Of the three presentations of ADHD, the combined type is the most common. According to some research, approximately 70% of adults with ADHD have the combined type. This article discusses how combined type ADHD is diagnosed and why getting an accurate diagnosis is beneficial. It also explores treatment options to help people manage inattentive, hyperactive, and impulsive traits.
Types of ADHD
There are three forms of attention deficit hyperactivity disorder (ADHD). These are:
Predominantly inattentive ADHD is characterized by problems regulating attention. Predominantly hyperactive/impulsive ADHD is characterized by impulsive and hyperactive behavior. Combined type ADHD is where both inattention and hyperactivity/impulsivity are present.
These different forms of ADHD used to be called ADHD subtypes. Then, when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, the term “subtype” was changed to “presentation.” For example, a person could be diagnosed with attention deficit hyperactivity disorder, combined presentation.
Diagnosing Combined Type ADHD
All ADHD types are diagnosed in the same way. A detailed evaluation is carried out by an experienced healthcare professional. This clinician gathers information from a variety of sources including an interview with you (or your child), your medical history, family medical history, and your experiences in school. The assessment might also include intellectual screening, memory testing, attention, and distraction tests, as well as an interview with your spouse. If it is a child being assessed, the child’s parent will most likely be interviewed. At the end of the evaluation, the clinician will determine if the criteria for ADHD outlined in the DSM-5 has been met. If it has, then a diagnosis of ADHD can be made. You or your child will be diagnosed with an ADHD presentation. This will be either inattentive, hyperactive-impulsive, or combined ADHD. Following is an adapted version of the 18 symptoms listed in the DSM-5.
Children up to age 16 must exhibit six or more symptoms of each type. People age 17 and older must exhibit five or more symptoms of each type. The symptoms need to have been present for at least six months. Several inattentive or hyperactive/impulsive symptoms need to have been present before the age of 12 (although not necessarily diagnosed). The symptoms should be noticeable in more than one setting, such as at school/work and at home. The symptoms need to affect the person’s ability to perform to his or her potential. The symptoms should not be better explained by another mental disorder, such as a mood disorder or anxiety disorder.
Inattentive Symptoms
Often makes mistakes that appear careless, either at school or work. These mistakes occur because of problems paying attention to detailsHas difficulty maintaining attention on school, work, reading, or fun activitiesDoes not appear to listen during conversations, even one on one. Seems internally distracted, for example thinking about other thingsFollowing through on instructions is challenging. Finishing a task or homework from beginning to end is rare due to getting sidetracked or losing focusTasks are avoided that involve mental effort for long periods of time like schoolwork, work projects, or formsFrequently loses items, for example, textbooks, wallet, keys, glasses, and cell phonesCan be easily distracted by external eventsIs forgetful while doing everyday activities like chores and errands
Hyperactive-Impulsive Symptoms
Being physically still is challenging. Will move feet and hands and squirmStaying seated is hard. Will often get up and move around, even in situations where sitting down is socially expected, like a classroom or work environmentWill run or climb at unsuitable times. Teenagers and adults might look physically still but experience internal restlessnessRarely participates in hobbies or play activities quietlyHas lots of energy and is frequently described as “always on the go” or “driven by a motor"Talks continually and might be known as a “chatterbox.” This can result in problems at school and workWill answer questions before they have been fully asked. Interrupt others while they are talkingWaiting for a turn is difficult, whether at play, in a line, or during a conversationIntrudes on other people’s activities and conversations
Why Getting a Combined Type ADHD Diagnosis Matters
As with many topics, knowledge is power. The more you know about your condition and the type of ADHD you have, the more empowered you feel. This in turns means you can get the right treatment for your symptoms so they are well managed. Knowing what ADHD presentation you have means you can distinguish between what is an ADHD symptom and what is part of your unique personality. Sometimes people struggle for years with an aspect of ADHD they think is just part of who they are, only to later find that it was related to ADHD and that treatment is available to help. In addition to the practical benefits, there are psychological benefits to knowing how ADHD affects you. There is a lot of moral judgment around behaviors that result from having ADHD. For example, not being able to sit still in a meeting might be called “disrespectful.” Understanding the subtleties of your ADHD type helps you to separate yourself from these negative comments and the shame and guilt that comes with them. This frees you to find a proactive solution instead.
What It Means to Have Combined Type ADHD
Having combined type ADHD does not automatically mean your ADHD is more severe compared to someone who is diagnosed with the predominantly hyperactive type or predominantly inattentive type. For example, a person who has predominantly hyperactive-impulsive type might still experience some symptoms from the inattentive symptom list. However, he or she would not have the full five or six symptoms to be given a combined ADHD diagnosis. Being diagnosed with combined type ADHD means your symptoms are more likely to be evenly distributed between the two types.
Combined Type ADHD Progression
When the DSM-5 was published, it replaced the term ADHD subtypes with ADHD presentations. This change reflected the new understanding researchers have of ADHD. Rather than being a fixed and stagnant condition that could be neatly divided into subtypes, we now know that a person’s ADHD presentation and severity are more fluid and can change with age and the setting. ADHD characteristics also tend to change with age. Predominantly hyperactive presentation could be an early developmental stage of combined ADHD. People diagnosed with hyperactivity will develop sufficient symptoms related to attention regulation in three to five years. These new symptoms will be strong enough that these people will meet the requirements to be diagnosed with ADHD combined presentation. For example, a person who experienced hyperactivity as a child and found it hard to sit still might be able to sit still when required as an adult but will feel internal restlessness and discomfort.
Treatments for Combined Type ADHD
If you or your child have combined ADHD, it is important to address both the inattentive and the hyperactive and impulsive symptoms. ADHD is a form of neurodivergence, which involves a difference in how a person’s brain processes and interprets information. It does not need to be cured, but there are strategies that people can use to help them manage different characteristics of their ADHD. As with all types of ADHD, the most effective treatment plan for combined ADHD is usually medication plus behavioral treatments like therapy, accommodations, social skills, and lifestyle changes. Instead, finding the right medication and dose is something that your doctor will be able to help with. You might try several ADHD medications until you find one that helps your ADHD symptoms and has minimal side effects.
A Word From Verywell
Combined type ADHD is characterized by both inattention and hyperactivity-impulsivity. Understanding your presentation of ADHD can help you better explore different ways to manage the traits that affect your ability to function in home work, school, and relationships. Finding ways to cope with certain behaviors, such as restlessness and difficulty focusing, can keep ADHD characteristics from creating disruptions in different areas of your life.
