Back to Basics II – Types of ADHD

There are three types of ADHD: Inattentive Type (ADHD-I), Hyperactive/Impulsive Type (ADHD-HI), and Combined Type (ADHD-C). Is it really as simple as this, though? Well, sort of. Let’s talk about it.

Pinnable image for this post, featuring a person running up a flight of stairs towards a light bulb.

The first thing to remember is that ADHD is diagnosed based on observed behaviours. The second thing to remember is that the division between the types is really kind of arbitrary. The third thing to remember is that which kind you’re diagnosed with has nothing to do with what treatments will or will not be helpful for you, because regardless of what type you have, it’s still all caused by a problem with your executive functioning.

ADHD-I Symptoms

  • Makes careless mistakes/lacks attention to detail
  • Difficulty sustaining attention
  • Does not seem to listen when spoken to directly
  • Fails to follow through on tasks and instructions
  • Exhibits poor organization
  • Avoids/dislikes tasks requiring sustained mental effort
  • Loses things necessary for tasks/activities
  • Easily distracted (including unrelated thoughts)
  • Is forgetful in daily activities

ADHD-HI Symptoms

  • Fidgets with or taps hands or feet, squirms in seat
  • Leaves seat in situations when remaining seated is expected
  • Experiences feelings of restlessness
  • Has difficulty engaging in quiet, leisurely activities
  • Is “on-the-go” or acts as if “driven by a motor”
  • Talks excessively
  • Blurts out answers
  • Has difficulty waiting their turn

If you are a child, you need to show at least six of the symptoms of a given type for at least six months, in multiple settings; if you are an adult, you need five. They also need to be evident prior to age 12. For ADHD-C, you need to meet the criteria for both ADHD-I and ADHD-HI.

But what if we look at these again, through the lens of executive dysfunction?

ADHD-I is then characterized by difficulties with:

  • Attentional Control;
  • Cognitive Flexibility;
  • Cognitive Inhibition;
  • Goal-Directed Behaviour;
  • Organizational Skills;
  • Planning;
  • Self-Monitoring; and
  • Working Memory.

Meanwhile, ADHD-HI is characterized by difficulties with:

  • Cognitive Flexibility;
  • Goal-Directed Behaviour;
  • Inhibitory Control; and
  • Self-Monitoring.

ADHD-C, then, is characterized by difficulties with everything.

But, well, I don’t know about you, but I see an awful lot of overlap on the executive functioning issues. In fact, what I see is that the thing that distinguishes ADHD-I from ADHD-HI is that ADHD-I has trouble with Attentional Control, Cognitive Inhibition, Organizational Skills, Planning, and Working Memory, while ADHD-HI has trouble with Inhibitory Control. Both types have difficulty with Cognitive Flexibility, Goal-Directed Behaviour, and Self-Monitoring.

This means that it would be incredibly strange for someone to have “pure” ADHD-I; some of the criteria for ADHD-HI are likely to show up at least some of the time (and more often than they would for someone who doesn’t have ADHD) since they’re caused by issues with the same executive functions. Same goes for “pure” ADHD-HI.

Okay, this post is getting a touch maudlin, so I’m going to take us in a new direction.

Last week’s printable was about identifying areas where you need supports. That’s important to know as you’re looking to develop systems and materials to help you manage your symptoms and your life; the thing is, nobody is made up of only deficits. We all have some strengths, and it’s really important to know what yours are.

For example, I was diagnosed with severe ADHD-C, and I honestly do struggle with an awful lot of things I “should” be good at as a stay-at-home-mother. At the same time, I have some strengths that help me get by, and I’m hoping I can find ways to harness them moving forward.

Executive FunctionDefinitionExample of Strengths
Attentional ControlThe ability to control what you pay attention to. It’s basically being able to concentrate.Hyperfocusing on important projects or topics.
Cognitive FlexibilityThe ability to change your behaviour and thought processes based on changes in your situation or gaining information.Understanding different points of view.
Cognitive InhibitionThe ability to tune out unrelated stimuli and stay on task or follow a train of thought.Hyperfocusing on a special interest to the exclusion of all else.
Goal-Directed BehaviourThe ability to control your behaviour so that you’re working towards achieving goals.Hyperfixating on a topic or activity such that you become an expert in a short amount of time.
Inhibitory ControlThe ability to stop before you act so you can choose the most appropriate way to behave in a given situation. It’s got a lot to do with self-control.Recognizing which fidgets or stims are inappropriate in certain settings, and choosing alternatives that are more appropriate.
Organizational SkillsAll that sorting, putting things away, etc.Setting up solid organizational systems.
PlanningThe ability to think ahead and to break goals down into smaller steps.Breaking down large tasks or projects into small steps.
Self-MonitoringThe ability to keep track of what you’re doing and how you’re coming across, as well as notice things like hunger, thirst, fatigue, pain, the need to use the bathroom, etc.Realizing that you always get hungry or thirsty at a particular time of day, and making sure you have a water bottle and snacks on hand.
Working MemoryThe ability to hold information in your mind so you can use it to make decisions and complete tasks.Keeping a notebook and pen on hand so you can write stuff down instead of having to remember it.

Note that these examples of strengths aren’t necessarily strengths in executive functioning; often we develop solid coping mechanisms in response to our struggles, and we should absolutely consider those mechanisms strengths that we have in those areas.

This week’s printable is a reproduction of this chart, with the example column blank. This is your opportunity to think about what you’re good at in each area of executive functioning, including ways you’re dealing effectively with your deficits.

You’re good at stuff, it’s just hard to see sometimes.

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