Understanding ADHD Subtypes
When it comes to understanding our ADHD it can be a bit of a minefield to navigate - one of our most pernicious problems is that often we're never really educated in what it means to have ADHD. And to top that off, what we learn from pop-culture just reinforces stereotypes that don't really reflect what ADHD is actually about.
One of the most important ways to help manage our ADHD is to accept it, but that can be really hard to do if we don't actually have a good grasp of what having ADHD means. So in today's episode, we're going to be diving into the ADHD subtypes (or presentations as it's now being called) → there are the 3 kinds of ADHD that you might be diagnosed with, hyperactive-impulsive, inattentive, and combined.
Today we're going to be exploring these presentations of ADHD and working on understanding how this can help define our own ADHD.
Before we really get started I just want to emphasize that I am not a doctor and that nothing I say in this episode should be considered a diagnosis. After I go through the subtypes you feel like you really resonate with one and haven't been diagnosed yet, my suggestion would to then go see a real doctor. Because one thing to always consider with ADHD is that its symptoms can also be mimicked by a lot of other conditions like depression (and of course you can also have depression and ADHD at the same time) - all I'm saying is that if what I'm saying sounds like you... well, this is a good first step to explore, but it definitely shouldn't be your last one.
ADHD is a spectrum disorder, which means that it includes a wide list of conditions and severity that can help define your ADHD. This also means that you probably don't have all the symptoms of ADHD → but this wide list of symptoms can also lead people to the conclusion, well, hey, "everyone's a little ADHD right?"
Well, yes, everyone does forget things. Everyone gets distracted from time to time. Everyone is impulsive from time to time. But what sets ADHD apart is that the symptoms are frequent and they also impair your day-to-day life. So yeah, everyone might lose their car keys every once in a while, but I lost my keys so frequently in college that I figured out my friend's schedules so that we could just walk back to the dorm together and I could get in regardless of if I had my keys. I even lost them for a month once... they were in my laundry basket... which also probably tells you something about how well I was on top of my laundry as well. Sheesh.
So yeah, everyone is going to experience the symptoms of ADHD, but for it to be a disorder it needs to impact you in several areas of your life and be consistent... or at least consistently inconsistent as it may be with ADHD.
Just take it from when I was diagnosed - in my mind everyone's brain worked like my brain did - the fact that I often had vastly different results from other people came from the notion that I was lazy, or that I just wasn't motivated enough. I mean there were things that I was amazing at - in middle school and high school I played the card game, Magic: The Gathering - I knew all the ins and outs of the rules. I even played a game with my friends where we'd they'd name a card and I'd be able to tell them what it did from memory. I couldn't have ADHD (or ADD) my memory for magic cards was amazing. And yet with that trap box of a mind, I still wasn't able to ace my history tests because I'd forget which date went with which battle.
ADHD can also have a lot of overlap with symptoms from depression, anxiety, sleep disorders, and other learning disabilities.
Now let's address some stuff about ADHD that you may have picked up over the years and answer some of the questions you may have... like what the heck happened to ADD? Okay, well I'm not going to get into the entire history of ADHD right now, but let's start off with the Diagnostic and Statistical Manual of Mental Disorders - or DSM - which is used by mental health professionals to diagnose many mental health conditions. Now the DSM gets updated every few years and during those updates, things change. In 1980, ADD was added to the DSM-III → before that it was known as Hyperkinetic Reaction of Childhood. ADHD was then added in an update to the DSM-III in 1987... and then in 1994 in the update to the DSM-IV ADD was removed and added as the inattentive subtype of ADHD.
Okay, so basically, ADD and ADHD we're combined... and this makes sense with how these subtypes work → and now a quick word on subtypes because that word is being phased out in favor of presentation because how your ADHD presents can change over time and the word subtype kind of implied that was more of a permanent condition rather than something that can change. AANNNAYWAYS... Basically, we have three presentations of ADHD → the hyperactive-impulsive, inattentive (which was formerly ADD), and combined type. The reason that the combination of ADHD and ADD makes sense is that combined type is the most common presentation of ADHD - and while studies have found various ratios, a "basic" breakdown is about 60% are combined, 30% are inattentive, and 10% are hyperactive-impulsive.
This breakdown was a little surprising for me since the stereotypical idea of ADHD is that of a kid bouncing off the walls with the hyperactive-impulsive presentation... how could that only be 10% of the ADHD diagnoses... and then I realized that the combined presentation.... you know means, combined so that hyperactive-impulsive presentation is represented in that 60% as well. Nonetheless, it still surprised me to see that the inattentive presentation was present in roughly 90% of diagnoses (that's the 60% from the combined type and 30% from just the inattentive presentation). It makes sense with what I see people most commonly struggling with, but yeah, still surprised me.
And also as a note here... yeah, the ADHD diagnosis has changed in the past, and I wouldn't be surprised if it changed again in the future as we learn more about the condition. While you're listening to this episode I want you to keep in mind that this episode isn't definitive and that, yeah, the science might change. None of this is set in stone.
We're going to start off with a little of that Hyperactive-Impulsivity... cause well we gotta be at the front of the line right?
As I mentioned earlier, this is that stereotypical view of ADHD where we see kids constantly squirming in their seats or bouncing off the walls. And just as a note, I don't know how common it is, but there have been a number of times in my life where I've run into walls so hard that I've literally bounced off of them. I mean, everyone has that happen right?
Anyways the hyperactive-impulsive presentation is characterized with:
Fidgety
Restlessness
Noisy
Talkative
Impulsive Reactions
Struggles to wait their turn
Disruptive
Now one thing to think about is that Hyperactivity can look a bit different in adults - it's a lot easier to see in kids since they are being, well, hyperactive - and let's just break down that word → as a prefix, hyper means to go above and beyond in an excessive extent → and so hyperactive simply a way of saying more active than you normally would be. I know, we know, this isn't rocket science here → but let's think about this in terms of being an adult. Instead, maybe we don't run down the halls anymore or try and climb the stairs from outside the banister. Instead, we're restless or we wear people out because we just want to do so many things. We can't stay seated at our desks → I mean I have an Apple Watch and one of the health features is a reminder to stand up for at least a minute every hour for 12 hours a day. I literally didn't know what it was measuring for the first month I had my watch, I just consistently hit that goal every day without even trying. Since owning the watch, which has been a couple of years now, I think I've missed that goal twice and both times was because I was really sick. So point is, I have trouble staying in my seat. I get up and move around all the time. It doesn't feel hyperactive, but it is more active than what we generally expect people to be. For me it's normal, I barely notice that I've gotten up → this is also why I'm back to using a sitting desk... when I had a standing desk I'd get distracted and walk away. Not quite the goal I was going for there. I need to invest in a tether to keep me in place... although I'd forget about it and probably pull the desk over as I tried to go check on something.
Okay, that's the hyperactive-impulsive side of things... let's look take a quick look at the inattentive side of things. Inattentive ADHD is predominately seen in girls, although remember that about 90% of diagnoses show inattentive symptoms (that's inattentive and combined... erm combined) so a vast majority of all diagnoses are going to include this side of ADHD. It is often thought of as spacey, apathetic behavior in children, and then as adults as a mood disorder or anxiety.
The symptoms are characterized as:
Careless Mistakes
Short Attention Space
Poor Listening Skills
Disorganization
"Laziness" or "Apathy"
Distractibility
Forgetfulness
Unable to follow through with commitments
There you have it - those are the indicators of both Hyperactive-Impulsive Presentation and the Inattentive presentation → now what I listed above wasn't the clinical symptoms - in a clinical setting you'd be gauged on 9 symptoms in each subtype - and then could be listed as combined type if you have 6 or more symptoms in both subtypes. And that's actually just for people 16 and under, once you reach 17 you only need to exhibit 5 symptoms in each category. ADHD is a developmental disorder so as we age we do expect to see some changes in how it presents, although most people who had ADHD as a kid tend to still have it as an adult.
Okay. That's how these presentations work. But so what?
Well one of the messages that I really want to make sure everyone here can really internalize is that we all ADHD in our own ways. Looking back on that list, there are a lot of symptoms, especially when we're looking at the combined type and we're definitely not going to have all those symptoms. Remember for clinical diagnosis you only need to have 6 of the symptoms present (5 if you're an adult), which means that the way your ADHD presents is always going to be different from how someone else's ADHD works. And this is an important idea for us to latch onto because there are going to be days when you doubt your ADHD. There are going to be days when you think that you've just been fooling everyone about your ADHD. And let me tell you, those aren't great days... those are the days where you decide that the reason everything is so hard for you isn't because of how your brain is wired, it's because you suck at being a person. That you're a piece of human garbage. That the ADHD was just an easy excuse and that here are your true colors.
I know this because I've been there. It didn't matter that I went through a fairly rigorous diagnosis and that I resonate so well with other ADHDers. It's hard. And it isn't helpful. But it's something most people with ADHD experience at some point... and a big part of that often comes from doing well at something. Yeah, I know, that's kind of messed up. Some days I am on point and I am getting everything done - I'm not forgetting things and I'm staying on task... well maybe not all of that at once, but enough where my brain asks me if you can do this, how can you have ADHD? Wow, way to rain on my parade brain. Not every day is going to be a struggle.
Or it might still come on a day I am struggling because my brain just wants to kick me while I'm down.
So it's helpful to understand that we all ADHD in our own ways. We all have the things we struggle with and we all have the things that we're good at and it's not all going to be dictated by what's typical for people with ADHD. Personally, I love working with spreadsheets... yeah, spreadsheets - oh man, getting the formulas to just how you want them to work... across multiple spreadsheets... muhaa <kiss> But I also know that for a lot of ADHDers spreadsheets kind of melt their brains.
And sometimes our symptoms lead us to go in the other direction - for a lot of people with the inattentive presentation, their punishment not for pay close attention to details and making careless mistakes leads them to become perfectionists. Or a hyperactive-impulsive presentation might switch to not talking after constant reprimands for always talking out of turn or not raising their hand in class. Or these people might not overcorrect in the opposite direction and still do all the same things - just because one person's ADHD works in one way, it in no way dictates how someone else might react.
And this is all to say, yeah, at some point you may find yourself doubting your ADHD - that happens, it can suck, but also it's normal.
The point here is that we all have our own unique ADHD and what's important is that you focus on doing the things that help your ADHD - while I explore a lot of things in this podcast, not everything is going to pertain to your special brand of ADHD. I know sometimes I just want to do all the things - and that's great, but sometimes I also don't need to do all the things, I can just do the things that are really going to make a difference because while doing all the things is great, it can also be a bit tiring. And while it can be hard to prioritize what you need over what looks really fun to do, it'll give you the time and energy to do those fun things.
This Episode’s Top Tips
ADHD is a spectrum disorder, which means that it includes a wide list of conditions and severity which means that your ADHD is just that, yours. No one is going to have the exact same symptoms that you do, so don't worry about comparing yourself to others even if you do resonate with a lot of the stories you hear in the community.
The three presentations of ADHD are Hyperactive-Impulsive, Inattentive, and Combined. We can roughly estimate that about 10% of diagnoses are hyperactive-impulsive, 30% are inattentive, and 60% are combined.
I know this was basically in the first tip, but it bears repeating - we're all going to be ADHDing in our own way - make sure you're not going to struggle with all the same things that everyone else does so focus on what's going to make the biggest difference for you.
