ADHD:Hyperactive/Impulsive Type: Explained in Plain Language
Imagine seeing this person in a meeting. Your observing as if a flay on the wall. Their knee is bouncing. Their pen is going. They're halfway out of the chair reaching for a water they don't need. They can’t sit still. You might not think twice or maybe you think their anxious or have to go to the bathroom. However, for the person with ADHD Hyperactive/Impulsive type it’s none of those things. In fact the feeling of needing to sit still is almost painful.
In this weeks article we dive into ADHD Hyperactive type (in plain language). Let’s dive in!
The Criteria
The DSM V, the Diagnostic and Statistical Manual, is the set of criteria we use to make mental health diagnoses. It's the standard clinicians work from.
It's also worth being honest about its limits. Real life and real experience aren't fully captured inside a manual, and plenty of what people live through doesn't appear anywhere in it. But as things stand today, this is how diagnoses get made. So looking closely at the criteria gives us a genuinely good sense of what hyperactive-impulsive ADHD is.
One note before the list. There are two other presentations, inattentive and combined, and each has its own criteria and its own article. This one is only about hyperactive-impulsive.
The threshold that comes before the list
Before any of the nine symptoms count for anything, the DSM sets a bar.
Six or more of them have to have persisted for at least six months, to a degree that's inconsistent with someone's developmental level, and they have to negatively affect social, academic, or occupational life. If you're 17 or older, that number drops to five.
There's also a note attached, and it matters. The symptoms can't be solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand the task or the instructions in front of you. If that's what's happening, this may be something else.
That phrase about developmental level is the one people skim past. As you read the nine, a lot of them are going to sound “normal”, or “normal” for a particular stage of life. The threshold exists to say it has to go past that. Not “typical” development, but something that's fallen outside those bounds. 📋
The nine criteria, in plain language
Often fidgets with or taps hands or feet, or squirms in their seat.
Often leaves their seat when staying seated is what's expected. A classroom, an office, anywhere that assumes you'll stay put.
Often runs about or climbs in situations where it doesn't fit.
Often unable to play or do leisure activities quietly.
Often "on the go," acting as if "driven by a motor." Uncomfortable being still for any stretch, in restaurants or meetings. Other people may experience this as restless, or as hard to keep up with.
Often talks excessively.
Often blurts out an answer before the question has finished. Finishing people's sentences, unable to wait for a turn in conversation.
Often has difficulty waiting their turn, including waiting in line.
Often interrupts or intrudes on others. Butting into conversations, games, or activities. Using someone's things without asking. For adults and adolescents, this often looks like taking over what another person was already doing.
Two more conditions:
Several symptoms have to have been there before age 12. Twelve is a fairly arbitrary number, and I'll say that plainly, but it's in the DSM and the idea underneath it isn't arbitrary at all. It has to have been persistent across the lifespan. It can't have started last week or last month. ADHD doesn't begin in adulthood. It's always been there.
Symptoms have to show up in two or more settings. If you talk excessively at work and nowhere else in your life, that's probably something about work. This isn't limited to one part of your life. It spills into nearly all of them.
Why this keeps getting called something else
Here's the part that frustrates me most.
Read those nine again and almost anyone can find themselves in one or two. Fidgeting, interrupting, talking a lot, hating stillness. On paper it looks clear and obvious. In practice it's a lot more gray, because there's a degree of ordinariness in nearly every criterion, and we all experience them at some point or another.
So people get labeled instead of understood. Someone with ADHD is told they have too much energy. Someone else is told they're rude. Or lazy. 😕 The behaviors look like everyday behaviors everyone deals with from time to time, so nobody goes looking for the pattern sitting underneath.
It also looks a great deal like anxiety. I made a video on that recently, and if you read some of these symptoms without knowledge of ADHD, anxiety is a completely reasonable guess, but it can be the wrong one.
If you're recognizing yourself in this
Two things that may help.
Research broadly. Watch things, read things, and be picky about the source. Credible resources only. As you take more in, you start to understand a lot more about what ADHD actually is and what it looks like in a real life. That understanding is worth having on its own.
Then find a professional who knows ADHD. Not just aware of it. Educated on it, with training and real expertise in it. Not every mental health professional understands ADHD, and that's exactly where the mislabeling happens. A client comes in, the clinician isn't familiar with it, and it gets called anxiety, or depression, or a lot of energy. The plan built on top of that never quite fits.
What actually helps
The good news is that there's a lot here.
Medication helps many people. So do specific therapy approaches, DBT and some forms of CBT among them. Executive function coaching helps too. All of it helps to varying degrees, because everyone's experience is different. Some people need medication. Some need more therapy, or more coaching. Most need some combination that shifts over time.
There's no single correct package. What's true is that this can be taught, learned, and worked through, and people live with hyperactive-impulsive ADHD far more effectively once the right support is around them.
Get in touch with us…
PRGRS Therapy is a group practice based in New York City that specializes in ADHD. We offer ADHD treatment New York State residents can access from wherever they are, and we make content like this because ADHD is a subject most people know far less about than they deserve to.
If you want to talk it through with someone who works with this every day, the link is below.
