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Types of ADHD: Inattentive, Hyperactive-Impulsive, Combined

Determining whether someone has ADHD takes a thorough psychiatric evaluation. There is no specific test that is perfect for diagnosing this condition. Many problems such as learning disabilities, anxiety, and depression may result in similar symptoms to ADHD. Since many conditions have similar symptoms, it is important to make sure the proper diagnosis is made. If you are diagnosed with ADHD, you will typically be assigned a particular subtype.

According to the DSM-5 there are three different subtypes of the condition that can be officially diagnosed. However, other doctors and researchers that have done more extensive work with SPECT brain scans suggest that there are in fact more than three types of attention-deficit/hyperactivity disorder. If you have ADHD, you can read up on the specific subtypes below and it may better help you understand the type that you are coping with.

3 Official Types of ADHD (DSM-5)

According to the DSM-IV, there are three official subtypes of ADHD that can be diagnosed. When individuals are assessed for ADHD, they are evaluated based on different categories including: inattentiveness and hyperactivity-impulsivity. Based on symptoms that an individual is experiencing, a specific subtype can be diagnosed.

Combined ADHD: This is the most common subtype of ADHD. It is characterized by symptoms of inattentiveness, hyperactivity, and impulsivity altogether. People with this subtype tend to have problems paying attention, focusing in school, and staying productive. They may also appear hyperactive and may make impulsive decisions often.

Inattentive ADHD: This is characterized by inattentiveness without the hyperactivity and/or impulsivity. This was previously referred to as just “ADD” with no “H” for hyperactivity. The change in name has confused some people and caused them to search for the difference between ADD and ADHD. Really what people mean when they say just “ADD” is this “inattentive” subtype.

Hyperactive-Impulsive ADHD: This is characterized by significant amounts of hyperactivity and impulsivity without the inattentiveness. In other words, these individuals are better able to pay attention, but they may be prone to bouts of fidgety behavior, restlessness, and may make impulsive decisions.

Dr. Amen: 7 Types of ADHD (Amen Clinics)

According to Dr. Amen who specializes in SPECT image scans, he has discovered 7 common types of ADHD. He uses SPECT imaging to identify brain activity or under-activity in certain regions and then assesses symptoms of the individual based on their brain activity. He has found that most people fit one of the 7 subtypes listed below. You can read below to determine which subtype best describes your situation. If you would like further clarification, you can always go get a SPECT scan – which looks at the activity in your brain.

1. Classic ADHD: The “classic” subtype of ADHD involves the person experiencing normal symptoms including hyperactivity, restlessness, and impulsivity. This is thought to be caused by low prefrontal cortex activity while the person is trying to concentrate.

In normal individuals, the prefrontal cortex becomes highly activated. Among individuals with classic ADHD, there isn’t enough activity, thus resulting in an inability to focus.

2. Inattentive ADHD: This “inattentive” subtype is characterized by normal ADHD symptoms in addition to low energy, low motivation, and an overall “spacey” demeanor. The individual may appear to be a space cadet and frequently is unable to pay attention no matter how hard they try. They may seem internally preoccupied with their thoughts or day-dreamy.

This is more common among women and is usually diagnosed later in life. People with this subtype are sometimes labeled as “lazy” and “spacey.” It is thought that these individuals also experience low prefrontal cortex activity while trying to concentrate and also reduced activity in the cerebellum.

3. Over-Focused ADHD: Individuals with “over-focused” ADHD are not able to pay attention because they have “too much” brain activity. They experience all the classic symptoms in addition they demonstrate rigid thinking, have difficulty shifting their attention, and often are plagued with negative thoughts.

This subtype is more common in families with addiction problems and/or obsessive-compulsive personalities. Brain activity is typically overactive in the anterior cingulate with low prefrontal cortex activity while the person attempts to concentrate.

4. Temporal Lobe ADD: This is classified by normal attention deficit symptoms, plus the person has a “short fuse.” They have trouble telling whether someone is trying to help them or insult them. So someone giving constructive advice may be taken as an attack by the person with this subtype.

They may have bouts of anxiety, abdominal pain, memory problems, and difficulties with reading and writing. It is common to find this subtype among families with learning disabilities and anger problems. It is thought that the person has low prefrontal cortex activity during concentration, but also low activity in their temporal lobes.

5. Limbic ADD: With this particular subtype, the individual will experience primary attention deficits with emotional dysfunction. The person may experience mild sadness, think negatively, have low energy, low self-esteem, and may be very irritable. Additionally, the person may socially isolate themselves, have appetite and sleep problems.

The treatment of this subtype with stimulants may exacerbate the underlying symptoms. In this subtype the person has an overactive limbic region of the brain and low prefrontal cortex activity during attempts to concentrate. In particular the deep limbic system may be hyperactivated in the brains of individuals with this type of ADD.

6. Ring of Fire ADD: This subtype is characterized by having primary ADD symptoms with extreme mood swings. The person may erupt with explosive anger, opposition to authority, rapid-fire thinking, excessive motor activity, and this individual may be highly sensitive to loud sounds and bright light.  This type of ADHD is sometimes made worse through the use of stimulants.

It is thought that these individuals have a high amount of brain activity throughout the entire cortex. In this subtype, the individual may not experience low prefrontal cortex activity during concentration. In other words, their brain maintains a hyperactivated or overactive activity pattern.

7. Anxious ADD: Common symptoms for this subtype include high levels of anxiety, nervousness, stress, and inattention. It is the anxiety that makes it difficult for the individual to pay attention. They may suffer from social anxiety, freeze up during test taking (e.g. test anxiety), and be prone to the physical effects of stress.

It is thought that anxious ADD is caused by increased activity in the basal ganglia during attempts to concentrate and during a resting state. It is also thought that decreases in activity in the prefrontal cortex – specifically the underside – while the person is concentrating leads to this type of ADD.

Does understanding your ADHD subtype help?

If you want to better understand yourself and your condition, it may be helpful to recognize the subtype of ADHD that you are dealing with – most people like specificity when it comes to mental disorders. Although most ADHD is characterized by low activity in the prefrontal cortex, there are other brain areas that may influence your specific subtype. Low activity in any area is usually treated with a stimulant medication like Adderall.

However, if you have over-focused, ring of fire, or anxious ADD, you may want to avoid stimulants because you likely already have a high level of physiological arousal. Therefore in these particular cases, it may help to learn how to calm yourself down. If you have the classic types of ADHD or the inattentive subtype, you can work with your psychiatrist to find a more specific treatment option.

Before pursuing any medication though, it is recommended to explore natural options. Many people have experienced a lot of success at managing their symptoms with natural remedies for ADHD. I think that natural options should always be pursued before taking a pharmaceutical medication because they carry less side effects, can be just as effective, and are pretty safe. Hopefully this article better helped you understand your subtype and gave you some more insight as to what might be going on inside your brain.

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