ADHD Definitions

Types or Presentations

Attention-Deficit/Hyperactivity Disorder (ADHD) is classified into three primary presentations based on the DSM-5-TR diagnostic criteria. These presentations reflect how symptoms manifest rather than being distinct "types," as symptoms can change over time.

ADHD Defining

1. Predominantly INATTENTIVE Presentation

Difficulty sustaining attention on tasks
Trouble organizing tasks and activities
Frequently loses necessary items
Easily distracted by external stimuli
Often forgetful in daily activities
Avoids tasks requiring sustained mental effort

2. Predominantly HYPERACTIVE-IMPULSIVE Presentation

Fidgeting or tapping hands/feet
Difficulty remaining seated
Excessive talking
Blurting out answers before questions completed
Difficulty waiting turns
Often interrupts or intrudes on others

3. COMBINED Presentation

Meets criteria for both inattentive and hyperactive-impulsive symptoms
Most commonly diagnosed presentation
Symptoms from both categories are equally present

Key Considerations

Developmental Changes: Symptoms often present differently across ages:

Children: More obvious hyperactivity and impulsivity
Adolescents/Adults: Inattention often becomes more prominent, hyperactivity may internalize

Gender Differences:

Boys often show more externalizing symptoms (hyperactivity/impulsivity)
Girls frequently present with inattention and internalizing symptoms

Co-occurring Conditions: ADHD commonly occurs with anxiety, depression, learning disabilities, and other neurodevelopmental conditions

Why "Presentations" Not "Types"

The shift from "subtypes" to "presentations" in the DSM-5 recognizes that:

Symptoms can change throughout life
Individuals may move between presentation categories over time
Environmental factors and coping strategies affect symptom expression

Understanding these presentations helps create targeted support strategies that address each individual's unique pattern of strengths and challenges.

Non-DSM-5 ADHD Presentations - Dr. Daniel Amen’s Seven Types of ADHD

Amen describes seven ADHD patterns based on brain imaging and clinical observation, not DSM-5 criteria. He uses SPECT scans (analyzing blood flow) from over 200,000 scans to argue ADHD is a spectrum needing tailored treatments. However, SPECT is not standard or recommended for ADHD diagnosis by major medical bodies like the American Academy of Pediatrics.

Classic ADHD – Mirrors the DSM combined presentation with hyperactivity, impulsivity, and inattention.
Inattentive ADHD – Characterized mainly by distractibility, forgetfulness, and mental disorganization.
Over-Focused ADHD – Features inflexibility, difficulty shifting attention, and a tendency to fixate on negative thoughts or routines.
Temporal Lobe ADHD – Associated with memory and learning challenges, emotional volatility, and occasional irritability or aggression.
Limbic ADHD – Marked by low mood, decreased motivation, and emotional sensitivity, overlapping somewhat with depressive features.
Ring of Fire ADHD – Described as intense emotional reactivity, agitation, and hypersensitivity to environmental or sensory input.
Anxious ADHD – Defined by anxiety, tension, and physical symptoms of stress combined with typical ADHD features.

Sluggish Cognitive Tempo (SCT) / Cognitive Disengagement Syndrome (CDS)

This proposed condition describes individuals who show pervasive mental fogginess, frequent daydreaming, slow information processing, and reduced alertness. Some researchers view it as a distinct condition; others see it as a subtype or related presentation.

Why These Models Resonate Beyond Official Diagnoses

Reflect real experiences: These models describe symptom clusters that many individuals with ADHD report but that are not fully captured by DSM-5 criteria.
Grounded in observation: They emerged from extensive clinical practice and attempts to explain patterns seen in patients that standard classifications overlook.
Useful for personalized understanding: They help conceptualize ADHD as a spectrum with diverse neurological and behavioral expressions.
Supported by emerging research: Areas like emotional regulation, cognitive tempo, and anxiety-linked ADHD are increasingly being studied

Conclusion

ADHD is generally described through three core presentations—inattentive, hyperactive-impulsive, and combined—but it can look very different from person to person. Beyond these official categories, other frameworks suggest a wider range of patterns and emotional or cognitive styles. While not formally recognized, these perspectives capture real variations in how people experience and express ADHD, emphasizing that the condition exists on a broad, individualized spectrum.