Can a person have ADHD without being hyperactive?

The use of the word “hyperactivity” in the ADHD diagnosis can be misleading. Not all children with ADHD are constantly racing around. Some can play video games or watch a movie with even greater intensity than a child without ADHD. In fact, they can become so over-attentive or so over-absorbed in some projects that they cannot easily change or re-direct their attention.

As these kids grow older, they react to too much or too little stimulation by “acting out” in the classroom or at day care. They may pull items off shelves, attack other kids, or seemingly “spin out of control” into a variety of silly behaviors. They can show signs of being hypersensitive to unusual sights or sounds. It is not unusual for these kids to have trouble adapting to changes in their daily routines and many (in one study, up to 63 percent)¹ demonstrate sleeping difficulties.

No doubt, most of these kids demonstrate very high levels of impulsive behavior, often at very early ages — even before the “terrible twos.” Unusual behaviors for these youngsters can include erratic and aggressive actions such as hair pulling, biting, pinching or hitting others. Temper tantrums, normal in most children, are often exaggerated in ADHD children — not usually out of anger, but by over-stimulation or even affectionate behavior. I’ve seen many perplexed moms whose two or three year old has displayed aggressive and abrupt behavior when being cuddled or hugged.

Because of these patterns, studies now suggest that ADHD can usually be diagnosed by age four and should not be diagnosed in those whose symptoms appear after age seven.

Nevertheless, the use of the word “attention deficit” can also be confusing. When someone with ADHD is really interested in something — a television program, movie, football game, computer game, or whatever — often they do not hear anything else but that. These people are capable of attending to particular activities, especially those activities that are highly stimulating (have multiple sources of stimulation) and highly interesting to them. Once you understand what’s going on in their minds — how they are wired — their behavior begins to make sense.

Whether hyperactive or not, most ADHD children, adolescents and adults share one overriding characteristic — distractibility — and not just minor distractibility, but major, big-time, big-league distractibility. Boys and girls, men and women with ADHD, to the surprise of most, usually do not have a short attention span. Because of this, it is not at all unusual for them to become lost in something for long periods of time – especially if the activity is something that deeply interests them.

This interest can so occupy their concentration and attention that they are unaware of virtually anything going on around them. When you see this, what you are seeing is a manifestation of their almost unappeasable and inexorable need for mental stimulation and activity, a need that seems to last for virtually every moment they are awake.

Endnotes
^{1. Chervin RD, Archbold KH, Dillon JE, et al. Inattention, Hyperactivity, and Symptoms of Sleep-Disordered Breathing. Pediatrics 2002;109:449-456.}