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Core ADHD symptoms

The are three main core set of symptoms experience by people with ADHD. They are inattentiveness, hyperactivity and impulsivity. In this guide we are going to focus on hyperactivity and impulsivity, these symptoms are described as the following: 

Hyperactivity:

• Feel like driven by a motor
• Restless
• Cannot sit still
• Always on the go
• Fidgety

Impulsivity:

• Interrupting often
• Answer questions before the person finishes asking
• Blurts out inappropriate comments
• Act before thinking
• Do things you later regret
• Difficulty waiting
   

Hyperactivity & Impulsivity

It is important to understand that ADHD is a lifelong condition, although symptoms can change over time. Most people with ADHD will have experienced these symptoms to some extent since childhood or in adulthood. Some people may be diagnosed with predominantly hyperactivity and impulsivity type ADHD. Although for ease healthcare professionals may described two sets of symptoms, hyperactivity and impulsivity, there is research evidence to suggest they are part of the same cluster of symptoms. In other words, they appear to share the same underlying problem in what is called inhibitory control.

What is Inhibitory Control?

Inhibitory control is the system within the human brain which we used to manage what we say and what we do. For those with ADHD this means it is difficult to suppress impulses, regulate behaviour (as seen in hyperactivity) effectively and manage attention. Due to these difficulties, this is why you may feel restless a lot of the time and say things which you later regret.  (please see: Strategies to Improve Inattentiveness). 

Impact on Everyday Living

It is not surprising that difficulties with hyperactivity and impulsivity can have a significant impact on everyday life. When symptoms make it difficult to manage daily activities healthcare professionals may call this functional impairment. This means that ADHD affects your ability to do your best at school, college, work, at home, or in your relationships are just some of the problems identified in research. Other problems you may experience poor sleep, impulsive use of alcohol and other substances, risky taking behaviours, e.g., such as driving too fast, gambling, or risky financial decision making. Many of these problems have been found at higher rates in people diagnosed with ADHD compared to the general population. 

Symptoms of Anxiety or Depression

Living with these ongoing challenges can also affect your emotional wellbeing. Many people with ADHD experience symptoms of anxiety or depression, often as a result of the difficulties they have faced over time. However, not everyone with ADHD develops anxiety or depression, and symptoms of hyperactivity and impulsivity can occur on their own.

Management of Hyperactivity & Impulsivity

For those with ADHD, hyperactivity and impulsivity may have been experienced over many years, which leaves one feeling overwhelmed to the idea of managing these difficulties. However, through a range of strategies practised overtime, which may include seeking professional support, a reduction in hyperactivity and impulsivity is possible. We call these compensatory strategies, they are evidence-based techniques which may compensate for your difficulties:

1. Develop daily sustainable routines 

Developing a routine not only helps with overall wellness, by can help manage the difficulties of hyperactivity and impulsivity by providing outlets for the physical symptoms throughout the day: 

• Plan for periods of work, rest and play. It may be helpful to use the momentum of hyperactivity to complete tasks, interspersed with other rewarding and interesting activities. Set a time and practise switching back of forth between work, rest and play.
• When you notice that you are hyperfocus on a task, set a timer for when you will finish, so you don’t exclude other important activities, e.g. like eating!
• Aim to eat at the same time every day, aim for a high protein diet which has been found to help stabilise blood sugars, helps in the production of amino acids which help with production of neurotransmitters, brain chemicals, which can aid attention and reduce hyperactivity.  
• Sleep, go to bed and awake at the same time every day, if this is difficult or feels impossible to achieve you may need to seek professional help.
• Winding down periods, set you self an hour before bedtime, where you practise deliberately reducing in activities.
   

2. Get a physical routine

Human beings are design to move, increasingly people’s life’s styles which include working from home has left people to become more sedentary, which is not helpful for those with ADHD.  

• Start a daily exercise routine, you don’t need to train for a marathon but find a physical activity/exercise which interests you and which can do every day.
• Take up a physical hobby or sport. Anything from gardening to rock climbing, from team sports and consider individual sports.
• Aerobic sports like running, swimming, and cycling have been found to increase brains levels of neurotransmitters, such as dopamine, norepinephrine (which the ADHD brain has problems processing) which can improve focus and reduce impulsivity. Some studies have found high level of these neurotransmitters up to 3 hours after exercise.
   

3. Use of technology

Increasing use of digital technologies has found to increased mental fatigue, which is already a symptom for those with ADHD. Be aware of your time spent watching TV, using your computer, iPads, and mobile phone. On the one hand these technologies can provide you with continues stimulus for your brain, which your assignment for college or job application cannot. On the other hand, it can create mental fatigue which you may already have problems with. Realise that the ADHD brain seeks new and exciting stimulus, making some technologies easy to pick up, but hard to put down.

• Reduce Doom scrolling (i.e., flicking through the endless video online over hours at a time), work to a time limit, to reduce mental fatigue. Try watching long form content, e.g. reading more than a 1000 word in text, or watching more than 10 minutes as a video. Then reduce short form content, e.g. reading 50 words or less in text and watching 5 minutes or less as a video.
• Stop using technology in bed or an hour before bed, use this new behaviour as part of your wind down routine.
• Reduce using technology altogether, find a more physical activities and different activities each day, e.g., cooking from scratch, DIY, playing games with your children, make a dress, and learn to play again, e.g., buy and build a Lego set!

4. Becoming conscious of your hyperactivity/impulsivity  
Before we can change a problematic behaviour, we need to become conscious of what we are doing. 

• Write a list of all the impulsive behaviours you are aware of, e.g. opening emails at work when you should be making call to a client.
• Write a list of triggers that lead to those impulsive behaviours, e.g. when bored (trigger), and ask yourself, what do your normally do? I start playing with my mobile phone (impulsive behaviour).
• Write a list of your emotions that trigger your impulsive behaviours, and plan to do something different when you feel the emotions again. An example, when feeling sad (emotional trigger), I binge watch TV box sets (impulsive behaviour).
• When starting personal projects, become aware of the impulse and urges to start the new and exciting thing! Ask yourself, it’s it the right time to start (when you’re supposed to be going to bed) and do I have enough time to start (when you about to leave home for work).
• Side missions / quests are times when you in earnest start an important task and then find yourself cleaning the car. Start to become aware of side missions/quest, then label them as such, to help you be aware when you’re on a side mission or quest to aid your refocusing.
• Don’t give into the P.I.G., become aware of the Problem of Immediate Gratification, these are activities you will do in impulse which will have consequence in the future (see below consequential thinking).
• Consequential thinking is a skill of reflection. When things have gone wrong, write down the urge and impulse that lead to the action, ask yourself what did you feel or think at the time? Write the learning points on a flash card, so next time you feel the impulse or urge you can remind yourself of the consequences. 
   

5. Other approaches to consider

Other helpful techniques might include slow breathing, taking a break, engaging in a distracting activity when feeling overwhelmed, for example:

• Gentler, calming movements, may be try developing lower-paced activities like yoga, tai chi, or mindful walking can also be beneficial. These approaches not only help lower stress levels but can also support greater awareness and control over impulses and reduce hyperactivity.
• Developing mindfulness skills, regular mindfulness practice can support focus, emotional regulation, and awareness of impulses. It may also help reduce sensitivity to distractions. For some people, sitting still for long periods can be difficult, so starting with brief sessions and gradually building up duration can make the process more manageable.
• Find a quiet place, there is some evidence to suggest the people with ADHD who stay up late into the night are more productive due to the lack of stimulation from the environment. Their brains feel calmer and more able to focus, suggesting that daytime environments can be over stimulating for the ADHD brain. Therefore, you might want to find your quiet place, somewhere which is calming where you can naturally unwind, your garden or spare room, the local park, or another accessible quiet place.
   

Building support and consistency

It is understandable if these approaches feel difficult at first, particularly if you have tried similar strategies before. Having support from someone you trust such as a friend, family member, or partner can make it easier to put these ideas into practice. Working together can help you build routines and develop healthier responses over time.

Progress often happens gradually, so focusing on small, manageable steps can be more sustainable. Structured support, such as guided sessions or group programmes, may also be available to help you explore and apply these strategies in more depth.

Considering medication

Medication is one possible option, but it isn’t suitable for everyone. It’s important to think about how ADHD affects your wellbeing and daily life. If it seems appropriate, you will be offered an appointment to discuss medication in more detail.

Adult ADHD evidence-based treatments

Please consider evidence-based treatments. If your find your hyperactivity-impulsivity causes significant problems with daily functioning across different areas of your life, you may want to consider:

• ADHD medication assessment (if not already prescribed).
• Adapted CBT for ADHD, available for those with depression and anxiety in your local NHS trust NELFT
• ADHD coaching, for those who want to focus on practical problems due to inattentiveness.
• Occupational Therapy for developing strategies for work or education.

We have a range of professionals who form the multidisciplinary team who can support you. We offer support from ADHD coaches and specialist occupational therapist, to help with the practical difficulties throughout the diagnosis processes. We have medical staff such as specialist nurses, psychiatrists and pharmacist, who will support you with the diagnosis, and if you decided to take medication. Finally, we have psychology staff, which includes assistant psychologist, practitioner psychologists and cognitive behavioural psychotherapist, to help support you with your mental health needs. The multidisciplinary approach allows the service offer tailored support for your current needs, now and into the future.