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As an ADHD coach, I get a lot of questions, both on and off the clock. Usually, I’m exited to answer questions about it (perhaps unreasonably so, but hey, it’s one of my special interests. Kind of meta, no? 🤣) One of the few questions about ADHD that make me cringe, though, is “How many types of ADHD are there?”
Part of the issue is personal; when I was diagnosed in 2019, the psychologist who assessed me was absolutely amazing and validating, and I couldn’t have asked for a better experience - except that he told me there were 9 different types of ADHD, which is pretty outdated, and is a great example of how so many physicians - even really great ones - are often wildly out of date, underinformed, or both.
Aside from that, though, the question assumes that ADHD can be tucked into neat, clear little boxes - and if you ask anyone who has actually lived with ADHD, they will assure you this is not the case.
So, in this blog I’ll give you the facts - what the current categorization system says regarding types of ADHD. And then I’ll hop back on my soap box, for those of you who care what I have to say. (Hi, mom.)
How many types of ADHD are there?
According to the most trustworthy sources I could find, including the American Psychiatric Association (APA), The National Institute of Mental Health (NIH), and The Attention Deficit Disorder Association (ADDA), there are three types of ADHD, aptly named for the type of symptoms that the person experiences:
- The Hyperactive/impulsive type: To be diagnosed with this type, you must exhibit at least five of these nine symptoms:
- (Hyperactivity) Fidgeting with hands and feet, being unable to sit still
- (Hyperactivity) Leaving their seat unexpectedly, for example, during meetings
- (Hyperactivity) Often feeling restless
- (Hyperactivity) Unable to take part in leisure activities quietly
- (Hyperactivity) Perceived as restless, hard to keep up with, or “always on the go”
- (Hyperactivity) Tendency to talk excessively
- (Impulsivity) Blurting out answers before a question or sentence is complete
- (Impulsivity) Difficulty waiting their turn
- (Impulsivity) Interrupting or intruding on what other people are doing
- The Inattentive type: To be diagnosed with this type, you must exhibit at least five of these nine symptoms, indicating attention dysregulation:
- Losing or misplacing important items
- Often distracted by unrelated thoughts
- Often forgetting to complete daily activities
- Short attention span and difficulty remaining focused
- Poor listening skills and inability to pay attention when spoken to directly
- Unable to finish tasks or follow instructions
- Avoiding work that requires sustained attention and mental focus
- Unable to pay close attention to details, resulting in careless mistakes
- Difficulty organizing tasks, time, or workspace
- The Combined type: If you have at least five symptoms from the inattentive-type list, AND at least five from the hyperactive/impulsive list, you meet criteria for the combined type of ADHD.
What makes the three types of ADHD problematic?
I’m so glad you asked. These are the problems I see with the type system in ADHD diagnoses, based on my own lived experience, my research, and practical experience working with clients:
- Too much overlap: The criteria are all about observable symptoms, but symptoms don’t exist in nice, separate categories. For example, no one is just hyperactive or just inattentive. We all have a mix of these traits. But which ADHD ‘type’ you fall into is just a matter of how many symptoms you experience in each category—and that may shift depending on the day, situation, our energy levels, age, hormone levels…and much more.
- Treatment doesn’t change: The underlying cause(s) of ADHD, to the best of our knowledge, are the same no matter which ‘type’ you have: low levels of dopamine, differences in brain structure, and differences in brain activity, all of which impact executive functioning. That means no matter your “type” of ADHD, the best course of action is going to be some blend of medication, lifestyle changes, therapy, and ADHD coaching. So, in the grand scheme, does it really matter what "type" you have?
- Nuance: There is a certain level of nuance that the diagnostic system just doesn’t capture. Take something like difficulty completing tasks—how do we know if it’s due to inattention or hyperactivity? It could be either, both, or neither, but the diagnostic criteria are rigid.
- Gender and culture differences: On top of that, gender and cultural biases sneak into the equation. ADHD symptoms often present differently in women, for example, or in people from different cultural backgrounds. This means a lot of people, especially women, LGBTQ+ folks, and people of color are too often misdiagnosed, or undiagnosed, for much too long.
- Societal norms: To make matters more complicated, the idea of what counts as a "symptom" is tied to social expectations. A lot of ADHD traits—impulsivity, restlessness, distraction—are seen as problems because they go against socially accepted behaviors. But are they truly problems, or are we just not fitting into the mold society wants us to fit into?
BIG asterisk here - I am not by any means arguing that ADHD doesn’t exist. There is clearly a difference in how ADHD brains and neurotypical brains function. I’m simply arguing that trying to categorize ADHD into types, versus a spectrum, is the same problem we have with dividing gender in binary terms. It completely fails to accurately capture the diversity of human experience.
The takeaway on ADHD types
At the end of the day, understanding the three main "types" of ADHD may be helpful for some as a starting point for self-discovery. However, they’re far from the full picture. ADHD is a spectrum, and everyone experiences it in their own unique way. The labels we use—whether inattentive, hyperactive/impulsive, or combined—are just broad categories that can’t capture the complexity of living with ADHD.
The most important thing? Finding the right combination of tools and support to manage your symptoms - whether that’s through medication, therapy, ADHD coaching, lifestyle modification, or a combination of all four. It’s not about fitting into a type; it’s about finding what works for you.
