ADHD-C: Understanding Combined ADHD

Medically reviewed by Karen Foster, LPC
Updated October 15, 2024by BetterHelp Editorial Team

ADHD-C, also known as combined type attention-deficit/hyperactivity disorder (ADHD) or combination ADHD, is a mixture of two major presentations of attention-deficit/hyperactivity disorder. In this article, we will use the terms “type” and “subtype’” interchangeably, but it is important to know that new changes in the DSM-V classify ADHD as just one disorder that presents itself in three distinct ways.

What is attention-deficit/hyperactivity disorder (ADHD)?

ADHD is a neurodevelopmental disorder that affects development, functioning, and cognitive control and can cause working memory deficits. It belongs to a group of externalizing disorders that also include conduct disorder and oppositional defiant disorder. 

Though it’s tough to get an exact number due to underdiagnosis in some demographic groups and other potential factors such as misdiagnosis, up to 9.4% of children in the United States have been diagnosed with ADHD at some point in their lives, though symptom severity may vary. It is the most common neurodevelopmental disorder in children, but with that in mind, it’s crucial to state that ADHD does not only affect minors—children with ADHD, diagnosed or undiagnosed, can go on to become adults with continued ADHD symptoms.

ADHD subtypes

Stereotypes surrounding ADHD may make it seem as though ADHD always presents the same way, but the truth is that it can–and does–vary from person to person. These variations can be broken down into one of the below subtypes based on criteria outlined by the current DSM-V.

1. Hyperactive-impulsive type ADHD

Getty
Learn to cope with combined ADHD

The first presentation of ADHD that we will cover is not ADHD-C, but the most commonly known or represented version of the disorder, particularly in preschool children, hyperactive-impulsive ADHD (ADHD-HI).

If the child is 16 years old or under and seeking to be officially diagnosed by a professional, they must present at least six of the hyperactive and impulsive symptoms below. If someone is 17 or older, they must experience five or more hyperactive symptoms.

  • Fidgets (i.e., whole body, hands, feet), squirms in seat, or taps

  • Runs or climbs on things in situations when doing so is inappropriate

  • Often leaves seats in situations in which one is expected to stay seated

  • Has trouble playing with toys or taking part in activities quietly

  • Seems to be driven by a motor or constantly on the go

  • Often interrupts or intrudes on others

  • Has trouble waiting for their turn

  • Talks excessively

  • Blurts out answers

On top of the above nine symptoms, the following criteria must be met for diagnosis.

  • The symptoms have been present for at least six months and are not better characterized by another diagnosis, such as a mood disorder.

  • Many of the ADHD signs and symptoms that qualify the diagnosis were present before the age of 12.

  • These symptoms present in more than one setting, such as at home, school, during extracurricular activities, or at work.

  • The symptoms experienced because of ADHD reduce the quality of life in school, at home, or socially.

2. Inattentive type ADHD

The second type of ADHD recognized in the DSM-5 is inattentive ADHD (ADHD I). Like with hyperactive-impulsive ADHD, individuals must have experienced inattention symptoms for at least six months, and several of these symptoms must have been noticed before age 12. Additionally, the symptoms must be present in more than one area of life, and they must reduce the quality of life in school, work, relationships, etc.

To be diagnosed with predominantly inattentive type ADHD, children 16 and younger must present six or more symptoms, and those 17 and older must present five inattentive symptoms.

  • Unable to pay close attention or making careless mistakes

  • Difficulty focusing on tasks or playful activities

  • Not listening (or seeming not to listen) when spoken to

  • Difficulty following through on instructions/completing tasks

  • Trouble organizing tasks

  • Avoiding tasks that require extended periods of concentrated thinking

  • Frequently losing items

  • Easily distracted

  • Forgetful while completing everyday activities 

3. Combined type ADHD 

As mentioned above, those with ADHD combined type (ADHD-C) have inattention and hyperactivity-impulsivity symptoms. If individuals have been diagnosed with both ADHD types, they are considered part of the ADHD-combined type group.

iStock/Rawpixel

Managing ADHD symptoms

No matter a person’s age, living with the hyperactive impulsive symptoms of ADHD-C can be challenging. Inattentive and combined types of ADHD may make it difficult to remain appropriately calm, be patient in situations, listen to others, and focus on tasks at hand.

Before you begin treatment or seek treatment for a loved one, it’s important to understand that ADHD-C is not the individual’s fault, nor are the symptoms of the condition. You should also recognize that while treatment may not dissolve symptoms, it can help those impacted by ADHD-C live with their symptoms and lead a happy and fulfilling life.

Treatment for ADHD-C, like treatment for other presentations of the disorder, might focus on various goals, including:

  • Reducing ADHD-C symptoms

  • Improving overall life functioning

  • Highlighting achievements and strengths

  • Increasing self-esteem

  • Navigating interpersonal relationships

  • If applicable, addressing co-occurring conditions (depression, anxiety, etc.)

Treatment of adults and children with ADHD can differ in some ways, but they do contain similar routes. Medication, therapy, and peer or social support options are often helpful for those who live with ADHD. For children who live with ADHD, part of the treatment program may involve education and training for parents.

According to the CDC and other expert sources, roughly 70-80% of those who live with ADHD benefit from medication. That said, behavioral therapy is suggested first for those under six years of age. Please consult with your prescribing doctor or primary care physician before considering any medication options.

The process of finding the right treatment plan, including the correct mix of therapy and medication, can take time. Here are some things you can do to support yourself or your child as you look for what works best for you:

Find people who understand

There are support groups for those who live with ADHD as well as support groups for those who have children living with ADHD. Even if those in these groups don’t have symptoms of both subtypes of ADHD, they can still offer support and understanding.

Ask for help from a loved one

When you have a to-do list and feel overwhelmed, are having a tough time initiating a task, or something else, don’t be afraid to ask for support. Oftentimes, having someone to accompany you while you work on a task can prove helpful. This is an action known as body doubling.

Double your time

Time management can be challenging for many people who live with ADHD-C. Some helpful steps include planning to leave early and setting alarms or other reminders accordingly. There are also a variety of time management apps specifically geared towards neurodivergent individuals.

Use technology to your advantage

If you have a smartphone, built-in apps may allow you to keep email tasks in one place, set phone reminders, and so on. You can also look for apps to help with making grocery lists, organizing doctors’ appointments, and storing passwords or other information that you don’t want to lose. There are apps made specifically for those who live with ADHD that you may wish to try.

Let yourself say “no”

Due to challenges related to time management, some people living with ADHD-C may unintentionally overbook themselves. By saying “no” to things that do not serve you, you free up your time for things that are actual priorities to you, and can provide yourself cushioning between tasks that can reduce stress. Practice taking a step back and thinking about your true threshold before you take something on. You might even practice saying something like, “Is it okay if I check my work schedule and let you know later on?” Be kind to yourself if you do forget or take too much on, as developing this habit can take time and is not always a linear process.

Find a therapeutic match

Many people living with ADHD benefit from therapy. When looking for a therapist, remember that not every therapist specializes in working with the same population, condition, or treatment. For example, someone experienced in adolescent psychiatry may be a good fit for a teen, and a therapist who specializes in adult ADHD may be better able to help adults find tools and systems that work for them as well as healthy ways to cope or self-soothe. 

Embrace curiosity and self-compassion over judgment

Sometimes, it takes trial and error to find what works. We’re all different, and it can be tempting to judge or shame ourselves when what works for someone else does not work for us. If it’s a child we’re caring for, we may get worried or even frustrated when a particular strategy falls through. However, when something doesn’t work, it is simply a chance to gain information and better understand how the individual functions. Stay curious, use creativity, and don’t be afraid to try something new when you need to.

Getty/AnnaStills
Learn to cope with combined ADHD

Get support for combined-type ADHD

Living with ADHD-C may mean it’s difficult to remember appointments, listen to those who are talking, and commit to showing up to a therapy session (or struggling to sit through one). Those symptoms, and others, may mean attending an in-person therapy appointment can be difficult or unappealing. 

Online therapy allows you to attend appointments from anywhere you have a stable internet connection, which means it may be easier to fit therapy into your life. Additionally, when you enroll in an online therapy platform, you’ll usually be able to communicate with your therapist through messages as well, not just during your scheduled video or phone session.

A review of studies that looked at online treatment for ADHD suggests that online interventions can help improve individuals’ social functions. One of these studies examined the role of online cognitive behavioral therapy (CBT) in treating adult ADHD and found that this form of therapy is likely effective.

Takeaway

Individuals living with ADHD-C experience both hyperactive-impulsive and inattentive forms of ADHD. While ADHD-C can be challenging to live with, individuals can learn to manage their symptoms in a way that lets them live a healthy and fulfilling life. Know that you do not have to attempt to manage your diagnosis or symptoms alone. Whether you're living with combined ADHD, coping with symptoms from another type of ADHD, or striving to support a loved one with an ADHD diagnosis, mental health professionals such as licensed online therapists are available to assist you.
Gain a better understanding of ADHD
The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
Get the support you need from one of our therapistsGet started