Recognizing the Types of ADHD

ADHD isn't necessarily a simple and straightforward diagnosis. There are various ADHD types and two schools of thought on the different subtypes of attention deficit hyperactivity disorder.

ADHD, or attention deficit hyperactivity disorder, is a behavioral disorder. But does that means that all kids who have it are hyperactive and can't pay attention? Not exactly. There are different types of ADHD, and the subcategories are intended to help better diagnose individuals and find the best treatment for each.

Types of ADHD According to the DSM-IV

The DSM-IV, the fourth edition of the Diagnostic and Statistic Manual of Mental Disorders published by the American Psychiatric Association, lists psychiatric disorders, diagnostic criteria, symptoms, and other valuable information about such conditions. Included are the types of ADHD and the criteria for each.

"There are three subtypes identified. By far the most common is combined," says Mark A. Riddle, MD, director of the division of child and adolescent psychiatry at the Johns Hopkins Children's Center in Baltimore. "There's hyperactivity and impulsivity in one and inattention in the other. And when you have some of both, it's combined."

Here are more specifics from the DSM-IV:

• ADHD, Combined Type (combined inattentive, hyperactive, and impulsive). People with combined ADHD show characteristics of all three symptoms. This is the most common type of ADHD. Criteria include the inability to pay attention to activities and instructions, difficulty listening and staying organized, and being forgetful and often losing things. Other criteria are impulsive behaviors like speaking out inappropriately, interrupting others, talking excessively, the inability to sit still, and fidgeting.
• ADHD, Predominantly Hyperactive-Impulsive Type. People with this type of ADHD show only symptoms of hyperactivity and impulsivity, but do not have problems with inattention. This is the least common type of ADHD. Criteria include hyperactive behaviors like being overly active physically (can't sit still, always running around), talking excessively, frequent fidgeting, and impulsive behaviors like the inability to wait their turn, speaking out inappropriately, and interrupting others’ conversations or activities.
• ADHD, Predominantly Inattentive Type (formerly called ADD or attention deficit disorder). People with this type of ADHD don't have any symptoms of impulsive or hyperactive behaviors, but have difficulty paying attention. This is the most common type of ADHD in girls. Criteria are limited to symptoms of inattention, like carelessness and forgetfulness in daily activities, disorganization, not listening, and difficulty following instructions or completing activities.

"The kids with hyperactivity and impulsivity — whether it's combined or just that subtype — those kids often get identified," says Dr. Riddle. The predominantly inattentive subtype, however, can often be the toughest to diagnose. "It gets missed because a teacher can't see it, the nursery school staff can't see it," says Riddle. "The youngster just has difficulty staying focused, usually in challenging settings." Often, this type isn't diagnosed until later in life.

Types of ADHD: Amen's Types

The DSM-IV types of ADHD are used most often by medical professionals, but there is another classification of types of ADHD by psychiatrist Daniel Amen. Based on his research and imaging scan results of the brain, Dr. Amen created a different set of types of ADHD that all have typical ADD symptoms such as short attention span, being easily distracted, unorganized, procrastination, and impulse control plus the following associated symptoms:

• Type 1 – Classic ADD. This type includes symptoms of inattention, impulsivity, hyperactivity, and restlessness.
• Type 2 – Inattentive ADD. Characteristics include inattention, acting "spacey," laziness, seeming lack of intelligence, lack of motivation, and unenergetic. This type tends to be diagnosed in older children or adults, and most often in girls.
• Type 3 – Overfocused ADD. Symptoms include inattention, frequent worrying, difficulty changing attention to another task, obsession with negative behaviors and thinking, resistance to change, and frequent arguing.
• Type 4 – Temporal Lobe ADD. People with this type are often quick tempered, have anxiety, show physical symptoms like stomach pain or headaches, and have difficulty remembering things. People with type 4 also tend to experience trouble reading.
• Type 5 – Limbic ADD. Includes symptoms of inattention, as well as signs of depression like insomnia, lack of appetite, problems with self-esteem, lack of energy, and frequent sadness. People with type 5 also tend to be socially isolated.
• Type 6 – Ring of Fire ADD. Characteristics include symptoms of inattention, anger and temper problems, talking a lot, sensitivity to lights and sounds, and being resistant to change.

Amen offers brain scans and treatments at his clinics across the country, but his types and research have not been validated by anyone else. Also, his theory is that you can truly heal ADD, while conventional research shows that isn't the case.

"The most effective way of managing ADHD is to teach an individual how to act in an environment around them," says Michael Manos, PhD, head of the Center for Pediatric Behavioral Health at the Pediatric Institute of the Cleveland Clinic in Cleveland.

No other research has ever been able to completely substantiate Amen's theories, says Manos, "nor have there been clear replicated studies that confirm the various subtypes of ADHD that he identifies." Amen's data has never been published in a peer-reviewed journal.

People who want answers and an explanation for ADHD should find a trusted health care professional with experience in dealing with ADHD. They can get the right diagnosis about the condition and, most importantly, get started on the road to recovery.