Combined type ADHD occurs when an individual has both inattentive and hyperactive-impulsive symptoms. A person with combined type ADHD will meet the sufficient criteria for both subtypes.

Attention deficit hyperactivity disorder (ADHD) is a behavioral condition that can feature a variety of symptoms. The three hallmark symptoms of ADHD are inattention, hyperactivity, and impulsivity. Depending on the symptoms a person has, a doctor can classify ADHD into three subtypes:

In this article, we will discuss what combined type ADHD is, including its diagnostic features, related conditions, and treatment options.

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As the name implies, combined type ADHD is when a person persistently presents with symptoms of both inattention and hyperactivity-impulsivity. A person’s behavior may indicate this subtype if they meet sufficient criteria for both the inattentive and hyperactive-impulsive subtypes.

Evidence suggests that around 8.4% of children and 2.5% of adults in the United States have ADHD. In some children, it is not uncommon for characteristics of ADHD to begin as early as age 3. Combined type ADHD is the most common presentation of ADHD. A small 2019 study estimates that 70% of adults with ADHD have the combined subtype.

Children with combined type ADHD may have difficulty paying attention in school and find it hard to stay seated during class or social gatherings. Adults with combined type ADHD may have trouble managing tasks and maintaining relationships.

ADHD has three subtypes. The symptoms and diagnostic criteria for each subtype are as follows:

ADHD predominantly inattentive presentation

  • difficulty paying close attention to details, which can result in careless mistakes
  • difficulty maintaining attention
  • an apparent lack of listening
  • difficulty following through with instructions
  • trouble with organization
  • avoidance or dislike of tasks that require sustained mental effort
  • tendency to lose items
  • easy distraction
  • forgetfulness in daily activities

ADHD predominantly hyperactive-impulsive presentation

  • frequent fidgeting with hands or feet or squirming
  • difficulty staying seated
  • excessive running or climbing in children or extreme restlessness in adults
  • problems engaging in activities quietly
  • behaving as if driven by a motor
  • excessive talking
  • answering before a person has finished asking a question
  • impatience or difficulty taking turns
  • frequently interrupting or intruding on others

ADHD combined presentation

Combined type ADHD involves symptoms of both the inattentive and hyperactive-impulsive types.

Individuals with ADHD often have other conditions, such as learning disorders, depression, and anxiety. One of the most common is oppositional defiant disorder (ODD).

Most people with ODD show symptoms of this condition before age 8. Some of the symptoms of ODD are:

  • getting angry often and more easily than others
  • becoming annoyed easily
  • annoying other people intentionally
  • fighting against rules adults have given

Some research suggests that children of parents with ADHD have a higher risk of ODD. Children who experience negative life events are also more likely to develop ODD.

Experts do not fully understand the exact cause of ADHD, but certain risk factors can increase the risk of developing the condition. One of the biggest risk factors is genetics — individuals whose family members have ADHD are more likely to have the condition themselves.

A recent study also indicates that an individual may have a higher risk of ADHD if their birthing parent experienced health conditions such as:

  • obesity or overweight prior to pregnancy
  • high blood pressure during pregnancy
  • preeclampsia

People who smoke during pregnancy are also more likely to have children with ADHD.

Additionally, babies with low birth weight or certain neonatal diseases are at a higher risk.

Are boys more likely to get ADHD?

Boys are generally more likely to receive an ADHD diagnosis than girls. In the past, this led researchers to believe that being male was a risk factor for ADHD.

But recent studies suggest that this difference has more to do with subjective social perceptions of gender. The criteria for ADHD symptoms relate to their presentation in boys. Girls are not likely to display the same symptoms as boys.

Additionally, girls typically face more social pressure to conform to certain behavior patterns. They are often better at developing coping strategies to mask their ADHD symptoms in public. The fact that more boys than girls receive a diagnosis may ultimately be a result of social bias.

In ongoing studies of ADHD, researchers hope to develop better strategies for identifying and diagnosing the condition in people of all genders.

Click here to learn more about ADHD gender differences.

Because there is no single test for ADHD, diagnosis requires a thorough evaluation. Medical professionals who may take part in this evaluation include:

Parents who suspect that their child may have combined type ADHD should visit their family doctor, who can refer them to the appropriate specialist for an assessment.

To meet the criteria for combined type ADHD, individuals must show a certain number of symptoms of both inattention and hyperactivity-impulsivity for at least 6 months. These symptoms include:

  • a tendency to lose or misplace necessary items
  • forgetfulness of daily tasks
  • limited attention span
  • difficulty listening
  • inability to sit still
  • difficulty waiting
  • excessive talking

While many people receive an ADHD diagnosis as children, it is also possible to receive a diagnosis later in life. The evaluation process is similar regardless of age, but the criteria for diagnosis may differ slightly between children and adults.

Treatment options for ADHD may involve medication, therapy and other behavioral treatments, or a combination of methods.

For children with ADHD, treatment may include education for parents or caregivers. By receiving training, caregivers can help children manage ADHD symptoms. Individuals with ADHD may also receive behavioral therapy to help them understand which behaviors are appropriate in which settings. Behavioral therapy is typically the first line of therapy for managing ADHD in children.

A doctor may also prescribe medication to assist with managing ADHD symptoms. Medications for ADHD can include long-acting stimulants such as Adderall, short- and intermediate-acting stimulants such as Ritalin, or non-stimulants such as Strattera.

Click here to learn more about ADHD medication types.

A person living with ADHD may also experience problems with self-esteem and depression. In that case, a person may benefit from other treatment options, such as psychotherapy.

Individuals with ADHD may experience difficulties with life transitions, particularly during adolescence. Symptoms of ADHD can make it harder for people to succeed in academic settings and can affect people’s relationships with friends, family, or romantic partners.

However, with the right support and treatment plan, a person can manage ADHD symptoms. Tools such as behavioral therapy, caregiver education, and medication can help make school, work, and relationships more manageable.

Combined type ADHD is one of three potential presentations of ADHD. It is the most common type. As the name suggests, it features a combination of inattentive and hyperactive-impulsive symptoms. Individuals with ADHD may also experience comorbid conditions such as ODD.

Although experts do not yet know the cause of ADHD, people with a family history have a higher risk of developing the condition.

After a person receives a diagnosis, behavioral therapy and medications can help them manage ADHD symptoms. With the right diagnosis and support team, people with combined type ADHD can manage their symptoms and live a full and healthy life.