Attention deficit hyperactivity disorder (ADHD) combined presentation can mean losing concentration one minute and feeling impulsive the next.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. Its symptoms are usually first noticed during childhood when hyperactive or inattentive behaviors begin to show. Sometimes, both types of behaviors are seen, and the diagnosis is ADHD combined type.
ADHD combined presentation is diagnosed when you’ve persistently experienced both of these types of ADHD symptoms for at least 6 months:
- hyperactivity and impulsivity
Hyperactivity and impulsivity
Examples of hyperactivity and impulsivity behaviors include:
- difficulty sitting for lengthy periods
- nonstop talking
- interrupting conversations
- low impulse control
- behaviors that may put your and other people’s safety in jeopardy
- difficulty relaxing or engaging in quiet activities
Examples of ADHD inattention symptoms include:
- frequently losing items like keys, your wallet, glasses, or phone
- hesitant to do tasks requiring prolonged mental effort
- mental and physical disorganization
- not following through on instructions or directions
- jumping from task to task without completing any
- making careless mistakes
- not paying attention when spoken to
Other types of ADHD
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), ADHD can present in several forms, including combined presentation. The diagnosis will depend on which symptoms are more dominant.
- inattention presentation: symptoms primarily of inattention
- hyperactivity and impulsivity presentation: symptoms related to low impulse control and hyperactivity
When you meet the diagnostic criteria for both of these types of ADHD, you’ll receive the ADHD combined presentation diagnosis.
All three types of ADHD can present with distinct levels of severity, according to the DSM-5.
- Mild: Symptoms meet the minimum diagnostic requirements, with few other symptoms seen. Impairment is minimal.
- Moderate: There are numerous dominant symptoms, and impairment is more than mild.
- Severe: Many symptoms beyond basic diagnosis surface, or several with noticeable severity or symptoms cause significant trouble socially and at work.
If you live with ADHD combined presentation, treatment and management will likely focus on hyperactivity, impulsivity, and inattention. Your health team may start by addressing the behaviors affecting you the most.
For example, if paying attention at school is a significant problem but hyperactivity and impulsivity aren’t as severe, your health team may focus on helping you manage inattention.
Stimulants are the go-to medications for treating ADHD symptoms.
Why stimulants are effective in ADHD treatment
Only two stimulant medications are used for ADHD:
Stimulants can help reduce the symptoms of ADHD combined presentation because they help with hyperactivity, impulsivity, and inattention.
Still, the medications carry some side effects, including:
- mood changes
- development of tics (uncontrollable, sudden movements or behaviors)
- withdrawal symptoms as the medication wears off
- sleep problems
- changes in appetite
If tic development is a concern, your health team may opt for one of two types of nonstimulant medications for ADHD:
- alpha-2 agonists (clonidine, guanfacine)
- norepinephrine reuptake inhibitors (atomoxetine)
Medication may not be enough to manage ADHD. Most mental health professionals use a “multimodel” approach — in addition to medication, they may recommend cognitive behavioral therapy and ADHD coaching.
Complementary or home remedies to treat ADHD often lack enough scientific evidence to prove their effectiveness. Still, some information indicates they may work for some people.
For ADHD, complementary practices may include:
- sensory integration training
- dietary management
- interactive metronome training
- electroencephalograms biofeedback
- vision therapy
- thyroid treatment
Is ADHD combined type a disability?
ADHD, regardless of presentation, is considered a disability under the Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973 (Section 504).
It may mean you could qualify for government assistance as well as learning accommodations set forth by the Individuals with Disabilities Education Act (IDEA).
Guidance from a healthcare team is essential to manage ADHD, particularly in severe cases. But self-care is also important.
Consider these tips to manage ADHD combined type:
1. Creating routines that work for you
Starting your day with a written plan can help you find a routine that speaks to your specific ADHD symptoms. The plan could involve scheduling meal breaks, chore goals, and routine tasks like taking out the garbage.
2. Decreasing the weight
It’s OK to pass along responsibility. For example, if you find it challenging to pay your bills on time, using auto-pay features or having a family member take on that role may help.
3. Minimizing distractions
If you need to get something done, minimizing your distractions may help. This might mean turning off your phone while you do a project or moving to an area of the house where there’s little clutter.
4. Allowing yourself to move
It’s OK to take a break from a task for a moment. Just because you know you live with symptoms of ADHD doesn’t mean you have to force yourself to never move a muscle.
Scheduling breaks and setting a timer for them can indulge your urge to be active without leading you down a path of distraction.
5. Making use of technology
Also, hyperactivity and impulsivity symptoms may benefit from mental strengthening games and programs designed with the ADHD brain in mind.
ADHD combined presentation involves symptoms of the other types of ADHD: hyperactivity, impulsivity, and inattention.
Like other forms of ADHD, the combined type can range in severity, and your treatment options may involve both medication and psychotherapy.
Self-care and a holistic approach can help prevent ADHD combined type from significantly impacting your life.