Understanding the 3 Types of ADHD

‍Hyperactive, Inattentive, or Both?

Have you ever felt like your brain works at a different speed than everyone else's? Do you struggle to stay focused, manage your impulsivity, or organize your thoughts? 🤔

The thing is, the different types of ADHD can be so confusing. Maybe you’re not hyperactive, or you don’t act impulsively. So, do you have ADHD or not? 🤯

Here’s the thing: Attention Deficit Hyperactivity Disorder (ADHD) can affect everyone in completely different ways. That’s because there are three different types!

• Hyperactive-Impulsive types are usually restless and full of energy, often blurting out their thoughts.
  
  
• Inattentive types are often prone to daydreaming and easily distracted.
  
  
• Combined types are usually a blend of both types.  

We’ll explore each of these in more detail, as well as the current diagnostic criteria (DSM-5) and how to seek a diagnosis. Keep reading to find out more.

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ADHD: One Size Doesn’t Fit All

Attention Deficit Hyperactivity Disorder is a complex neurodivergent condition that can affect a person's ability to perform daily tasks, deal with school or work environments, and behave in certain situations. 

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Everyone experiences ADHD differently, from symptoms to intensity.

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Since the early 1900s, when ADHD was first identified, our understanding was quite limited. However, in the last decade alone, our grasp of the disorder has expanded significantly.

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We now understand that ADHD is a disorder with behavioral symptoms, NOT an attitude problem. 

Experts think that this neurodivergent condition may have something to do with our brain structure. There seem to be differences between brains diagnosed with ADHD and neurotypicals. 🧠

Over the years, we’ve learned a lot, like how it can affect a child's behavior and how it can cause issues in adults, too. Researchers have discovered other common symptoms along the way, too.

You see, experts first believed that ADHD only affected children who were inattentive and easily distracted. 🧒 Now, mental health experts can categorize ADHD into three types based on the predominant symptoms. 

Not Everyone with ADHD is Hyperactive

I know - crazy, right? It’s in the name - but it didn’t used to be.

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That’s because earlier versions of the Diagnostic and Statistical Manual for Mental Disorders (DSM) used to use the term Attention Deficit Disorder With Or Without Hyperactivity (ADD).

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Back then, they didn’t think hyperactivity was a common symptom.

But when the American Psychiatric Association realized it was, they added hyperactivity. That’s when ADD became ADHD - Attention Deficit Hyperactivity Disorder.  

It wasn’t until the 4th Edition of the DSM (we’re on the 5th now) that the three different types were recognized. It's now required whenever a qualified mental health professional diagnoses someone with ADHD.

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Today, according to the American Psychiatric Association, to diagnose ADHD accurately, you must meet the criteria of the type you present as. 

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The 3 Types of ADHD

ADHD is a complex condition and can be challenging to diagnose. 

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I know other people with ADHD who struggle with things I don’t, and vice versa. I need to work on my emotional regulation because I can easily feel triggered, but my friend handles her feelings like a champ! 💪

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We both have ADHD, yet our experiences and symptoms are completely different.

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That is where the three types of ADHD can help us understand ourselves better. 

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During diagnosis, a mental health professional will assess your symptoms against the DSM-5 criteria and determine which type of ADHD you’re presenting.

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These three ADHD types are:

• Predominantly Hyperactive-Impulsive Type
• Predominantly Inattentive Type
• Combined Type

Knowing how your symptoms and traits of ADHD present can help parents, teachers, and mental health professionals better understand your unique experience with ADHD. 

Different types benefit from different treatments, so knowing which criteria you fit into will allow you to properly discuss the course of managing and treating ADHD with your physician.

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Diagnosing ADHD

Figuring out which type of ADHD you have depends on your experience with the symptoms of ADHD over the last 6 months and how much it impacts your life in multiple areas. 

Your assigned mental health professional may also conduct psychological testing or hold questionnaires and interviews, which can further help assess if you display symptoms of ADHD. 

Some doctors may ask for a detailed family history of medical conditions as ADHD can run in families through genetics.

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After finding out your Attention Deficit Hyperactivity Disorder (ADHD) presentation, it should be easier to understand how it will impact your day-to-day life. A clinical psychologist, or your mental health doctor, can recommend a proper treatment plan and management personalized for your diagnosis. 

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Behavior therapy, medication, and lifestyle changes are some of the main ways to help people with ADHD.

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Now, let’s break down each of the three types…

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Predominantly Hyperactive-Impulsive Presentation

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AKA The High Energy Ones 🏎️

If you have the hyperactive-impulsive type of ADHD, you’re likely always on the go, feeling like you’re driven by a motor to keep moving and doing. You follow your impulses and may make rash decisions you regret (or don’t) later. 

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Generally, hyperactive ADHD is the more recognized type, because the symptoms are more noticeable. People with hyperactive ADHD tend to fidget or stim (repeating certain movements or sounds). They struggle to sit still and wait their turn, or may interrupt others or blurt out answers in a way that isn’t considered ‘socially acceptable’. 🙄 

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In school, they’re usually the kids who are told they talk too much or are disruptive, or they might be the class clown, blurting out jokes at inappropriate times, but that’s not always the case. 

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Getting Diagnosed with Hyperactive-Impulsive Type ADHD

The following symptoms are the DSM-5 (Diagnostic and Statistical Manual for Mental Disorders) criteria for Hyperactive-Impulsive ADHD.

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Hyperactive Symptoms 

• Fidgeting, tapping hands or feet, or squirming in their seats.
• Frequently stands up when they're expected to remain seated. 
• Experiences the feeling of restlessness, like needing to climb something, or pace back and forth.
• Tending to do everything loudly.
• Feeling constantly on the go, where other people struggle to catch up.
• Hyperactive behavior, like talking excessively.

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Impulsive Symptoms

• Difficulty with impulse control, such as blurting out answers even if questions aren't directed to them.
• Dislikes waiting for long periods and can be impatient. 
• Interrupting conversations and feeling the need to tell someone something, even if it isn’t necessary.

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To get a diagnosis for this type of ADHD, these hyperactive and impulsive symptoms must have had a disruptive impact on your life for at least six months, or not be appropriate for the individual’s developmental level.

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Children up to the age of 16 must have at least 6 symptoms. Everyone else aged 17 and up must have at least 5 symptoms. 

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If you satisfy this criterion, the mental health expert might categorize you under the Predominantly Hyperactive-Impulsive Type. 

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Treatment for Hyperactive-Impulsive ADHD

It’s easy to see how being hyperactive and impulsive can impact your day-to-day life. You might make impulsive extreme decisions like quitting your job or moving countries just because you feel like it, without considering the consequences.

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In social situations where you’re expected to act a certain way, your behavior may be too high energy for those around you, leading to judgment or rejection.  

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Hyperactive-impulsive ADHD can be treated at any age. Options include:

• Behavioral therapy is worth exploring as soon as you have a diagnosis. A psychologist or therapist can help you spot the signs of your hyperactive and impulsive behavior and find ways to manage them.
• Stimulant medication can help as it calms down those with ADHD, rather than stimulate them. 
• Regular exercise is great for releasing all that extra energy, especially if you struggle to sleep at night due to internal hyperactivity. Exercise has been proven to help with ADHD symptoms. 
• Stick to a healthy, balanced diet. Pay attention to what you eat and how it makes you feel. An excess of sugar, for example, may worsen your symptoms. 

But what about if you’re not hyperactive?

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Predominantly Inattentive Type ADHD Presentation

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AKA The Daydreamers 💭

If you present as the inattentive type of ADHD, you’ll tend to have difficulty organizing and finishing tasks, following instructions, and paying attention to detail. 

You may also be easily distracted or daydream often. Children with this type of ADHD may be tagged as the "daydreamer" in class. You may also find you’re constantly being told to focus. 🧚

As an adult, this can look more like forgetting important appointments or meetings, losing your phone and keys regularly, or walking into things that should be unmissable. You may seem overly clumsy or ‘away with the fairies’ and tend to zone out, even mid-conversation.  

On the flip side, you may find you’re more introspective and creative than most. Combined with ADHD hyperfocus, you may excel at completing creative projects. 

If you have the predominantly inattentive presentation of ADHD, you may not show many (or any) hyperactive or impulsive behaviors.

Let’s look at the symptoms in closer detail…

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Getting Diagnosed with Inattentive ADHD

The following symptoms are the DSM-5 (Diagnostic and Statistical Manual for Mental Disorders) criteria for Inattentive ADHD:

• Trouble paying attention to details and often make careless mistakes.
• Difficulty sustaining attention in tasks or conversation.
• Does not seem to listen when spoken directly or gets distracted easily.
• Usually start tasks eagerly but have a hard time finishing them off or have struggles following instructions.
• Difficulty organizing tasks, activities, thoughts, or schedules.
• Dislikes doing things or activities that require sustained mental effort or getting reluctant to do paperwork or school-related work.
• Forgetting and misplacing important things frequently.
• Distracted with external stimuli or sensory overload.
• Generally forgetful in managing tasks and activities like home organization, errands, and meeting deadlines.

To get a diagnosis, you’ll need to explain how your (or your child’s) inattentive symptoms interfere with or create difficulties in social, academic, or work life. 

Children up to the age of 16 must have 6 or more symptoms which continuously persist for 6 months for someone to be diagnosed with Inattentive ADHD. 

Adults and teens aged 17 and up must have at least 5 symptoms for at least 6 months. 

As well as the nine symptoms, your assessor will also check the following:

• The symptoms are present before the age of twelve. 
• The symptoms are happening in two or more settings (home, school, work, etc.)
• There is clear evidence that the symptoms interfere with the person’s development or quality of life. 
• The symptoms are NOT better explained by another type of mental health disorder. However, please note that ADHD can coexist with other mental health conditions. 

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Treatment for Inattentive ADHD

Outside of school or work, which is where there’s an obvious need to focus, inattentive ADHD can impact all areas of life. 

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Many with this presentation of ADHD experience anxiety and low self-esteem due to feeling forgetful, being labeled ‘unreliable’ or coming across as ‘all over the place.’ 

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In reality, many people with ADHD mask their symptoms most of the time. So, while inattentive ADHD, which is typically more internal, may not be obvious, they may still assume everyone is judging them, resulting in mental health struggles. 

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The good news is that the symptoms of inattentive ADHD can be treated by finding the tools and routines that work for you. 

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Here are a few things you can try:

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• Behavioral therapy can teach you actionable ways to manage your symptoms, like getting rid of distractions and how to react to unpredictability or rejection. 💬
• Researching and learning organization tips and tricks can help you keep both your mind and your environment free of clutter, giving you space to breathe. There are plenty of life organization tools online that may be able to act as an external ‘second brain’.  
• Stimulant medication may be able to cut through the noise of distractions and allow you to focus. 
• Sticking to a routine can provide you structure, so there’s less chance of forgetting or misplacing something. ⏰
• Break down your tasks into smaller steps so it’s easier to follow, with step-by-step instructions. Plus, completing the smaller steps builds momentum and gives you the motivation to keep persevering
• Meditate. Many people with ADHD struggle to meditate, but it can help improve your focus and help you hone in on what’s important.

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Combined Presentation ADHD Type

Someone with Combined ADHD will experience symptoms from both the Hyperactive-Impulsive and Inattentive criteria. 

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This can look like struggling to pay attention and focus and difficulty listening and following instructions. They may also be easily distracted, jump from task to task, or have trouble controlling impulsive behavior. 

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When a person experiences enough hyperactive-impulsive symptoms and inattentive ADHD traits, they may be diagnosed with the Combined Presentation ADHD. 

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According to statistics from the American Psychiatric Association, this type of ADHD is the most common presentation and principal diagnosis among children and adults.

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To be diagnosed with the combined presentation, you’ll need to have symptoms that meet the criteria of both inattention and hyperactivity-impulsivity for the past 6 months.

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Key Takeaways

ADHD is a complex neurodivergent condition, and manifests differently in everyone.

• There are three main presentations of ADHD, including:
  
  
• Predominantly Hyperactive-Impulsive Type: You're always on the go, struggle to sit still, and act impulsively. Common symptoms include fidgeting, blurting out answers, and interrupting others.
• Predominantly Inattentive Type: You have difficulty focusing, lose things easily, and tend to daydream. You may be seen as ‘spacey’ or forgetful, but you can also be highly creative and introspective.
• Combined Type: You experience symptoms from both the hyperactive-impulsive and inattentive presentations. This is the most common type of ADHD.
  
  
• The correct diagnosis is crucial for getting proper support and management. A mental health professional will assess your symptoms against DSM-5 criteria and determine your type.

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• Whether you have Hyperactive ADHD, Inattentive ADHD, or Combined Type ADHD, the symptoms can be mild to severe and can impact your life in many ways.

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• Although there is no cure for this condition, with early intervention, proper management, and lifestyle changes, people with ADHD can still live happy and fulfilling lives. 

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Sure, getting a diagnosis is no easy feat, but remember that it’s worth it. Getting to know the real you is the first step to being kind to yourself and building the awesome life you deserve, not in spite of your ADHD, but alongside it. 💕

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What’s Next?

To dive deeper into the diverse symptoms and treatment options for ADHD, check out these related articles. 👇

Understanding the Spectrum of Hyperactivity in ADHD

The Quiet Struggle: Inattention in ADHD

Understanding and Managing Hyperactive-Impulsive Symptoms in ADHD