When is it more than just ‘Normal’ Hyperactivity?

When is it more than just ‘Normal’ Hyperactivity?

By Dr. Jess Levy, University Hospitals Case Medical Center

Studies seem to indicate that Attention Deficit Hyperactivity Disorder (ADHD) is both under-diagnosed and over-diagnosed in young people.

How can researchers come to such wildly different conclusions? It turns out that in some groups of children, symptoms of ADHD, like poor attention span and hyperactivity, are quickly attributed to ADHD, while in other groups the same symptoms are either ignored or dismissed as “oppositional” behaviors. Factors such as gender, ethnicity and family income seem to play a role in the likelihood that a child will be diagnosed with ADHD.

Even within the field of pediatric mental health, there is a great deal of controversy surrounding ADHD. Clinicians wishing to increase awareness of the disorder argue that untreated ADHD is linked to a wide range of problems later in life, including depression, anxiety and substance use. Others take a more reserved stance and point out that the rapid rise in ADHD diagnoses coincides with increased consumer demand for stimulant medications.

It can be difficult for families to know when to worry about their child being too hyperactive. Perhaps a teacher alerts parents that their son is more fidgety than his classmates. Or maybe parents noticed that their daughter acts “wilder” than her siblings. On the other hand, we know that some kids are naturally more energetic than others. I often hear parents say that that they were hyperactive themselves as children and turned out just fine. Even when a child clearly has symptoms of ADHD, there are concerns about the stigma of having a mental health condition and worries about the side effects of ADHD medications.

Finding the Right Answer

What should you do if you are worried that your child is too hyperactive? As with any behavioral concern, don’t hesitate to seek guidance from a trusted source. A good starting point is to discuss your concerns with your child’s teachers. Because teachers are accustomed to working with groups of children, they often are invaluable in distinguishing normal versus abnormal behaviors.

If concerns persist, you likely will want to get a professional opinion. Most pediatricians and family doctors have experience handling behavioral concerns and carry the added benefits of accessibility and familiarity with your child. Psychologists and other mental health providers are invaluable guides, as well. Based on your child’s symptoms and your provider’s comfort level treating mental health concerns, you may wish to see a child and adolescent psychiatrist who has expertise in behavioral health concerns.

Here are some things to keep in mind if you are worried about your child being too hyperactive:

  • ADHD is more than just hyperactivity. In order to make the diagnosis, providers look for other symptoms, such as poor focus, distractibility, avoidance of work requiring a lot of thought, and impulsivity (acting without thinking). Some children with ADHD only have problems with attention span and not with hyperactivity or impulsivity.


  • Other mental health conditions can mimic ADHD. Disorders such as anxiety, learning problems and emotional concerns can cause a child to look hyperactive or distractible. Also, it is possible for a child to have multiple diagnoses simultaneously (for example, ADHD and anxiety). An experienced professional can help sort out these diagnoses.


  • ADHD is developmentally contextual. We expect younger children to be naturally more fidgety, and have more difficulty following directions compared to older children. Even within the same age group, expectations vary based on IQ and maturity level.


  • ADHD is a chronic condition. Symptoms should be present before age 12, and very often are noticed by the time the child is in pre-school. We do not know exactly what causes ADHD, but we think genetics play a large role.


  • It is not enough to just have the symptoms to be diagnosed with ADHD. There also has to be concerns that the symptoms are causing problems in the child’s life in multiple settings, such as home and school.


Figuring out the difference between a normally active child and the ADHD child can be complicated. Pay attention to any concerns raised by teachers and other influential adults in your child’s life. More importantly, trust your instincts.

A knowledgeable healthcare professional will help make (or exclude) a diagnosis of ADHD in your child. If your child does have ADHD, your provider can work with you on creating an effective, evidence-based treatment plan tailored to your family’s needs.

Dr. Levy specializes in child and adolescent psychiatry at University Hospitals Case Medical Center. uhhospitals.org

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