ADHD has three presentations: predominantly inattentive (difficulty focusing), predominantly hyperactive-impulsive (restlessness), and combined type (both symptom clusters). DSM-5 classification.
ADHD Types: Understanding the Three Presentations
Complete Guide to Inattentive, Hyperactive-Impulsive, and Combined ADHD
By Dr. Ryan S. Sultan, Assistant Professor of Clinical Psychiatry Columbia University Irving Medical Center → NIH-Funded ADHD Researcher | 411-Cited Publications | International Speaker
Published: February 14, 2026 | Updated: February 14, 2026
ADHD is not a single, uniform condition—it presents in three distinct patterns, each with different symptom profiles, challenges, and treatment considerations. Understanding which type of ADHD you or your child has is essential for effective diagnosis, treatment planning, and self-understanding.
📊 The Three ADHD Presentations (DSM-5)
1. Predominantly Inattentive Presentation (20-30% of cases)
Difficulty with focus, organization, and sustained attention. Formerly called "ADD."
2. Predominantly Hyperactive-Impulsive Presentation (5-10% of cases)
Excessive physical activity, restlessness, and impulsive behavior.
3. Combined Presentation (60-70% of cases)
Significant symptoms of BOTH inattention AND hyperactivity-impulsivity.
Note: These are presentations, not separate disorders. All are ADHD—the difference is symptom profile.
Why Type Matters
Understanding your ADHD type is important because:
Different symptom profiles: Inattentive type looks very different from hyperactive type
Age of diagnosis varies: Hyperactive children identified earlier; inattentive often missed until adulthood
Gender patterns differ: Girls more likely inattentive; boys more likely hyperactive or combined
Treatment response varies: Some medications work better for certain presentations
Functional impairment differs: Inattentive may struggle academically; hyperactive with behavior/social
Comorbidities vary: Inattentive type has higher anxiety rates; hyperactive has more oppositional behavior
As a psychiatrist trained in ADHD research at Columbia University, I emphasize that accurate subtyping—combined with understanding individual strengths and challenges—enables truly personalized treatment.
Predominantly Inattentive Presentation
Formerly known as "ADD" (Attention Deficit Disorder)"
What is Inattentive ADHD?
Inattentive ADHD involves significant difficulty with attention, focus, and organization WITHOUT prominent hyperactivity or impulsivity. People with this presentation may appear "spacey," "daydreamy," or "in their own world." They're not bouncing off walls—they're quietly struggling to maintain focus.
Prevalence: 20-30% of all ADHD cases (but likely underdiagnosed, especially in girls/women)
DSM-5 Diagnostic Criteria for Inattentive Type
Must have 6 or more (5 or more for ages 17+) of the following symptoms for at least 6 months:
1. Fails to give close attention to details or makes careless mistakes
Overlooks errors in schoolwork, work documents, or other activities
Work appears sloppy despite effort
Misses important details in instructions
2. Has difficulty sustaining attention in tasks or play
Mind wanders during lectures, conversations, or reading
Difficulty staying focused during lengthy tasks
Needs frequent breaks to maintain concentration
3. Does not seem to listen when spoken to directly
Appears to be elsewhere mentally during conversations
Needs information repeated
"Did you hear what I just said?" is common question from others
4. Does not follow through on instructions and fails to finish
Starts projects but doesn't complete them
Gets sidetracked in the middle of tasks
Numerous unfinished projects accumulate
5. Has difficulty organizing tasks and activities
Poor time management and planning
Difficulty breaking large tasks into steps
Messy workspace, backpack, car, home
Trouble prioritizing competing demands
6. Avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort
Relies heavily on external memory aids (lists, alarms, others)
What Inattentive ADHD Looks Like in Real Life
Elementary School Child:
Teacher says: "Bright but doesn't apply themselves"
Homework takes 3 hours (should take 30 minutes)
Daydreams during class, misses instructions
Desk a mess, frequently loses assignments
Reading comprehension poor despite good decoding
Not disruptive—may be overlooked for diagnosis
High School/College Student:
Procrastinates until deadline panic sets in
Excellent test scores but inconsistent grades
Loses track of long-term assignments
Listens to lectures but doesn't retain information
Takes twice as long to complete work as peers
Compensates with intelligence until demands exceed capacity
Adult Professional:
Chronically running late despite best intentions
Email inbox overwhelming (hundreds of unread messages)
Starts projects enthusiastically, struggles to finish
Difficulty in meetings (mind wanders, misses key points)
Workspace cluttered, paperwork piles up
Described as "smart but disorganized"
The "Inattentive ADHD" Experience
People with inattentive ADHD often describe their experience as:
"It's like trying to tune into a radio station but you can't quite get the frequency right. The signal keeps drifting. You're trying SO HARD to focus but your mind just...won't stay put."
"I can hyperfocus for hours on things that interest me, but ask me to do something boring and necessary? My brain literally rebels. It's not laziness—it's like pushing a boulder uphill."
"People think I'm not listening, but I am—it's just that five other thoughts are also happening simultaneously and by the time I process what you said, the conversation has moved on."
Why Inattentive ADHD Gets Missed
Inattentive ADHD is frequently undiagnosed, especially in:
Girls and Women:
Fewer behavior problems—not disruptive in class
Better social skills mask difficulties
Higher anxiety (internalizing rather than externalizing symptoms)
Symptoms attributed to "being anxious" or "depressed"
Compensate longer with organizational systems before reaching breaking point
Intelligence compensates for executive dysfunction
Succeed until high school/college when demands increase
"Not working to potential" but still passing
Often diagnosed in 20s-30s when coping strategies fail
Adults:
Childhood symptoms misattributed to other causes
Developed elaborate compensatory strategies
Self-employed or chose careers matching ADHD strengths
Symptoms blamed on "stress" or "getting older"
Predominantly Hyperactive-Impulsive Presentation
The most recognizable ADHD presentation
What is Hyperactive-Impulsive ADHD?
Hyperactive-impulsive ADHD involves excessive physical activity, restlessness, and difficulty controlling impulses WITHOUT significant attention problems. This is the "classic" ADHD most people picture—the child who can't sit still, constantly moving, acting before thinking.
Prevalence: 5-10% of all ADHD cases (least common; often evolves into combined type)
DSM-5 Diagnostic Criteria for Hyperactive-Impulsive Type
Must have 6 or more (5 or more for ages 17+) of the following symptoms for at least 6 months:
Hyperactivity Symptoms:
1. Fidgets with or taps hands or feet, squirms in seat
Constantly moving—tapping, clicking pens, jiggling legs
Cannot sit still even when required
Needs to touch/manipulate objects
2. Leaves seat in situations when remaining seated is expected
Gets up during class, meetings, meals
Wanders around when should be seated
Children: leaves desk repeatedly during lessons
3. Runs about or climbs in situations where inappropriate
Children: climbing on furniture, running indoors
Adolescents/adults: feelings of restlessness, pacing
Cannot engage in leisure activities calmly
4. Unable to play or engage in leisure activities quietly
Loud during play
Difficulty with quiet activities (reading, puzzles)
Prefers high-energy, stimulating activities
5. "On the go," acting as if "driven by a motor"
Constant need for activity
Uncomfortable being still
Internal sense of restlessness
Always needs to be doing something
6. Talks excessively
Non-stop talking
Difficulty letting others speak
Continues talking even when topic exhausted
Impulsivity Symptoms:
7. Blurts out answers before questions completed
Can't wait for question to finish
Completes others' sentences
Calls out in class before being recognized
8. Has difficulty waiting their turn
Impatient in lines, games, conversations
Struggles with delayed gratification
Wants immediate results
9. Interrupts or intrudes on others
Butts into conversations or games
Can't wait for appropriate time to speak
Takes over others' activities
Intrudes on others' personal space
What Hyperactive-Impulsive ADHD Looks Like
Preschool/Elementary Child:
Always on the move—climbing, running, jumping
"Doesn't have an off switch"
Trouble sitting through story time, meals, car rides
Constantly touching things, getting into everything
Loud, boisterous play
Difficulty with turn-taking games
Frequent injuries from impulsive risk-taking
Peers find them "too much"—social rejection common
Adolescent:
Overt hyperactivity decreases but restlessness remains
Internal restlessness more than external hyperactivity
Cannot relax—always needs to be "productive"
Takes on too many commitments impulsively
Interrupts in meetings, social situations
Impulsive purchases
Career/relationship changes made hastily
High-energy jobs sought (entrepreneur, sales, emergency services)
Described as "intense" or "overwhelming"
Why Hyperactive Type is Most Diagnosed (In Children)
Hyperactive-impulsive ADHD is most likely to be diagnosed in childhood because:
Impossible to miss: Disruptive behavior gets noticed
Teacher complaints: "Can't sit still," "always interrupting," "distracting class"
Safety concerns: Impulsivity leads to injuries
Social problems: Peer rejection prompts evaluation
Boys more affected: Hyperactive-impulsive more common in males (diagnosed 2-3x more)
However: Pure hyperactive-impulsive type is least common overall—most children initially diagnosed with this type eventually develop combined type as attention problems emerge.
Combined Presentation
The most common ADHD type
What is Combined ADHD?
Combined presentation means significant symptoms of BOTH inattention AND hyperactivity-impulsivity are present. This is not "the worst" or "most severe" ADHD—it simply means both symptom clusters are prominent.
Prevalence: 60-70% of all ADHD cases (most common by far)
Diagnostic Criteria for Combined Type
Must meet criteria for BOTH:
6+ inattentive symptoms (5+ for ages 17+)
AND 6+ hyperactive-impulsive symptoms (5+ for ages 17+)
Both present for at least 6 months
What Combined ADHD Looks Like
Combined type involves the full spectrum of ADHD symptoms:
Child with Combined Type:
Can't sit still AND can't focus when seated
Disorganized AND impulsive
Loses belongings AND interrupts constantly
Homework incomplete because distracted AND physically restless
Academic AND behavioral problems
Both teacher and parents report concerns
Adult with Combined Type:
Internal restlessness + attention difficulties
Jumps from task to task without completing any
Impulsive decisions + poor follow-through
Starts many projects, finishes few
Interrupts in conversations + loses track of what was said
Written instructions (compensate for auditory processing)
Frequent check-ins for long-term assignments
Note-taking support (missed information during lectures)
Hyperactive-Impulsive Type Accommodations:
Movement breaks during class/work
Flexible seating (standing desk, wobble chair)
Shortened work periods with breaks
Physical jobs/roles (not sedentary all day)
Fidget tools (stress balls, putty)
Combined Type Accommodations:
Both attention and behavioral supports
504 Plan or IEP outlining specific needs
Regular communication between home/school/work
Modified workload if necessary
Gender Differences in ADHD Types
ADHD type distribution differs significantly by gender:
Gender Distribution by Type
ADHD Type
Boys/Men
Girls/Women
Male:Female Ratio
Hyperactive-Impulsive
Much more common
Rare
~4:1
Combined
More common
Less common
~2-3:1
Inattentive
Common
Common
~1-1.5:1 (most equal)
Why Girls Often Have Inattentive Type
Biological factors:
Genetic/hormonal differences may affect symptom expression
Girls may have different neurobiological pathways to ADHD
Hyperactivity less pronounced in female ADHD
Social factors:
Girls face stronger social pressure to sit still, be quiet
Girls with hyperactivity labeled "tom boys" rather than "ADHD"
Impulsivity in boys = "boys being boys"; in girls = "behavioral problems"
Girls internalize symptoms more (anxiety vs. acting out)
Diagnostic bias:
Teachers refer hyperactive students (more often boys)
Inattentive students (more often girls) overlooked
Diagnostic criteria developed primarily from studies of hyperactive boys
Quiet, daydreaming girls don't fit "classic ADHD" stereotype
The "Quiet ADHD Girl" Phenomenon
Many women describe their childhood experience:
"I was the 'space cadet,' always staring out the window. Teachers said I was 'bright but not applying myself.' I tried SO HARD but just couldn't stay focused. Nobody thought it was ADHD because I wasn't disruptive."
These girls often:
Struggle silently for years without identification
Develop anxiety/depression as secondary conditions
Symptom shopping: Identifying with symptoms because they're trendy
Ignoring comorbidities: ADHD symptoms overlap with anxiety, depression, trauma
Oversimplification: ADHD is complex; 60-second videos can't capture nuance
My Recommendation:
Use social media as a starting point, not an ending point. If you recognize yourself in ADHD content, that's valuable awareness—but seek comprehensive professional evaluation before concluding you have ADHD. Many conditions mimic ADHD, and accurate diagnosis determines effective treatment.
The three types of ADHD are: (1) Predominantly Inattentive Presentation - difficulty with focus, organization, and attention; (2) Predominantly Hyperactive-Impulsive Presentation - excessive physical activity and impulsive behavior; (3) Combined Presentation - symptoms of both inattention and hyperactivity-impulsivity. Combined type is most common (60-70% of cases), followed by inattentive (20-30%), and hyperactive-impulsive (5-10%).
2. What is inattentive ADHD?
Inattentive ADHD (formerly called ADD) involves 6+ symptoms of inattention without significant hyperactivity. Symptoms include difficulty sustaining attention, easily distracted, forgetfulness, losing items, avoiding tasks requiring sustained effort, appearing not to listen, and trouble organizing. More common in girls and women, often diagnosed later in life.
3. Is ADD and ADHD the same thing?
ADD (Attention Deficit Disorder) is the outdated term for what is now called ADHD Predominantly Inattentive Presentation. The term "ADD" was eliminated in 1987 when the DSM-III-R renamed all presentations "ADHD." Today, all three types are called ADHD with different presentations: inattentive, hyperactive-impulsive, or combined.
4. Can ADHD type change over time?
Yes, ADHD presentation can change over the lifespan. Hyperactivity typically decreases with age, so children with hyperactive-impulsive type often develop combined type, and combined type may shift toward inattentive type in adulthood. Internal restlessness remains but overt hyperactivity (running, climbing) diminishes. Presentation changes don't mean ADHD went away—symptom expression evolved.
5. Which ADHD type is most common?
Combined Presentation is most common, accounting for 60-70% of ADHD cases. Inattentive Presentation accounts for 20-30%, and Hyperactive-Impulsive Presentation is least common at 5-10%. Distribution varies by age (hyperactive-impulsive more common in young children) and gender (inattentive more common in females).
6. Why is inattentive ADHD often missed in girls?
Inattentive ADHD in girls goes undiagnosed because: (1) no disruptive behavior—quietly struggling doesn't get attention, (2) stereotype of ADHD is hyperactive boy, (3) girls mask symptoms better socially, (4) symptoms attributed to anxiety or just "being spacey," (5) teachers refer hyperactive students more often. Result: many women diagnosed in 30s-40s after years of struggling.
7. Does having combined type mean ADHD is more severe?
No. Combined type means BOTH inattention and hyperactivity-impulsivity are prominent, not that ADHD is "twice as bad." Severity depends on symptom intensity and functional impairment, not type. Someone can have mild combined type or severe inattentive type. Type describes symptom pattern, not severity.
8. Can adults have hyperactive ADHD?
Yes, but it looks different than childhood hyperactivity. Adults with hyperactive symptoms experience: internal restlessness ("driven by a motor"), constant fidgeting/leg-bouncing, inability to relax, excessive talking, impulsive decisions, taking on too many commitments. Physical hyperactivity (running, climbing) decreases but mental/internal hyperactivity persists.
9. Is medication different for different ADHD types?
Medication works similarly across types, but emphasis varies:
Inattentive: Focus on improving attention and organization
Hyperactive-impulsive: Focus on reducing hyperactivity and improving impulse control
Combined: Addresses both domains
All types respond well to stimulants (70-80% response rate). Non-stimulants like Strattera, Wellbutrin, and Intuniv work for all types. Choice depends more on individual factors (side effects, coexisting conditions, substance use history) than type.
10. I have some symptoms of inattentive and some of hyperactive. What does that mean?
If you have symptoms from both categories but don't meet full criteria for combined type (6+ in each category), you're diagnosed with whichever type you DO meet criteria for. Example: 7 inattentive + 4 hyperactive-impulsive = predominantly inattentive type. However, treatment addresses ALL impairing symptoms regardless of type designation. Type is clinical shorthand, not rigid categorization.
Conclusion: Understanding Your ADHD Type Empowers Treatment
ADHD is not one-size-fits-all. The three presentations—inattentive, hyperactive-impulsive, and combined—represent distinct symptom patterns with different challenges, trajectories, and treatment considerations.
Key Takeaways:
Combined type is most common (60-70%), but distribution varies by age and gender
Inattentive ADHD is often underdiagnosed, especially in girls and adults
ADHD type can change over time as brain matures and symptoms evolve
All types respond to evidence-based treatment—medication and behavioral interventions work
Social media raised awareness but also spread misinformation—seek professional evaluation
Type designation guides treatment but doesn't limit it—all symptoms addressed
At Columbia University and New York-Presbyterian, I provide comprehensive ADHD evaluation and treatment informed by the latest research, including my NIH-funded work. Understanding your specific ADHD presentation is the foundation for personalized, effective treatment.
📞 Expert ADHD Type Assessment
Comprehensive evaluation with Dr. Ryan Sultan
NIH-Funded ADHD Researcher | Columbia University Psychiatrist
Accurate Diagnosis | Personalized Treatment | Evidence-Based Care
Determine your ADHD type | Tailored treatment plan | Insurance accepted Email: Rss9006@NYP.org
⚕️ WHEN TO SEEK ADHD TYPE ASSESSMENT
Professional evaluation is essential for accurate ADHD type diagnosis. Seek consultation if:
✓ You recognize yourself in any of the three ADHD presentations described above
✓ Social media content prompted "Could this be me?" thoughts (good starting point—now get professional evaluation)
✓ You're a woman with inattentive symptoms who's been told "you don't have ADHD"
✓ Childhood hyperactivity decreased but attention problems persist
✓ You're intelligent but consistently underperforming academically or professionally
✓ Previous ADHD treatment didn't work (may have been wrong type or approach)
✓ Symptoms vary across settings (need comprehensive cross-setting evaluation)
✓ You've self-diagnosed from TikTok/social media but want accurate professional assessment
What to Expect: Comprehensive evaluation includes detailed clinical interview, rating scales (self/family/work), developmental history, symptom assessment across all presentations, comorbidity screening, and personalized treatment planning.
This page provides educational information based on current research and clinical experience. It should not replace professional medical advice. If you have concerns about ADHD, consult a qualified healthcare provider for personalized evaluation and treatment.
