Hyperactivity & Restlessness

What does your restlessness feel like?

You might recognise several of these:

• I need to keep moving. I shift position, tap, pace, stand up or find long periods of sitting increasingly uncomfortable.
• My mind and body run at different speeds. I feel driven from one activity to another, or my thoughts keep racing even when I look calm.
• Waiting and slowing down are difficult. I interrupt, speak before I have finished thinking, or find it hard to hold back an immediate response.
• Movement actually helps me. Rocking, walking, fidgeting or repeating a movement may help me regulate sensory input, manage emotions or concentrate.
• I feel agitated rather than energetic. I cannot settle, and the urge to move feels unpleasant. It may have appeared after a change in medication.
• My activity level has changed suddenly. I am much more active than usual, need far less sleep, talk more rapidly or feel unusually driven.

Notice one distinction: Does moving leave you feeling better and more able to function, or is the movement itself distressing? Has this always been part of your life, or is it new?

What might actually help?

If you’ve always felt physically restless or find it difficult to hold back impulses

Consider an ADHD assessment or review of your existing ADHD treatment, particularly if difficulties affect work, relationships or daily routines. ADHD-related hyperactivity in adults can feel like persistent internal restlessness rather than obvious running around.

What happened in research? In a four-week trial involving adults with diagnosed ADHD, about 69 in 100 taking lisdexamfetamine met the study’s definition of meaningful overall ADHD improvement, compared with 37 in 100 taking a placebo. The result covered ADHD symptoms overall, not a 69% reduction in restlessness specifically (Mattingly et al., BMC Psychiatry, 2013). More recent evidence from 113 trials supports stimulant medicines and atomoxetine for short-term improvement in core adult ADHD symptoms, although individual response and side effects vary (Ostinelli et al., The Lancet Psychiatry, 2025).

Where to go: Ask an ADHD specialist about medication, practical adjustments and ADHD-focused psychological support. NICE’s ADHD guidance explains the options; medicines require individual assessment and monitoring. If you’re already treated, tell your clinician whether the problem is physical restlessness, impulsive decisions, difficulty switching activities—or all three.

A digital option for adults with ADHD: attexis is a German-language prescription CBT-based programme that includes a module on restlessness and motor hyperactivity. In a trial of 337 adults with confirmed ADHD, adding attexis to usual care improved overall ADHD symptom scores by about 5 points more than usual care alone after three months; daily functioning also improved (D’Amelio et al., Psychological Medicine, 2026). This was not a hyperactivity-only result. The trial excluded several coexisting diagnoses, including autism and severe mood or psychotic disorders, so we cannot assume the same effect in those groups. Access is currently centred on the German healthcare system.

If moving or fidgeting helps you cope with sensory experiences

Keep the movement that helps, where it is safe. For many autistic people, rocking, pacing, hand movements or using sensory objects can make environments easier to tolerate. Trying to eliminate harmless movement may increase discomfort rather than improve functioning.

If noise, crowds or social demands push your restlessness higher, consider changes to the environment: permission to stand, a quiet workspace, movement breaks, or a suitable object to handle while listening. An autism-informed occupational therapist may help if sensory distress is affecting everyday life.

What does the evidence say? Autism guidance recommends adjusting environments and understanding why a behaviour occurs before trying to change it. There is no reliable clinical percentage showing how much a particular fidget product or movement break improves autistic adults’ functioning; we should not pretend otherwise (NICE autism guidance).

Free resource: The National Autistic Society’s guide to stimming explains when repetitive movement is helpful and when additional support may be needed.

If you feel constantly on edge or driven to move by fear

If the restlessness comes with tension, feeling unsafe, scanning for danger, flashbacks or panic, ask for help with what is keeping you on alert, rather than trying only to suppress the movement.

For people with PTSD, therapies such as trauma-focused CBT—including cognitive processing therapy and prolonged exposure—are recommended treatments. They can address trauma-related arousal as part of broader recovery. We cannot give an honest percentage for how much they reduce pacing or restlessness specifically, because that is not usually the outcome measured (NICE PTSD guidance).

Where to go: Ask your mental-health clinician for a therapist trained in treatment for your actual condition. A general relaxation app is not a substitute for trauma-focused treatment when PTSD is driving the problem.

If the restlessness began after starting or changing medication

Get a medication review promptly. An intensely uncomfortable urge to move, especially after starting or increasing an antipsychotic medicine, may be akathisia. This can be mistaken for ordinary anxiety or worsening hyperactivity. It can be severe and requires a clinician to assess the medication and treatment options (New York State Department of Health, medication-induced movement disorders).

Do not suddenly stop or change prescribed medication on your own. If the agitation is unbearable, or comes with thoughts of harming yourself, seek urgent medical help.

If the urge to move is mainly in your legs when resting at night, especially with unpleasant leg sensations, ask about restless legs syndrome instead. It may need a different assessment, including checking for iron deficiency (NHS restless legs guide).

If your activity and energy have increased sharply

A sudden change is different from lifelong hyperactivity. If you need very little sleep without feeling tired, are talking or thinking much faster, or are taking unusual risks, contact your mental-health team promptly. These changes can occur during hypomania or mania, particularly if you have bipolar disorder. This is not a situation to manage by adding stimulating activities or trying an ADHD treatment independently (NICE bipolar quality standard).

One thing to try this week

If your restlessness is familiar and not a new or alarming change, choose one situation where it gets in your way—perhaps meetings, reading, eating with others or settling in the evening.

For three days, notice:

• What was happening? Waiting, noise, a demanding task, excitement, worry or a particular medication time?
• What did you need to do? Walk, tap, speak, change tasks, escape the setting?
• Did movement help? Did you return feeling clearer, or did the distress continue?

Then try one change that fits: stand while listening, agree a movement break, choose a quieter space, or discuss persistent impulsivity with your clinician. Keep track of what improves your actual day—finishing the conversation, staying comfortable in the room, returning to work, or sleeping better—not whether you appeared perfectly still.

If the restlessness is new, severe, medication-related or accompanied by a marked change in sleep or mood, prioritise an assessment instead of a self-experiment.