ADHD Combined Type: Symptoms and Diagnosis

Key Takeaways

• Combined type ADHD has symptoms of both inattention and hyperactivity-impulsivity.
• ADHD is diagnosed by checking if you have at least six inattention and six hyperactivity-impulsivity symptoms.
• Getting treated for ADHD can involve both medication and behavioral therapy.

Some people with ADHD struggle to focus (inattentive type), while others have a hard time staying still (hyperactive/impulsive type). For some people, it’s both.

Combined type ADHD is a presentation of attention-deficit hyperactivity disorder characterized by symptoms of both inattention and hyperactivity-impulsivity. To be diagnosed with this type, a person must have six inattention and six hyperactivity-impulsivity symptoms.

Of the three presentations of ADHD, the combined type is the most common. According to some research, approximately 70% of adults with ADHD have the combined type.

Let’s take a closer look at how combined type ADHD is diagnosed and why getting an accurate diagnosis is beneficial. We’ll also explore some treatment options to help people manage inattentive, hyperactive, and impulsive traits.

The 3 Types of ADHD

There are three presentations of attention deficit hyperactivity disorder (ADHD):

• Predominantly inattentive ADHD, characterized by problems regulating attention.
• Predominantly hyperactive/impulsive ADHD, characterized by impulsive and hyperactive behavior.
• Combined type ADHD, where both inattention and hyperactivity/impulsivity are present.

  Previously labeled as subtypes, these were renamed to presentations in 2013 with the publication of the DSM-5. For instance, a person may now be diagnosed with attention deficit hyperactivity disorder, combined presentation.

Even though the official term is now presented, many people still use the terms “subtypes” and “types.” Occasionally, combined ADHD might be referred to as ADHD-C.

How Combined Type ADHD Is Diagnosed

All ADHD types are diagnosed through the same process. A healthcare professional conducts a thorough evaluation, gathering information from an interview with you (or your child), your medical history, family medical history, and school experiences.

The assessment may also include intellectual screening, memory testing, attention and distraction tests, and an interview with your spouse. If a child is being evaluated, the child’s parent will likely be interviewed.

After the evaluation, the clinician will check if the criteria for ADHD in the DSM-5 are met. If so, a diagnosis is made. You’ll be diagnosed with a presentation of ADHD: inattentive, hyperactive-impulsive, or combined.

ADHD Diagnostic Criteria

The DSM-5 lists 18 symptoms of ADHD: nine for inattention and nine for hyperactivity-impulsivity. For a combined ADHD diagnosis, these conditions must be met:

• Children up to 16 should show six or more symptoms from each category.
• Individuals 17 and older should show five or more symptoms from each category.
• Symptoms must persist for at least six months.
• Some symptoms must have appeared before age 12, even if not diagnosed.
• Symptoms should be noticeable in more than one setting, like school/work and home.
• Symptoms must impact the person’s ability to reach their potential.
• Symptoms should not be better explained by another mental disorder, such as a mood or anxiety disorder.

Following is an adapted version of the 18 symptoms listed in the DSM-5.

Inattentive Symptoms

• Often makes mistakes that seem careless at school or work due to trouble focusing on details.
• Has difficulty maintaining attention on schoolwork, tasks, reading, or leisure activities.
• Does not appear to listen during conversations, even one-on-one, and seems distracted by internal thoughts.
• Struggles to follow through on instructions, rarely completing tasks or homework without losing focus.
• Avoids tasks requiring prolonged mental effort, like schoolwork, projects, or filling out forms.
• Frequently loses items such as textbooks, wallets, keys, glasses, or cell phones.
• Is easily distracted by external events.
• Is forgetful during daily activities like chores and errands.

Recap

Inattentive traits all come down to one key factor: attention. Because it’s so hard to focus, these inattentive characteristics make it hard to pay attention, follow instructions, and stay on task.

Hyperactive-Impulsive Symptoms 

• Being physically still is challenging. Will move feet and hands and squirm
• Staying seated is hard. Will often get up and move around, even in situations where sitting down is socially expected, like a classroom or work environment
• Will run or climb at unsuitable times. Teenagers and adults might look physically still but experience internal restlessness
• Rarely participates in hobbies or play activities quietly
• Has lots of energy and is frequently described as “always on the go” or “driven by a motor”
• Talks continually and might be known as a “chatterbox.” This can result in problems at school and work
• Will answer questions before they have been fully asked. Interrupt others while they are talking
• Waiting for a turn is difficult, whether at play, in a line, or during a conversation
• Intrudes on other people’s activities and conversations

Recap

Hyperactive-impulsive symptoms are all about energy and the ability to control impulses. These characteristics make it tough to sit still. This means they have lots of energy, but it’s often hard to control and restrain in certain situations.

Why Getting a Combined Type ADHD Diagnosis Matters

As with many topics, knowledge is power. The more you know about your neurotype and your presentation of ADHD, the more empowered you feel. This, in turn, means you can get the right treatment, accommodations, and support that can help you manage your ADHD characteristics.

Knowing what ADHD presentation you have means you can distinguish between what is an ADHD symptom and what is part of your unique personality. Sometimes, people struggle for years with an aspect of ADHD they think is just part of who they are, only to find later that it is related to ADHD and that treatment is available to help.

In addition to the practical benefits, there are psychological benefits to knowing how ADHD affects you. There is a lot of moral judgment around behaviors that result from having ADHD. For example, being unable to sit still in a meeting might be “disrespectful.”

A person who makes what seems like careless mistakes at school may be labeled “unmotivated.” Unfortunately, these labels are often internalized and affect a person’s confidence and self-worth. Adults and children with ADHD often call themselves lazy or stupid, when they are neither.

Understanding the subtleties of your ADHD type helps you to separate yourself from these negative comments and the shame and guilt that comes with them. This frees you to find a proactive solution instead.

What It Means to Have Combined Type ADHD

Having combined type ADHD does not automatically mean your ADHD is more severe compared to someone who is diagnosed with the predominantly hyperactive type or predominantly inattentive type.

For example, a person who has predominantly hyperactive-impulsive type might still experience some symptoms from the inattentive symptom list. However, they would not have the full five or six symptoms to be given a combined ADHD diagnosis. Being diagnosed with combined type ADHD means your symptoms are more likely to be evenly distributed between the two types.

Anyone diagnosed with ADHD after May 2013 (when the DSM-5 was published) is told how severe their ADHD is. It could be mild (while still meeting the ADHD criteria), moderate, or severe. This rating is a more accurate way to know the severity of your condition, rather than judging it based on the type of ADHD you have.

How Combined Type ADHD Progresses Over Time

When the DSM-5 was published, it replaced the term ADHD subtypes with ADHD presentations. This change reflected the new understanding researchers have of ADHD. Rather than being a fixed and stagnant condition that could be neatly divided into subtypes, we now know that a person’s ADHD presentation and severity are more fluid and can change with age and the setting.

ADHD characteristics also tend to change with age. Predominantly hyperactive presentation could be an early developmental stage of combined ADHD. Symptoms of hyperactivity and impulsivity tend to decline as a person ages.

People diagnosed with hyperactivity will develop sufficient symptoms related to attention regulation in three to five years. These new symptoms will be strong enough that these people will meet the requirements to be diagnosed with ADHD combined presentation.

For example, a person who experienced hyperactivity as a child and found it hard to sit still might be able to sit still when required as an adult but will feel internal restlessness and discomfort.

Treatments and Support for Combined Type ADHD

If you or your child have combined ADHD, it is important to address both the inattentive and the hyperactive and impulsive symptoms.

ADHD is a form of neurodivergence, which involves a difference in how a person’s brain processes and interprets information. It does not need to be cured, but there are strategies that people can use to help them manage different characteristics of their ADHD.

As with all types of ADHD, the most effective treatment plan for combined ADHD is usually medication plus behavioral treatments like therapy, accommodations, social skills, and lifestyle changes.

There are no specific ADHD medications that work best for certain types of ADHD.

Instead, finding the right medication and dose is something that your doctor will be able to help with. You might try several ADHD medications until you find one that helps your ADHD symptoms and has minimal side effects.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Jacqueline Sinfield

Jacqueline Sinfield is an ADHD coach, and the author of “Untapped Brilliance, How to Reach Your Full Potential As An Adult With ADHD.”

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