Do you have trouble focusing? Do you find yourself tapping or fidgeting, unable to sit still? If so, you might have what’s called combined attention-deficit/hyperactive-impulsive disorder (ADHD). It’s one of the ways ADHD can present itself, but what exactly is combined ADHD?
In short, combined ADHD is when a person experiences both inattentive and hyperactive-impulsive symptoms simultaneously. Keep reading to learn more about this condition, what causes it, and how it’s treated.
What Are The Types of ADHD?
ADHD can show up in three different ways:
- Inattentive presentation: Trouble staying focused on tasks
- Hyperactive-impulsive presentation: Trouble with restlessness or difficulty waiting your turn
- Combined presentation: A mixture of inattentive and hyperactive-impulsive symptoms
Research shows that the inattentive type is the most common, followed by the hyperactive-impulsive type and then the combined type. Since combined ADHD includes traits from both categories, it can make life a bit more challenging.
Signs and Symptoms of Combined ADHD
Some signs and symptoms of combined ADHD may be easy to spot (frequently interrupting others), and others (daydreaming) may not be as obvious. However, both are important when it comes to treatment. Here’s how the symptoms break down:
Inattentive Symptoms
Inattentive ADHD symptoms can be attributed to executive dysfunction, which makes it harder to plan, prioritize, and follow through. Common signs include:
- Difficulty staying focused during tasks or conversations
- Frequently losing important items like keys
- Trouble following multi step instructions
- Avoiding or procrastinating on tasks that require mental effort
- Masking careless mistakes due to not paying attention
Hyperactive-Impulsive Symptoms
Hyperactive-impulsive symptoms are more visible, but they can also include mental restlessness. Adults with ADHD are also more likely to overestimate the benefits of a decision, which can lead to riskier behaviors. Signs may include:
- Fidgeting, tapping, or difficulty sitting still
- Talking excessively or interrupting others
- Impulsive decision-making like blurting out answers
- Struggling to wait turns in conversations, games, or work tasks
- Restlessness or mental hyperactivity
Causes of ADHD Combined Type
ADHD is caused by several different factors, starting with genetics. It’s one of the most heritable psychiatric conditions, with siblings having twice the risk compared to the general population. Environmental influences, like smoking during pregnancy, also contribute to a higher risk of developing ADHD.
Researchers have also found differences in certain parts of the brain that help explain the symptoms seen in combined ADHD, including:
- Frontal cortex changes that affect behavior, attention, and emotional control
- Limbic system disruptions that influence motivation and mood
- Basal ganglia changes that affect motor learning, planning, and multitasking
- An overactive default mode network (DMN) that pulls focus away from tasks and toward unrelated thoughts
All of these factors can interact, making it more likely for inattentive and hyperactive-impulsive symptoms to appear together in the combined presentation.
How is Combined Type ADHD Diagnosed?
According to the DSM-5, a diagnosis requires that:
- Symptoms from the inattentive and hyperactive-impulsive categories are present
- Signs appear before the age of 12
- Symptoms occur in two or more settings (home, work, school)
- Day-to-day functioning severely affected
Healthcare providers may use interviews, self-report scales, and input from parents, teachers, or partners. It’s also important to rule out other possible explanations, like anxiety or depression.
While ADHD is sometimes criticized as being overdiagnosed, research shows the opposite is more common in adults. In fact, fewer than 20% of adults with ADHD are properly diagnosed and treated for their symptoms.
Treatments for Combined ADHD
From medications and lifestyle changes to psychotherapy and coaching, there are several ways to treat ADHD. It may take trial and error to find what works best for you as not every treatment fits every person.
Stimulant Medications vs. Non-Stimulant Medications
Medication is usually a part of treatment for combined ADHD, with stimulants being the first-line option. However, non-stimulants may be used when stimulants aren’t a good fit.
Stimulants, like methylphenidate and amphetamines, increase dopamine activity, which plays a role in motivation and executive function. They have a 70-80% success rate in reducing core ADHD symptoms.
Non-stimulants, on the other hand, target norepinephrine, another neurotransmitter responsible for attention and self-control. These are prescribed when stimulants don’t work well or cause side effects such as increased anxiety or sleep problems.
Psychotherapy
Therapy may also be recommended, especially if symptoms overlap with anxiety or depression. Two types used to treat ADHD include:
- Cognitive Behavioral Therapy (CBT) helps people recognize negative thoughts that might lead to procrastination or impulsivity. By learning coping skills and how to better control their emotions, patients learn to manage their thoughts more effectively.
- Dialectical Behavior Therapy (DBT) teaches mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. These skills improve focus, strengthen self-control, and build resilience in relationships.
Psychotherapy can also address co-occurring conditions. Children with ADHD are at a higher risk of developing additional behavioral or emotional issues. Without treatment, these challenges can follow individuals into adulthood.
ADHD Coaching
While therapy can help you process your emotions, ADHD coaching can teach you the skills you need to work through your other symptoms. Coaches help with time management, organization, accountability, and building systems that make everyday life easier. Coaching is not a licensed profession; however, many ADHD coaches choose to take additional learning courses or earn credentialing to better support their clients’ needs.
A coach will start by learning which symptoms are the biggest challenge and which areas of life are affected. From there, they’ll work with clients to create a treatment plan that addresses inattentive, impulsive, and hyperactive symptoms. It may help improve:
- Planning and management skills
- Time management and accountability
- Self-esteem and self-motivation
- Relationships and communication
- Judgment and decision-making
ADHD coaching is a newer approach to treating ADHD, but it’s been showing promise: a recent review of 19 studies found 17 improvements in symptoms. Six showed better overall well-being and three found improvements lasted over time.
Lifestyle Changes
Professional treatment can only help you so much in treating combined ADHD, which is why it’s important to build a lifestyle that aligns with your mental health goals. Helpful strategies include:
- Regular exercise to boost dopamine and serotonin
- Structured routines for predictability
- A balanced diet, consistent sleep schedule, and mindfulness practices
- Digital tools like timers, reminders, and apps to stay organized
Find Balance at Cura Behavioral Health
If you’re feeling like you’re constantly juggling ADHD symptoms that make you feel scattered and exhausted, it may be time to seek professional support. At Cura Behavioral Health, our therapists and prescribers work with you to address the challenges that come with combined ADHD. We take the time to understand your goals and create a plan that fits your needs. If you’re ready to find strategies that actually help, give us a call today.
Sources:
- The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses – Journal of Affective Disorders
- Why Do People Engage In Risky Behaviors? How Perceived Benefit Motivates Adults with ADHD – Additude Magazine
- Attention Deficit Hyperactivity Disorder – StatPearls
- Inside the ADHD Brain: Structure, Function, and Chemistry – Attention Deficit Disorder Association
- Is ADHD Overdiagnosed in Adults?: How Misunderstood Adult ADHD Is – Attention Deficit Disorder Association
- Changing between stimulant and non-stimulant ADHD medication: What you need to know – Understood
- The Impacts of Co-Occurring Developmental Language Disorder on the Academic, Interpersonal, and Behavioral Profiles of Children With Attention-Deficit/Hyperactivity Disorder – Perspectives of the ASHA Special Interest Groups
- Emerging Evidence for the Efficacy of Coaching for Attention-Deficit/Hyperactivity Disorder (ADHD) – Penn Medicine
