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Written by:Dr. Karmen Smith, LCSW, DD

Published On: July 25, 2022

Medically reviewed by: Bisma Anwar, MA, MSc, LMHC

Reviewed On: July 25, 2022

Updated On: July 17, 2023


If you or a loved one’s been diagnosed with ADHD combined type, you might be wondering what that really means. While you’re probably already familiar with the condition attention deficit hyperactivity disorder (ADHD), you may not have ever heard it attached to the word “combined.” If that’s the case, you’re likely curious about how combined ADHD differs from the ADHD you’ve always heard about.

In short, many people don’t even realize there are three types of ADHD — distractible and inattentive ADHD, impulsive/hyperactive ADHD, and combined type ADHD.

ADHD combined type, as the name suggests, causes symptoms from both inattentive and distractible and impulsive/hyperactive ADHD types. Especially if you’ve never heard of it, you might be surprised to learn that the combined form of ADHD is actually the most common type.

We’re diving into what that means here — from symptoms to causes to treatment types. If you’re curious about what ADHD combined type is, you’re in the right place. Keep reading to learn more.

What is ADHD Combined Type?

ADHD combined type is a third type of ADHD, the mental health condition marked by difficulty paying attention, hyperactivity, and impulsiveness. When someone is diagnosed with combined ADHD, they’ll exhibit symptoms from each of the three ADHD subtypes.

  • Distractible and inattentive type — difficulty paying attention; easily distracted
  • Impulsive/hyperactive type — can be impulsive; likely to have trouble sitting still
  • Combined type — a combination of both the above types

We’re still learning about ADHD, but one interesting study shows many preschool children who were originally diagnosed with impulsive/hyperactive type ADHD were later diagnosed with ADHD combined type. While the research done here might suggest that ADHD impulsive/hyperactive type is just an earlier form of ADHD combined type, this is not yet proven.

Symptoms of ADHD Combined Type

All ADHD types have a range of symptoms and severity, and anyone with ADHD might exhibit some, or all, of the symptoms specific to the type they have. Thus, not everyone with combined ADHD will have all of the following symptoms, and some can be more prominent for one person than they are for another.

So what is ADHD combined type in terms of symptoms? People who live with combined ADHD generally might:

  • Have trouble paying attention
  • Be easily distracted
  • Often seem forgetful
  • Be overly sensitive
  • Have great difficulty staying on task
  • Look, seem, or be disorganized
  • Become extremely overwhelmed by information and choices
  • Be hyperactive (talkative or loud)
  • Show signs of impulsivity (interrupt others, make rash decisions, be impatient)
  • Make careless mistakes
  • Have very strong emotions or reactions

“Social media’s quick format has been linked to a shortened attention span, and in the future interventions may focus on addressing content, format, and algorithms. Parents and teachers may have noticed how mobile internet devices have increased ADHD symptoms in school age children. Behavioral therapy may be helpful in addressing the quantity of time exposed to such content.”

Licensed Clinical Social Worker (LCSW), DD Karmen Smith

Causes of ADHD Combined Type

We don’t have one exact known cause for combined ADHD. However, several factors seem to contribute to someone being more prone or susceptible to getting an ADHD diagnosis.


The most significant risk factor for ADHD is genetics. Research shows that genes appear to play an integral role in the cause of ADHD.

Studies focused specifically on families, twins, and adoptees link ADHD to genetics. The research uncovered a possible heritability rate of 74%. High heritability suggests that genetics accounts for much of the variation in a trait between different people.

Alcohol or cigarette use during pregnancy

Drinking during pregnancy might cause an increased risk of 5 times the average odds of having a child with ADHD. In addition, there also appears to be a link between mothers who smoked during pregnancy and an increased risk of ADHD.

Brain injury

A study of almost 200 children with traumatic brain injuries (TBI) concluded that 62% of the participants developed ADHD, compared to 15% of the non-TBI cohort. Our understanding of the link isn’t complete yet, though, as some children were diagnosed with ADHD shortly after their injury, while others were diagnosed as long as 6 years post-injury.

Exposure to toxins

Certain chemicals, including lead, can decrease children’s attention spans, interfering with the same parts of learning that ADHD does. Lead is known to impair attention and has been linked to disruptive behavior in the classroom, specifically in hyperactivity and inattention.

Early-life exposure to lead has been linked to failure to complete high school, violent inclinations, addictive habits, and other behavioral and emotional issues.

In addition, polychlorinated biphenyls (PCBs) are hazardous industrial chemicals that build up in the sediments at the bottoms of rivers, lakes, and coastal areas. These compounds can accumulate in the fatty tissues of fish and other animals, posing substantial health concerns to people who consume contaminated seafood regularly.

In several studies, PCBs have been proven to negatively affect children’s IQ and learning.

“According to research there can be many causes of ADHD such as genetics, toxins, or brain injuries. Even early childhood trauma can be linked to this disorder. Most people with this diagnosis may not know the direct or indirect cause, focusing mostly on lessening symptoms through therapeutic interventions.”

Licensed Clinical Social Worker (LCSW), DD Karmen Smith

Diagnosing ADHD Combined Type

It’s important to point out that just because you’re sometimes forgetful or distracted doesn’t mean you have combined ADHD. However, if your symptoms start to interfere with your daily life or relationships, it’s always worth seeing a doctor.

Many primary physicians can diagnose combined ADHD. They’ll likely do a complete check-up and bloodwork to rule out anything else that may be causing symptoms. They’ll want to review family and health history and more to get a full picture of your physical and mental well-being.

For children, the American Association of Pediatrics recommends that doctors get information from parents, teachers, and other adults in a child’s life. This information helps your doctor get a clearer picture of what symptoms are present and in which types of situations they occur.

Medical professionals use criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose ADHD combined type. There are a total of 18 ADHD symptoms — 9 of which are inattentive and distractible type, and 9 of which are impulsive/hyperactive type. For a diagnosis to be made, the following must be true:

  • 6 or more symptoms of each type of ADHD (ages 17 and up only need to exhibit 5)
  • Symptoms must be obvious for at least 6 months and present in more than 1 setting
  • Symptoms must be interfering with the ability to function normally
  • Symptoms must not be related to another condition

In addition to primary care physicians, other doctors, like psychiatrists, psychologists, or neurologists, can also diagnose combined ADHD. If you want to rule out other mental health conditions, a specialized doctor is able to do more extensive testing than a pediatrician or primary care doctor can.

Treatment for ADHD Combined Type

If you or a loved one has combined ADHD, you know how frustrating it can be. One minute, there are hyper or agitated feelings, and the next, an inability to focus can take over.

While there’s no cure for ADHD (of any type) and we aren’t 100% certain about what causes ADHD, treatment is available and can be very successful for most people when it comes to how to deal with ADHD.


If symptoms affect your daily life, your doctor may want to prescribe medication to help you manage your condition. There are 2 main types of ADHD medication:

    • Stimulant medication
    • Non-stimulant medication

Sometimes, antidepressants are used off-label to treat ADHD as well, although extreme caution must be used. There’s a link between the use of antidepressants to treat ADHD and a higher risk of suicide in adults with adult ADHD.

While medication isn’t required when it comes to how to treat ADHD, many people successfully use it. Be patient, however, because ADHD treatment is not a one-size-fits-all approach. What might work for one person with combined ADHD may not work for another.

Your doctor can help you choose the proper medication and dosage based on your needs.


In addition to medication, therapy is highly recommended for people with ADHD combined type. A skilled therapist can help you with:

      • Coping skills
      • Social skills
      • Setting up routines
      • Building self-esteem
      • Encouraging optimism
      • Improving motivation

Many people with combined ADHD feel their best and see the most success when a treatment plan consists of a combination of therapy for ADHD and medication. Working with your doctor is the best way to determine the right course of action for you, your symptoms, and your goals for treatment.

Looking for help but not sure where to start? Talkspace is an online therapy platform that will help you get the mental health treatment you need. Get ADHD combined type therapy from an experienced, caring mental health professional who can offer you effective sessions right from the comfort of your own home (or office, or car, or park…).

Talkspace makes therapy possible when and where you want it. It’s accessible, convenient, and affordable. Learn more about how Talkspace can help you manage and cope with ADHD combined type today.

See References

Dr. Karmen Smith, LCSW, DD

Dr. Karmen Smith is a board-certified Clinical Social Worker in the state of Nevada. She has worked over 20 years for Clark County Family Services with abused and neglected children in the shelter, adolescents in juvenile detention, and adults who have suffered severe trauma. Dr. Smith is a shamanic teacher and minister of metaphysics and her doctorate is in Pastoral Counseling.

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