Understanding ADHD Combined Type

Living with ADHD Combined Type can feel like a constant battle between focus and restlessness. This subtype of ADHD combines symptoms of inattention and hyperactivity-impulsivity, making it the most comprehensive and often the most challenging form to manage. 

From struggling to maintain focus and organization to dealing with excessive movement and impulsive actions, individuals with ADHD Combined Type face unique hurdles in their daily lives. Learn more about ADHD Combined Type, and call us today if you have any questions or are in need of support.

What Is ADHD Combined Type?

ADHD Combined Type is a subtype of Attention Deficit Hyperactivity Disorder that encompasses symptoms of both inattention and hyperactivity-impulsivity. This type is diagnosed when an individual exhibits six or more symptoms from each category, making it the most comprehensive form of ADHD.

Characteristics and Symptoms of ADHD Combined Type:

Inattention

Individuals with ADHD Combined Type often struggle with maintaining focus, staying organized, and completing tasks. Common symptoms include:

• Difficulty sustaining attention in tasks or play activities

• Frequent careless mistakes in schoolwork or other activities

• Trouble listening when spoken to directly

• Failure to follow through on instructions and complete tasks

• Avoidance of tasks requiring sustained mental effort

• Frequent loss of items necessary for tasks and activities

• Easy distraction by extraneous stimuli

• Forgetfulness in daily activities

Hyperactivity

Hyperactivity in ADHD Combined Type manifests as excessive movement and a constant sense of restlessness. Symptoms include:

• Fidgeting with hands or feet or squirming in seat

• Leaving seat in situations where remaining seated is expected

• Running or climbing in inappropriate situations

• Inability to play or engage in activities quietly

• Acting as if "driven by a motor," always on the go

• Excessive talking

Impulsivity

Impulsivity leads to hasty actions without considering the consequences. Individuals may exhibit:

• Blurting out answers before questions have been completed

• Difficulty waiting their turn

• Interrupting or intruding on others' conversations or games

ADHD Combined Type Vs. Other Types of ADHD

ADHD is generally classified into three types: Inattentive Type, Hyperactive-Impulsive Type, and Combined Type. While the Inattentive Type is marked primarily by symptoms of inattention without significant hyperactivity or impulsivity, the Hyperactive-Impulsive Type is characterized mainly by hyperactivity and impulsivity without significant inattention. 

ADHD Combined Type, on the other hand, includes a mix of symptoms from both categories, making it more complex and often more challenging to manage. This comprehensive symptom profile requires a multifaceted approach to treatment and support.

How ADHD Combined Type Is Diagnosed

Diagnosing ADHD Combined Type involves a thorough evaluation process to identify and differentiate it from other conditions accurately. Let’s explore how ADHD Combined Type is diagnosed, the role of healthcare professionals in this process, and its prevalence across different age groups, along with comorbidities that often accompany ADHD:

Criteria and Evaluation Process

The diagnosis of ADHD Combined Type is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed with this type, an individual must exhibit at least six symptoms of inattention and six symptoms of hyperactivity-impulsivity for at least six months, to a degree that is inconsistent with developmental level and that negatively impacts social, academic, or occupational activities.

The evaluation process includes:

• Comprehensive medical and psychological history

• Behavioral assessments and standardized rating scales

• Input from parents, teachers, and other caregivers

• Observations in multiple settings (e.g., home, school, work)

Role of Healthcare Professionals

Healthcare professionals, including pediatricians, psychiatrists, psychologists, and neurologists, play a crucial role in diagnosing ADHD Combined Type. They conduct detailed assessments to rule out other potential causes of the symptoms and ensure an accurate diagnosis. Their expertise helps in developing an effective treatment plan tailored to the individual's needs.

Common Comorbidities

Individuals with ADHD Combined Type frequently experience comorbid conditions, which can complicate diagnosis and treatment. Common comorbidities include:

• Anxiety: Many individuals with ADHD also suffer from anxiety disorders, which can exacerbate attention and hyperactivity symptoms.

• Depression: The challenges and frustrations associated with ADHD can lead to depression, particularly if the disorder is not adequately managed.

• Learning Disabilities: Difficulties with reading, writing, and math are common, requiring additional educational support.

• Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD): These behavioral disorders are more prevalent in children with ADHD, leading to further social and academic challenges.

Understanding the diagnosis and prevalence of ADHD Combined Type is essential for providing effective support and intervention strategies, helping individuals manage their symptoms and improve their quality of life.

Impact of ADHD Combined Type on Daily Life

Living with ADHD Combined Type can significantly impact various aspects of daily life. Individuals face numerous challenges that affect their academic performance, workplace productivity, social interactions, and relationships. However, with the right coping mechanisms and strategies, they can better manage these difficulties and lead fulfilling lives.

Challenges Faced by Individuals with ADHD Combined Type:

Academic Performance

Students with ADHD Combined Type often struggle in academic settings due to their symptoms of inattention, hyperactivity, and impulsivity. These challenges include:

• Difficulty focusing on lectures and assignments

• Frequent mistakes and incomplete tasks

• Trouble organizing and prioritizing work

• Poor time management leading to missed deadlines

• Increased likelihood of disruptive behavior in class

• Lower academic achievement compared to peers

Workplace Productivity

In the workplace, ADHD Combined Type can affect an individual's ability to perform effectively and efficiently. Common issues include:

• Inability to stay focused on tasks for extended periods

• Procrastination and difficulty starting or completing projects

• Forgetfulness and misplacing important items or documents

• Trouble following through on instructions and assignments

• Impulsivity leading to hasty and sometimes poor decision-making

• Strained relationships with colleagues and supervisors due to misunderstandings or erratic behavior

Social Interactions and Relationships

ADHD Combined Type can also impact social interactions and relationships, causing:

• Difficulty listening and paying attention during conversations

• Frequent interruptions and talking over others

• Impulsive actions that may be perceived as rude or inconsiderate

• Challenges in maintaining long-term friendships and romantic relationships

• Increased likelihood of conflicts and misunderstandings

• Feelings of social isolation and low self-esteem due to repeated negative experiences

Coping Mechanisms and Strategies

Despite these challenges, individuals with ADHD Combined Type can adopt various coping mechanisms and strategies to improve their daily lives:

• Organization Tools: Using planners, calendars, and apps to keep track of tasks, deadlines, and appointments.

• Break Tasks into Smaller Steps: Dividing large projects into manageable chunks to make them less overwhelming.

• Time Management Techniques: Setting timers, creating schedules, and prioritizing tasks to better manage time.

• Mindfulness and Relaxation: Practicing mindfulness, meditation, and relaxation techniques to reduce stress and improve focus.

• Exercise and Healthy Lifestyle: Engaging in regular physical activity and maintaining a balanced diet to boost energy and concentration.

• Professional Support: Seeking help from therapists, counselors, or coaches who specialize in ADHD to develop personalized strategies and provide guidance.

• Educational Accommodations: Utilizing support services such as tutoring, special education programs, and accommodations like extended time for tests.

• Workplace Adjustments: Discussing accommodations with employers, such as flexible schedules, quieter workspaces, or task delegation to better match strengths and weaknesses.

By understanding the impact of ADHD Combined Type on daily life and implementing effective coping mechanisms, individuals can better navigate their challenges and enhance their academic, professional, and social experiences.

ADHD Combined Type and Substance Abuse

Individuals with ADHD Combined Type are at a significantly higher risk for substance abuse compared to those without the disorder. The impulsivity, inattention, and hyperactivity associated with ADHD can lead to a greater propensity for experimenting with substances as a way to self-medicate or cope with their symptoms.

Link Between ADHD and Substance Abuse

Studies have shown a strong correlation between ADHD and substance abuse. The constant search for stimulation and the difficulty in managing impulses can drive individuals to use substances like alcohol, nicotine, and drugs to temporarily alleviate their symptoms or to feel more "normal."

Higher Risk for Addiction

The characteristics of ADHD Combined Type, such as poor impulse control, risk-taking behaviors, and difficulty with delayed gratification, contribute to an increased vulnerability to addiction. Additionally, the social and academic struggles that come with ADHD can lead to feelings of low self-esteem and frustration, making substance use an attractive escape.

Common Substances Abused

Individuals with ADHD Combined Type often abuse substances such as:

• Alcohol: Frequently used to manage social anxiety and impulsivity.

• Nicotine: Provides a short-term boost in concentration and alertness.

• Marijuana: Used to calm hyperactivity and reduce anxiety.

• Prescription Stimulants: Misused to enhance focus and productivity.

Impact of Substance Abuse on ADHD Symptoms

Substance abuse exacerbates ADHD symptoms, creating a vicious cycle. For example, alcohol can increase impulsivity and inattention, while drugs like marijuana can impair cognitive function and motivation. Conversely, untreated ADHD can lead to increased substance use as individuals attempt to self-medicate. This interplay highlights the need for integrated treatment approaches that address both ADHD and substance abuse simultaneously.

How to Treat ADHD Combined Type

Treating ADHD Combined Type effectively requires a comprehensive approach that combines medication and behavioral interventions. Here's how different treatments can help manage this challenging condition:

Medication

Stimulants: Commonly prescribed for both children and adults, stimulants like Adderall and Ritalin increase neurotransmitter levels to improve focus and reduce hyperactivity and impulsivity.

Non-Stimulants: Medications like Strattera and Qelbree are used when stimulants are ineffective or cause undesirable side effects. They work more slowly but have longer-lasting effects.

Combination Therapy: Some healthcare providers prescribe both stimulants and non-stimulants to maximize benefits and minimize side effects.

Behavioral Interventions

For Children: Behavioral counseling is the first line of therapy. Training for parents and caregivers is essential to manage symptoms without aggravating them.

For Adults: Cognitive Behavioral Therapy (CBT) helps adults develop coping strategies to manage irritation and anxiety, improve focus, and reduce negative behaviors.

Family-Based Therapies: These sessions address the impact of ADHD on family dynamics, offering support to both the individual with ADHD and their family members.

Lifestyle Changes and Self-Management

Organization Skills: Using planners, calendars, and reminder apps can help individuals stay organized and on track.

Social Skills Training: Programs to improve social interactions and relationship-building skills.

Healthy Habits: Encouraging regular exercise, a balanced diet, and good sleep hygiene to enhance overall well-being and cognitive function.

By integrating these treatments, individuals with ADHD Combined Type can manage their symptoms more effectively and improve their quality of life.

Struggling with ADHD Combined Type? We Can Help

Understanding ADHD Combined Type is essential for managing its challenges and improving daily life. A comprehensive approach to treatment — combining medication, behavioral therapy, and lifestyle changes — can significantly enhance well-being. 

If you or a loved one is dealing with ADHD and substance abuse, The Forge Recovery Center is here to provide the support and resources needed for recovery. Our team is dedicated to helping you overcome these challenges and achieve a healthier, more balanced life. Reach out to us today to start your journey towards recovery.

Written by

The Forge Recovery Center

Reviewed by

Jeremy Arzt

Chief Clinical Officer

September 20, 2024