The Three ADHD Subtypes and How to Recognize Them

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Attention-deficit/hyperactivity disorder (ADHD) is a behavior disorder that causes symptoms of inattention, hyperactivity, and impulsivity, all of which range in severity and interfere with regular daily activities.

ADHD usually develops in childhood but can continue into adulthood. People with this condition often struggle with impulsive behaviors, being too active, and finding it hard to pay attention. ADHD doesn’t look the same in everyone. The type of ADHD a person has depends on the primary symptoms and behaviors they exhibit. 

There are three major ways in which ADHD symptoms can present. These ways were previously referred to as “subtypes” in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) but are called “presentations” in the current DSM-5. We'll use them synonymously here.

The Three ADHD Subtypes

As all ADHD symptoms vary from person to person, it's important to learn about the characteristics of each presentation so you can recognize which one you or a loved one might be dealing with.

  1. Inattentive: The main symptoms of this type include a lack of focus, frequent inattention, and disorganization.
  2. Impulsive/Hyperactive: People dealing with this subtype show no inattentiveness, but are restless and fidgety. This is the rarest ADHD subtype.
  3. Combined: This is the most common ADHD subtype, in which individuals show symptoms of the other two types.

Inattentive Type ADHD

People with this presentation do not show any signs of hyperactivity or impulsivity. They instead tend to have difficulty maintaining focus and being attentive. It’s often difficult for people with inattentive type ADHD to pay attention and engage in organized activities for long periods of time.

Some behaviors and symptoms people with this presentation of ADHD might exhibit include: 

  • Short attention span 
  • Easily distracted 
  • Unable to pay close attention to details 
  • Difficulty listening when being spoken to 
  • Forgetful when performing everyday activities 
  • Often careless and constantly losing things like keys, books, and phones
  • Struggles with engaging in organized tasks and activities 
  • Finds it difficult to follow instructions 

Impulsive/Hyperactive Type ADHD 

This is the least common type of ADHD. People with this form of the condition will exhibit hyperactive and impulsive behaviors, but no symptoms of inattention. You’d find people with this form of the condition moving around constantly and fidgeting excessively.

This presentation is typically characterized by the following symptoms of impulsivity: 

  • Interrupting or intruding on others 
  • Acting without thinking 
  • Being impatient and having difficulty waiting their turn 
  • Blurting out the answer to a question before it has been completed

Symptoms of hyperactivity usually include the following behaviors: 

  • Restlessness 
  • Talking excessively 
  • Being unable to focus on one task at a time 
  • Excessive fidgeting 
  • Being unable to engage in any activities quietly 

Combined Type ADHD 

This is the most common form of the condition. People with this type of ADHD experience a combination of impulsivity, hyperactivity, and inattention symptoms.

A diagnosis of combined type ADHD in a child requires that six or more symptoms of inattention and six or more symptoms of hyperactivity/impulsivity be present for at least six months. Those 17 years or older require five or more of each.

Causes

The exact cause of ADHD is unknown. However, current research shows that genetics might play a role in a person developing the condition. In other words, if you have a family history of the condition, then you may be more likely to develop it.

Children with ADHD have also been reported to have low levels of dopamine. While this might not be solely responsible for causing the condition, it is thought to be a contributing factor to the development of the brain disorder. 

The condition is more common in boys than in girls, and might often result in the development of other conditions like anxiety disorder, depression, or substance abuse. Girls with the condition are more likely to exhibit signs of inattention than hyperactivity or impulsivity. 

Other factors that have been thought to contribute to the development of the condition include: 

  • Smoking or alcohol use during pregnancy 
  • Head injuries 
  • Low birth weight 
  • Exposure to environmental toxins either at a very young age or during pregnancy

Diagnosis 

If you suspect your child has ADHD, you will need to take them to a qualified pediatrician or mental health expert to get a diagnosis. They’ll typically ask for a detailed history of your child’s symptoms and put your child through a series of tests to observe their behaviors. 

Medical experts use the DSM-5 criteria to make a conclusive diagnosis of ADHD. The manual details nine behaviors and symptoms for hyperactivity/impulsivity as well as nine behaviors and symptoms for inattention.

A child is diagnosed with ADHD when they display at least six of the behaviors and symptoms listed for either type. While an adult or teenager is required to exhibit at least five of these symptoms, the symptoms must also be so severe as to disrupt a person’s regular functioning. 

Symptoms of ADHD can start to show between the ages of 3 and 6 and are often mistaken for bad behavior. If left undiagnosed and untreated, the condition may cause poor academic performance, difficulty maintaining healthy relationships, and anti-social behaviors.  

Treatment 

There is currently no cure for ADHD, but effective treatment of the condition will reduce the severity of symptoms and enable a person living with ADHD to have improved daily functioning.

ADHD is typically treated with a combination of medication and behavior therapy. However, there is no one-size-fits-all form of treatment. Finding the ideal treatment for you or your child’s ADHD depends on many factors.

Your doctor will consider your or your child’s age, the severity of the symptoms, and medication intolerances before recommending a treatment plan. Treatment could include either one or a combination of the following options.

Medication 

There are two types of medication typically used to treat ADHD: stimulant and non-stimulant. 

  • Stimulant medications: This is the most common type of medication used to treat ADHD. Stimulants work by increasing the production of dopamine and norepinephrine in the brain. These are chemical messengers that play a vital role in regulating thinking and attention. Some common examples are Ritalin (methylphenidate), Adderall (amphetamine), and Dexedrine (dextroamphetamine).
  • Non-stimulant medications: Non-stimulants might take a little longer than stimulants to work but are effective in improving focus and attention. They are typically recommended for people who experience intolerable side effects on stimulants. Examples include Strattera (atomoxetine), Intuniv (guanfacine), and Qelbree (viloxazine).

Behavior Management 

Parents of children with ADHD are usually advised to take behavior management classes to help their child with their ADHD symptoms instead of using a behavior therapist. The aim is replacing negative behaviors with positive ones. This is done by monitoring their actions and engaging in practical tasks that can improve negative behaviors. 

A Word From Verywell 

Parenting a child with ADHD can be challenging but is not impossible. Practicing healthy habits like exercising regularly, eating a balanced diet, and getting enough sleep is also important for managing symptoms of ADHD.

If you suspect you or your child is exhibiting symptoms of the condition, you should see a medical expert as soon as you can for a proper diagnosis and treatment plan. 

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