Combined ADHD Type: Explained
If you're experiencing a blend of difficulties related to focus, impulsiveness, and restlessness, you might be encountering symptoms of Combined Type ADHD. We're here to provide a helping hand, whether you're researching for yourself or a loved one. With the proper support, those living with Combined ADHD can live healthy, fulfilling lives.
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ADHD is a complex neurodevelopmental condition that affects individuals of all ages. Between the Hyperactive-Impulsive Subtype and the Inattentive Subtype, there’s also the Combined Subtype that – and as the name suggests – those living with it experience a combination of symptoms from both subtypes.
The three ADHD subtypes consist of the following:
ADHD Predominantly Inattentive Type (formally known as ADD)
ADHD Hyperactive-Impulsive Type
ADHD Combined Type
The Inattentive Subtype of ADHD is characterized by symptoms such as difficulty paying attention, forgetfulness, and disorganization.
The Hyperactive-Impulsive ADHD Subtype is characterized by fidgeting, restlessness, interrupting others, and impulsive behaviour.
When someone’s living with Combined ADHD, they often experience symptoms of both Inattentive and Hyperactive-Impulsive ADHD. How this manifests looks different for everyone. Let’s say someone’s having trouble paying attention in class; they may also feel the urge to fidget or talk out of turn while trying to fight the feeling. It can be incredibly draining as someone must work more to address the inattentive, hyperactive, and impulsive symptoms.
Combined ADHD in adults
While this article will focus on adults living with Combined ADHD, the symptoms can also apply to children. Combined ADHD is one of the most common subtypes of ADHD diagnosed in adults. Many adults with Combined ADHD may have also had the same diagnosis in childhood, but it is possible for the symptoms of ADHD to change over the lifespan.
What is Combined ADHD?
For someone living with Combined ADHD, rather than predominantly struggling to focus on a task (Inattentive) or fighting the impulse to get up and move around (Hyperactive-Impulsive), they’re often saddled with both. Experiencing both sets of symptoms can lead to more notable challenges in their day-to-day life.
The compounding symptoms of Combined ADHD can make it difficult to follow through on commitments, with hardships often experienced in professional/academic and social settings. It’s important not to minimize or invalidate the symptoms. Someone living with ADHD is likely already using their energy to stay on track and maintain the social conventions designed for a neurotypical world – empathy goes a long way.
What are the symptoms of Combined ADHD?
Since Combined ADHD symptoms are defined by inattention, hyperactivity and impulsivity, it touches upon many aspects of someone’s life, including:
Difficulty paying attention or staying focused: You struggle with concentrating for extended periods and are easily distracted by external stimuli, contributing to difficulty following through on tasks.
Hyperactivity and restlessness: You may appear to others to be constantly on the go, always moving or fidgeting, having difficulty sitting still, and potentially struggling with waiting in line or engaging in “quiet” activities.
Impulsivity and poor decision-making: You experience difficulty regulating emotions and behaviour, leading to impulsive actions such as interrupting others, speaking out of turn, and taking risks without considering the consequences.
Time management and organization struggles: You may often miss deadlines, show up late to appointments, and have a hard time with organizing or tidying up, leading to living and working in cluttered spaces.
Feelings of being overwhelmed: It may feel easy to start tasks but difficult to complete them. You find this contributes to a sense of being overwhelmed when the unfinished projects begin to accumulate.
For more information, check out this complete list of symptoms for all ADHD subtypes.
The impact of Combined ADHD on work, school, and relationships
There’s no doubt that those living with Combined ADHD have to endure hardships in their daily life – including keeping up and maintaining their performance at work, school and in their relationships.
In the workplace or education settings, living with Combined ADHD can lead to time management issues, struggling to meet deadlines and staying organized. We know how much job security and academia are tied to performance, so it’s often a lot of added pressure that can lead those living with Combined ADHD to experience increased stress and frustration. Working desk jobs and prolonged sitting can also create a great deal of pressure and stress for someone with Combined ADHD.
Living with Combined ADHD can significantly impact relationships as well. From struggling to listen to others to difficulties completing tasks or following through on commitments, it can strain personal relationships and cause difficulty maintaining them. A diagnosis of combined ADHD can be more complicated than other subtypes due to the groups of symptoms.
What causes Combined ADHD?
ADHD is a complex condition, and there is no single cause. ADHD does have a strong genetic component – individuals with a family history of ADHD are at a higher risk of developing the condition.
However, research also indicates that many additional factors are in play: a combination of genetic, environmental, and neurological factors contribute to the development of the condition.
How do you get diagnosed with Combined ADHD?
You can access online self-screening tests that can help identify the symptoms of Combined ADHD, but they cannot be relied upon for a formal diagnosis. Patients should consult a healthcare professional for an accurate diagnosis.
Medical diagnosis in Canada
The diagnostic process for Combined ADHD is usually performed by a healthcare professional that specializes in ADHD. The assessment often includes a clinical interview and review of medical history and the use of assessment tools. In some cases, you may be given a neurocognitive assessment and physical exam.
People with Combined ADHD must display at least 10 of the total symptoms (or 12 if under the age of 17), comprised of at least five inattentive behaviours and five hyperactive-impulsive behaviours.
The diagnostic criteria for ADHD include the following:
1. Persistent and excessive hyperactivity and impulsivity that interferes with functioning or development, as evidenced by at least six of the following symptoms:
Often fidgets with hands or feet or squirms in seat
Leaves seat in situations when remaining seated is expected
Runs about or climbs in situations where it is inappropriate
Unable to play or engage in leisure activities quietly
Often “on the go,” acting as if “driven by a motor”
Blurts out an answer before a question has been completed
Difficulty waiting their turn
Interrupts or intrudes on others
2. Persistent and excessive inattentiveness (difficulty focusing, organizing and staying on task) that interferes with functioning or development, as evidenced by at least six of the following symptoms:
Trouble paying attention to details or making careless mistakes.
Issues remaining focused on tasks and activities.
Difficulty listening well, daydreaming or seeming distracted.
Trouble with following instructions and/or finishing tasks.
Difficulty with organizing tasks and activities.
Avoiding or disliking tasks that require continuous mental effort.
Losing things frequently.
Easily distracted by outside stimuli.
Forgetful in daily activities.
3. Several symptoms are present before the age of 12 years.
4. Several symptoms are present in two or more settings, such as at home, school, or work.
5. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
How do you treat Combined ADHD?
Effective treatment for Combined ADHD involves a combination of medication and non-medication strategies. It's important to work closely with a healthcare provider to develop an individualized treatment plan and be open to adapting to see what suits you best.
Medication, such as stimulants, can help someone living with Combined ADHD manage their symptoms of both inattention and hyperactivity/impulsivity. However, there’s no one-size-fits-all solution – it’s recommended that practicing a routine of good nutrition, exercise, and getting the recommended hours of sleep every night can contribute to better focus, reduced impulsivity and better health outcomes.
Talk therapies such as Cognitive-behavioural therapy and Acceptance and Commitment Therapy are often effective in helping individuals living with Combined ADHD develop the skill to manage symptoms. Your therapist will help you identify your challenges and work with you to develop more effective coping mechanisms. Additional family or talk therapy may also be helpful for those living with ADHD and for their loved ones to address prospective interpersonal issues related to ADHD.
Lifestyle changes can contribute to the effectiveness of medication and therapy in treating ADHD. Some examples of this could include:
Exercise: Regular exercise reduces stress levels and can be highly effective in managing ADHD. Exercise is especially helpful for reducing symptoms related to hyperactivity.
Sleep: Consistent, quality sleep can help regulate your mood and behaviour since a lack of sleep can worsen symptoms. Many people with ADHD have difficulties with keeping a regular sleep schedule.
Nutrition: Eat a healthy and balanced diet and try to avoid sugary and processed foods, which can exacerbate symptoms.
Time Management: Consider using tools like calendars, timers and to-do lists to help you stay organized and focused.
Stress Reduction: Activities like meditation, deep breathing or yoga can help you work through daily stress.
Frida support & services
Everyone’s experience with ADHD is unique, and there’s no denying that mental health struggles can be overlooked and often misunderstood. Thankfully, there are more and more resources, support and solutions to help you improve your well-being and find strength in your diagnosis.
If you suspect you or anyone in your life is living with ADHD, getting a diagnosis is essential to understanding your symptoms. Consider taking a 2-minute ADHD assessment with Frida to get started. From there, our diagnostic assessment is comprised of the following steps:
Complete a medical questionnaire/screener (5 – 7 minutes long)
Complete a medical assessment form (20 minutes long)
Schedule and undergo an ADHD assessment appointment (75 minutes)
Receive your diagnosis results
Remember, progress takes time. Not every treatment will suit everyone's needs, so it's important to be patient and open to experimentation in order to find the most effective combination of interventions.