Identifying And Explaining 7 Types Of ADHD
Attention deficit hyperactivity disorder (ADD/ADHD) is a mental health condition that can cover a wide array of symptoms and behaviors. Read on to learn more about how to identify the seven types of ADD proposed by Dr. Daniel Amen, a nationally recognized psychiatrist and clinical neurologist, and gain a general understanding of each type.
What is ADHD?
According to the Centers for Disease Control, ADHD is one of the most common neurodevelopmental disorders seen during childhood. Studies show that individuals with ADHD may have reduced blood flow in certain areas of the brain responsible for emotional control, impulse control, and attention.
The disorder is frequently diagnosed during childhood and often persists into adulthood. The exact cause and risk factors for developing ADHD are unknown, but research shows that the following elements may play a role:
- Genetics (the leading contributor, according to modern research)
- Maternal alcohol, substance, or tobacco use during pregnancy
- Exposure to environmental risks like heavy metals during pregnancy or childhood
- Premature birth and low birth weight
- Brain injury
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
ADHD vs. ADD: Why terminology evolves past outdated terms
According to the Child Mind Institute, the mental health industry has stopped using attention deficit disorder (ADD) as a diagnosis. Instead, the diagnosis is simply ADHD; some children with this disorder experience hyperactivity while others do not.
“The bottom line is that the diagnosis of ADHD can still apply even if a child doesn’t have hyperactive or impulsive behaviors. That can be confusing for parents. It’s especially crucial that kids with prominent inattentive symptoms of ADHD are still evaluated by a trained clinician, as these children could be more likely to be overlooked at school.” —Dave Anderson, Ph.D., Child Mind Institute
Typical core ADHD symptoms and characteristics include:
- Difficulty concentrating or short attention span
- Trouble controlling impulsive behaviors
- Hyperactivity
- Disorganization and problems with follow-through
- Symptoms may cause trouble at home, school, and with friends
- Careless mistakes
- Distractibility
- Unnecessary risks
- Difficulty taking turns
- Frequent squirming, fidgeting, or inability to be still
- Often forgets or loses things
- Challenges with resisting temptation
Exploring seven types of ADHD
1. Classic
This is the most common type of ADHD. According to Dr. Amen, classic ADD symptoms in children include colicky, active, wiggly babies and restless, talkative, impulsive children. Hyperactive, conflict-driven behavior often demands attention. Parents may feel exhausted and overwhelmed by their child’s nonstop, difficult-to-control behaviors.
Dr. Amen uses brain scans to study the disorder, and his research shows that classic ADHD often involves decreased activity in parts of the prefrontal cortex, basal ganglia, and cerebellum. Abnormalities in these brain structures affect the brain’s production of dopamine, a neurotransmitter related to attention, motivation, and the body’s idle speed.
Symptoms of classic ADD may include:
- Trouble listening when others talk
- Boundless energy, as though powered by a motor
- Constant movement and preference for physical activity
- Tendency to be noisy
- Excessive talking
- Frequent interruptions
- Chronic low level sadness that is not depression
2. Inattentive
Inattentive ADHD is the second most common type, according to Dr. Amen’s research. People with this kind of ADHD tend to have quieter, more introverted personalities and may frequently daydream, leading them to be labeled unmotivated, slow, or lazy. Because there are fewer behavioral problems with this type of ADHD, it is often missed. Brain scans show the same decreased activity as classic ADHD.
In addition to many of the core symptoms and characteristics listed above, people with inattentive ADHD may experience:
- Trouble focusing
- No hyperactivity
- Difficulty paying attention when others talk
- Tendency to lose items and possessions
- Time management problems
- Poor attention to detail
- Frequent daydreaming and complaints of boredom
- Unmotivated, apathetic, or preoccupied appearance
- Sluggish or slow movements and persistent fatigue
3. Overfocused
Focus requires the ability to shift your attention to a new activity at will. However, for people with overfocused ADHD (also called over-focused ADD), this can prove to be a substantial challenge. Rather than being unable to pay attention, this type of ADHD involves becoming hyper-focused on a topic while tuning out everything around them. Brain scans show increased activity at rest and concentration in the anterior cingulate gyrus region of the brain, along with the previously mentioned decreased activity.
In addition to many of the core symptoms and characteristics listed above, people with overfocused ADHD may experience:
- Senseless or excessive worrying
- Tendency to get stuck in negative thought loops
- Oppositional or argumentative personality traits
- Compulsive behaviors
- Tendency to hold grudges
- Trouble shifting from one activity to another
- Likelihood of becoming upset if things aren’t done a certain way
- Likely to maintain their own opinion and ignore others
- May or may not include hyperactivity
4. Temporal lobe ADHD
Temporal lobe ADHD (also called temporal lobe ADD) involves the typical features of the disorder—and adds symptoms associated with issues in the brain’s temporal lobes, such as learning, memory, mood stability, aggression, temper, and in some cases, violence. Brain scans show decreased activity in the temporal lobe at rest and concentration and the reduced activity of classic ADHD.
In addition to many of the classic symptoms and characteristics listed above, people with temporal lobe ADHD may experience:
- Memory problems
- Auditory processing issues
- Mood instability, such as irritable behavior and quick temper
- Sensitivity or mild paranoia
- Periods of spaciness or confusion, panic, or fear for no reason
- Visual disturbances, such as seeing shadows
- Episodes of déjà vu
- Medical history involving head injury
- Headaches or abdominal pain with no apparent origin
- Dark thoughts
- Potential learning disabilities
- May or may not include hyperactivity
5. Limbic ADHD
Limbic ADHD (also referred to as limbic ADD) affects the region of the brain responsible for emotional control and the “fight or flight” response. Depression influences the same brain area. Dr. Amen’s research indicates that a brain scan study—which shows increased deep limbic activity in addition to classic ADHD patterns—can be used to differentiate between the two mental health conditions and determine the best treatment method.
In addition to many of the core symptoms and characteristics listed above, people with limbic ADHD may experience:
- Moodiness and frequent irritability
- Negative attitude
- Low energy levels
- Tendency toward social isolation
- Feelings of hopelessness and perceived helplessness
- Guilt
- Anhedonia or loss of interest and enjoyment in activities
- Sleep pattern changes
- Chronic low self-esteem
- May or may not include hyperactivity
6. Ring of fire ADHD
People with Ring of Fire ADHD (sometimes referred to as ring of fire ADD) typically show patterns of high activity in the entire brain and have trouble “shutting off” their minds, which can make thoughts and emotions overwhelming. Stimulant medications alone may make ring-of-fire ADD symptoms significantly worse. According to Dr. Amen, Ring of Fire ADHD can be related to infection, allergy, brain inflammation, or bipolar disorder. Brain scan study shows a “ring” of overactivity, though there is often variability between individuals.
In addition to many of the core symptoms and characteristics listed above, people with ring of fire ADD tend to experience:
- Unpredictable behavior
- Sensitive to touch, noise, light, or clothing
- Cyclic mood swings from high to low and back
- Rigid, inflexible thinking
- Oppositional defiance
- Periods of behavior that may include mean, nasty, or insensitive comments, increased talkativeness, or increased impulsivity
- Demanding things be their way
- Grandiose thinking
- Rapid speech and racing thoughts
- Anxious or fearful appearance
- Irritability
- May or may not include hyperactivity
7. Anxious ADHD
Anxious ADHD involves decreased activity in the prefrontal cortex with overactivity in the basal ganglia, which relates to anxiety and controls the body’s “idle speed,” according to Dr. Amen’s brain scan study. ADHD symptoms tend to be magnified by stress or anxiety, and treatments typically include both calming and stimulating the brain.
In addition to many of the core symptoms and characteristics listed above, people with anxious ADHD may experience:
- Frequent anxiety or nervousness
- Physical stress symptoms like headaches
- Tendency to freeze in social situations
- Dislike speaking in public, often with extreme nervousness
- Predicts the worst will happen
- Active avoidance of conflict
- Fear of being judged
How therapy can help manage symptoms
There are many effective treatments for ADHD. Therapy and medications are the most effective treatment options for managing ADHD symptoms. In addition to therapy and medication, certain lifestyle changes, like exercising regularly and getting enough good quality sleep, are proven to help manage ADHD symptoms.
Internet-based therapy has been an excellent solution for many people’s mental health needs. Online therapy platforms like BetterHelp, while not working with children, can help you adjust your parenting style and develop healthy coping skills to manage stress. A licensed therapist can also help you understand the mechanics of ADHD and how it’s likely to affect your child.
Recent research indicates that online parenting interventions like therapy can be an effective addition to an ADHD treatment plan. Teletherapy also typically has substantially lower costs and shortened wait times. Additionally, virtual therapy providers may offer flexible appointment formats, so it’s easier to fit treatment into your busy schedule.
Takeaway
After receiving an ADHD diagnosis, your family will likely go through a period of adjustment, and it can be helpful to use this time to educate yourself about the condition. The information included in this article may offer some insight into the seven distinct types of ADHD and how they may affect your child.
Read more below for answers to questions commonly asked about the types of ADHD.
Are there seven types of attention deficit hyperactivity disorder?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, lists only three subtypes of ADHD: predominantly hyperactive, predominantly inattentive, and combined. However, some experts have proposed other categories to classify ADHD/ADD symptoms. While these categories are not diagnostically relevant, they may help a person better conceptualize their experience. According to Dr. Amen, his seven types listed above may make it easier to decide on treatment directions, but significantly more empirical evidence is required to support his assertion.
What is the “Ring of Fire” type?
Ring of Fire ADHD is one of seven theoretical subtypes of ADHD conceptualized by Dr. Daniel Amen, a psychiatrist and brain imaging specialist. Ring ADHD is characterized by sensitivity to noise, light, and touch, periods of mean behavior, negative thought patterns, unpredictable behavior, and anxiety. It earned its name because of Dr. Amen’s research on brain images. He identified a ring of hyperactivity around the cerebral cortex, indicating an overabundance of activity in several brain areas. Dr. Amen theorizes that overstimulation significantly contributes to the symptoms of ADD.
What is the rarest type?
Evidence suggests that the hyperactive subtype of ADHD is the rarest. The majority of those diagnosed with ADHD are diagnosed with either the inattentive or combined subtypes. Those with combined ADHD have symptoms of both hyperactivity and inattention. Those with the purely hyperactive subtype have only symptoms of hyperactivity and problems with impulse control but no symptoms of inattention. One study found that only 3% of patients who were diagnosed with ADHD received a diagnosis of the hyperactive subtype.
Is attention deficit hyperactivity disorder a part of Autism?
ADHD and autism spectrum disorder (ASD) are not the same condition, but they often overlap. There may be some confusion due to the high comorbidity of the two conditions. They often present together, with one study asserting that 50% to 70% of individuals on the autism spectrum also qualify for a diagnosis of ADHD. People with the dual diagnosis of ASD and ADHD display symptoms of both conditions. Because so many people on the spectrum have ADHD, observers likely attribute symptoms of one condition to the other. Classic ADD and ADHD lack the symptoms common in those on the autism spectrum.
Are ADHD brains normal?
Research indicates that ADHD is associated with changes in brain structure and chemistry. The prefrontal cortex, the area of the brain associated with self-control and executive function, is smaller in children diagnosed with ADHD. Other areas of the brain, like the amygdala and hippocampus, also appear smaller and may take longer to mature. Modern brain scanning techniques, like functional MRIs, have also indicated that blood flow may be reduced in certain areas of the cerebral cortex, the topmost part of the brain responsible for higher-order functions. Decreased blood flow may make symptoms worse.
Neurochemicals also play a role, primarily dopamine. Evidence suggests that a dopamine deficiency may contribute to ADD symptoms. While dopamine is used in almost every system of the brain, two are especially relevant to ADHD: the dopamine reward pathway and the mesocortical pathway.
The dopamine reward pathway releases dopamine when a person does something pleasurable, producing a pleasant feeling that makes it more likely the person will repeat the behavior. The mesocortical pathway helps the prefrontal cortex with executive function tasks like planning, inhibition, and decision-making. Evidence suggests that both pathways are distorted in children with ADHD.
What causes attention deficit hyperactivity disorder?
The underlying causes of ADHD are still not fully understood, but research has revealed some important clues about its origins. The risk factors for ADHD include both genetic and environmental sources. Researchers know that ADHD is hereditary; a parent with ADHD is more likely to have a child with ADHD than a parent without the condition. Scientists have discovered specific genes common in people with ADHD, and it may one day be possible to diagnose the disorder through genetic tests.
Environmental factors also play a role. ADHD is much more common in children growing up in poverty. Risk is also increased if a child experiences adverse experiences, trauma, or an unstable home. There are also some chemical toxins, like lead and organophosphate pesticides, that are linked to ADHD. Finally, ADHD is found at higher rates in children born to mothers who smoked, drank, or experienced excessive stress during pregnancy.
What does mild ADHD look like?
Mild ADHD likely appears similar to ADHD but has a lower impact on a person’s daily life. A person with mild ADHD may have a higher level of function than someone whose symptoms are more severe. In some cases, ADHD symptoms may be “sub-clinical,” meaning there is some evidence of hyperactivity, impulsivity, or inattention, but the symptoms do not rise to a level that significantly interferes with a person’s life. Mild ADHD may also refer to anxious ADD, a theoretical subtype of ADD that is not well-supported by research.
The person may still have some difficulty shifting focus or doing other cognitive tasks. One of the goals of treating ADHD with medication and behavioral therapy is to give a person the pharmacological support and skills to lower their symptom threshold for as long as treatment continues.
How do I confirm if I have ADHD?
Confirming ADHD requires an in-depth evaluation by a mental health professional that often spans several sessions and lasts for hours. It is more complex than taking a test, filling out a survey, or completing a symptom checklist. If a psychologist or therapist does the evaluation, they may also refer you to a medical professional to rule out underlying medical causes that might contribute to possible ADHD symptoms.
At the start of the evaluation, the clinician will complete a detailed medical, psychological, and family history to get as much information as possible about your symptoms. They may use a structured clinical interview and will likely employ ADHD rating scales that can provide more information about certain domains of behavior related to ADHD.
The clinician may also order further testing, like cognitive assessments, achievement testing, computerized testing, and other tests of brain function to look for specific information or rule out other conditions. Once all the details are collated, the clinician analyzes it thoroughly and determines if a diagnosis of ADHD is appropriate. They will likely also provide treatment recommendations and referrals for medication, if necessary.
Who is at risk for ADHD?
Nearly everyone is at risk for ADHD, but the chances of developing the condition are highest for specific groups. Researchers have identified genetic components that are thought to contribute to the altered brain structure and chemistry present in ADHD. Genetic risks are also supported by ADHD’s heritability, meaning that a person with ADHD is more likely to have a child with ADHD than someone without the condition. Environmental risk factors also play a role, with research indicating that lead and pesticide exposure can contribute to altered brain development. Adverse experiences as a child, such as poverty, violence in the home, poor parental attachment, and housing instability, are all likely to increase the risk of ADHD.
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