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1. Motor symptoms of ADHD

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1. Motor symptoms of ADHD

1.1. Hyperactivity

Motor hyperactivity is a very common symptom of ADHD. However, hyperactivity is not a mandatory symptom of ADHD. There are ADHD sufferers who suffer a lot from their symptoms, who were / are neither hypermotor as a child nor full of inner restlessness as an adult.

1.1.1. Motor hyperactivity as an ADHD symptom

Motor hyperactivity is a characteristic of ADHD-HI and ADHD-C. In the ADHD-I subtype (predominant attention problems), hyperactivity is less pronounced.1
Hyperactivity often subsides in adolescence. The literature describes that hyperactivity in adults usually turns into a form of constant inner restlessness. This will have to be discussed.

Fidgeting and constant moving could be understood as an internal correction of vigilance (basic internal tension) and too low dopamine level. Movement increases dopamine levels.23 Fidgeters who are forced to sit still are (still) more likely to give wrong answers than when they are allowed to move.2 Likewise, exercise before school (to work out motor restlessness) increases learning success.2

1.1.2. Manifestations of motor hyperactivity

  • for young children:
    • Extended child defiance phase
    • If necessary with excessive veritable tantrums
  • for children:
    • Constant fidgeting with hands and feet or sliding around on the chair (DSM IV/5)
    • Frequently stands out in class and other situations where sitting is expected (DSM IV/5)
    • Frequently runs around or climbs excessively in situations where this is inappropriate (in adolescents or adults, this may be limited to a subjective feeling of restlessness) (DSM IV/5)
    • Often has difficulty playing quietly or engaging in leisure activities quietly (DSM IV/5)
    • Is often “on the move” or often acts as if he/she is “driven” (DSM IV/5)
    • Often talks excessively (DSM IV/5; rated as an impulsivity trait in ICD-10). Speech diarrhea is still seen in some adults as well
  • for adults:
    • Hyperactivity (external/physical) decreases up to 60% in adults4
    • Physical restlessness in adults possibly only to a lesser extent
      • Foot bobbing with high frequency (in each case even if deliberately suppressed)5
      • Finger drumming (even if deliberately suppressed)5
      • Nail biting6
      • Lips bite
      • Tie legs in knots / wrap around chair leg to limit movement6

1.1.3. Age-related decline in motor hyperactivity

Data from the ADxS.org symptom test show the following changes in age groups:

Age group motor hyperactivity inner restlessness attention problems
5- 9 years (n = 9) 0.70 0.80 0.75
10 - 14 years (n = 15) 0.72 0.68 0.83
15 - 19 years (n = 48) 0.45 0.62 0.81
20 - 29 years (n = 373) 0.49 0.70 0.81
30 - 39 years (n = 492) 0.49 0.74 0.83
40 - 49 years (n = 301) 0.46 0.74 0.78
50 - 59 years (n = 158) 0.46 0.72 0.80
60 - 75 years (n = 32) 0.42 0.74 0.72
Men (n = 630) 0.52 0.73 0.81
Women (n = 823) 0.45 0.72 0.80

As of June 2020. The values given reflect the severity of the symptoms relative to each other.
Limitations of the informative value:

  • There are few data sets with subjects under 20 years of age and significantly too few data sets with subjects under 10 years of age for a robust conclusion.
  • No separation was made between ADHD-I and ADHD-HI, so the (random) ratio of ADHD-I to ADHD-HI may bias the data for small group sizes.
  • Only those records were evaluated in which the symptom test found evidence of existing ADHD.
  • It is a non-validated online self-test (screening).

The data are in agreement with the thesis that attention problems are not yet fully developed in children up to 15 years of age and that motor hyperactivity decreases in adulthood. However, they suggest that hyperactivity does not change into inner restlessness, but that inner restlessness also exists in children and merely regresses less than hyperactivity. After the regression of motor hyperactivity, inner restlessness only seems to become more visible.

The inner restlessness, the constant circling of thoughts (rumination), could be called the “little brother” of hyperactivity.

Inner restlessness as an independent symptom besides hyperactivity?

An interesting consideration is whether Inner Restlessness, which according to the data may already be present in children, due to the fact that it does not seem to regress or regress only slightly, unlike Hyperactivity, could indicate that Inner Restlessness could be a symptom to be distinguished from Inner Restlessness / Inner Drivenness.
Thinking from the original (possible) benefit of stress symptoms (originally = before humans became sedentary), it might have been helpful if children develop an increased willingness to move in a dangerous situation, so that they can better escape together with the group in dangerous situations. Adults benefit less from hyperactivity because they are the ones who have to fight the stressors. When fighting stressors, an increased urge to move is no longer as important as it is with children (who can contribute little to the fight against the stressors); in contrast, doing everything possible to fight the stressor and not resting until the danger is dealt with comes to the fore.

A parallel to this is that attention problems in adults can also decrease significantly or even remit completely (albeit less frequently or more weakly than hyperactivity and impulsivity),7 without a change to a different symptom picture being described in the latter. However, our data show at best only a very weak decrease of attention problems in adults.

It is doubtful whether inner restlessness / inner drive might fit better under a heading of “drive problems” and there represent the counterpart to listlessness, just as distractibility (too easy switching of the focus of attention) and task switching problems / hyperfocus (difficult switching of the focus of attention) form counterparts within the umbrella term “attention problems”. This is contradicted by the fact that listlessness correlates strongly with ADHD-I and less with ADHD-HI, whereas distractibility and task switching problems correlate equally with ADHD-HI and ADHD-I.

1.1.4. Hyperactivity as a symptom of stress

Hyperactivity, fidgetiness is known as a typical symptom in severe stress, as well as that during stress the thoughts are concentrated on the stressor (thought circling, rumination).
Symptoms of stress are:

  • Unrest89
    Inner restlessness is a typical symptom of the approaching end state of burnout.10
  • Restlessness1112
  • Movement restlessness13

The stress hormone CRH, which is released in the first stage of the HPA axis by the hypothalamus, directly mediates an urge to move. Increased locomotor activity is a direct effect of the stress hormone CRH.141516139

Symptoms that are directly mediated by stress hormones themselves may nevertheless also be ADHD-specific symptoms. Chronic stress like ADHD mediate their symptoms through dopamine and noradrenaline deficiency in the brain.

1.2. Gross motor problems in ADHD

Gross motor and fine motor disorders should be considered separately from motor hyperactivity.

Appearances:

  • Clumsiness
    • Frequent bumping/hanging
  • Many accidents (clumsiness meets hectic pace)
    • Frequent injuries (esp. ADHD-HI)
    • Bruises
  • Coordination problems (dyscoordination)
    • E.g. learning to ride a bike only at 6 years old
    • E.g. difficulty keeping balance or standing on one leg17
  • Difficulties of force dosage

Preliminary data from the ADxS.org online symptom test (as of October 2018) suggest that gross motor problems are far more common in ADHD-HI with hyperactivity than in the ADHD-I subtype. Research supports the association between gross motor problems and hyperactivity/impulsivity.18

1.3. Fine motor problems in ADHD

Gross motor and fine motor disorders should be considered separately from motor hyperactivity.

Appearances:

  • Spidery handwriting19
    • Disproportionate increase in dictation under time pressure20
  • Children find it difficult to color pictures neatly20
  • Precision mechanics are difficult (e.g., smooth cuts with scissors, insert small screws)

Fine motor problems are about equally common in ADHD-HI as in ADHD-I.19


  1. Diamond (2005): Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit (with hyperactivity), Development and Psychopathology 17 (2005), 807–825, S. 819

  2. Studie des MIND Institute der Universität California, zitiert nach Winkler in http://web4health.info/de/answers/adhd-menu.htm

  3. http://helga-simchen.info/Thesen-zu-ADS

  4. Barkley, Benton (2010): Das große Handbuch für Erwachsene mit ADHS

  5. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 61

  6. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 61

  7. Mick, Faraone, Biederman (2004): Age-dependent expression of attention-deficit/hyperactivity disorder symptoms, Psychiatr Clin N Am 27 (2004) 215–224

  8. Dr. Rolf Merkle, Diplom-Psychologe: Stress – was versteht man darunter?

  9. Gruber: Fragebögen zur Stressdiagnostik; Fragebogen 1: Streß-Folgen

  10. Prof. Dr. med. Volker Faust: Erschöpfungsdepression; Seelische Störungen erkennen, verstehen, verhindern, behandeln; PSYCHIATRIE HEUTE; Arbeitsgemeinschaft Psychosoziale Gesundheit

  11. Merkle (2013): Stress – was versteht man darunter?

  12. Hebold (2004): Stress und Stressverarbeitung bei Kindern und Jugendlichen, in: Schluchter, Tönjes, Elkins (Hrsg.), Menschenskinder! Zur Lage von Kindern in unserer Gesellschaft. Band zur Vortragsreihe des Humanökologischen Zentrums der BTU Cottbus, Seite 86

  13. Edel, Vollmöller (2006): ADHS bei Erwachsenen, Seite 113

  14. Rensing, Koch, Rippe, Rippe (2006): Mensch im Stress; Psyche, Körper Moleküle, Seite 96, Seite 151

  15. Egle, Joraschky, Lampe, Seiffge-Krenke, Cierpka (2016): Sexueller Missbrauch, Misshandlung, Vernachlässigung – Erkennung, Therapie und Prävention der Folgen früher Stresserfahrungen; 4. Aufl., S. 45

  16. Arborelius, Owens, Plotsky, Nemeroff (1999): The role of corticotropin-releasing factor in depression and anxiety disorders. J Endocrinol 1999; 160: 1–12, Seite 5 zitiert nach Egle, Joraschky, Lampe, Seiffge-Krenke, Cierpka (2016): Sexueller Missbrauch, Misshandlung, Vernachlässigung – Erkennung, Therapie und Prävention der Folgen früher Stresserfahrungen; 4. Aufl. S. 46

  17. Cook, Kelshaw, Caswell, Iverson (2019): Children with Attention-Deficit/Hyperactivity Disorder Perform Differently on Pediatric Concussion Assessment. J Pediatr. 2019 Aug 30. pii: S0022-3476(19)30956-4. doi: 10.1016/j.jpeds.2019.07.048.

  18. Jansen, Philipsen, Dalin, Wiesmeier, Maurer (2018): Postural instability in adult ADHD – A pilot study. Gait Posture. 2018 Oct 17;67:284-289. doia: 10.1016/j.gaitpost.2018.10.016.

  19. Mokobane, Pillay, Meyer (2019): Fine motor deficits and attention deficit hyperactivity disorder in primary school children. S Afr J Psychiatr. 2019 Jan 22;25:1232. doi: 10.4102/sajpsychiatry.v25i0.1232. eCollection 2019.

  20. Krause, Krause (2014): ADHS im Erwachsenenalter, S. 85

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