The different types – presentations – of ADHD explained
October 25, 2018 by Margaret Paton
You may have a hunch that your child or even you tick the box for Attention Deficit/Hyperactivity Disorder (ADHD). A diagnosis impacts those affected in their everyday life, often leading to communications problems.
A counselor of the Today Parent Team, Susie Garlick, says: “Our ADHD children are not horrible, undisciplined or unruly children, we have just created a world that no longer allows them to fit inside the box.”
Diagnosis – the lowdown
One in nine children aged between four and 17 in the US have been diagnosed with ADHD – that’s about 6.4 million children, according to the health website, MedicalNewsToday. Age four is the earliest a child can be diagnosed, says the American Academy of Pediatrics. About a third of children diagnosed continue to have the disorder into adulthood, according to a report by Viser and associates. And, it’s more difficult to diagnose ADHD in teenagers.
So, how is it diagnosed? Well, there isn’t a single test for it, so health professionals need to gather much information to make a diagnosis including a typical rating scale with up to 90 questions about the frequency of ADHD type behaviours. And although there’s no cure, there is help.
The authoritative source on this is the American Psychiatric Association. It last updated its information about ADHD five years ago to help clinicians diagnose adults as well as children presenting with the condition. They’ve explained it in their Diagnostic and Statistical Manual of Mental Disorders (DSM-5), that is, the fifth edition.
Symptoms to look for
That manual says those with ADHD:
• Present in multiple settings (such as school and home) with a pattern of behaviour that can result in performance issues socially, educationally or at work
• Fall into two categories of (1) inattention, and (2) hyperactivity and impulsivity
• Have at least six symptoms from either/both of those categories if they’re children (and that these present before age 12)
• Have at least five symptoms from either/both of those categories if they’re aged 17+.
And these symptoms would have been happening for at least six months. However, over time symptoms may change and in fact, so can the diagnosis of which type of ADHD. At the time of diagnosis, you’ll usually hear if it’s rated mild, moderate or severe. That’s actually a more accurate indicator of the severity of your condition than the type. But it’s still important to know about the three presentations – formerly known as subtypes.
Three presentations of ADHD
Ok, you might be confused because the DSM talks about ‘two categories’ and in a way, they’re right. There are two categories of inattentive, hyperactive-impulsive, and the third presentation is a combination of those two. Let’s unpack them.
Predominantly Inattentive ADHD
This presentation of ADHD affects females from than males. It means that those diagnosed are easily distracted, find it hard to pay close attention to details, but they don’t exhibit hyperactivity or impulsiveness. They may appear to be daydreaming, seem forgetful about their belongings, make simple mistakes, have trouble following instructions and organizing tasks, get bored easily and don’t like exerting mental effort for prolonged periods. In short, they exhibit poor centration skills and are easily distracted.
Predominantly Hyperactive-Impulsive ADHD
There are two elements here – hyperactivity and impulsivity.
Hyperactivity is shown through constant movement and talking – always being ‘on the go’. Symptoms include not being able to sit down or stay still for long, fidgeting and squirming particularly when it’s inappropriate to do so. They have trouble staying on task.
People with this presentation of ADHD tend to struggle to control powerful emotions so their anger can flare up. That’s the impulsivity part. They can be risk takers who don’t think through their actions, perhaps even jump the gun saying inappropriate things or answering before they’ve heard the whole question. You may find them interrupting others often and not being so great at waiting their turn.
ADHD combined includes symptoms of the other two types and it’s the most common and mostly widely researched. As mentioned above, symptoms can change with age and the setting. Such a diagnosis in children typically means they are hyperactive and have difficulty paying attention.
The way forward
Knowing which presentation of ADHD has been diagnosed is a step in the right direction to get treatment and management. ADHD is treated through psychology, behavior therapy, parent training in behavior therapy (also called parent behavior training), behavioral peer interventions, behavioral classroom management, organization training, and psychostimulant medication. Restricting the consumption of food additives, preservatives or sugar, though sometimes helpful, won’t ‘cure’ ADHD either.
And panning out a bit further, another approach (often complementary) is to focus on their strengths, interests and talents – rather than deficits. It’s what the ADDitude magazine calls the ‘abundance model’ as opposed to the ‘deficit model’.
American Psychiatric Association’s two-page factsheet on Attention Deficit/Hyperactivity Disorder (under DSM-5 ‘Updated Disorders’)
Consumer health information website, healthline
Diagnosing ADHD in Children: Guideline and Information for Parents factsheet from healthychildren.org. (Also available as an audio file and in Spanish)