Hyperactivity and Adult ADHD
Hyperactivity (i.e., excessive movement not fitted to the setting in which it occurs) in adults may look different to how it presents in children with ADHD. Adults with ADHD may find that hyperactivity has lessened with age but now manifests more as fidgeting or, they may tap their feet or hands when seated, shift in their seat or be generally restless or, they may be verbally verbose or talk very fast.[1]
Adult ADHD and Type of Presentations
What is typical behaviour and what is ADHD? Almost everyone has some symptoms of ADHD at some point in their lives. If your difficulties are recent (e.g., thyroid issues, menopause or other medical or psychiatric issues; major life changes, or less structure) or only occurred occasionally in the past, you probably don’t have ADHD.
ADHD is only diagnosed when symptoms are severe enough to cause ongoing problems in more than one area of your life. These persistent and disruptive symptoms can be traced back to early childhood.
Adult ADHD symptomology is characterised by
persistent inattention and/or hyperactivity - impulsivity.
inattentive or hyperactive-impulse symptoms that were also present prior to the age of 12 yrs.
inattentive or hyperactive-impulse symptoms that are also present in two or more settings e.g., home, work.
clear evidence that the symptoms interfere with or reduce the quality of, social, academic, or occupational functioning.
There are three types of presentations in Adult ADHD:
Inattentive presentations (no hyperactivity, no impulsivity)
Hyperactive-impulsive presentation (no inattention)
Combined presentation (both hyperactivity and/or impulsivity and inattention)
There are three severity levels:
Mild – few, if any, symptoms in excess of those required to make the diagnosis are present, and the symptoms result in no more than minor impediments in social or occupational functioning.
Moderate – symptoms or functional impairment between “mild” and “severe” are present.
Severe – Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.
This blog post is primarily concerned with the hyperactive symptomology. If you have the hyperactive-impulsive presentation or a combined presentation, please also see the separate blog post on Impulsivity and Adult ADHD and Inattention and Adult ADHD.
What causes ADHD?
There is no single identified cause of ADHD; rather, there are a range of factors relating to people’s genes, neurobiology (the structure and function of the brain) and prenatal, perinatal, and postnatal environmental influences that increase their chances of developing ADHD.[2]
Williams et al. note in their review of Adult ADHD that Posner and colleagues research found that the prenatal and perinatal risk factors substantially associated with ADHD consisted of “prematurity, low birth weight, maternal smoking history, stress, trauma and obesity”[3]. ADHD symptomology was found to be exacerbated by “postnatal risk factors such as trauma, parenting style, artificial colours and fragrances, pollutants, and pesticides.”[4]
What does Hyperactivity look like in Adult ADHD?
Adults exhibiting hyperactive symptomology may find themselves experiencing:
Restlessness – the constant need to move or feelings of agitation or being “on edge”[5]. A sense of as if driven by a motor. The DSM 5 – TR gives the example of being unable or uncomfortable being still for extended periods of time as for example when in a meeting or in a restaurant.
Fidgeting - in adults, hyperactivity becomes less visible and more likely manifests as fidgeting behaviour such as with excessive feet or hand movements or shifting in one’s seat, playing with a pen or repeatedly checking their phone but can also be auditory.
It is important to recognise that everyone fidgets. However, for those adults with ADHD it can be a positive tool to burn off excess energy and help harness focus on tasks.
When a person with ADHD is fidgeting, it may indicate that they are:
under stimulated, bored, nervous/anxious/stressed or impatient.
subconsciously replacing or masking their hyperactivity depending upon the situation.
fidgeting to provide a break from racing thoughts, help with emotional control as well as harness focus. Fidgeting can help the person with ADHD to focus on the task to be performed provided the fidget does not require more concentration than the task or more constant attentional awareness.
Research suggests that when engaged with fidgeting behaviour whilst performing an under stimulating task, it arouses the brain to actually improve overall performance with respect to the task. Consequently, it is important to identify behaviours that don’t further distract from the task at hand, and which specifically work for you and the task you are trying to complete.
Work difficulties – the degree to which an adult worker with ADHD has difficulty will be directly related to the symptoms that they have. They may for example, miss salient information as they may have difficulty sitting still or require frequent breaks when in a meeting.
Racing thoughts[6] - mental restlessness. It may be that when the adult with ADHD tries to be still, they are flooded with thoughts which can result in agitation, discomfort and guilt.[7]
Getting bored easily - When bored, you might suddenly zone out on the task at hand. Adults with ADHD seek boredom relief which can trigger behaviours such as fidgeting or acting out. This can frustrate the individual and people around them, which can lead to feelings of rejection and increased isolation.
Talking excessively and social and relationship difficulties – excessive talking might manifest as over-explaining or “info-dumping” (i.e., talking at length and excitedly about a topic you enjoy).[8] Research suggest that adults with ADHD have difficulties understanding social cues, attuning their behaviour to other people and have a more difficult time of keeping friendships.[9] In intimate partner relationships the non-ADHD partner may interpret the restless behaviour as boredom or that their partner doesn’t care enough about them to participate in an activity that interests them.[10] It can be a source of conflict and devolve into blame and criticism.
Craving Excitement[11]
Chronic Multitasking – this may be triggered by the restlessness.
Difficulty staying focused on tasks – see the blog post on Inattention and Adult ADHD for strategies to address this
Time and organisation challenges – see the blog post on Inattention and Adult ADHD for strategies to address this.
Frequent mood swings[12] - see the blog post on Impulsivity and Adult ADHD for emotional regulation strategies
How is ADHD Manifesting in You?
Gain clarity around your particular symptoms of adult ADHD. How is it manifesting itself in your life?
Self-reflection is important. Consider Journalling to write about this. You might start with asking yourself the following questions:
How is my ADHD manifesting?
What are the behaviours?
What are the positive and negative consequences of the behaviours?
What precipitates the behaviours?
What patterns do I see?
How is it impacting me?
Strategies to Manage Hyperactivity
The following strategies are not exhaustive. Try what resonates with you and find what works for you so that you can incorporate them into your own tool kit:
Restlessness
Develop a system capable of managing your restlessness. For example, engage with a physical activity across the day e.g., short exercise breaks, take the stairs whenever possible, take the long way around to facilities in the office or consider volunteering to do minor errands.[13]
Wherever possible, leave the office during lunchtime. Block this time out in your electronic calendar as an automatically reoccurring item. That way a meeting cannot be booked with you at that time. Leave the office - even if it is only to walk around the block. Do not eat lunch at your desk in the misguided belief that you will accomplish more by doing so. More often than not, it will be an invitation to colleagues, with their own workload issues, to interrupt you. Leaving the office allows your brain to recharge and be exposed to different sights and sounds. It is also an ideal opportunity to daydream which allows the brain to restore and recalibrate itself thereby allowing you to be more innovative and productive at work.
Fidgeting
It is important to identify behaviours that don’t further distract from the task at hand, and which specifically work for you and whatever task you are trying to engage with and complete. Here are some strategies to try[14]:
Set a fidgeting time limit – for how often and for how long you will fidget.
Find an Accountability Partner – they will be able to advise you if you have been fidgeting for too long.
Play with pens – twirl between fingers.
Use Fidget Toys – These can vary from spinners to buttons, to stretchy toys and a fidget cube.
Knit or crochet – this is a great fidget option due to the repetitive motions required through the activity. This is preferable for those who know how to knit or crochet. If one is new to this skill, it may take more focus which could deviate a person from the task they seek to accomplish.
Tap your fingers – Tapping one’s fingers on the surface of an object may provide an outlet for excess energy and thus be a productive fidget strategy. However, in performing this fidget, it is important to be conscious of those around them to avoid distracting others or being disruptive.
Wiggle Your Toes – Wiggling one’s toes will provide an outlet for excessive energy and may be less disruptive to others.
Chew gum – This provides a simple repetitive motion to stimulate one’s brain without requiring intense mental focus.
Doodling and Colouring in – find or create a simple artwork that doesn’t require intense focus.
Play with Textured Items – touching items with texture will provide mental stimulation as it processes the texture without distracting from the task at hand. Keep a box of sensory items handy on your desk.
Use a stress ball – this is a transportable item to keep on hand throughout the day. The repetitive motion of squeezing and releasing will stimulate the brain.
Use a stretch band – stretch bands offer tension/resistance with which to engage in that doesn’t require too much focus.
Sit on balance balls – bouncing on yoga or balance balls may help you focus your attention on the task at hand. However, you need to be aware of your ability level when attempting this fidget strategy as you don’t want the activity to be more distracting than helpful.
Pace or walk – pacing or walking will stimulate the body without distracting the mind. Moving throughout different spaces will provide simple stimuli to the mind as it observes a new setting, whilst the walking/pacing motion will stimulate the body.
Engage in physical activity – even if it is stationary like an under-desk treadmill, under the desk bike pedals or other machines that will allow for engagement in physical activity without taking one away from the workplace.
Listen to music or ambient noise – a sound machine will stimulate an individual’s mind and prevent them from becoming distracted by other environmental stimuli.
Brown noise is particularly conducive to ADHD focus i.e. brown noise also called red noise, produces a rumbling sound that’s deeper than a bass-like tone. The sound level decreases as the frequency increases. It is similar to a steady heavy rainfall or shower with good pressure.
Listen to a podcast or watch a TV show – listening or watching something one has already seen (aka comfort show) may require less mental focus as it fades into the background. However, carefully consider this strategy as it may provide more distraction than resistance.
Engage with a dedicated Mobile Game or Phone Application for Fidgeting – these are designed for the restless mind and can help to relieve anxiety and pass time.
Engage in Repetitive Household Chores – the repetitive nature of things like folding laundry can act as a productive fidget.
Boredom
The following strategies are not exhaustive. Again, try what resonates with you and find what works for you so that you can incorporate them into your own tool kit:[15]
Figure out your elements of interest – figure out what activities, outlets of expression or work interest you. Once you figure this out, try to spend some time each day focusing on that activity to help stimulate you and prevent boredom setting in.
Write Down Your Top Joys – Identify and write down your top interests and joys so that when boredom sets in you have a pre-prepared menu to select from.
Use things like Index Cards, if you aren’t a list person. That way, you can pull one out when bored and do the activity on that card.
Remix Boring Tasks – Try incorporating a stimulating task into a boring task. Some ways to do this might include: walking whilst making a work call; set a timer to take a break; working outside or in a preferred environment; creating small rewards for yourself that you can enjoy once the task is complete.
Engage in Stimulating Activities – quick puzzles or brain games; fidget toys (covered above); playing games with yourself to motivate you to complete a tedious task e.g., self-designed competition to see how much you can achieve in a specific time limit; go for a run, go dancing, go skiing; learn a new skill such as cooking, or learning a new language; get creative with painting, pottery, mixed media and so forth.
Reward Yourself – develop a set schedule of reward at least once per hour, with something that is enjoyable to you e.g., make a phone call to a friend, read a few pages of a book you are reading, do some exercise, have a snack.
Practice Mindfulness
To sharpen your self-awareness – bring attention to your present and observe it without judging it.
“Mindfulness meditation can be broken down into three basic steps: (a) bringing attention to the “attentional anchor,” such as breathing; (b) noting that distraction occurred and letting go of distraction; and (c) refocusing back to the “attentional anchor.” Research has demonstrated that mindfulness meditation can reduce self-reported ADHD symptoms, improve attentional task performance, modulate the brain’s electrical activity, alter dopamine levels, and change neural activity.”[16]
Whilst practicing mindfulness, if you experience distraction and let it go but distraction reoccurs, simply gently repeat letting the distraction go and return to the “attentional anchor”. Do this as many times as needed.
Engage with Stillness
It is important to stretch the comfort zone around being still. This may be something initially difficult to do but definitely worth establishing.
Practicing a breathing exercise that works for you, can help calm the mental chatter. See the app mentioned below; Smiling Mind App — Smiling Mind; Calm - The #1 App for Meditation and Sleep or any other app that you have found that works for you and addresses deep breathing, mindfulness and stillness practices.
Consider engaging with water and “the blue mind effect” – it is a deeply restful state that generates well-being and restoration. Dr Elissa Epel in her book The Seven-Day Stress Prescription notes that “whether it’s being in the ocean or a pool, or floating in a saltwater tank” exposure to water can induce a sense of well-being and peace[17]. Research into floating in water has shown that it increases our connection between our sensory awareness and our body.[18] Attention turns towards the breath, physiological sensations like the heart beating, and away from ruminations. It is theorised that floating also reduces blood pressure and muscle tension.[19]
Employ Progressive Muscle Relaxation
If you have been experiencing muscle tension, trying a Body Scan or a Progressive Muscle Relaxation technique may be helpful. Progressive Muscle Relaxation is about tensing and relaxing your muscles. This activity can help manage your anxiety and distress and promotes enhanced emotional regulation.[20]
Do Tai Chi and /or Yoga
Engaging with mindful activities like Tai Chi and/or Yoga is linked to stress reduction and muscle relaxation and can be beneficial for adults with ADHD.
It is even better when these activities are paired with being in the natural environment. Dr Elissa Epel notes that by “shifting our physical environment, we can shift our mental state…the mind moves from conditioned thought patterns – rapid thoughts, negative self-talk, anticipating what’s next – to discursive thought, which is slower, calmer, creative, curious. Immersion in nature immediately reduces the amount of human-created sensory stimuli we are used to – from screens, information, urban sounds. It enforces a mental break. It is a sanctuary environment that calms the mind and eases the body.”[21]
Self-soothing Skills
When we engage with the five senses (i.e., sight, touch, sound, taste and smell) when we are feeling distressed, they can help us calm down and better manage the situation.
Try identifying what you already know works for you. Consider creating a self-soothe bag or box where you place items or representation of the items in the box or bag that you can readily access when needed to manage your distress.
If you don’t already know or have something for each sense, experiment to find what works for you.
If you didn’t want to use a bag or box, the index card system might work just as well for you. Here you would write a heading of one sense per card with bullet points under each heading of things you know that help you destress. Store the cards in a readily accessible place.
Another technique to consider is the 5–4–3–2–1 grounding technique involves focusing on five sights, four textures, three sounds, two smells, and one taste to anchor in the present moment[22].
Psychological Scaffolding
· Join Support Groups -Adult education and support groups can be extremely helpful. For example: Adult ADHD groups | Focused Foundations
· Consider Coaching - This can be beneficial if looking for ongoing support in specific areas
Core Practices
The following are not exhaustive but are key to good health and well-being:
Engage with a Breathing Exercise – try One Deep Breath: Best Breathwork & Meditation App; Smiling Mind App — Smiling Mind; Calm - The #1 App for Meditation and Sleep or any other app that you have found that that works for you and addresses deep breathing practices.
Get sufficient Sleep – Quality sleep is an overall component of good health. Creating appropriate sleep hygiene practices that include setting a structure around when you want to go to sleep and when you want to get up each day and maintaining this as consistently as possible along with a good winddown routine before bed is thus conducive for sleep.
Where this occurs, benefits include improved energy levels, improved mood, improved cognitive functioning which can lead to enhanced problem solving and better decision-making skills, improved cardiac functioning as during sleep the heart and vascular system are able to rest, and reduced blood pressure. Good quality sleep is also associated with less risky behaviour, reduced stress, lowered anxiety and/or depression levels. Ultimately, we cope better when we have had quality sleep.
Exercise – there are numerous benefits to regular exercise such as walking, going to the gym or swimming, for example regular exercise can tire the body out and prepare it better for sleep as well as provide increased energy levels, bone and muscle strength, better bone density and less muscle loss, cardiovascular health, improved skin health, improved mood, improved self-esteem.
Eat healthily and regularly – it is important to establish a sustainable mindful routine. Just like with exercise, there are numerous benefits to eating healthily and regularly. These include improved digestive functioning, enhanced immune system functioning as there is a steady nutrition supply, improved blood pressure regulation, stabilised blood sugar levels which aids mood regulation and strengthens bones.
Moderate caffeine intake – an over indulgence in caffeine can result in sleep difficulties, irritability, frequent urination, chest pain, rapid heart rate and/or altered heartbeat rhythm called atrial fibrillation, increased blood pressure due to the stimulatory effect on the nervous system, anxiety – it triggers the release of adrenaline; high doses well in excess of 250mg might result in caffeine intoxication ( DSM – 5 – TR) where symptoms such as restlessness, nervousness, excitement, insomnia, psychomotor agitation, gastrointestinal disturbances might occur.
Hydrate – when we regularly hydrate with water across the day, we garner multiple benefits some of which include improved cognitive functioning, improved energy levels, improved mood, improved physical performance, supportive of kidney function and detoxification, helps with body temperature regulation, healthy hair and skin and, it helps with waste elimination.
However, it is important to work out what is the right amount for you. Your need for hydration will depend upon things like the climate where you live, your age, your weight, your diet and how active you are.
Just like any habit, consider building a hydration habit and view it as an act of self-care. Consider carrying a water bottle around and setting alarms to remind you to take regular sips of water. You could also consider tracking your intake via an app or journal, if that would be easier for you.
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References
[1] Levrini, A. PhD (2023). Succeeding with Adult ADHD. APA Life Tools pg 5 - 6
[2] ADHD in adults | APS; Williams, O. C. et al (2023) Adult attention deficit hyperactivity disorder: a comprehensive review. Ann Med Surg (Lond).Apr 12;85(5):1802–1810
[3] Williams, O. C. et al (2023) pp 1803
[4] ibid
[5] Understanding Hyperactivity in Adults: Symptoms and Management - ADHD Melbourne
[6] ADHD in Adults
[7] Why Can’t I Just Sit Still? The ADHD Discomfort with Rest & Stillness | Sarah Hardy Coaching Blog
[8] ADHD in Adults: Symptoms, Diagnosis & Treatment
[9] Levrini, A. PhD (2023).pp 113
[10] Ibid pg 114
[11] Adult ADHD - ADHD Support Australia
[12] Understanding Hyperactivity in Adults: Symptoms and Management - ADHD Melbourne
[13] Levrini, A. PhD (2023).pp 207
[14] Ref: Mayo Clinic website; www.adhdsupportaustralia.com.au. The Mini ADHD Coach – Harnessing ADHD Fidgeting to Enhance Focus by Alice Gendron; ADHD Fidgeting: Tips to Improve Focus by Choosing Therapy; Fidgeting Strategies that help People with ADHD Focus by Steph Coelho
[15] How to Reset Boredom Intolerance in ADHD by Jenna Fletcher; How to manage ADHD in Adults: Coping Strategies for Adult ADHD by Max Von Sabler
[16] Levrini, A. PhD (2023).pp 265
[17] Epel, E PhD (2022). The Seven-Day Stress Prescription. Penguin Life pp 125
[18] Ibid
[19] ibid
[20] Progressive Muscle Relaxation Information Sheet
[21] Epel, E PhD (2022).pp 122
[22] Evidence-Based ADHD Calming Techniques For Adults: Find Peace & Focus | Life Skills Advocate