Reviewed by Heather Cashell, LCSW
ADHD, or Attention-Deficit / Hyperactivity Disorder, has been labeled a variety of different names since its discovery.
Today, we know the different types of ADHD to be as follows:
- Inattention Type
- Hyperactive / Impulsive Type
- Combination Type
However, that has not always been the case.
The History Of ADHD
The first notion of the existence of ADHD was actually made by a Scottish physician, Sir Alexander Crichton, around 1800. As we refer to it today, Crichton seemed to focus primarily on the inattentive type and noticed a pattern of recognizing it in children.
Likewise, in the 1840s, the German physician Heinrich Hoffmann seemed to pick up on what we refer to today as the hyperactive/impulsive type. Through his observations, he became the creator of the 19th-century children’s book “Fidgety Phil.”
Though its presence was noticed, ADHD was not extensively studied or normalized during the 19th century. The next most significant deep dive was done by the British pediatrician Sir George Frederic Still in 1902, upon his release of significant lectures regarding the “defect of moral control.” While still recognizing a child’s intelligence, he also noted their tendency to lack physical or mental control.
Although progress was still made with ADHD research, the disorder was still massively misunderstood until late in the 20th century.
Hyperkinetic Impulse Disorder
After being referred to as a “defect of moral control,” the next significant name ADHD took on was “hyperkinetic impulse disorder.” This came about in 1957, shortly after the production of the first “Diagnostic and Statistical Manual of Mental Disorders” in 1952.
Hyperkinetic is pretty much a direct synonym to hyperactivity. Hyperkinetic Impulse Disorder, as it was labeled, clearly focused on what we know today as the hyperactive/impulsive type of ADHD.
For decades, ADHD was referred to as a condition in need of medical treatment rather than a more fully understood condition. It was not even until 1968 that the American Psychiatric Association (APA) recognized the disorder.
Updated for the third time in 1980, the “Diagnostic and Statistical Manual of Mental Disorders” renamed ADHD from “hyperkinetic impulse disorder” to “ADD” (Attention Deficit Disorder). Because of its recent historical relevance and similarity in name, people often still confuse ADD with ADHD. There are no significant differences other than the specificity in condition.
Though the DSM-3 did acknowledge ADD with hyperactivity and ADD without hyperactivity, it was not all-encompassing, and hence the next name change in 1987 with the revised DSM-3. Finally, we’ve reached the official title: ADHD.
With the knowledge of its history and context of its prevalence, let’s now review the ADHD types as we know them today.
As stated in the beginning, the three types of ADHD, as we know them today, are: inattentive, hyperactive/impulsive, or a combination of both.
As the name suggests, a person with ADHD inattentive type typically has difficulty paying attention to the “right” thing at the “right” time.
Some symptoms include:
- Lack of attention to detail as it pertains to work in a school or in a job setting.
- Generally forgetful with instruction, conversation, or objects.
- Struggles to stay organized.
- Frequently daydreams or “spaces out.”
- Avoids or procrastinates on lengthy tasks that require more focus.
- Cannot remember to do/complete routine activities.
- Personal hygiene
- Paying bills
- Starting/finishing chores
- Responding to texts/emails/phone calls
Most people can relate to being occasionally forgetful or disorganized. However, someone with ADHD inattentive type struggles with these symptoms daily and needs assistance to keep focused and in order.
Because of the way ADHD has historically been studied, many people still think of it as a hyperactivity disorder. While hyperactivity can be a way ADHD presents itself, it is not the only way. This misconception is frequently driven by the disproportional study of males to females.
In the 1902 primary research of the previously mentioned British pediatrician Sir George Frederic Still, Still studied 15 boys and 5 girls. This trend to give ADHD a primarily male focus was set from the start of ADHD research. This was, in part, because the hyperactivity component was seemingly less prevalent in females.
So, what is hyperactivity and impulsivity as it pertains to ADHD?
Some symptoms include:
- Being impatient
- Inability to stay on task.
- Struggling with quiet activities
- Little consideration for consequences (impulsive)
- Constant movement
- Getting up and down.
- Talking constantly
- Trouble transitioning topics
- Can make inappropriate comments
- Interrupts others
A person with ADHD is least likely to be diagnosed with just hyperactive/impulsive type. The most common diagnosis is ADHD combination type.
ADHD combined type is a combination of inattention, hyperactivity, and impulsivity. Though a person might lean one way or the other, combined ADHD suggests that a person has presentations of both types.
Because ADHD finally encompasses a larger umbrella under which a variety of presentations lie, the DSM-5 decided it was important to rate the severity of the ADHD on a moderate, mild, or severe scale.
With 6.1 million children diagnosed with ADHD, the National Center for Biotechnology Information (NCBI) reported that 41.8% of children experience mild ADHD, 43.7% have moderate ADHD, and 14.5% present severe ADHD.
Thanks to the DSM-5, ADHD is not only categorized by severity but is also now diagnosed by more standardized criteria. Though the criteria are still not as specific as other disorders such as ASD (Autism Spectrum Disorder), it still provides a clearer standard for physicians and parents everywhere.
Published in 2013, the DSM-5 and the APA guidelines for diagnosing the different types of ADHD are as follows:
- Ages 2-16 must present at least six symptoms of inattention.
- Ages 17+ must present at least five symptoms of inattention.
- Older adults must present some symptoms for a consistent period of 6 months, which does not correlate with the developmental stages.
- Hyperactivity / Impulsivity:
- Ages 2-16 must present at least six symptoms of hyperactivity/impulsivity.
- Ages 17+ must present at least five symptoms of hyperactivity/impulsivity.
- Older adults must present some symptoms for a consistent period of 6 months that does not correlate with the developmental stage.
Additionally, the DSM-5 outlines: “Many of the symptoms must have been present before the age of 12, regardless of the age of diagnosis; Many of the symptoms are presented in two or more environments; The symptoms are interfering with work (school or otherwise); Those symptoms are not caused by or explained by another mental disorder.”
Anxiety And Depression
ADHD cannot be caused or explained by anxiety and depression, but ADHD, especially when undiagnosed, can lead to anxiety and/or depression.
According to the NCIB, almost 2/3rds of the 6.1 million children diagnosed with ADHD also have another present condition:
- 1% have Behavioral Problems
- 7% have Anxiety
- 8% have Depression
- 7% have Autism Spectrum Disorder
- 2% have Tourettes
For many with ADHD, there can be an ever-present feeling of frustration that certain things come at a slower, more strenuous pace. It’s unfair to compare a brain with ADHD to a brain without, but once children begin to do that on their own accord, anxiety and depression can closely follow suit.
For parents, caretakers, and physicians, be aware of co-occurring conditions. For those with ADHD, seek assistance if ADHD begins taking a toll on your overall mental health.
High Functioning ADHD
Presenting six or more ADHD symptoms does not necessarily mean a person is incapable of functioning in daily life to a “normal” degree. A person with high functioning ADHD will usually fall into the “mild” or “moderate” categories.
ADHD does not speak directly to a person’s intellect or talents. A person with high functioning ADHD might take longer to complete tasks or need assistance staying organized, but it might not impact their daily life as aggressively as a person with “severe” ADHD.
Learning how to manage ADHD is an important skill that can be taught and can often alleviate certain ADHD causes. Here are some tools to start managing ADHD. These management tools can be used by parents of children with ADHD or by an adult with ADHD:
- Lists: Write everything down. In the absence of certain executive functions, it can be difficult to remember and organize one’s thoughts or responsibilities unless written in an accessible, timely fashion.
- Association: Practice the power of association as it pertains to rewards. Upon completing a task, provide a reasonable reward as an incentive to propel onward and garner positive associations with otherwise difficult tasks.
- Patience: As a parent, practice patience for your child’s condition. As an adolescent or adult with ADHD, practice patience with yourself. This can often mean saying no to things. Those with ADHD hyperactivity/impulsivity or ADHD combination type can be prone to over-committing themselves. It’s okay to say no or to ask for help in these circumstances.
- Routine: Structure is not innate to a person with ADHD. It is much more important to practice. Establishing a routine can help strengthen memory.
- Explore: A person with ADHD might struggle in the classroom but excel at an extracurricular activity. While also working through the classroom struggles, don’t forget to cultivate those other talents or skills. Self-esteem is important for everyone to practice improving and especially important for children with ADHD to foster.
- Self-care: Practically, make sure you or your child is getting plenty of sleep and regularly eating healthy foods.
Though ADHD has been around for centuries, it is still in the early process of being understood and researched. You don’t need to have all the answers, and you are not expected to. If you’re unsure whether or not you or your child has ADHD, take this short, free, and confidential assessment to find out.