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How do you distinguish between a kid who's just overly active to one who truly is hyperactive?

Well, if you have about $2500 or great insurance, a full battery neuropsych eval would do .... for starters
Please don't call me "ridiculous" for stating that ADD/ADHD are on a spectrum of disorders that includes autism.
I've just had a heart to heart with another Mom who has raised over $2 million for autism research on behalf of one child, but still doesn't have answers for her other child's ADD/social dysfunction and other conditions.
"Autism" is in itself not easy to pigeonhole. Don't get me started on terms like "atypical" and "high function" and "low function" and "Institutional autism" and all the shades of gray on the spectrum of brain-related behavioral dysfunction
Been there

I’ve seen many of these expensive evals and many if not most are relatively useless. I would never do it to distinguish “overactive vs. hyperactive” unless, only possibly, if autism was a concern.