Table 2.

DSM-PC: Developmental Variation: Impulsive/Hyperactive Behaviors

Developmental VariationCommon Developmental Presentations
V65.49 Hyperactive/impulsive variationEarly childhood
Young children in infancy and in the preschool years are normally very active and impulsive and may need constant supervision to avoid injury. Their constant activity may be stressful to adults who do not have the energy or patience to tolerate the behavior. The child runs in circles, doesn't stop to rest, may bang into objects or people, and asks questions constantly.
During school years and adolescence, activity may be high in play situations and impulsive behaviors may normally occur, especially in peer pressure situations.Middle childhood
High levels of hyperactive/impulsive behavior do not indicate a problem or disorder if the behavior does not impair function. The child plays active games for long periods.
 The child may occasionally do things impulsively, particularly when excited.
 The adolescent engages in active social activities (eg, dancing) for long periods, may engage in risky behaviors with peers.
Special Information
Activity should be thought of not only in terms of actual movement, but also in terms of variations in responding to touch, pressure, sound, light, and other sensations. Also, for the infant and young child, activity and attention are related to the interactions between the child and caregiver, eg, when sharing attention and playing together.
Activity and impulsivity often normally increase when the child is tired or hungry and decrease when sources of fatigue or hunger are addressed.
Activity normally may increase in new situations or when the child may be anxious. Familiarity then reduces activity.
Both activity and impulsivity must be judged in the context of the caregiver's expectations and the level of stress experienced by the caregiver. When expectations are unreasonable, the stress level is high, and/or the parent has an emotional disorder (especially depression), the adult may exaggerate the child's level of activity/impulsivity.
Activity level is a variable of temperature. The activity level of some children is on the high end of normal from birth and continues to be high throughout their development.
  • Taken from: American Academy of Pediatrics. The Classification of Child and Adolescent Mental Diagnoses in Primary Care. Diagnostic and Statistical Manual for Primary Care (DSM-PC), Child and Adolescent Version. Elk Grove Village, IL: American Academy of Pediatrics; 1996