Attention deficit hyperactivity disorder (ADHD) is divided into two categories: inattention and hyperactivity-impulsivity. Some people can experience symptoms of both types, which is known as ADHD combined type.
ADHD is a neurodevelopmental disorder. It’s typically diagnosed in children, but adults can experience symptoms, too.
Read on to learn more about what combined type ADHD is and how to treat it.
ADHD tends to shows up as predominantly inattentive or predominately hyperactive-impulsive. When someone has six or more symptoms of each type, they have combined type ADHD.
Examples of inattentiveness symptoms include:
- struggling to follow instructions
- appearing to not listen when spoken to
- becoming easily distracted
- having difficulty following through on tasks or assignments
- losing or forgetting things or events
Hyperactivity and impulsivity symptoms
The most common symptoms of hyperactivity and impulsivity include:
- fidgeting or squirming
- being unable to remain seated for long periods
- talking nonstop
- blurting out answers
- being impatient
- interrupting or butting into other peoples’ conversations
- having difficulty waiting your turn
- being constantly “on the go,” acting as if “driven by a motor”
A person with combined type ADHD will display six or more of these signs and six or more signs of inattentiveness.
Also, to diagnose ADHD, a person must have:
- several inattentive or hyperactive-impulsive symptoms present before the age of 12 years
- symptoms present in two or more settings (such as at home, school or work; with friends or relatives; in other activities)
- symptoms that interfere with or reduce the quality of social, school, or work functioning
- symptoms that are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder)
Opposition defiant disorder (ODD) is when your child or teen shows a pattern of opposition toward you or an authority figure. Up to 60 percent of individuals with ADHD also have ODD.
The behaviors may be related to hyperactivity or impulsivity due to ADHD. It may also be how children cope with frustration or emotional stress from ADHD.
ODD usually appears as a pattern of:
A child with ODD may also display an argumentative personality or intentionally engage in defiant behaviors. Behavioral therapy can help treat the symptoms of ODD.
The causes of ADHD are likely the same for all types, but science hasn’t found a cause for ADHD. But some studies have found several potential factors that can influence a person’s risk of developing ADHD. For example, environmental factors may play a role.
Risk factors for all subtypes of ADHD include:
- Inherited genes: One study found that ADHD may run in families. Another study published in
JAMA Psychiatryshows that several genes may make people more likely to develop ADHD.
- Environmental factors during infancy or pregnancy: Exposure to toxins such as lead may increase a child’s risk for ADHD.
- Brain injury: A small number of children who experience a traumatic brain injury may develop ADHD.
- Alcohol or tobacco use during pregnancy: A study by the Washington University School of Medicine found that pregnant women who smoke increase their child’s risk for developing ADHD. Drinking alcohol and using drugs during pregnancy can also increase a child’s risk for the disorder.
- Low-birth weight or premature delivery: According to a study in the journal Pediatrics, babies born before their due date are more likely to have ADHD when they’re older.
No single test can diagnose ADHD. The method to diagnose ADHD is the same for all types, though the criteria for combined type ADHD are slightly different. For combined type ADHD, a doctor will look for six or more symptoms from both inattentiveness and hyperactivity or impulsiveness types.
What your doctor will do
First, the doctor will conduct a thorough medical examination to rule out other conditions. Some disorders such as learning disability or anxiety disorder can mimic ADHD.
Then, they’ll watch your child for the symptoms associated with the subtypes of ADHD. This could mean observing your child during the day. You and your child will also take several ADHD rating scales. Your doctor will use these to help make an evaluation or diagnosis.
These scales don’t give a definitive answer, but they can help you and your doctor see the bigger picture. The surveys will ask about your child’s behavior in school, at home, or in other settings.
Asking other people, such as teachers and other family members, who interact with your child to provide behavior descriptions may also show a bigger picture of your child’s behavior.
ADHD medications may help improve your child’s inattention and hyperactivity or impulsivity symptoms. They may also help improve physical coordination.
Stimulants: Doctors usually prescribe psychostimulants. These help ease the behavioral signs of ADHD and make focusing on everyday tasks easier. The drugs work by increasing brain chemicals that play a part in attention and concentration.
Psychostimulants are safe for you and your child when taken as directed. In some cases, they may cause unintended side effects. Talk with a doctor if you or your child has existing health conditions or experiences side effects from stimulants such as:
- lack of appetite
- problems with sleeping
- personality changes
- anxiety or irritability
- stomach pain
Nonstimulant drugs: Your doctor may prescribe nonstimulants. These medications work slower, but they still improve the symptoms of ADHD. In some cases, antidepressants also work for symptoms of ADHD. But the Food and Drug Administration (FDA) hasn’t approved antidepressants as a treatment.
Psychotherapy: Therapy combined with medication is effective for children, especially those 6 to 12 years old. Research also shows that behavioral approaches and interventions work extremely well for children and teenagers with ADHD.
Behavioral therapy: The goal of this treatment is to help change behavior. It teaches you and your child to strengthen good behaviors. Behavioral therapy can help a parent, teacher, or therapist guide a child to learn positive behaviors.
Behavior therapy may include parent training, class management, peer interventions, organization training, or a combination of these therapies.
Cognitive behavioral therapy (CBT): CBT teaches coping strategies to modify unwanted behavior and help with mood and anxiety symptoms. There are few studies on CBT and ADHD, but early studies
Family therapy: ADHD can also impact relationships with parents and family members, especially before someone is diagnosed. Family therapy can help everyone learn how to cope with and manage a family member’s symptoms of ADHD. It can also help with communication and family bonding.
Children with ADHD need to have structural support. Organization and consistency can help a child manage their symptoms. Together, you and your child can:
- develop a routine and schedule
- plan for changes in the schedule as far in advance as possible
- create an organization system so that everything has a place
- be consistent with rules
- recognize and reward good behavior
If your child has ADHD, you can also encourage good behavior by:
- minimizing distractions when they’re completing a task
- limiting choices when your child needs to choose
- helping them build a healthy lifestyle
- creating positive experiences through activities your child enjoys and does well
Adults can work with a therapist or counselor to learn organization or life management tools. These include:
- developing and maintaining a routine
- getting used to creating and using lists
- using reminders
- breaking down large tasks or projects into smaller steps
For adults and children with ADHD, clear communication is key. Research shows that people with ADHD have communication problems, from following instructions to considering other people’s perspectives.
It may help to take the time and leave clear step-by-step instructions when engaging your child. You can also help by building their social skills.
Read more: How can you help a child with ADHD control their aggression? »