Hyperactivity

• What is hyperactivity?
• Features of hyperactivity
• Common causes of hyperactivity
• When to approach your health care professional
• Questions your health care professional may ask

 

• Examinations/tests your health care professional may perform
• How is hyperactivity treated?
• What can parents, families and teachers do to help?

What is hyperactivity?

Hyperactivity is a common issue faced by many parents and families of children. Not only children can be hyperactive – it is also experienced by some adolescents and even adults. Hyperactivity may be described as an excessive level of activity in a person compared to what is normally expected for their age. Many normal children may at times be hyperactive or restless, but when the hyperactivity begins to affect performance in school, social relationships or behaviour at home, an underlying disorder may be suspected.

Features of hyperactivity

A hyperactive child often: 

• Is "on the go", or acts as if "driven by a motor"
• Cannot remain seated in situations where sitting quietly is expected (e.g. may often leave his/her seat in class or at dinner)
• Fidgets in seats, touches everything, or taps things noisily
• Runs about or climbs excessively in situations where it is inappropriate (e.g. may roam or dash around playing with whatever is in sight)
• Talks excessively

Hyperactive teenagers or adults may feel internally restless or report needing to stay busy.

Common causes

• Attention deficit hyperactivity disorder (ADHD)
• Hearing problems
• Specific learning disabilities
• Sleep disorders
• Hyperthyroidism
• Some medications
• Psychiatric conditions (e.g. bipolar affective disorder, depression, anxiety)
• Family disruption (e.g. divorce)
• Ineffective discipline or chaotic family environment
• Neglect or abuse

ADHD is one of the most common causes of hyperactivity in children, and occurs in around 3-5% of school aged children. ADHD also affects 4% of adults, but the symptoms of hyperactivity generally decrease with age.

When to approach your health care professional

Many young children have a small degree of hyperactivity and restlessness, which may just be a normal variant of childhood. Disorders like ADHD often begin before preschool age, but for most children it goes unnoticed until they land into trouble at school. Occasionally teachers may be the first to recognize that the child has a problem.

If the hyperactivity is affecting behaviour at home, performance in school, or social relationships, then there may be an underlying condition and parents should seek help from a health care professional. The first port of call is often the family general practitioner or school psychologist, who will assess the child and make appropriate recommendations or referrals.

Questions your health care professional may ask

During the consultation, your health care professional may ask for a description of the symptoms, including their start and development. Often there will be questions about past illnesses or injuries, current medications (prescribed and over the counter) and family history, particularly of ADHD and related conditions. In children, the details of the pregnancy, delivery, and the child’s developmental milestones are important, as well as risk factors such as maternal smoking, alcohol, drug use and major illness. Your healthcare professional may also need to know about your socioeconomic environment and any major stressors.

 

 

Examinations/tests your health care professional may perform

The doctor may perform some of the following examinations:

• Height, weight, head circumference measurements
• Blood pressure and pulse
• Hearing and vision screening
• Developmental assessment
• Nutritional status assessment
• Signs of thyroid dysfunction
• Examination of the nervous system

Often, other tests may be required, which may consist of:

• Questionnaires to be filled out by the parents and school teacher
• Tests of intelligence, individual subject areas, language skills, attention and executive functioning
• Blood tests may sometimes be required

These tests may help the health care professional diagnose the problem, assess the severity of the problem, look for associated conditions (e.g. learning disabilities), and exclude other medical conditions that may be causing hyperactivity.

How is it treated?

The treatment for hyperactivity may vary from patient to patient depending on the underlying cause and personal circumstances. It may involve several simultaneous treatment strategies. For example, a child with ADHD may be treated with both medications and behavioural interventions at the same time.

Medications 

Stimulants are the most common medication of choice in treating patients with hyperactivity. It is also the first line medication for children diagnosed with ADHD. Examples of stimulants include methylphenidate (e.g. Concerta, Ritalin) and dexamphetamine. When used under medical supervision for the treatment of ADHD, stimulant medications have been shown to be generally safe and effective. To date, there is no evidence of them causing drug abuse or dependence. If there is no improvement after an adequate trial of stimulants, your doctor may prescribe other medications (e.g. antidepressants).

Other treatments

Behavioural therapy, parent training, social skills training and school-based interventions are effective in treating some patients with ADHD or with hyperactivity due to other causes.

Because many patients require combined treatment, your general practitioner or paediatrician may need to refer you to other health professionals (e.g. a psychologist, psychiatrist or neurologist) for further treatment.

What can parents, families and teachers do to help?

Parents and carers should get informed about the diagnosis, causes, features and treatment of their child’s condition, in order to understand what the child is going through and to help manage it. Good behavioural management principles and strategies are important in managing hyperactive disorders such as ADHD. Some centers offer parent training, which has been shown to be an effective intervention.

Teachers can help by implementing school-based interventions, which are designed to improve school behaviour, academic productivity, and achievement. This includes reducing task demands, making tasks more stimulating, and token reinforcement.

Useful information

For more information on childhood ADHD and its symptoms and treatments, as well as some useful tools and animations, see Childhood ADHD.

For more information on ADHD in adults and its treatments, as well as some useful tools and animations, see Adult ADHD.

References

1. Sadock B, Sadock V. Chapter 39: Attention deficit disorders. In: Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 8th ed. Lippincott Williams & Wilkins, Philadelphia. 2005.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM-IV-TR, 4th ed. American Psychiatric Association, Washington DC. 2000.
3. Dreyer B. The diagnosis and management of attention-deficit/hyperactivity disorder in preschool children: The state of our knowledge and practice. Curr Probl Pediatr Adolesc Health Care. 2006; 36(1): 6-30.
4. Schweitzer J, Cummins T, Kant C. Attention-deficit/hyperactivity disorder. Medical Clinics of North America. 2001; 85(3): 757-77.
5. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry. 1999; 56: 1073-86.
6. Wilens T, Faraone S, Biederman J. Attention-deficit/hyperactivity disorder in adults. JAMA. 2004; 292: 619-623.
7. Millstein R, Wilens T, Biederman J, Spencer T. Presenting ADHD symptoms and subtypes in clinically referred adults with ADHD. J Attent Disord. 1997; 2(3): 159-66.
8. Wender P, Reimherr F, Wood D, Ward M. A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adults. Am J Psychiatry. 1985; 142: 547-52.
9. Spencer T, Wilens T, Biederman J, Faraone, S, Ablon S, Lapey K. A double blind, crossover comparison of methylphenidate and placebo in adults with childhood onset attention deficit hyperactivity disorder. Arch Gen Psychiatry. 1995; 52(6): 434-43.
10. Spencer T, Biederman J, Wilens T, et.al. Efficacy of a mixed amphetamine salts compound in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2001; 58(8): 775-82.

Other symptoms related to Hyperactivity:

• Impulsivity
• Inattention