What Is Combined Type ADHD?

Combined type attention deficit hyperactivity disorder (ADHD) is the most common of the three presentations of ADHD. The others are predominantly inattentive presentation and predominantly hyperactive-impulsive presentation. As the name suggests, people with combined type ADHD show both inattentive and hyperactive symptoms.

Although it's difficult to say what percentage of people with ADHD have combined type, one small study estimates that about 70% of adults with ADHD had combined type.

Treating combined-type ADHD can be challenging since there are two different symptom sets. However, this type is not necessarily worse or more disruptive than other presentations of ADHD.

This article will review the symptoms of combined-type ADHD, as well as treatment options and how to cope.

Signs of Combined Type ADHD

The DSM-5 ADHD criteria outlines two sets of symptoms for people with ADHD. A diagnosis can be made if a person under the age of 17 has six or more of the outlined symptoms in one category for the past six months, or if an adult has five of the symptoms. People with combined-type ADHD meet the criteria for both sets of symptoms.

Inattentive Symptoms

People who have predominantly inattentive ADHD mostly have trouble paying attention and following through. The symptoms of inattentiveness include:

• Difficulty paying attention or listening
• Losing important items
• Being easily distracted
• Forgetfulness
• Having trouble paying attention
• Appearing not to be listening
• Making careless mistakes
• Avoiding tasks that require focus

Hyperactive-Impulsive Symptoms

People who primarily have hyperactive or impulsive-type ADHD often have more physical symptoms. These can include:

• Squirming or fidgeting
• Inability to remain seated
• Running or climbing inappropriately, or (in adults) restlessness
• Trouble staying quiet
• Appearance of being driven by "a motor" or often “on the go”
• Being overly talkative
• Inability to wait their turn
• Interrupting frequently

What to Expect from Someone with Combined Type ADHD

People with combined-type ADHD are often impulsive and hyper. They might have difficulty reaching their full potential at school or work because their symptoms interfere with their ability to complete tasks. In some other cases, they have trouble making friends, although many kids with ADHD form meaningful friendships.

Children with ADHD are at increased risk for other conditions, including learning disorders, depression, anxiety, or behavioral problems. Because of that, the American Academy of Pediatrics recommends that all kids with ADHD be screened for additional conditions. Knowing all the conditions that a child is navigating can help you develop a treatment plan that will work for them.

You should also work with your child and their therapist to develop healthy ways of coping with excess energy or impulsiveness. Kids with ADHD are at increased risk for injury. Be proactive in talking to your child about safety measures, like always wearing a helmet while riding a bike.

How to Treat Combined Type ADHD

Combined type ADHD is treated with medications that can help reduce symptoms, and behavioral adaptations that can help a person control the symptoms they still have.

If you’re the parent of a child with combined-type ADHD, you can also benefit from training and therapy that teach you how to more effectively engage with your child. In addition, you can request that their school help make behavioral accommodations to help your child succeed. 

Medication treatments

• Stimulants: These medications, including Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine), can quickly reduce ADHD symptoms in as many as 80% of kids with ADHD.
• Non-stimulants: These medications, including Strattera (atomoxetine) and Qelbree (viloxazine), work more slowly but the effects may last longer.

In some cases, your healthcare provider may recommend a combination of stimulant and non-stimulant treatments. 

Behavioral interventions

People, especially children, with combined type ADHD benefit from behavioral interventions that help them succeed at school and in other settings. These can include:

• Behavioral therapy: This aims to increase positive behaviors and decrease negative or risky behaviors. 
• Social skills training: Therapy that helps people better understand and abide by social cues. 
• Organizational skills training: Helps the person develop methods to combat forgetfulness and disorganization.

Summary

Combined type ADHD is one of three presentations of ADHD laid out in the DSM-5. To be diagnosed with combined type ADHD, a person needs to exhibit both hyperactive/impulsive and inattentive symptoms.

Although a person with combined-type ADHD has two types of symptoms, their ADHD is not necessarily worse than that of people with a single presentation. Medications and behavioral interventions can help people with combined-type ADHD succeed in school, work, and social settings.

A Word From Verywell

Getting a diagnosis of combined-type ADHD might come as a relief, or it can seem overwhelming. Remember that there are treatments—both medical and behavioral—that can support people with ADHD in reaching their full potential. The key is finding a treatment regimen that works for you or your child. 

Combined type ADHD might seem more complex than having just one presentation. However, it does not necessarily mean that the symptoms are more disruptive than in someone with only one type of presentation. Talk with your healthcare provider to get a better idea of what your diagnosis of combined type ADHD means, and how best to manage it.