimulants. The stimulants (amphetamines and methylphenidates) are the first choice because they have a high response rate, over 70%[3] of people.

Doctors use non-stimulant medication as a second-line treatment when patients can’t take stimulants because of side effects or co-existing medical conditions.

Medication for impulse control in ADHD

Therapy

Psychotherapy uses different approaches to help deal with sudden, regrettable decisions, restlessness, mood swings, and socially inappropriate behavior caused by predominantly hyperactive-impulsive ADHD.

Cognitive-behavioral therapy (CBT) involves changing thoughts with negative associated feelings into more positive ones. Other CBT techniques include self-control strategies. 

Family and marital therapy helps adults with ADHD rebuild relationships with loved ones. The patient with ADHD can learn how their behavior is affecting others, and family members can better understand how to deal with the display of ADHD symptoms.

In Conclusion

Pure hyperactive-impulsive ADHD is rare in adults; however, it does happen, although the symptoms are more subtle than those in children. Importantly, hyperactive-impulsive symptoms are also part of the most common subtype: combined ADHD.

If you’ve recognized some of the adult presentations of hyperactive-impulsive ADHD in yourself, and would like to find out whether you have this condition, book an online ADHD appointment at MEDvidi today; take the first step to get an accurate diagnosis and a personalized treatment plan.

FAQ

The rarest form of ADHD is the predominantly hyperactive-impulsive type; only 1 out of 10[3] people with ADHD has this subtype.

Hyperactivity in adults with ADHD might present with:

  • tapping or twitching hands and feet,
  • rocking or swiveling on chairs,
  • clicking or tapping pens,
  • feeling uncomfortable sitting for a normal period,
  • a general feeling of restlessness and difficulty relaxing,
  • racing thoughts,
  • generally being loud,
  • overworking,
  • always being on the go,
  • being told that other people can’t keep up with them.
Impulsive behaviors in adults with ADHD present as talking excessively and interrupting conversations; completing other people’s sentences; difficulty waiting in lines or traffic; taking over tasks or using things without permission; and taking risks or making spontaneous, regrettable decisions.

Yes, you can have inattentive and hyperactive ADHD; it is known as combined ADHD and is the most common subtype[3] .

No, you don’t have to be hyperactive to have ADHD; 2 out of 10 people[3] only have inattentive symptoms.

Sources

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9 sources
  1. Magnus W, Anilkumar AC, Shaban K. Attention Deficit Hyperactivity Disorder. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
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  2. Livingstone LT, Coventry WL, Corley RP, Willcutt EG, Samuelsson S, Olson RK, Byrne B. Does the Environment Have an Enduring Effect on ADHD? A Longitudinal Study of Monozygotic Twin Differences in Children. J Abnorm Child Psychol. 2016 Nov;44(8):1487-1501. doi: 10.1007/s10802-016-0145-9. PMID: 26993487; PMCID: PMC5027180.
    Source link
  3. Magnus W, Anilkumar AC, Shaban K. Attention Deficit Hyperactivity Disorder. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
    Source link
  4. Olagunju AE, Faraz Ghoddusi. Attention-Deficit/Hyperactivity Disorder in Adults. American Family Physician. 2024;110(2):157-166.
    Source link
  5. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison.
    Source link
  6. Gibbins C, Weiss MD, Goodman DW, Hodgkins PS, Landgraf JM, Faraone SV. ADHD-hyperactive/impulsive subtype in adults. Ment Illn. 2010 Sep 9;2(1):e9. doi: 10.4081/mi.2010.e9. PMID: 25478092; PMCID: PMC4253348.
    Source link
  7. Bachmann K, Lam AP, Philipsen A. Mindfulness-Based Cognitive Therapy and the Adult ADHD Brain: A Neuropsychotherapeutic Perspective. Front Psychiatry. 2016 Jun 27;7:117. doi: 10.3389/fpsyt.2016.00117. PMID: 27445873; PMCID: PMC4921925.
    Source link
  8. DeBoer LB, Powers MB, Utschig AC, Otto MW, Smits JA. Exploring exercise as an avenue for the treatment of anxiety disorders. Expert Rev Neurother. 2012 Aug;12(8):1011-22. doi: 10.1586/ern.12.73. PMID: 23002943; PMCID: PMC3501262.
    Source link
  9. Becker SP. ADHD and sleep: recent advances and future directions. Curr Opin Psychol. 2020 Aug;34:50-56. doi: 10.1016/j.copsyc.2019.09.006. Epub 2019 Sep 20. PMID: 31629217; PMCID: PMC7082190.
    Source link
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Dorianne Green
Written by:
Dorianne Green
Medical Writer
Dr. Henry Bradford
Medical Reviewer:
Dr. Henry Bradford
MD
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