Hyperactivity: What Causes It and When to Get It Checked

What hyperactivity looks like

In children

• fidgeting, squirming, tapping and getting up when expected to sit
• running or climbing at inappropriate times
• talking excessively and interrupting
• difficulty playing quietly or waiting a turn
• acting as if "driven by a motor"
• acting before thinking, such as running into the road

In teenagers and adults

Hyperactivity tends to become less visible with age:

• inner restlessness, feeling unable to relax
• choosing active jobs, or difficulty sitting through meetings and films
• talking too much, finishing other people's sentences
• impulsive spending, driving or decisions
• leg jiggling and constant need to be doing something

What is normal for age

Toddlers and preschoolers are naturally very active, have short attention spans and act impulsively. Hyperactivity is only a concern when it is clearly beyond what is typical for the child's developmental age, lasts at least 6 months, and causes difficulties in more than one setting, such as at home and at preschool or school. Boys are referred more often than girls, while girls more often have inattentive symptoms that are missed.

Causes of hyperactivity

ADHD

Attention-deficit/hyperactivity disorder is a neurodevelopmental condition. About 1 in 10 US children have been diagnosed with it, and many continue to have symptoms as adults. It has a strong genetic component. Diagnosis requires several symptoms of hyperactivity-impulsivity and/or inattention, beginning before age 12, present in two or more settings, and impairing daily life.

Sleep problems

Children who are short of sleep often become more active and irritable rather than visibly tired. Obstructive sleep apnea from enlarged tonsils and adenoids is a recognized cause of ADHD-like behavior. Clues are snoring, pauses in breathing, mouth breathing, restless sleep and bedwetting. Restless legs syndrome and irregular schedules also play a role.

Anxiety, stress and trauma

Anxiety can cause restlessness, fidgeting and poor concentration. Children exposed to trauma, neglect, family conflict or major changes may show hyperactivity and hypervigilance, as seen in PTSD.

Other developmental and mental health conditions

• Autism spectrum disorder: often occurs with ADHD. Repetitive movements and sensory seeking can look like hyperactivity.
• Learning disabilities and language disorders: a child who cannot follow lessons may become restless and disruptive.
• Tic disorders and Tourette syndrome: often coexist with ADHD.
• Bipolar disorder: episodes of mania or hypomania involve high energy, reduced need for sleep, racing thoughts and risky behavior, lasting days and differing from the person's usual self.
• Intellectual disability and fetal alcohol spectrum disorder.

Medical causes

• Overactive thyroid: restlessness, weight loss, sweating, tremor and a fast heart rate.
• Hearing or vision problems: a child who cannot hear or see well may seem distracted and fidgety.
• Medicines: decongestants, asthma medicines (such as albuterol), steroids and some anti-seizure drugs.
• Caffeine and energy drinks, nicotine, and stimulant drugs.
• Lead exposure in young children living in older housing.
• Low blood sugar and hunger.
• Brain injury after a concussion or traumatic brain injury.
• PANDAS: a sudden onset of obsessive-compulsive symptoms, tics and hyperactivity after strep infection in some children.

Does sugar cause hyperactivity?

Controlled studies have not found that sugar causes hyperactivity in children, including those with ADHD. Parents' expectations and the exciting settings where sweets are eaten, like parties, likely explain the link. Some children are sensitive to certain artificial food colorings, but diet changes have a small effect at most.

How hyperactivity is assessed

A pediatrician, family doctor, psychiatrist or psychologist will:

• take a detailed history of development, behavior, sleep, family history and recent stresses
• gather information from parents, teachers or partners using standardized rating scales such as the Vanderbilt scales
• examine the child or adult, including hearing, vision, growth and heart
• screen for anxiety, depression, learning disorders, autism and substance use
• order blood tests, such as thyroid function, only when the history suggests a medical cause
• arrange a sleep study if sleep apnea is suspected

There is no single blood test or brain scan for ADHD.

Managing hyperactivity

Treating the cause

Treatment depends on what is driving the behavior: removing adenoids or tonsils for sleep apnea, treating hyperthyroidism, adjusting medicines, cutting out caffeine, or providing therapy for anxiety and trauma.

ADHD treatment

• Under 6: parent training in behavior management is the first-line treatment.
• Ages 6 and older: a combination of behavioral approaches, school support and medication is most effective. Stimulant medicines (methylphenidate, amphetamines) are the most studied. Non-stimulants are alternatives.
• Adults: medication, coaching and cognitive behavioral therapy.

Practical strategies at home and school

• regular sleep and wake times, with screens off an hour before bed
• daily physical activity and movement breaks
• clear, short instructions and visual schedules
• praise for specific good behavior, consistent consequences
• seating near the teacher and away from distractions
• breaking tasks into small steps with short timed work periods

Frequently asked questions

What causes hyperactivity in children?

ADHD is the most common cause of persistent hyperactivity, but lack of sleep, sleep apnea, anxiety, stress or trauma, learning or language difficulties, autism, hearing problems, an overactive thyroid and some medicines can all cause similar behavior. A full assessment helps separate them.

Can you be hyperactive without ADHD?

Yes. Many children and adults are hyperactive due to poor sleep, anxiety, stress, caffeine, medicines, thyroid disease or other conditions. Some children are simply energetic and within the normal range. ADHD is diagnosed only when symptoms are long-lasting, appear in multiple settings and cause impairment.

How does hyperactivity show in adults?

Adults are less likely to run or climb. Hyperactivity usually shows as inner restlessness, difficulty relaxing or sitting still in meetings, talking excessively, interrupting, impulsive decisions and a constant need to be busy. It often comes with disorganization and inattention.

At what age can hyperactivity be diagnosed?

ADHD can be diagnosed from age 4, according to American Academy of Pediatrics guidance, though symptoms must be clearly beyond normal for the child's age. Many children are diagnosed after starting school, when the demands on attention and sitting still increase.

Does sugar make children hyperactive?

Research has not shown that sugar causes hyperactivity, even in children with ADHD. The excitement of parties and holidays, where sweets are common, is a more likely explanation. A balanced diet, regular meals and limiting caffeinated drinks are still sensible.