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Understanding the Three Types of ADHD

types of adhd

Attention-deficit hyperactivity disorder (ADHD) affects about 11 percent of school-aged children according to the nonprofit support group Children and Adults With Attention-Deficit/Hyperactivity Disorder (CHADD). For 75 percent of these kids, symptoms will persist through adulthood and include restlessness, and difficulty controlling urges or paying attention.

But not all cases of ADHD are the same. In fact, there are three specific types of this disorder, and some are more easily spotted than others.

Those three types, according to the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-5), are:

  • Predominantly inattentive
  • Predominantly hyperactive/impulsive
  • Combined

Generally speaking, the distinction between the types of ADHD is based on whether symptoms fall more into one of the two camps — inability to pay attention or hyperactivity/impulsivity — or straddle both.

Exactly what causes ADHD is not fully understood, but certain risk factors seem to predispose a person to developing all of the types of ADHD. These include genetics, smoking, alcohol or drug use during pregnancy, exposure to environmental toxins during pregnancy or at a young age, being born at a low birth weight or sustaining a brain injury.

1. ADHD predominantly inattentive type

With ADHD inattentive type, you or your child:

  • Doesn’t pay close attention to details and often makes careless mistakes in school or on the job
  • Has difficulty staying focused on the task at hand
  • Doesn’t seem to listen when spoken to
  • Doesn’t follow through on instructions, complete schoolwork, chores or job responsibilities
  • Has trouble getting and staying organized and often exhibits poor time management
  • Tends to avoid tasks that require sustained focus
  • Often loses things such as papers, books, keys, wallet, cell phone or eyeglasses
  • Is easily distracted
  • Tends to forget what is expected, including daily responsibilities

To be diagnosed with ADHD inattentive type, you must have six of these symptoms (or five for people over 17 years), explains the federal Centers for Disease Control and Prevention (CDC). These criteria appear in the DSM-5, which doctors use to diagnose mental disorders. In addition, these symptoms must be severe enough to impair the person’s ability to function, be present in more than one setting (for example, in school and at home) and start before age 12.

Kids with ADHD inattentive type may sometimes slip through the system as they are not disruptive or hyperactive like their counterparts with ADHD hyperactive/impulsive type. This type of ADHD also tends to occur more frequently in girls.

ADHD inattentive type was formerly known as attention deficit disorder (ADD).

2. ADHD predominantly hyperactive/impulsive type

With ADHD hyperactive/impulsive type, you or your child:

  • Fidgets often
  • Can’t stay seated
  • Has a hard time staying quiet
  • Is always “on the move"
  • Talks too much
  • May blurt out an answer before a question has been asked or finish other people’s sentences
  • Has trouble waiting your turn
  • Regularly interrupts conversations, games or activities

To be diagnosed with ADHD hyperactive/impulsive type, you must have six of the symptoms (or five for people over 17 years), the CDC states. These symptoms also must impair the person’s ability to function, be present in more than one setting and start before age 12.

This is the least common type of ADHD, according to Johns Hopkins Medicine in Baltimore, but it’s often easier to spot than ADHD inattentive type because symptoms tend to be more disruptive.

3. ADHD combined type

This is the most common type of ADHD, according to the National Institute of Mental Health (NIMH). It is marked by both impulsive and hyperactive behaviors as well as inattention. In other words, it shares symptoms with both the ADHD hyperactive/impulsive type and the ADHD inattentive type.

To be diagnosed with ADHD combined type, you or your child should have six or more symptoms of inattention plus six or more symptoms of hyperactivity and impulsivity, the CDC states.

ADHD symptoms tend to appear between the ages of 3 and 6 and can continue through life. These symptoms may change with time, which means that what was once ADHD inattention type can become ADHD combined type, or vice versa.

How the type of ADHD is determined

There is no one blood test or other exam that says “you have this type of ADHD,” Instead, it's a diagnosis based on symptoms that have occurred over the past six months. Input from parents and teachers and sometimes the child can be helpful in establishing a diagnosis of ADHD inattention type, hyperactivity-impulsivity type or combined type. The DSM-5 now requires that ADHD be classified as “mild,” “moderate” or “severe” based on the degree of symptoms and how they interfere with the person's life.

It is also important that other possible causes of the symptoms, such as learning disabilities, are ruled out. As part of the diagnosis process, your doctor will also look for conditions that may travel with ADHD, such as anxiety or depression. More than two-thirds of children with ADHD have at least one co-existing condition, the American Academy of Pediatrics (AAP) points out.

Treating all types of ADHD

Treatment for all types of ADHD typically involves a combination of medication and behavioral therapy. Factors that play a role in the treatment choice include age, overall health and the extent of the symptoms.

Stimulants and non-stimulants are the two main types of ADHD medication.

Stimulants increase the brain chemicals that aid in thinking and attention to improve focus. Like all drugs, stimulants do confer their fair share of side effects, including:

  • Loss of appetite
  • Sleeping problems
  • Sudden, repetitive movements (tics)
  • Anxiety and irritability
  • Stomach pain
  • Head pain

Non-stimulant medications may also help control ADHD symptoms. These drugs may be prescribed if stimulants cause too many side effects or are not working as well as expected. Non-stimulants can also be used with stimulants to boost their effects. These medications don’t start to work as quickly as stimulants do.

Sometimes, antidepressants may also be used to treat co-existing conditions, such as anxiety or depression.

Behavioral therapy, including training for parents, can help children with ADHD change their behavior. This often involves creating structure throughout the day. Parents learn to help kids with ADHD by praising them for what they do well instead of criticizing what they do wrong. The CDC recommends behavioral therapy be tried first for young children, noting that it can be as effective as medication in some cases.

Often, ADHD treatment in kids includes interventions at school to help the child thrive academically. These accommodations may include academic remediation, extended time for testing or preferential seating at the front of the class.

Adults also can benefit from therapy to treat their ADHD. Some therapies may focus on tips for better time management and organization. There are also cognitive behavior therapy programs designed specifically for adults with ADHD. This type of therapy helps to change how you think about challenges and has spillover benefits on actions. It can also help with anxiety and depression, which tend to accompany ADHD.

In addition, other types of therapy, such family and marital therapy, can be effective ways to reduce stress that ADHD symptoms can put on a household.

ADHD can cause problems at school, work and in interpersonal relationships when untreated or undertreated. Studies suggest that individuals with ADHD are more likely to fail in school, become depressed, have difficulty sustaining relationships and abuse drugs and alcohol. They are also may experience difficulties with peers and engage in risky, thrill-seeking behaviors. With proper treatment, however, ADHD symptoms can be managed, and you or your child can learn to live with ADHD and thrive at work, school and home.

If you or someone you love is struggling with symptoms of ADHD, schedule a visit with your doctor to start the process and get the needed help.

Article references

  1. Children and Adults with Attention-Deficit/Hyperactivity Disorder, ADHD Overview. https://chadd.org/about-adhd/overview/
  2. American Psychiatric Association, What Is ADHD? https://www.psychiatry.org/patients-families/adhd/what-is-adhd
  3. Centers for Disease Control and Prevention, ADHD Diagnosis. https://www.cdc.gov/ncbddd/adhd/diagnosis.html
  4. American Academy of Pediatrics, Understanding ADHD. https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Understanding-ADHD.aspx
  5. Johns Hopkins Medicine, Attention-Deficit / Hyperactivity Disorder (ADHD) in Children. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adhdadd
  6. National Institute of Mental Health, Attention-Deficit/Hyperactivity Disorder. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-  
  7. Children and Adults with Attention-Deficit/Hyperactivity Disorder, CBT. https://chadd.org/for-adults/cognitive-behavioral-therapy/