ADHD: Hyperactive-Impulsive Type

Medically Reviewed by Zilpah Sheikh, MD on October 22, 2023
5 min read

Hyperactive-impulsive attention-deficit/hyperactivity disorder (ADHD) is a type of ADHD for which the main symptoms are near-constant movement and/or trouble controlling behavior. Kids who have it tend to act without thinking first. Maybe your child can't sit still. They're talking a mile a minute at times that aren't OK.

Hyperactivity is just one sign of ADHD. Kids who have it seem to always be on the move. Kids who are impulsive may interrupt when you're talking. They may play out of turn.

Adults can also have hyperactive-impulsive ADHD. But it's less common because hyperactivity tends to lessen with age.

No single test can tell for sure that your child has hyperactive-impulsive ADHD. Your doctor will first try to rule out other things that can cause hyperactivity and impulsivity. It could be stress or emotional issues. The behavior might simply be normal for their age. Sometimes, vision problems or learning disabilities can make it hard for a child to sit still.

The doctor will look for these symptoms of hyperactivity and impulsivity:

  • Fidgeting or squirming (not being able to sit still)
  • Nonstop talking
  • Trouble focusing on quiet tasks such as reading
  • Running from place to place; acting like they're driven by a motor
  • Constantly leaving their seat, jumping, or climbing on furniture and other places they shouldn't
  • Being impatient
  • Blurting out comments or answers at times they shouldn't
  • Interrupting when people are talking or speaking out of turn
  • Trouble waiting for a turn or standing in line
  • Not recognizing when situations are dangerous
  • Often getting into trouble

Many children who like to run and jump may have high energy. But that doesn't mean they have hyperactive-impulsive ADHD. To count as ADHD, symptoms have to be on the extreme side and cause problems in the child's life. Also, they have to have the symptoms for at least 6 months.

For a doctor to diagnose ADHD, your child must also:

  • Have had signs of it before age 12
  • Show symptoms in more than one place, not just at home
  • Not have some other condition that better explains their hyperactivity and impulsivity

Kids with ADHD usually still have it once they grow up. If you're an adult and think you may have hyperactive-impulsive ADHD, ask your doctor. The signs may look different in older teens or adults. Instead of physically moving around a lot, you may be restless or jump from one activity to the next.

There's another type of ADHD called inattentive ADHD. The main symptom of this type involves trouble focusing. Children who have it are easily distracted and may seem to daydream or zone out. They may lose things a lot, make careless mistakes, or have trouble finishing chores or other tasks.

But they may not often seem restless, move constantly, or blurt out inappropriate comments.

Most people with ADHD have symptoms of both hyperactive-impulsive and inattentive ADHD (called the "combined type"). They may be always on the go and have trouble staying organized. If your child has ADHD, the signs may also change over time.

As with all types of ADHD, the causes of hyperactive-impulsive ADHD aren't clear. Scientists say it's due in large part to genes passed down from parent to child. But experts aren't sure yet which specific genes make it more likely to get ADHD. A child is more likely to have ADHD if a close family member has it.

Other things that may raise the risk for ADHD:

  • Cigarette smoking and alcohol use during pregnancy
  • Being born premature
  • Low birth weight
  • Being exposed to lead during early childhood
  • Brain injuries

Many parents think sugar makes their child hyperactive. But there is no evidence that refined sugar causes ADHD or makes it worse.

There may be a link between ADHD and food additives such as artificial colors and preservatives. But that hasn't been confirmed.

Once your child is diagnosed with hyperactive-impulsive ADHD, the next step is to treat it. Every child's treatment plan can be different. Sometimes, it takes trying a few things to find the right one.

ADHD treatment usually starts with medication. Doctors can use several types of drugs to treat it.

Stimulant drugs. Despite their name, stimulant drugs don't rev up or excite kids with ADHD. They calm them down. These medications include:

  • Dexmethylphenidate (Focalin, Focalin XR)
  • Dextroamphetamine/amphetamine (Adderall, Adderall XR)
  • Lisdexamfetamine (Vyvanse)
  • Methylphenidate (Concerta, Quillivant XR, Ritalin)
  • Serdexmethylphenidate/dexmethylphenidate (Azstarys)

They come in different forms, including:

  • Pills (tablets and chewables)
  • Capsules
  • Liquids
  • Skin patches

No stimulant has been proven to work better than others. Each child responds differently to these medicines.

Nonstimulant drugs. Although nonstimulant medicines may not work as well as stimulants, they have fewer side effects. This type of medication includes:

  • Atomoxetine (Strattera)
  • Clonidine ER (Kapvay)
  • Guanfacine ER (Intuniv)
  • Viloxazine (Qelbree)

High blood pressure medicines are another choice. These drugs can help control impulsivity and hyperactivity symptoms.

  • Clonidine (Catapres, Kapvay)
  • Guanfacine (Intuniv, Tenex)

Antidepressants. Drugs that affect mood, including bupropion (Wellbutrin), sometimes help with ADHD symptoms.

Often, a child will need a combination of medicine and other treatments. You may need to work with your doctor to adjust the medicine as your child's symptoms change and as they grow.

Parents and pediatricians should watch carefully for side effects of medicine. Common ADHD stimulant drug side effects include:

  • Loss of appetite
  • Weight loss
  • Slowed growth
  • Disrupted sleep
  • Irritability
  • Tics(sudden, repetitive movements and sounds)
  • Anxiety

Stimulant medications have also been linked to more serious side effects, including:

  • Heart problems
  • Psychiatric problems (such as hallucinations or hearing voices)

Strattera and antidepressant medications also may cause suicidal thoughts in children and teenagers.

Because of these rare risks, it's important to call your doctor right away if you notice any unusual symptoms in your child. While taking these medicines, kids should have the following carefully checked:

  • Height
  • Weight
  • Blood pressure
  • Heart rate

Along with medicine, behavior therapy can help with hyperactivity. A psychologist or therapist can help kids with ADHD learn how to spot and control their hyperactive and impulsive behaviors.

Kids can learn how to create and follow routines. They can also work to improve their social skills. Parents and teachers can use a system of rewards and consequences to reinforce good behaviors.