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Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis.

Title: Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis.
Name(s): Kofler, Michael J, author
Raiker, Joseph S, author
Sarver, Dustin E, author
Wells, Erica L, author
Soto, Elia F, author
Type of Resource: text
Genre: Journal Article
Date Issued: 2016-06-01
Physical Form: computer
online resource
Extent: 1 online resource
Language(s): English
Abstract/Description: Hyperactivity, or excess gross motor activity, is considered a core and ubiquitous characteristic of ADHD. Alternate models question this premise, and propose that hyperactive behavior reflects, to a large extent, purposeful behavior to cope with environmental demands that interact with underlying neurobiological vulnerabilities. The present review critically evaluates the ubiquity and environmental modifiability of hyperactivity in ADHD through meta-analysis of 63 studies of mechanically measured activity level in children, adolescents, and adults with ADHD relative to typically developing groups. Random effects models corrected for publication bias confirmed elevated gross motor activity in ADHD (d=0.86); surprisingly, neither participant age (child vs. adult) nor the proportion of each ADHD sample diagnosed with the inattentive subtype/presentation moderated this effect. In contrast, activity level assessed during high cognitive load conditions in general (d=1.14) and high executive functioning demands in particular (d=1.39) revealed significantly higher effect sizes than activity level during low cognitive load (d=0.36) and in-class schoolwork (d=0.50) settings. Low stimulation environments, more rigorous diagnostic practices, actigraph measurement of movement frequency and intensity, and ADHD samples that included fewer females were also associated with larger effects. Overall, the results are inconsistent with DSM-5 and ADHD models that a) describe hyperactivity as ubiquitous behavior, b) predict a developmental decline in hyperactivity, or c) differentiate subtypes/presentations according to perceived differences in hyperactive behavior. Instead, results suggest that the presence and magnitude of hyperactive behavior in ADHD may be influenced to a considerable extent by environmental factors in general, and cognitive/executive functioning demands in particular.
Identifier: FSU_pmch_27131918 (IID), 10.1016/j.cpr.2016.04.004 (DOI), PMC4902796 (PMCID), 27131918 (RID), 27131918 (EID), S0272-7358(15)30156-2 (PII)
Grant Number: R34 MH102499
Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at
Subject(s): Adult
Age Factors
Attention Deficit Disorder with Hyperactivity/physiopathology
Attention Deficit Disorder with Hyperactivity/psychology
Executive Function/physiology
Psychomotor Agitation/physiopathology
Psychomotor Agitation/psychology
Sex Factors
Persistent Link to This Record:
Host Institution: FSU
Is Part Of: Clinical psychology review.
Issue: vol. 46

Choose the citation style.
Kofler, M. J., Raiker, J. S., Sarver, D. E., Wells, E. L., & Soto, E. F. (2016). Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis. Clinical Psychology Review. Retrieved from