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ADHD Combined Type: What to Know About It

Combined type ADHD
Written by:

Rabia Khaliq

MSc in Applied Psychology

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Attention deficit hyperactivity disorder (ADHD) affects 2.5% to 6.7% of adults and 5% to 7.2% of children worldwide. According to recent estimates [1*] , the frequency among children in the United States (U.S.) is much greater, at roughly 8.7% or 5.3 million.

However, ADHD symptoms may also carry into adulthood. Signs of ADHD in adults usually resemble those of children to a large extent, but the difference lies in how they exhibit them or handle them.

Several treatment options are available to manage ADHD symptoms, but first, the right diagnosis should be made, including the ADHD subtype. Let’s review all three of them and explore a combined type in more detail.

Get comprehensive help for ADHD online: from an initial assessment to ongoing support.

Types of ADHD

Symptoms of adult ADHD usually present themselves in three forms. These are:

  • Predominantly inattentive presentation. A person struggles with problems paying and keeping attention.
  • Predominantly hyperactive-impulsive presentation. It is characterized by hyperactive-impulsive symptoms like fidgeting, blurting out answers, interrupting conversations, etc.
  • Combined ADHD type. This one has the features of both above-mentioned types.

Combined ADHD: Diagnosis and Tests

The Diagnostic and Statistical Manual of Mental Disorders (DSM [2*] ) outlines 18 symptoms of ADHD, 9 for the predominantly inattentive presentation, and 9 for the predominantly hyperactive-impulsive presentation. In the International Classification of Diseases version 10, the ICD-10 code for ADHD combined presentation is F90.2.

For adults to get diagnosed with a combined ADHD type, they need to meet the following criteria set by the DSM-5:

  • People aged 17 years and more need to present at least five symptoms of each of the other presentations.
  • The symptoms should have manifested for a minimum of six months.
  • ADHD symptoms should be present in two or more settings like at college, home, or work.
  • Several symptoms should have been present before age 12, even though they may not have been diagnosed.
  • The symptoms should not be better explained by another mental disorder like anxiety disorder.
  • The symptoms should affect the patient’s ability to handle their work and social or academic setups.

When diagnosing ADHD in adults, a medical practitioner will usually conduct a thorough evaluation. A review of medical history, observations, self-report questionnaires, and clinical interviews may all be part of this. The assessment procedure may also involve the use of standardized tests, such as the Conners Adult ADHD Rating Scales (CAARS [3*] ).

Symptoms of Combined ADHD

People with ADHD of a combined type can get a diagnosis if they represent several symptoms of the two other presentations of this disorder: inattentive and hyperactive-impulsive. Let’s review them in detail.

Inattention Symptoms

  • Making frequent mistakes at work, college, or home, largely due to failure to pay attention to details.
  • Difficulty keeping attention in different activities, whether academic, leisure, or work.
  • Not listening when being talked to, even during one-on-one conversations, and instead appearing distracted.
  • Difficulty following through on tasks and instructions. Patients are easily sidetracked or lose focus, often making it hard to complete a task from beginning to end.
  • Trying to avoid tasks and chores that require prolonged attention.
  • Getting easily distracted by external events.
  • Often losing things like keys, wallet, documents, gadgets, etc.
  • Often forgetting daily chores and tasks.

Symptoms of Hyperactivity and Impulsivity

  • Struggling to stay still, often squirming or fidgeting by moving feet and hands.
  • Finding it hard to stay seated, often getting up to move around even when sitting down is expected or socially appropriate, like at work.
  • Experiencing constant internal restlessness.
  • Rarely taking part in leisure hobbies or activities quietly.
  • Seeming to be constantly energetic and always on the go.
  • Constantly talking and perceived as a chatterbox.
  • Often answering the questions before they are asked.
  • Finding it difficult to wait for their turn.
  • Tending to intrude on the activities and conversations of others.
Consult a healthcare professional online to know whether you have ADHD and receive personalized treatment.

What to Expect From Someone With a Combined Type ADHD

Hyperactivity, impulsivity, and concentration problems are common in people with a combined type of ADHD. They may experience shifts in their level of focus and become quickly sidetracked. Impulsivity might show up as making abrupt choices or speaking without considering consequences, which can occasionally cause social difficulties. In addition, hyperactivity can manifest as restlessness or agitation, and problems with time management can make it difficult to plan or carry out sequential activities.

When engaging with someone who has a combined type of ADHD, it is essential to be understanding and patient. Acknowledge their efforts, communicate clearly, and offer assistance in establishing structured environments.

What Causes the Combined Type of ADHD

The causes of ADHD are the same across all three presentations. However, there is no one precise cause but several common risk factors. These include:

  • Heredity. Several studies [4*] have found that ADHD may run in families and that certain genes are more likely to cause ADHD.
  • Brain injury. A traumatic brain injury can increase the risk of ADHD.
  • Low birth weight or premature delivery. One study [5*] in the Pediatrics journal showed that babies born underweight or prematurely can have a high risk of developing ADHD.
  • External factors during pregnancy/infancy. The use of alcohol or tobacco during pregnancy increases the risk of a child developing ADHD. Exposure to toxins can also increase the chances of the baby being born with ADHD or developing it later.

What Is the Link Between ADHD and Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) and ADHD frequently overlap. These conditions have several common elements, specifically impulsivity and emotional dysregulation. People with ADHD can struggle with impulse control that affects their ability to think before acting, similarly, ODD is marked by persistent patterns of defiant, disobedient, and hostile behavior.

ADHD and comorbid oppositional defiant disorder can trigger difficulties in controlling emotions, behavior, and interpersonal interactions. The defiant behavior that characterizes ODD may be influenced by the impulsivity observed in ADHD. Moreover, agitation and rage are additional manifestations of the emotional dysregulation linked [6*] to ADHD that can exacerbate oppositional behaviors.

It’s important to keep in mind that, despite their noticeable overlap and interconnections, ODD is not always a sign of ADHD and vice versa. On the other hand, having a single condition raises your chances of having the other. ODD and ADHD together can make emotional and behavioral self-regulation problems worse [7*] .

Treatment for the Combined Type of ADHD

Treating a combined type of ADHD involves using the same kinds of medications and behavioral therapies as for other types of the disorder. 

  • Medications. Healthcare professionals may prescribe stimulants (AdderallRitalin) or non-stimulant medications (StratteraIntuniv).
  • Psychotherapy. It can be used in addition to pharmacological treatment or alone. The most common options in this case are behavioral and cognitive-behavioral therapy. Both aim to change a patient’s behavior patterns and strengthen their healthy habits. These also help to develop skills for coping with unwanted symptoms and behaviors.

Self-help Tips for Managing Combined ADHD

Besides the other treatment options, the following tips can help people with a combined type of ADHD to manage their life in a better way.

  • Structured routine: To bring consistency, create a daily schedule that remains the same.
  • Regular breaks: To avoid feeling overwhelmed, break up your work and other duties into smaller, more manageable pieces.
  • Organizational strategies: To keep organized, use tools like planners, calendars, and reminders.
  • Effective communication: Encourage honest dialogue to resolve issues and establish reasonable expectations.
  • Support system: To ensure comprehension and help, establish a robust support system.
  • Healthy lifestyle: Make frequent exercise, stick to a well-balanced diet, and get enough sleep for your general well-being.
ADHD requires a personalized approach to treatment: receive your individual recommendations from a medical expert online!

In Conclusion

Adult ADHD can significantly affect many spheres of life, from careers to relationships to self-development. However, with proper diagnosis and treatment, one can successfully manage it. It may be a bit more challenging for people with ADHD of a combined type due to a variety of symptoms. But with a personalized treatment plan, it is possible. Contact MEDvidi to get your mental health checked and know more about ADHD treatment tailored to your needs.

Frequently Asked Questions

Only a qualified healthcare professional can make an accurate diagnosis. Generally, a person with inattentive ADHD exhibits more symptoms related to inattention and a lack of focus while a person with a hyperactive presentation tends to present symptoms of impulsivity. A combined type can be differentiated from other presentations of ADHD because a person shows symptoms of both types at a time.
F90.2 is a diagnosis code in ICD 10 for combined type ADHD. It denotes the co-occurrence of hyperactive-impulsive and inattentive symptoms.
Each person with ADHD can have symptoms of a different level of severity. Due to a variety of symptoms, a combined type may provide particular difficulties; nevertheless, severity varies from case to case.

While the exact number of individuals with combined type ADHD is unknown, a small study suggests that over 70% of adults with the disorder have combined type.

Age-related differences in symptoms may occur, but the criteria for diagnosis are the same. It’s possible that adults have coping strategies in place, which hide some symptoms.

Managing impulsivity and inattention are difficulties associated with combined type ADHD. Whereas, positively channeled energy can lead to increased creativity and spirit. Still, note that ADHD requires professional support to make sure you don’t overlook important issues while focusing on potentially positive effects.

Comorbid conditions can make ADHD treatment more difficult. When treating comorbidities and ADHD together, a complete treatment strategy is needed, which frequently includes counseling and medication.

Sources

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7 sources
  1. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis?
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  2. DSM-5 Changes: Implications for Child Serious Emotional Disturbance
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  3. https://pubmed.ncbi.nlm.nih.gov/26794674/
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  4. Genetics of attention deficit hyperactivity disorder
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  5. Low and High Birth Weight and the Risk of Child Attention Problems
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  6. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review
    Source link
  7. Impact of Comorbid Oppositional Defiant Disorder on the Clinical and Neuropsychological Characteristics of Korean Children With Attention-Deficit/Hyperactivity Disorder
    Source link
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Written by:

Rabia Khaliq

MSc in Applied Psychology
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