Attention-Deficit/Hyperactivity Disorder (ADHD) affects how a child focuses, controls impulses, and manages their energy throughout the day. Contrary to the belief that ADHD looks like restlessness, there are actually different types of ADHD.
Each type of ADHD has its own pattern of symptoms. This guide provides a clear overview of each type to help parents better understand their child’s behavior.
How is ADHD Classified?
ADHD is classified using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This guide helps healthcare providers understand which behaviors and symptoms to look for so children can be properly evaluated.
The DSM-5 describes three ADHD presentations, based on the challenges that are most noticeable for a child. These include inattention, hyperactivity and impulsivity, and the combined type, which includes a mix of both inattention and hyperactivity-impulsivity.
What are the Types of ADHD?
ADHD is a common neurodevelopmental condition that affects about 6.5 million children in the United States [*]. Children with ADHD may struggle to sustain their focus, control impulsive responses, or regulate movement.
The three types of ADHD are:
- Predominantly Inattentive Presentation
- Predominantly Hyperactive-Impulsive Presentation
- Combined Presentation
To be diagnosed with ADHD, symptoms need to have been present for at least 6 months and occur in more than one setting, such as both home and school. They must make daily activities more difficult across different areas of life.
Predominantly Inattentive Presentation
Predominantly inattentive ADHD is when difficulties with attention and focus are more noticeable than hyperactivity or impulsiveness. A child may struggle to filter distractions or stay engaged even when they want to do well.
Children with predominantly inattentive ADHD may appear withdrawn or “in their own world.” Because they are not typically disruptive, adults may mistake these challenges for laziness.
This type of ADHD occurs at similar rates in boys and girls, but girls are more likely to be identified with this presentation. Because inattentive behaviors are less disruptive, a diagnosis can be missed in many children [*].
Predominantly Hyperactive-Impulsive Presentation
Predominantly hyperactive-impulsive ADHD is marked by constant movement and quick reactions. Sitting still, waiting, or slowing down can feel especially difficult for them, even when they understand the rules.
Since these behaviors are more visible than inattentive behaviors, they are easier for adults and teachers to notice early on.
Predominantly hyperactive-impulsive presentations are especially more commonly diagnosed in boys [*]. This is largely because externalizing behaviors — such as running around, interrupting, and fidgeting — quickly draw attention.
Externalizing behaviors tend to lead to earlier identification, whereas more subtle inattentive behaviors may go unnoticed, especially in girls.
Combined Presentation
In the combined presentation, children have difficulties with both self-regulation and focus. They may become easily distracted, forget details, or have disorganized work, and at the same time, display restlessness, impatience, or impulsive actions.
For example, a child with the combined type might start a homework assignment but quickly get distracted, fidget in their chair, and then leave the task unfinished. In the classroom, they may have trouble listening to instructions while also moving around frequently.
The combined presentation is the most commonly diagnosed type of ADHD. It is seen more often in boys, as outward behaviors are easier for adults to spot.
How ADHD Types are Diagnosed
There is no single test that can tell whether a child has a specific type of ADHD. Instead, mental health professionals or pediatricians use a careful evaluation process to understand a child’s patterns.
This usually involves gathering information from multiple sources, such as parents and teachers. In some cases, input from the child is also included.
Clinicians may rely on standardized questionnaires or rating scales to assess symptom patterns across different settings.
Note that diagnosing ADHD in young children is more challenging because many ADHD-like behaviors (e.g., impulsivity, short attention span, high energy) are also typical parts of early childhood.
Treatment Options for ADHD Types
Children with different ADHD types use the same treatment options, with some adjustments based on their needs.
For example, behavior therapy and school supports may focus on attention and planning for one child, and on impulse control and emotional regulation for another.
For preschool-aged children (4-5 years), behavior therapy is recommended as the first approach. Medication is generally considered for children ages 6 and older if behavioral strategies and school supports are not enough to manage symptoms.
Healthcare providers usually consider medication as part of a comprehensive treatment plan, which combines different strategies (like behavior therapy, school accommodations, and parent guidance).
Follow-up visits are an important part of treatment. These appointments allow healthcare providers to check how well strategies and/or medication are working, and adjust doses if needed [*].
These follow-ups also give parents a chance to share their observations from home and school and ask questions.
Can ADHD Type Change Over Time?
Yes, a child’s ADHD type may shift over time. ADHD is a chronic condition that usually begins in childhood and can continue into adolescence and adulthood.
About 50–80% of individuals diagnosed with ADHD in childhood still experience some challenges later in life. The diagnosis may remain the same, but characteristics can change as a child grows.
Research shows that as children get older, many become less physically hyperactive, but may still experience inner restlessness, difficulty concentrating, or feeling mentally “on the go.” [*]
For example, a child who was diagnosed with a combined presentation when they were younger may later show fewer hyperactive behaviors but continue to struggle with attention, organization, or follow-through. At that point, their ADHD may be described as predominantly inattentive presentation instead.
Resources
If you’d like to learn more about the different types of ADHD or get support for your child, the following trusted resources offer guidance for families:
