ADHD-C: Understanding Combined ADHD

ADHD-C, also known as combined 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 ADHD?

ADHD is a neurodevelopmental disorder that affects both development and functioning. Though it’s tough to get an exact number due to underdiagnosis in some demographic groups and other potential factors such as misdiagnosis, about 9.4% of children in the United States have been diagnosed with ADHD at some point in their life. 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. ADHD also affects adults and can be diagnosed in adulthood.

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 usually be broken down into one of the following subtypes.

The Three Types Of ADHD

Hyperactive-Impulsive 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, Hyperactive-Impulsive ADHD (ADHD-HI).

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

1. Fidgets (i.e., whole body, hands, feet), squirms in seat, or taps
2. Runs or climbs on things in situations when doing so is inappropriate
3. Often leaves seats in situations in which one is expected to stay seated
4. Has trouble playing with toys or taking part in activities quietly
5. Seems to be driven by a motor or constantly on the go
6. Often interrupts or intrudes on others
7. Has trouble waiting for their turn
8. Talks excessively
9. Blurts out answers

On top of the above 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 must also be present in more than one setting such as at home, school, during extracurricular activities, or at work.
• The symptoms experienced because of ADHD must reduce the quality of life in school, at home, or socially.

Inattentive ADHD

The second type of ADHD recognized in the DSM-5 is inattentive ADHD (ADHD-IA). Like with hyperactive-impulsive ADHD, individuals must have experienced 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, children 16 and younger must present six of the following symptoms, and those 17 and older must present five symptoms.

• Unable to pay close attention or making mistakes that may seem “careless” to others
• 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

Combined ADHD

As mentioned above, those with combined ADHD (aka ADHD-C) have symptoms of both hyperactive-impulsive and attentive ADHD. If individuals have been diagnosed with both types of ADHD, they are said to have combined ADHD.

Managing ADHD-C

No matter a person’s age, living with ADHD-C can be challenging. This type of ADHD may make it difficult to remain appropriately calm, be patient in situations, listen to others, and focus on tasks at hand. While some of the management techniques applied to ADHD-IA and ADHD-HI, the unique aspects of ADHD-C mean specialized management protocols may be the most successful.

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 a happy and fulfilling life.

ADHD-C Treatment

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

• Reducing ADHD-C symptoms.
• Improving overall life functioning.
• Highlighting achievements and strengths.
• If applicable, addressing co-occurring conditions (depression, etc.).

Many people with ADHD also benefit from and focus on goals such as increasing self-esteem or navigating interpersonal relationships. Treatment of adults and children 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 often involves 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 in symptom management:

• 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 sit or stand with you while you work on a task can prove helpful—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.
• 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.” By saying “no” to things that do not serve you, you free up your time for things that are actual priorities. However, due to challenges related to time management, people living with ADHD-C may unintentionally overbook themselves. 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 this can take time and is not a linear process for most.
• 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. A therapist that specializes in ADHD may be better able to help you find tools and systems that work for you as well as healthy ways to cope or self-soothe.
• Use 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. Stay curious, use creativity, and don’t be afraid to try something new when you need to

Get Support

Living with ADHD-C may mean it’s difficult to remember appointments, listen to those that are talking, and commit to showing up to a focusing therapy session. 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, where you enroll in online therapy with BetterHelp, you’ll be able to communicate with your therapist through multiple means, not just during one focused session.

A review of studies that looked at online treatment for ADHD found 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 adults with ADHD. Results showed that this form of therapy may be a promising form of treatment for those with ADHD.

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 how to live a healthy and fulfilling life.