Can fidgeting be a normal behavior?

Can Fidgeting Be Normal?

Yes, fidgeting is a normal behavior that serves as a source of energy expenditure and spontaneous physical activity in daily living for most people. 1

Fidgeting as Normal Physiological Behavior

Fidgeting represents a form of nonexercise activity thermogenesis (NEAT), which encompasses the spontaneous physical activities of daily living, including fidgeting while sitting and standing while reading. 1 This is a natural mechanism through which the body expends energy beyond structured exercise and represents normal human movement patterns. 1

• When individuals engage in fidgeting, they increase their metabolic rate above the baseline 1 metabolic equivalent associated with sedentary sitting. 1
• Even minimal movements like fidgeting can substantially increase nonexercise activity thermogenesis values compared to completely sedentary behavior. 1

Fidgeting in Different Contexts

In Healthy Populations

• Fidgeting during lectures and cognitive tasks appears to serve a functional role in maintaining attention and improving retention of material over time. 2
• Research demonstrates that fidgeting increases as a function of time on task during lecture viewing, and this fidgeting makes a unique contribution to retention of material beyond attention levels alone. 2
• The relationship between fidgeting and retention suggests it may serve as a compensatory mechanism to maintain arousal during cognitively demanding activities. 2

In ADHD Populations

While fidgeting is normal, it manifests differently in ADHD:

• In children and adolescents with ADHD, fidgeting and finger tapping are among the cardinal behavioral symptoms that decrease with stimulant medication treatment. 1
• Stimulants decrease interrupting, fidgeting, and finger tapping while increasing on-task behavior in classroom settings. 1
• In adults with ADHD, recent research suggests fidgeting may function as a self-regulating mechanism for attention and alertness during cognitively demanding tasks. 3
• Increased fidgeting during correct trials on cognitive tasks and among participants with lower reaction time variability supports the theory that fidgeting aids arousal and improves sustained attention in ADHD adults. 3

Clinical Distinction: Normal vs. Pathological

The key distinction lies in degree, context, and functional impairment:

• Normal fidgeting occurs as part of spontaneous daily movement and increases during tasks requiring sustained attention. 1, 2
• In ADHD, fidgeting becomes excessive enough to interfere with classroom performance, social interactions, and task completion. 1
• The diagnostic criteria for ADHD specifically include fidgeting/squirming as one of six hyperactive-impulsive symptoms that must persist for at least 6 months and cause clinically significant impairment in multiple settings. 4

Assessment Considerations

When evaluating fidgeting in clinical contexts:

• In pain assessment for elderly or cognitively impaired patients, fidgeting is recognized as a normal pain behavior indicator alongside other body movements like guarding and restricted movement. 1
• In functional neurological disorders, fidgeting may appear as part of body movements during stress, but this differs from the persistent pattern seen in ADHD. 1
• The temporal relationship and context matter: fidgeting that occurs exclusively during emotional distress or specific situations may represent different underlying mechanisms than persistent fidgeting across all contexts. 5

Common Pitfalls to Avoid

• Do not pathologize normal fidgeting that serves adaptive functions for energy expenditure and attention maintenance. 1, 2
• Do not assume all fidgeting in ADHD is maladaptive: in adults with ADHD, fidgeting may represent a compensatory mechanism that aids sustained attention rather than purely a symptom requiring suppression. 3
• Do not rely solely on fidgeting as a diagnostic criterion: ADHD diagnosis requires comprehensive evaluation including persistence of symptoms before age 7, presence in multiple settings, and clinically significant impairment beyond just the presence of fidgeting. 4
• Avoid misinterpreting fidgeting devices: while fidget spinners and similar devices are popular, evidence suggests their benefit relates more to general object manipulation rather than any inherent property of the devices themselves. 6

Practical Implications

From a workplace and public health perspective:

• Encouraging movement and fidgeting while sitting can increase nonexercise activity thermogenesis and reduce the adverse health effects of prolonged sedentary behavior. 1
• Standing workstations and opportunities for spontaneous movement should be viewed as supporting normal physiological needs rather than accommodating pathology. 1
• The distinction between normal fidgeting and pathological hyperactivity should be based on functional impairment across multiple life domains, not merely the presence of movement. 4