Child Development

Types of ADHD: Inattentive, Hyperactive-Impulsive, and Combined

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Attention-Deficit/Hyperactivity Disorder (ADHD) is a common condition that comes with a range of potential symptoms. These symptoms either fall under the category of inattention or the category of hyperactivity/impulsivity.

Based on the symptoms a person experiences, ADHD may be identified as a particular "type" or presentation of the disorder. So, what are the types of ADHD? What might diagnosis and treatment look like for the disorder, and is prevention possible? Let's talk about it. 

Types of ADHD

As with other diagnoses and disorders, everyone with ADHD experiences symptoms differently. The presentations of ADHD are technically specifiers rather than separate diagnoses. Because of this, it is also common for the presentation of ADHD to change over time.

So, an individual with any presentation of ADHD may simply say, "I have ADHD," when they talk about the condition. These specifiers are used to clarify the symptoms a person is most apt to struggle with or experience, which can inform their treatment needs. With that in mind, here are the three types of ADHD:

Inattentive Presentation

Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation is diagnosed when someone under the age of 17 experiences either six or more of the following symptoms or if someone above the age of 17 experiences five or more of the following symptoms:

  • Difficulty sustaining focus during activities or tasks.
  • Trouble following through on instructions and failure to finish schoolwork, chores, or duties in the workplace (one may start tasks but become sidetracked, etc.) 
  • Avoidance of, dislike of, or reluctance to engage in tasks that require sustained mental effort (such as homework or workplace tasks). 
  • Making seemingly careless mistakes or failing to give close attention to details when engaging in tasks or activities. 
  • Appearing as though one isn't listening when spoken to directly.
  • Difficulty organizing tasks and/or activities.
  • Frequently losing things necessary for tasks or activities (school or work supplies, glasses, personal care items, kitchen items, etc.)
  • Being easily distracted by outward stimuli. 
  • Forgetfulness in daily activities. 

Hyperactive-Impulsive Presentation

Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type is diagnosed when someone under the age of 17 experiences either six or more of the following symptoms or if someone above the age of 17 experiences five or more of the following symptoms:

  • Frequent fidgeting, squirming, or hand-tapping.
  • Blurting out an answer before a question has been completed.
  • Being "on the go" or acting as though one is "driven by a motor" often. 
  • Interrupting or intruding on others (for example, "butting in" when other children are playing a game or having a conversation). 
  • Frequent inability to play or engage in leisure activities quietly.
  • Restlessness or running/climbing in situations where it is inappropriate to do so.
  • Trouble remaining seated in situations where one is expected to do so (such as the classroom). 
  • Difficulty waiting for one's turn.
  • Speaking excessively often. 

Combined Presentation

Attention-Deficit/Hyperactivity Disorder, Combined Presentation, is diagnosed if an individual meets the criteria for both Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive, and Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive. In other words, if someone experiences either five or six (depending on age) of the symptoms in both the hyperactive-impulsive and inattentive category, they would have ADHD, combined presentation. 

Although these are the main presentations of ADHD that we typically talk about, and these are the specifiers that we see in the diagnostic and statistical manual of mental disorders or DSM (a manual that professionals use to diagnose a range of disorders or conditions), some experts also say that there are seven types of ADHD. Although these don't receive formal recognition, someone may use one of the seven terms to depict the way they experience life with ADHD.

Diagnosis

ADHD can be diagnosed by a number of different medical professionals. This could be a child's pediatrician, a psychiatrist, or another individual who works with ADHD and has the required credentials to provide an accurate diagnosis for the disorder. There are a couple of different boxes that need to be checked for a person to receive a diagnosis of ADHD. Here are some important things to note:

  • Regardless of a person's age at the time of diagnosis, an individual must have experienced symptoms of ADHD in childhood (before the age of 12). If you are an adult, you will be asked to reflect on childhood experiences and symptoms when you are assessed for a potential diagnosis. 
  • Although a person with ADHD may live with multiple diagnoses, and this is actually very common (for example, about 50% of adults who live with ADHD also have an anxiety disorder), the symptoms of ADHD themselves must not be better attributed to another disorder or condition.
  • There must be clear evidence that the symptoms of ADHD impede on or reduce the quality of an individual's functioning and social, academic, or occupational settings.

For many, a diagnosis is what opens the door to treatment, as well as access to or awareness of other tools that can help an individual with ADHD succeed, such as school accommodations. If you are seeking a diagnosis for yourself or someone in your care, such as a child, there are a number of different ways to take the first step. You can look for testing in your area yourself by searching for a specialist, or you may be able to get a referral from another medical provider that you see on a regular basis, such as your primary care physician. 

Treatment

Regardless of the type of ADHD someone is concerned with, the recommended treatments are generally similar or the same. Here are some of the standard treatments used for ADHD: 

  • Prescription medication. Medications such as Adderall, Ritalin, Strattera, and Vyvanse may be used to treat ADHD in adults and minors above the age of six. If needed, your prescribing doctor will be able to offer guidance and discuss any of your potential concerns about taking medication for ADHD. 
  • Games designed for ADHD treatment. There are games designed to treat ADHD symptoms that can be a helpful addition to an individual's treatment plan. While they aren't as well-known as other treatment methods for ADHD, they are backed by research and are proven effective. 
  • Behavioral therapy. Therapy is a helpful modality for people with ADHD of all ages. There are various therapeutic modalities that people with ADHD and co-occurring conditions and concerns may benefit from. The type of therapy that is used or recommended will vary based on what an individual wants to work on, their age, and other factors. For young kids, parent behavior training is one of the first recommendations for ADHD treatment.

All of the above treatments are known to have the potential to reduce symptoms in those who live with ADHD. For example, it’s indicated that 70-80% of people who live with ADHD benefit from stimulant medication. Other mechanisms, such as lifestyle choices, reward systems, and routines, can also be helpful in caring for yourself or someone else who strives to manage ADHD symptoms.

The best treatment plan will vary from person to person, and it's okay to try various tools until you find what works for you. Accommodations and school interventions or changes to a child's education plan may be a supportive part of treatment and care for a child with ADHD.

Is Prevention Possible?

ADHD is marked by differences in the brain, and while there are various potential risk factors, it is not possible to prevent ADHD. One of the most well-known risk factors for ADHD is a history of the condition in the family, especially in siblings and parents. Some people do experience partial remission from ADHD symptoms as they age, though this isn't always the case.

While you can't prevent ADHD, what you can do is set a child who lives with ADHD up for success early on through symptom management and reduction tools. Symptom management is something that individuals can work on and improve at any point in their lives, regardless of how old they are or when they were diagnosed.