By Tim Aiello, MA, LPC, NCC, ADHD-CCSP
Clinical Director, Myndset Therapeutics
Introduction
When people think of ADHD, hyperactivity often brings to mind a child bouncing off the walls. However, hyperactivity doesn’t disappear with age; it simply evolves. In adults, hyperactivity can present externally, such as fidgeting or constant movement, or internally, as a relentless flood of thoughts or restlessness. Unfortunately, these manifestations are often overlooked, as many adults learn to mask their external hyperactivity or internal experiences remain unseen.
This article explores the nuanced presentation of hyperactivity in adults with ADHD, emphasizing the often-overlooked internal experience, supported by current evidence-based research.
Hyperactivity in ADHD: A Lifespan Perspective
ADHD is a neurodevelopmental condition characterized by inattention, impulsivity, and hyperactivity. While hyperactivity is more pronounced and visible in children, it persists into adulthood in about 50–70% of cases (Faraone et al., 2015). However, adult hyperactivity often looks different, influenced by environmental expectations, social norms, and personal coping strategies.
External Hyperactivity in Adults
External hyperactivity in adults is less overt than in children but still noticeable to those paying attention. Common examples include:
Fidgeting and Movement; Many adults with ADHD engage in small, repetitive movements, such as tapping fingers, bouncing legs, or shifting in their seat. In my own experience, I frequently find myself fidgeting with objects or moving in my office chair during sessions. These actions serve as self-regulation strategies to maintain focus and manage restlessness.
Physical Activity; Adults with ADHD may gravitate toward activities that allow for physical engagement, such as pacing during phone calls or engaging in exercise as an outlet. Research suggests that these behaviors are attempts to modulate dopamine levels, which are often dysregulated in ADHD brains (Volkow et al., 2009).
Multitasking Tendencies; A drive to tackle multiple tasks simultaneously, even if inefficient, can be a manifestation of external hyperactivity.
Internal Hyperactivity: The Overlooked Experience
Internal hyperactivity, often described as "hyperactivity of thought," is a persistent and intense experience for many adults with ADHD. It involves a racing mind, difficulty slowing down thoughts, and a sense of internal restlessness.
Mental Restlessness: Adults may feel like their thoughts are always "on," jumping from one idea to the next. This can make it hard to focus on a single task or relax during downtime.
Intrusive Thoughts and Overthinking: The hyperactive mind often produces intrusive thoughts or leads to overanalyzing situations, contributing to anxiety and emotional dysregulation.
Difficulty Sleeping: The inability to “turn off” the brain is a common issue, leading to difficulties falling asleep or staying asleep (Gormley et al., 2020).
Masking and Misunderstanding in Adults
Many adults with ADHD learn to mask their hyperactivity, especially in professional or social settings, where such behaviors may be deemed inappropriate. For example:
Subtle Fidgeting: Instead of overt movement, adults may find discrete ways to fidget, such as twirling a pen or tapping toes under a desk.
Channeling Hyperactivity: Adults may direct their hyperactivity into socially acceptable outlets, such as high-energy jobs, hobbies, or exercise routines.
Masking can make hyperactivity less apparent, leading to underdiagnosis or misdiagnosis in adults. Additionally, because internal hyperactivity isn’t visible, it is often dismissed or misunderstood, even by mental health professionals unfamiliar with adult ADHD presentations (Kooij et al., 2019).
The Neurobiology of Hyperactivity
Hyperactivity in ADHD is rooted in differences in brain function, particularly in the dopamine and norepinephrine systems. These neurotransmitters play a critical role in regulating attention, impulse control, and activity levels. In individuals with ADHD, dysregulation in these systems leads to heightened activity levels, whether physical or mental (Volkow et al., 2009).
Functional imaging studies also highlight differences in the prefrontal cortex and basal ganglia, areas involved in executive functioning and motor control, further explaining the persistence of hyperactivity across the lifespan (Faraone et al., 2015).
Why Recognizing Adult Hyperactivity Matters
Failing to recognize hyperactivity in adults with ADHD can have significant consequences. Internal hyperactivity, for example, is often associated with:
Increased stress and anxiety.
Difficulty focusing or completing tasks.
Challenges in interpersonal relationships, as the racing mind may lead to miscommunication or impulsive decisions.
By acknowledging both external and internal hyperactivity, adults can better understand their experiences and seek appropriate strategies for management.
Strategies for Managing Hyperactivity
Managing hyperactivity in adults with ADHD often involves a combination of behavioral strategies, therapy, and, when necessary, medication.
Mindfulness and Relaxation Techniques: Mindfulness practices, such as deep breathing or meditation, can help calm the racing mind and improve self-awareness.
Channeling Energy Productively: Engaging in regular physical activity or hobbies that involve movement can provide an outlet for restlessness.
Cognitive-Behavioral Therapy (CBT): CBT can help adults with ADHD identify and reframe thought patterns associated with internal hyperactivity.
Medication: Stimulant and non-stimulant medications can help regulate dopamine levels, reducing both external and internal hyperactivity.
Sensory Tools: Fidget tools or weighted items can provide a discreet way to channel physical restlessness during work or other settings.
Conclusion
Hyperactivity in adults with ADHD is multifaceted, presenting externally through movement and internally as a racing mind. While it often goes unrecognized due to masking or subtlety, understanding its full expression is crucial for effective support and treatment.
If you experience hyperactivity—whether external, internal, or both—know that you’re not alone. Recognizing these traits is the first step toward strategies that can help you thrive.
At Myndset Therapeutics, we specialize in supporting adults with ADHD, helping them understand and manage the complexities of their condition. Reach out today to learn more.
References
Faraone, S. V., Biederman, J., & Mick, E. (2015). The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological Medicine, 36(2), 159-165.
Gormley, M. J., Roxborough, H. M., & Barkley, R. A. (2020). Sleep and ADHD: A meta-analysis of objective studies. Journal of Attention Disorders, 24(5), 651-662.
Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., ... & Asherson, P. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56(1), 14-20.
Volkow, N. D., Wang, G. J., Newcorn, J., Kollins, S. H., Wigal, T. L., Telang, F., ... & Swanson, J. M. (2009). Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway. Molecular Psychiatry, 16(11), 1147-1154.
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