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ADHD Combined Type: What to Know About It

Written by:

Dorianne Green

Medical Writer

Medical Reviewer:

Laura Maleknia

CRNP, FNP-C

Updated: 01.20.2025

Highlights

Attention deficit hyperactivity disorder (ADHD) has three types: predominantly inattentive, predominantly hyperactive/impulsive, and combined.
Combined type is the most common of the subgroups of ADHD.
Treatment might vary according to ADHD type and severity. Behavioral therapy and medication are the most common options.

You’ve always known about attention deficit hyperactivity disorder (ADHD); maybe you have this condition or know somebody who does, but weren’t aware that there are different ADHD types.

So why does this matter? Believe it or not, it is essential to know what type of ADHD you have because it will help you to know what coping strategies to use to feel better; you’ll find out more about it below. Before that, though, let’s do a quick-fire review of the basics of ADHD.

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ADHD is a common mental health condition, and although it starts in childhood, in some people, it continues into adulthood or might only be diagnosed later in life; it is estimated to affect 3 to 6% of adults[1] . The pillars of the condition are having varying symptoms resulting from low attention, high activity or energy, and low impulse control. Importantly, these symptoms are not age-appropriate, causing distress and poor functioning in daily life in two or more settings (e.g., work and home).

In 2013, the diagnosis principles changed to include the following types of ADHD:

This article will focus on the combined type of ADHD.

What Is Combined Type ADHD?

As the name “combined type ADHD” suggests, the person with ADHD has both low attention and high energy symptoms. This is an overly basic explanation, and specific criteria need to be met, which we’ll run through in detail.

How Common Is It?

The combined subtype of ADHD is by far the most common presentation of attention deficit hyperactivity disorder, with 7 out of 10 people with ADHD[1] falling into this category. This is followed by those with mostly inattention symptoms at 2 out of 10, and the predominantly hyperactive presentation is only 1 out of 10 ADHD diagnoses.

"ADHD can sometimes cause feelings of self-doubt, but it’s vital to remind yourself that you are not defined by your challenges. With ongoing self-care, therapy, and support, you can build resilience and improve your self-esteem. If you're struggling, consider reaching out to a healthcare provider who can help guide you with personalized strategies and treatment options to enhance your well-being."

Laura Maleknia, CRNP

Healthcare provider at MEDvidi

How It Differs From Other Types

The first step is processing how an ADHD combined presentation differs from those with mostly inattentive or hyperactive-impulsive symptoms.

Let’s look closely at how the predominantly inattentive and hyperactive/impulsive types are diagnosed in adult ADHD according to the Diagnostic and Statistical Manual (DSM)-5[2] criteria.

Diagnosing predominantly inattentive ADHD type

Diagnosing ADHD predominantly hyperactive/impulsive type

Five or more of the nine symptoms below, present for six months:

Often struggles to be attentive to details, makes careless mistakes
Often finds it challenging to sustain attention
Often does not seem to listen when addressed directly
Often has difficulty following instructions and finishing tasks at home, school, in the workplace
Often has trouble organizing tasks and activities
Often dislikes, avoids, or shows reluctance to engage in tasks demanding sustained mental effort
Often tends to lose things essential for performing or completing tasks or activities
Is often prone to distraction by external stimuli
Is often forgetful in daily activities

Five or more of the nine symptoms below, present for six months:

Often fidgets with or taps hands or feet or squirms
Often cannot remain seated in situations when it is expected
Often feels restless
Often unable to play or take part in leisure activities quietly
Is often “on the go” or acting as if “driven by a motor”
Often talks excessively
Often blurts out an answer before a question has been completed
Often has difficulty waiting his/her turn
Often interrupts or intrudes on others

If you notice several similar symptoms, see a healthcare provider for online ADHD diagnosis and treatment.

Diagnosing ADHD Combined Type

Now that you know what is needed to confirm predominantly inattentive and hyperactive-impulsive ADHD, how to diagnose ADHD combined type? We’ve hinted at it before; it means that the person has to present a mix of both low attention and high activity.

DSM-5 specifies[2] that a combined ADHD diagnosis requires enough symptoms for both inattention AND hyperactivity-impulsivity diagnosis to be present for the past 6 months. In plain language, this means at least 10 symptoms: 5 of which are inattentive and 5 hyperactive-impulsive.

There is also a rating scale on how severe the ADHD symptoms of combined presentation are:

Mild combined ADHD: There are the minimum number of symptoms needed for diagnosis, for example, five inattentive and five hyperactive-impulsive symptoms. Also, work and social life are only slightly impacted.
Moderate combined ADHD: Somewhere in between.
Severe combined ADHD: Many more symptoms are present than those required to make the diagnosis, or there is significant ongoing trouble and dysfunction at work and home.

So, what would this look like in real life?

Symptoms of Combined ADHD

You might be experiencing a mixture of the signs listed below. Firstly, some inattentive symptoms, which are due to difficulty paying attention, present as:

Making careless mistakes
Overlooking essential details and having poor work quality
Being easily distracted by things around you
Taking extra mental effort to get through tasks
Not being ‘present’, daydreaming
Not completing tasks and getting sidetracked
Being messy and having a disorganized work presentation
Repeatedly being late or missing appointments
Losing important items like reading glasses, keys, or mobile phones
Avoiding boring or complicated tasks like preparing reports, completing forms, reviewing lengthy papers
Neglecting paying bills, shopping, returning calls, or household chores
Not getting around to routine health checks or car services
Having poor time management
Failing to meet deadlines

Next, hyperactivity/impulsivity might manifest in the following[2] :

Not being able to sit still
Being restless, agitated, twitchy, or jumpy
Being loud, overbearing, and prone to excessive talking
Interrupting conversations
Not being able to wait in queues
Being ‘on the go’, and others are unable to keep up
Using other people’s things without asking permission
Engaging in irresponsible behavior
Saying inappropriate[3] things at inappropriate times
Being accident prone

If this sounds like you, and you haven’t been diagnosed with adult ADHD, why not take a free, 5-minute screening test?

Causes & Risk Factors

You might have other thoughts, for example, about why you would have a combined presentation of ADHD in the first place. Let’s look at the risk factors and other contributing causes.

First, the biological family members of a person with attention deficit hyperactivity disorder have a higher risk of also having it because it runs in DNA. A concrete example of this is that a sibling of a person with ADHD has a 9 times higher risk of having ADHD than the sibling of someone who doesn’t have this condition. Also, studies in adoptive families show that genes trump a shared environment with regard to ADHD risk.

In addition, evidence suggests that there are also possible non-genetic or environmental factors[4] , some of which are:

Mothers smoking or drinking alcohol during pregnancy
Premature delivery
Low birth weight[5]
Higher levels of family conflict
Exposure to toxins and heavy metals like lead and mercury
Exposure to chemicals such as pesticides
Excessive screen-based media use
Poor sleep-wake cycles
Childhood stroke
Brain injury

Next, we’ll discuss how the combined presentation of ADHD might negatively impact everyday life.

Early diagnosis increases the chances of successful ADHD treatment. See a medical provider for an assessment within 24 hours.

Challenges of People With Combined Type ADHD

Some struggles of combined ADHD relate to difficulty concentrating and can manifest as poor work and learning performance. The result might be a failure to climb the corporate ladder, disciplinary hearings, and job hopping. Neglecting everyday essential activities can result in a poor credit rating, unhealthy diets and personal hygiene, and household clutter.

People with the combined subtype of ADHD often have significant trouble ‘fitting in’ and are frequently criticized[3] . This is usually a result of their hyperactive-impulsive symptoms and poor emotional control, which are seen as socially unacceptable. Other consequences might be poor interpersonal relationships, risk-taking behaviors such as substance abuse, and having multiple sexual partners.

Another challenge is that other mental health conditions often co-occur with ADHD and impact quality of life. The most common is substance use disorder (SUD), followed by mood disorders (depression), anxiety disorders, and personality disorders; another associated condition is oppositional defiant disorder (ODD). These need to be considered in any person with ADHD when seeking treatment.

So, how do you tackle these challenges? Let’s start with some coping strategies you can practice daily.

10 Self-help Tips for Managing Combined ADHD

Make lists and use organizational tools like calendars, diaries, and planners.
Use alarms and set reminders.
Take regular breaks.
Limit environmental distractions by working in a quiet, private environment free of clutter and electronic devices.
Break tasks into smaller, manageable steps.
Stay physically active, as this improves focus[6] and decreases anxiety[7] .
Ensure a healthy sleep pattern to ensure better focus[8] .
Practice mindfulness to regulate emotions[9] and increase focus by paying attention to how you feel in the moment without judgment.
Use stress balls, fidget toys, or chew gum if you’re restless.
Join ADHD support groups.

These tips should be the baseline interventions for every person with ADHD, but if you are still having problems at work and home, you should consult with a healthcare provider for personalized ADHD treatment.

"Living with ADHD means embracing both the strengths and the struggles that come with it. With consistent routines, self-awareness, and a focus on healthy outlets for your energy, you can find balance and thrive despite the obstacles. If you need help, healthcare providers at MEDvidi are here for you."

Laura Maleknia, CRNP

Healthcare provider at MEDvidi

Treatment for the Combined ADHD in Adults

Treatment options for combined presentation of ADHD might involve therapy, medication, or both.

Medications for ADHD Treatment

Healthcare professionals often prescribe medication as the mainstay of the treatment plan. Stimulant medications[1] (amphetamines and methylphenidates) are the first-line medications for any type of ADHD, and they work well in 7 out of 10 individuals. Unfortunately, some patients can’t take stimulants, but there are other options available, such as non-stimulants.

In the case of co-existing anxiety disorders and depression, a specific mental health treatment such as antidepressants may also be helpful.

Behavioral Interventions

Cognitive-behavioral therapy (CBT) is a talk therapy that helps you change how you think, feel, and act. By identifying unwanted thoughts and emotions, you can process them and increase positive behaviors.

Other helpful behavioral treatments might include family or relationship therapy, where everyone will learn about ADHD, its effect on behavior, and how to manage it and encourage and reinforce change.

Summing Up

It is important to get a proper diagnosis, including the type and severity of attention deficit hyperactivity disorder as this may influence the treatment options that your healthcare provider incorporates into your personalized plan. Book an appointment at MEDvidi to go through a detailed symptom assessment online within 24 hours.

FAQ

Is ADHD combined type a disability?

“Americans with Disabilities Act (ADA): A disability is a physical or mental impairment that substantially limits one or more major life activities.”

ADHD combined type is not, by definition, a disability. It is a mental health disorder that falls under the category of brain development (neurodevelopmental) disorders. However, in severe cases that permanently affect the person’s ability to learn, work, concentrate, or socialize, ADHD combined type can be classified as a disability. This might qualify the person for adjusted or adapted work or learning conditions.

What are the struggles of combined ADHD?

The struggles related to ADHD symptoms of the combined type are caused by difficulty concentrating and manifest as poor work and learning performance and neglecting everyday essential activities. Hyperactivity, impulsivity, and poor emotional control may lead to criticism, poor interpersonal relationships, and risk-taking behaviors.

What are the strengths of people with ADHD combined type?

Hyperactivity and impulsivity can be seen as hidden ADHD superpowers[10] . High energy can make the person with ADHD combined presentation the life of the party or help them keep going during sports, social events, and home renovations. Being impulsive and spontaneous can also result in adventure and creativity. However, it is important to keep track of the effects of ADHD symptoms on your life and seek professional help when needed.

What are the symptoms of combined ADHD in women?

Women are more likely to present with inattentive symptoms than hyperactivity, which is not as easy to recognize and might result in a delayed diagnosis. This increases the risk of poor self-esteem, difficult relationships, and mental disorders like anxiety and depression.

What is the best medication for combined type ADHD?

Stimulants[1] (amphetamines and methylphenidates) are the first-line medications for any type of ADHD, and they work well in 7 out of 10 individuals; for patients who cannot take stimulant medications, other options, called non-stimulants, are available. Sometimes, patients may not need medication at all and only require therapy.

What is the link between ADHD and oppositional defiant disorder?

Comorbid oppositional defiant disorder occurs in 6 out of 10 people with ADHD[5] . This may be due to shared risk factors such as family history and higher levels of family conflict and their shared symptoms of impulsivity and a poor ability to control emotions. The risk of developing ODD in a person already diagnosed with ADHD is higher if they come from a poorer household, hang out with the wrong crowd, or have repeated criticism from their parents.

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