HyperactiveImpulsive

Hyperactiveimpulsive refers to the hyperactive-impulsive presentation of attention-deficit/hyperactivity disorder (ADHD). In this presentation, hyperactivity and impulsivity dominate the clinical picture, with fewer or less persistent symptoms of inattention than in other ADHD presentations. It is one of three presentations described in the DSM-5-TR, alongside predominantly inattentive and combined presentations.

Core features include fidgeting or tapping, leaving seat in situations where staying seated is expected, running or climbing in inappropriate situations (or in adults and older adolescents, feeling restless), talking excessively, blurting out answers before questions are completed, difficulty waiting turn, and interrupting or intruding on others. For a diagnosis, these symptoms must cause impairment in social, academic, or occupational functioning and be present in two or more settings.

Diagnosis typically requires that symptoms emerge before age 12 and are not better explained by another condition. The presentation can persist into adolescence and adulthood, though hyperactivity may diminish over time while impulsivity symptoms can remain.

The hyperactiveimpulsive presentation is differentiated from the other ADHD presentations by the relative prominence of hyperactivity and impulsivity over inattention. Prevalence estimates vary, but this presentation is often identified earlier in childhood and may be less common as a primary presentation in adolescence or adulthood compared with the combined presentation.

Treatment is usually multimodal, combining behavioral therapies, parent training, and educational accommodations with pharmacotherapy. Stimulant medications (such as methylphenidate or amphetamine preparations) are commonly used, with non-stimulants (such as atomoxetine or guanfacine) as alternatives or adjuncts.