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.

ADHD is a neurodevelopmental disorder that affects both development and functioning. Though it’s tough to get an exact number due to lack of diagnosis 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.

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, in family relationships, in extracurricular activities, or at work.
• The symptoms experienced because of ADHD must reduce the quality of life in school, at home, or socially.

People with this type of ADHD experience symptoms of hyperactivity and impulsivity. This was the case with seven-year-old Amber, explored below.

Hyperactive ADHD: A Closer Look

Although Amber was diagnosed with primarily hyperactive ADHD at age 7, it was once thought that she lived with ADHD-C. However, as she aged, her inattentive symptoms diminished and her hyperactive symptoms continued.

In the classroom, she frequently got in trouble with her teacher for leaving her seat during lesson time, blurting out answers, and talking with other students. Multiple times per week, she came home with a “frowny face’” on her behavior report. Listening to the teacher talk and completing homework was difficult because she was so easily distracted. At home, her impulsivity led her to do things that were potentially dangerous, such as playing in the street. She was always on the go and always into things.

After getting an official diagnosis, Amber was able to see a therapist who was able to offer behavioral therapy sessions. This helps to reduce her symptoms, allowing her to function better at school and at home.

Inattentive ADHD

Because studies have found that ADHD often runs in families, it is not surprising that Amber’s twin sister, Amy, was also diagnosed with Attention Deficit Hyperactivity Disorder. Her symptoms, however, were very different from Amber’s.

Unlike Amber, Amy was diagnosed later (at age 11). Since the average age of diagnosis is 7, Amy is the exception and not the rule. Why did it take so long to diagnose Amy? Her symptoms did not look like “traditional ADHD.” As the signs of the disorder mostly deal with not being able to pay attention, those diagnosed with inattentive ADHD must exhibit at least six of the following:

• Unable to pay close attention or making mistakes that may seem “careless” to others.
• Difficulty focusing on tasks.
• Not listening (or seeming not to listen) when spoken to.
• Having trouble with organization or managing time.
• Avoiding tasks that require extended periods of thinking.
• Frequently losing items.
• Being easily distracted.
• Memory issues, specifically forgetting to do daily tasks.

Similar to the first type of ADHD, someone over the age of seventeen who exhibits at least five of the symptoms above can be diagnosed with Inattentive ADHD.

Inattentive ADHD: A Closer Look

As siblings, Amy and Amber spent a good deal of class time together. While Amber tended to be chatty, Amy frequently stared aimlessly out the window. She did not do well in class, though not in the same way as Amber; even if quietly, she had difficulty paying attention. She also had trouble keeping up with her books and supplies, staying organized, and completing her homework. It seemed like every other day, Amy was losing her papers or forgetting to bring her folder to class.

Although she was very intelligent, she had a tough time making grades. In most of her classes, she had C’s and D’s. Because she wasn’t failing her classes, Amy flew under the radar. Still, life was hard for her in general. Because Amber required so much individual attention, Amy’s symptoms were often overlooked, both at home and in school.

It was only when she broke down to her school counselor about feelings of depression related to what Amy was going through in class that someone recognized her symptoms. Two months later, a doctor diagnosed her with ADHD. Her parents and teacher were surprised because they did not know there was more than one presentation of ADHD, and as a result, they had never suspected that Amy also had the disorder. Amy also experienced benefits from ADHD treatments like therapy.

ADHD-C

ADHD with primarily hyperactive/impulsive symptoms can be challenging to manage, and so can primarily inattentive ADHD. Having a combined presentation (ADHD-C) can also having a significant impact on one’s life if not properly treated and managed. To be diagnosed with this presentation of ADHD, a child or adult must exhibit hyperactivity and inattentive symptoms. It is common for children and adults with any type or presentation of ADHD to experience difficulty regulating emotions, and although symptoms of any subtype of ADHD may be categorized as mild, moderate, or severe, they can still affect a person’s life and emotional wellbeing. The good news is that addressing symptoms can help.

Understanding ADHD-C and what treatments help might be the first step toward a more fulfilling life that’s easier to manage. ADHD is not your fault, nor are the symptoms of the condition, and you can absolutely live a happy and fulfilling life with ADHD. In fact, ADHD is not “bad,” and just means that you function differently. Many people with ADHD-C go on to craft amazing paths for themselves, even after diagnosis. People with ADHD frequently have tremendous strengths in addition to any challenges they may face, and the right care can help you or your child utilize those strengths with confidence.

ADHD-C Treatment

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

• 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 be different 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 treatment is often 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.
• 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, even if it is simply in the form of asking someone to sit or stand with you while you work on a task. Some people call this body doubling, and it can be helpful for those who live with ADHD.

• Double your time. Time management is tough for many people who live with ADHD. You may plan to leave early and set alarms or other reminders accordingly. This can be advantageous for parts of life such as medical appointments and social opportunities.
• 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, organize doctors’ appointments, and store 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.” You can’t do it all! 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 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, regardless of presentation or type, benefit notably from therapy. Not every therapist specializes in working with the same population, condition, or treatment. Finding a therapist who specializes in ADHD can be a game-changer when it comes to finding a provider who understands what you’re going through and can offer guidance tailored to what works best for you. A therapist can help you find tools and systems that work for you as well as healthy ways to cope or self-soothe if and when needed.
• Use curiosity and 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

Again, a therapeutic match is very important for many people who live with ADHD and other conditions. ADHD can pair with additional concerns, whether that is a co-occurring diagnosis, or a direct complication related to symptoms. The good news is that the support of a caring, knowledgeable mental health professional can help.

You can look for a specialist who offers in-person care near you, or you can get quality care online from a licensed, independent therapist or counselor through a platform like BetterHelp. The mental health professionals who offer services through BetterHelp all have assorted areas of knowledge and experience, including with ADHD, making it faster and easier to find the right fit.

Whether you’re an adult with ADHD, the parent or guardian of a child who has ADHD, or if you’re seeking care for another concern that affects your life, an online therapist may be able to support you.