What Are The 3 Types Of ADHD?

Reviewed by Aaron Horn, LMFT

Published 12/22/2020

Attention-deficit hyperactivity disorder isn’t a single, unified condition. Not everyone who has ADHD shows the same signs or symptoms. Depending on a person’s symptoms, they can have one of the three different types of ADHD. In this article, you will learn what these three forms are by learning about the core symptoms of ADHD and what can be done to treat them.

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What Is ADHD?

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition that frequently appears during a person’s childhood. If left undiagnosed and untreated, it can persist until adulthood.

Many of the signs and symptoms become noticeable during school. They might display behaviors like not being able to sit still, being extra talkative, daydreaming, not paying attention, and difficulties completing homework.

However, these are only a handful of the possible symptoms that someone with ADHD can display and they all can be divided into two main clusters - inattention and hyperactivity.

These are important when determining what type of ADHD someone has, and in the next section, you will get a complete picture of the signs and symptoms of ADHD by reading the DSM-5 criteria.

ADHD DSM-5 Criteria

The DSM (Diagnostic and Statistical Manual) of the American Psychiatric Association is a handbook used by all mental health professionals in the United States to diagnose disorders, including attention-deficit hyperactivity disorder.

Below, you will read about the diagnostic criteria used to help professionals accurately diagnose kids and adults to begin the right treatment. [1]

  1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
  • Often fails to give close attention to details or make careless mistakes in schoolwork, work, or other activities.
  • Often has trouble holding attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
  • Often has trouble organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period (such as schoolwork or homework).
  • Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted
  • Is often forgetful in daily activities.
  1. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to the extent that is disruptive and inappropriate for the person’s developmental level:

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  • Often fidgets with or taps hands or feet or squirms in their seat.
  • Often leaves their seat in situations when remaining seated is expected.
  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
  • Often unable to play or take part in leisure activities quietly.
  • Is often “on the go,” acting as if “driven by a motor.”
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.
  • Often has trouble waiting for their turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)
  1. In addition, the following conditions must be met:
  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
  • Several symptoms are present in two or more settings (such as at home, school, or work, with friends or relatives, in other activities).
  • There is clear evidence that the symptoms interfere with or reduce the quality of social, school, or work functioning.
  • The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during schizophrenia or another psychotic disorder.

Depending on the symptoms reported by these criteria, doctors can categorize them into one of three types, which will be covered next.

The 3 Types Of ADHD

By using the DSM-5 criteria and carefully looking at a person’s symptoms, attention-deficit hyperactivity disorder can be divided into three categories, also known as presentations:

  • Predominantly Inattentive
  • Predominantly Hyperactive-Impulsive
  • Combined Presentation

Here are the requirements for each type of ADHD, as follows:

Predominantly Inattentive Presentation

If a child or adult is diagnosed with having the predominantly inattentive presentation type, it means that they've had symptoms for the last 6 months (six indicators for those up to 15 years of age, and five for 17 and older) in the inattentive symptom cluster but not in the hyperactive one.

This doesn’t mean that someone who is predominantly inattentive doesn’t have any hyperactivity-impulsivity symptoms at all. However, signs of inattentiveness like difficulties paying attention, following instructions, and finishing tasks will be much more apparent.

Predominantly Hyperactive-Impulsive Presentation

Instead of inattentive symptoms, this type of ADHD involves showing enough signs of hyperactivity-impulsivity. This means that individuals with this presentation will primarily show signs such as an inability to sit still, restlessness, and speaking too much or at inappropriate times.

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Because of the impulsivity and excessive movements, this type of ADHD is most often associated with getting hurt and injured or causing other accidents. [1] Because of this, parents and teachers of children with hyperactivity-impulsivity issues should try to create an environment that is safe by removing dangerous objects.

Combined Presentation

A combined presentation occurs when an individual diagnosed with ADHD has many signs and symptoms of symptom clusters discussed. According to the National Institute of Mental Health, the combined presentation is the most common type seen in kids. [2]

A combined presentation doesn’t mean that an individual has an equal amount in both inattentiveness and hyperactivity-impulsivity. Instead, there are enough symptoms of both of them, 6 for people under 17 years old, and 5 for those who are older.  Someone can have every single symptom of inattentiveness but only 6 in hyperactivity and still be considered combined ADHD because the minimum for each was met.

Although there may be similarities between people, each person with ADHD is different. Specific individuals can struggle with certain areas more than others, which is evident from these different presentations. Nonetheless, all of the symptoms can significantly impair anyone with ADHD, regardless of their type.

Are The ADHD Presentations Permanent?

The types of ADHD a person has can change over time, and therefore, is not permanent. However, this doesn’t mean that people with ADHD will outgrow their symptoms. Rather, it indicates that the condition can evolve.

For example, if someone was diagnosed as being predominantly hyperactive and impulsive, there is always the possibility that they can transition into the inattentive or combination types as they age.

In fact, it is very common for those who start preschool to struggle with hyperactivity-impulsivity issues. Still, as they reach elementary school, they begin to show inattentiveness symptoms, which can severely affect their academic performance. [2] Once they reach adolescence, hyperactivity might start to fade away, but the others can still persist.

This means that parents and doctors need to keep up with their child’s symptoms to ensure that they are managing these symptoms and can live a more productive life and improve their chances of success.

How Is ADHD Treated?

Regardless of the type of ADHD a person has, the condition is treated by using a combination of medication and behavioral therapy.

Medication, which is typically a prescription stimulant, can help increase dopamine and norepinephrine levels, which are essential neurochemicals involved in attention and focus. There are also non-stimulant medications people can use that may also help if the side effects become a concern.

Despite being considered relatively safe, these medications can have side-effects even at the prescribed dose. Therefore, they will need to be monitored carefully by parents and doctors to help minimize these risks.

Medication generally isn’t prescribed for children under 6 years of age. Instead, behavioral therapy is usually recommended first.

Behavioral therapy can help address many of the other symptoms of ADHD and replace negative behaviors with positive ones. Your therapist may suggest techniques such as adhering to schedules and routines and promoting other healthy habits that can improve discipline.

These good behaviors can be rewarded by parents and teachers without a therapist's assistance and can be easily applied.

For example, if a child wants to play video games or spend time with their friends, they will be instructed to complete their homework and eat their dinner first. If they comply, they should be rewarded quickly after their excellent behavior as this can help improve positive reinforcement.

If they don’t, they should not be rewarded for bad behavior, which will have the opposite effect on them.

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Additionally, as a child gets older, parents and other guardians will most likely need to modify their reward and punishment system to achieve similar results.

For instance, time-out might be ineffective for a teenager, but taking away privileges or assigning them chores might have the similar effect as time-out did when they were younger.

Do You Or Your Child Have ADHD?

Getting help with ADHD will require a diagnosis from a doctor or mental health professional. Therefore, making an appointment is necessary and as soon as possible since ADHD is a chronic condition that doesn’t go away with age.

Many individuals don’t get diagnosed until adulthood. Statistics regarding adult ADHD have been on the rise due to the diagnoses being missed earlier.

If it sounds like this may apply to you, you can also take this free ADHD test and determine if you might be dealing with undiagnosed ADHD. It’s not a substitute for a diagnosis, but the results may be able to help a doctor figure out what type of ADHD you or your child has.

Since the symptoms change with time, you should continue to make follow-up visits and changes to treatment strategies to ensure that they are properly managed.

Conclusion

Hopefully, by reading this article, you have a better understanding of the ADHD symptoms and how they are taken into account when determining the type of ADHD someone has. However, no matter how challenging the symptoms may be, ADHD can be managed. People with the disorder can be successful at home, school, and for the rest of their lives with treatment.

References

  1. Centers for Disease Control and Prevention. (2020, September 21). Symptoms and Diagnosis of ADHD. Retrieved from https://www.cdc.gov/ncbddd/adhd/diagnosis.html
  2. National Institute of Mental Health. (2019, September). Attention-Deficit/Hyperactivity Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml