Attention deficit hyperactivity disorder (ADHD) is divided into two categories: inattention and hyperactivity-impulsivity. Some people can experience symptoms of both types, which is known as combined type ADHD.

ADHD tends to show up as predominantly inattentive or predominantly hyperactive-impulsive. When someone has six or more symptoms of each type, they have combined type ADHD.

  • lacking attention to detail
  • making careless mistakes
  • trouble holding attention
  • not following through on instructions
  • difficulty finishing tasks
  • trouble organizing tasks and activities
  • avoiding tasks that require mental effort over a long period of time
  • losing important items
  • being easily distracted
  • being forgetful

Common symptoms of hyperactivity and impulsivity include:

  • fidgeting, tapping, or squirming
  • being unable to remain seated for long periods
  • talking nonstop
  • blurting out answers
  • interrupting or jumping into other people’s conversations
  • having difficulty waiting your turn
  • being constantly “on the go,” acting as if “driven by a motor”
  • being unable to participate in leisure activities
  • feeling restless

Also, to diagnose ADHD, a person must have:

  • several inattentive or hyperactive-impulsive symptoms present before the age of 12 years
  • symptoms present in two or more settings (such as at home, school or work; with friends or relatives; in other activities)
  • symptoms that interfere with or reduce the quality of social, school, or work functioning
  • symptoms that are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder)

The risk factors for combined type ADHD are the same as for other types.

Inherited genes

One 2020 study estimates that the heritability of ADHD is as high as 80%. Variants of specific genes may play a role.

Environmental factors

Exposure to toxins such as lead and pesticides may increase a child’s risk for ADHD, but more research is needed.

Brain injury

A small number of children who experience a traumatic brain injury may develop ADHD.

Substance use during pregnancy

Smoking while pregnant may increase a child’s risk for developing ADHD. Drinking alcohol during pregnancy can also increase a child’s risk, but research is mixed.

Low birth weight or premature delivery

According to a 2023 study, babies born before their due date are more likely to have ADHD.

No single test can diagnose ADHD.

The method to diagnose ADHD is the same for all types, though the criteria for the combined type ADHD are slightly different. For combined type ADHD, a doctor will look for six or more symptoms from both inattentiveness and hyperactivity or impulsiveness types.

First, the doctor will conduct a thorough medical examination to rule out other conditions. Then, they’ll watch for symptoms associated with the subtypes of ADHD.

The person being assessed will also take several ADHD rating scales. The doctor will use these to help make an evaluation or diagnosis. These scales don’t give a definitive answer, but they can help the person and the doctor see the bigger picture. The surveys will ask about behavior at school, home, or other settings.

Medication

ADHD medications may help improve symptoms of inattention, hyperactivity, or impulsivity and improve physical coordination.

Doctors usually prescribe stimulants. These help ease the behavioral signs of ADHD and make focusing on everyday tasks easier. They increase brain chemicals that play a part in thinking and attention.

Stimulants are safe when taken as directed. In some cases, they may cause unintended side effects. Some conditions can interfere with stimulants, such as diabetes, anxiety, and depression.

Talk with a doctor if the person taking them experiences side effects from stimulants such as:

  • lack of appetite
  • anxiety or jitteriness
  • headaches
  • weight loss
  • trouble sleeping
  • shortness of breath
  • palpitations
  • chest pain
  • arrythmia

The doctor may also prescribe nonstimulants. In some cases, antidepressants may also be prescribed for symptoms of ADHD. But the Food and Drug Administration (FDA) hasn’t approved antidepressants as a treatment.

Therapy

Combined with medication, therapy is effective for treating ADHD. It can help a person with ADHD better manage:

  • daily challenges
  • gain confidence
  • impulsive or harmful behaviors

Therapy can be especially beneficial for someone managing other conditions, such as anxiety or depression.

There are a few different types of therapy for ADHD:

Behavioral therapy

The goal of this treatment is to help change behavior by strengthening good behaviors.

Behavior therapy may include parent training, class management, peer interventions, organization training, or a combination of these therapies.

Cognitive behavioral therapy (CBT)

CBT teaches coping strategies to modify unwanted behavior and help with mood and anxiety symptoms.

It can help someone reframe negative thoughts and work on organizational and time management skills, which can help them complete daily tasks.

Family therapy

ADHD can also affect relationships with parents and family members, especially before someone is diagnosed.

Family therapy can help everyone learn how to cope with and manage a family member’s symptoms of ADHD. It can also help with communication and family bonding.

For children

Children with ADHD need to have structural support. Organization and consistency can help a child manage their symptoms. Together, you and your child can:

  • develop a routine and schedule
  • plan for changes in the schedule as far in advance as possible
  • create an organization system so that everything has a place
  • be consistent with rules
  • recognize and reward good behavior

If your child has ADHD, you can also encourage good behavior by:

  • minimizing distractions when they’re completing a task
  • limiting choices when your child needs to choose
  • helping them build a healthy lifestyle
  • creating positive experiences through activities your child enjoys and does well

For adults

Adults can work with a therapist or counselor to learn organization or life management tools. These include:

  • developing and maintaining a routine
  • getting used to creating and using lists
  • using reminders
  • breaking down large tasks or projects into smaller steps

Combined type ADHD is when a person displays symptoms of inattentiveness as well as symptoms of hyperactivity and impulsivity.

Risk factors, treatment, and management are largely the same when compared to inattentive and hyperactive impulsive ADHD types. The difference is in the diagnosis, as individuals must display six or more symptoms from both categories.