What Do The Different Types Of ADHD Look Like?
Attention-deficit hyperactivity disorder (ADHD), formerly known as attention deficit disorder (ADD), is a neurodevelopmental disorder associated with hyperactive and impulsive behavior and difficulty maintaining focus. It is one of the most commonly diagnosed disorders in children. Children with diagnosed ADHD may have trouble at home and school, and adults with ADHD may similarly struggle with interpersonal relationships and work life.
ADHD is a varied and complex disorder, and its impact can change considerably from person to person. There are three types of ADHD, each with its own unique presentation. A clinician will consider the common symptoms of each subtype when making a diagnosis and compare them to observed or reported behaviors of the person they are diagnosing. A qualified child psychiatrist, physician, psychologist, or therapist with advanced training in ADHD is required for an accurate diagnosis.
The three types of ADHD
ADHD is divided into three distinct presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Each presentation (or type) of ADHD can impact a person differently.
Predominantly inattentive presentation (ADHD – PI)
The inattentive ADHD subtype is characterized by, as the name implies, inattentive behavior. Inattention refers to difficulty holding focus, staying on task, or staying organized. There are nine symptoms related to this type of ADHD:
- Trouble staying focused on tasks
- Frequently does not pay attention to details or makes careless mistakes
- Difficulty organizing activities and tasks
- Being easily distracted
- Not following through on instructions or failing to complete chores or work assignments
- Forgetting to do routine chores
- Avoiding things that require long periods of focus
- Losing items needed to complete activities or tasks
- Not listening when directly spoken to
When diagnosing a potential case of ADHD – PI, a clinician will note the presence of reported or observed inattention symptoms and look for other causes of these symptoms. For example, a child who is struggling to organize their school materials or waiting for his or her turn may qualify for ADHD – PI, or they may not fully understand the task, or they may be defiant. A lack of comprehension or stubborn behavior does not qualify as a diagnosis of ADHD – PI, but the person's symptoms may appear similar.
Predominantly hyperactive-impulsive presentation (ADHD – HI)
The defining features of ADHD – HI are hyperactivity and impulsivity. Hyperactivity and impulsivity are two sides of the same coin. Impulsivity refers to difficulty thinking through behaviors before acting on them. Someone with hyperactive impulsive type may lack self-control, seek immediate gratification, or make important decisions without considering long-term consequences.
Hyperactivity in ADHD – HI may appear as near-constant motion and fidgeting, excessive talking, or extreme restlessness. The concept of inhibition is closely related to impulsivity and hyperactivity. Inhibition is a person's ability to prevent themselves from saying, doing, or thinking things that are unhelpful to them. In ADHD – HI, a person has difficulty inhibiting their impulses (lack of self-control) and hyperactivity (movement and restlessness). In some cases, they may resort to young age alcohol use, substance abuse, or other risky behaviors.
An individual diagnosed with hyperactive impulsive ADHD may experience hyperactivity and impulsivity. However, they may still be able to focus on tasks and maintain attention at a similar level to their peers. Conversely, an individual diagnosed with ADHD – PI may display few, if any, symptoms of hyperactivity or impulsivity.
Combined presentation (ADHD – C)
Combination ADHD is straightforward. A person is diagnosed with ADHD – C if they experience both inattention and hyperactive/impulsive symptoms. It is important to note that individuals can still experience hyperactivity and impulsivity if they are diagnosed with the inattentive ADHD subtype, and the reverse is also possible.
However, in ADHD – PI, the inattention symptoms are significantly more severe than the hyperactivity/impulsivity symptoms. The reverse is true for ADHD - HI. The critical feature of ADHD – C is the presence of symptoms of hyperactivity, impulsivity, and inattention in equal severity.
How to diagnose ADHD
ADHD diagnoses have been on the rise, with nearly 10 percent of children meeting the disorder's criteria. ADHD diagnoses have also risen for adults, with almost 5 percent of adults now meeting the requirements. Although adult diagnoses of ADHD continue to increase, ADHD is still considered a disorder of childhood, and different procedures are used to diagnose adults and children.
ADHD diagnoses in children
A diagnosis of ADHD is based on criteria defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). The criteria are divided into two categories: inattention and hyperactivity/impulsivity.
For children under the age of 16 years, at least six symptoms of inattention are required for a diagnosis of ADHD – PI. Six symptoms of hyperactivity/impulsivity are also needed to meet the criteria for a diagnosis of ADHD-HI. Six or more symptoms in both categories warrant a diagnosis of ADHD-C.
The DSM–V has several additional criteria for ADHD:
- Some symptoms of inattention/hyperactivity must be present before the child is 12 years old (if diagnosed in adolescence).
- Symptoms must be present in two or more settings (e.g., home and school).
- Symptoms must interfere with school, social situations, or family life.
- Another mental disorder must not better explain the symptoms.
Other mental health conditions mimic symptoms of ADHD, such as anxiety disorders, personality disorders, and mood disorders. Because of the complexity of making an ADHD diagnosis, to diagnose ADHD, medical professionals will use many sources of information to determine the basis of the child's difficulties accurately.
ADHD assessments typically include an extensive review of the child's mental health and medical history and reports from those who know the child well (family members, teachers, coaches, etc.). Standardized behavior rating scales are commonly used, which can quickly compare a child's behavior to what is developmentally appropriate. Psychological testing is also typically included to determine the child's level of executive function (ability to plan and make decisions) and cognitive strengths or challenges. While the cause of ADHD is unknown, doctors believe it may be genetic and, in some cases, result from low birth weight, brain injury exposure toxins during pregnancy, so a detailed history may be necessary for diagnostic purposes.
ADHD diagnoses in adults
A professional assessing an adult with ADHD symptoms will follow a process nearly identical to the process of evaluating a child. An adult must meet the same criteria: at least six symptoms related to inattention or hyperactivity/impulsivity per DSM–V criteria.
It is important to note that the requirement for age at symptom onset remains the same for adults as it does for children. Adults must have experienced ADHD symptoms before turning 12 years old. There is no such thing as adult-onset ADHD, though the initial diagnosis may have been missed in childhood. If difficulty sustaining attention, focusing, or controlling impulses appear in adulthood but were not present in childhood, then the concerns are due to some other factor or medical conditions, not ADHD.
The same information used to assess ADHD in children is required for adults. The clinician will consider reports from those who know the person well, standard rating scales will likely be used, and psychological testing will be administered to determine executive function and a cognitive profile. This information, along with the reports of the person being assessed, can help a clinician understand whether the symptoms are due to ADHD or some other condition.
How are ADHD symptoms treated?
For both children and adults, ADHD is most commonly treated using a medication class known as stimulants. (Note that ADHD medication is only deemed safe for children ages 6 and older, so preschool aged children will not qualify for medication.)
Stimulant medications increase dopamine levels in the brain. Dopamine is a neurotransmitter associated with attention and inhibition, and increasing dopamine levels can significantly increase a person's ability to control impulses and maintain focus. Stimulants substantially impact the prefrontal cortex, the area of the brain associated with planning, inhibition, and decision-making.
Stimulants are highly effective in treating ADHD. While medication is typically the first-line treatment for ADHD, it is considered a short-term solution, and researchers are still studying the long-term effects from stimulants.
Recent research has focused on a two-pronged approach to the treatment for ADHD. Evidence suggests that a combining behavioral therapy and ADHD medication is significantly more effective than medication alone in children and adolescents, with similar research being conducted to determine if therapy is also effective for adults with ADHD.
Researchers are investigating a promising treatment path that uses medication to address the ADHD symptoms in the short term and behavior therapy to manage ADHD symptoms in the long term. Medications relieve symptoms quickly but may not be effective over a longer time. On the other hand, behavioral therapy takes months to administer effectively but may offer more long-term care. It's important to note that an effective treatment plan will depend on the individual.
How can online therapy help with ADHD or other mental disorders?
If you're concerned about your own difficulties with attention and inhibition, online therapy offers the opportunity to talk things over with a therapist without the schedule disruption that comes with meeting a therapist in person. A therapist won't be able to prescribe medication, but they are qualified to assess ADHD symptoms and help you manage them through therapy. Research suggests that ADHD interventions administered online are just as effective as those administered in person.
If you're worried your child may have ADHD, a therapist can help you understand their behavior and support you through the process of helping them. A licensed therapist can use empirically supported tools, like parent training, to help you address your child's behavior and manage your own stress. Parent training and other strategies therapists use to support parents are just as effective when provided online as in person.
Takeaway
ADHD is a complex neurodevelopmental disorder that varies considerably from person to person. While it is typically diagnosed in adulthood, diagnosis and treatment are available for adults who struggle with attention and inhibition. While medication is typically the first-line treatment for ADHD in adults and children, psychotherapy is a valuable tool that has been shown to significantly reduce the level of ADHD symptoms and increase the effectiveness of medication used to treat the symptoms of ADHD.
Are there 3 or 7 subtypes of ADHD?
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is the primary source of diagnostic information regarding mental health disorders used by clinicians in the United States. The International Classification of Diseases, developed by the World Health Organization, is the main source of diagnostic information in most of the rest of the world.
Both guiding documents list only three subtypes of ADHD: predominantly inattentive, predominantly hyperactive/impulsive, or combined. The misconception that ADHD is classified into seven types comes from the work of Dr. Daniel Amen, a psychiatrist and brain imaging specialist. While his conclusions are based on his research, robust, empirical studies have yet to confirm his findings. ADHD likely has only 3 distinct presentations that are unique to the disorder, but it may also be likely that using more categories allows patients to better identify with their diagnosis.
What is Type 3 ADHD in adults?
Type 3 ADHD is likely a misnomer or reference to information about ADHD that is not empirically supported. There are only 3 subtypes of ADHD, but they are not officially referred to as “Type 1, Type 2, and Type 3.” If someone were following that convention, they would likely use “Type 3 ADHD” to refer to the combined presentation of the disorder, while Type 1 and Type 2 might refer to the inattentive type ADHD and hyperactive type ADHD, respectively.
What are the 3 most common parts of the definition of ADHD?
The 3 broadest and most common parts are inattention, hyperactivity, and impulsivity. Each of those categories has corresponding symptoms, which, if identified through a comprehensive ADHD evaluation, likely indicate that a person meets the criteria for an ADHD diagnosis.
Are there still 3 ADHD types?
Only 3 ADHD subtypes are recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD). Both the DSM and ICD are guiding documents that define diagnostic criteria for ADHD and other neurodevelopmental disorders. Each document lists the following ADHD subtypes: predominantly inattentive, predominantly hyperactive/impulsive, and combined type. Other classifications exist, but they are not empirically supported or evaluated with the same level of rigor as the categorization present in the DSM and ICD.
Which type is most common?
There are 3 ADHD subtypes: predominantly inattentive, predominantly hyperactive/impulsive, and a combined type. The predominantly inattentive diagnosis is given when a person experiences symptoms mostly related to focus and concentration and is the most common type diagnosed. The predominantly hyperactive subtype is given when a person displays hyperactive and impulsive symptoms, like struggling to stay still or difficulty waiting. It is likely the rarest subtype diagnosed. Combined type ADHD is diagnosed when both hyperactivity/impulsivity and inattention symptoms are present.
What type of disorder is ADHD?
ADHD is a neurodevelopmental disorder characterized by difficulty focusing, concentrating, or inhibiting behavior without sustained mental effort. It is a chronic condition with both genetic and environmental risk factors. Scientists debate whether ADHD is present from birth or if a person is merely genetically predisposed to developing the condition, but environmental factors trigger it.
Regardless, ADHD usually develops at a very young age and persists throughout childhood. About half of those diagnosed will drop below the diagnostic threshold in young adulthood and will likely no longer require treatment for their symptoms. The other half will continue to display symptoms through adulthood. This may mean that managing ADHD will require sustained mental effort.
What is the rarest type?
The rarest form of ADHD is the predominantly hyperactive/impulsive subtype. Some studies suggest that only 3% of those diagnosed are likely to have purely hyperactive ADHD or the impulsive behaviors associated with impulsive type ADHD. The most common form of ADHD is the primarily inattentive subtype, with the combined subtype falling in the middle.
How is ADHD diagnosed?
In the United States, ADHD is diagnosed according to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A qualified mental health professional uses those criteria for a comprehensive evaluation. The evaluation typically begins with the clinician taking a thorough history and conducting a clinical interview. They will likely use tools like ADHD rating scales to gather additional information and may initiate other tests like cognitive assessments, specific ability tests, or computerized testing to gather additional information about behavioral symptoms.
Once all information is gathered, the clinician will use their experience and expertise to determine whether the results indicate that ADHD is the most likely diagnosis. It is important to remember that a genuine ADHD evaluation is a comprehensive process that often takes several hours over multiple sessions. The evaluation will also rule out other conditions and help find alternative explanations besides ADHD. If an ADHD diagnosis is warranted, the clinician will typically either prescribe stimulant medication or refer the client to a medical provider. They will also likely initiate or recommend behavioral training to help manage symptoms.
Can I have ADHD if I'm not hyperactive?
Hyperactivity is not required for an ADHD diagnosis. The condition has 3 subtypes: predominantly inattentive, predominantly hyperactive/impulsive, and combined. Those diagnosed with the inattentive subtype show symptoms related to difficulty concentrating or focusing, but they show little or no hyperactivity signs. Inattentive ADHD has a significant impact, like making it hard to follow instructions or making careless mistakes. ADHD medications effectively treat both hyperactivity and inattention.
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