What is ADHD Combined Presentation?

ADHD combined type is sometimes used to describe ADHD Combined Presentation, which is one of the three primary types of ADHD. The others are ADHD Predominantly Hyperactive-Impulsive Presentation, and ADHD Predominantly Inattentive Presentation.[i]

Combination type ADHD is, as the name suggests, a combination of all three primary characteristics of ADHD. It is the most common form of ADHD, being twice as common as the inattentive presentation and around eight times more common than the hyperactive-impulsive presentation.[ii]

For decades, the Drake Institute has used advanced treatment technologies to create customized treatment protocols for patients with ADHD and other brain-based conditions. Brain map-guided neurofeedback and neurostimulation help our ADHD patients reduce their symptoms and lead better lives.

For more information about how the Drake Institute treats ADHD and several other brain-based disorders, please fill out the consultation form or call us at 800-700-4233.

Combined Presentation ADHD Symptoms

What is ADHD combined type, and what does it look like?

Because this subtype of ADHD is represented by a combination of hyperactivity, impulsivity, and inattention, signs of combined ADHD will include symptoms from the other subtypes.[iii] For example, a person with ADHD combined type may experience difficulties focusing as well as difficulty controlling hyperactivity and impulsive behaviors.

ADHD predominantly combined type has specific diagnostic requirements.[iv] To be diagnosed with the combination type ADHD, an individual must exhibit at least 6 of the 9 symptoms listed for each of the two categories, inattentive and hyperactive-impulsive. For those age 17 and older, only 5 of 9 symptoms are required to receive a diagnosis.

The specific symptoms for each presentation are below: 

ADHD Hyperactive-impulsive presentation

  • Often fidgets with or taps hands or feet or squirms in their seat.
  • Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the workplace, or in other situations that require remaining in place).
  • Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, this may manifest as feeling restless.)
  • Often unable to play or engage in leisure activities quietly.
  • Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to remain still — in restaurants or meetings, for example — for any extended time without significant discomfort; others may say the patient is restless, fidgety, or difficult to keep up with).
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed (e.g., completes people’s sentences).
  • Often has difficulty waiting his or her turn (e.g., while waiting in line, while speaking in conversations).
  • Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

ADHD Inattentive presentation

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, turns in inaccurate work).
  • Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
  • Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
  • Often has difficulty organizing tasks and activities (e.g., struggle to manage sequential tasks, keep materials and belongings in order, organize work, manage time, and meet deadlines).
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, this may include preparing reports, completing forms, reviewing lengthy papers).
  • Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted by extraneous stimuli (for older adolescents and adults, this may include unrelated thoughts).
  • Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, this may include returning calls, paying bills, keeping appointments).

ADHD Severity Levels

All types of ADHD may present in different degrees of severity, characterized as mild, moderate, and severe. Indicating this level is now a requirement for diagnosis as defined by the DSM-5. The severity levels indicate how much difficulty the symptoms cause in social, work, or school settings and may change over time.[v]

Mild

As described by CHADD: “Few symptoms beyond the required number for diagnosis are present, and symptoms result in minor impairment in social, school or work settings.”

Moderate

Symptoms or functional impairment are between mild and severe.

Severe

More symptoms than the required diagnostic number are present, with one or more symptoms being particularly severe. Symptoms of this severity level result in marked impairment in social, school, or work settings.

How is Combined Type ADHD diagnosed?

ADHD is diagnosed by clinicians according to criteria in the DSM-5. For children up to age 16 to receive a diagnosis, they must exhibit six or more of the listed symptoms for at least six months. For individuals 17 and older, at least 5 of the symptoms must be present.[vi]

The symptoms are divided into two categories: inattention and hyperactivity/impulsivity. If enough of the criteria are met in both categories, a person will be diagnosed with ADHD combined type, or more formally known as ADHD combined presentation.

Can Children Grow Out of ADHD?

Symptoms and signs of combined ADHD are typically caused by an underlying dysregulation of the brain.

ADHD is a lifelong diagnosis for many, but some individuals may outgrow the disorder. Symptoms may change over time, especially as adulthood is reached.[vii]

At the Drake Institute, we’ve had some patients who by the completion of their treatment program no longer meet the criteria for ADHD.

How the Drake Institute Treats ADHD

Over the last 40 years, the Drake Institute has clinically pioneered the use of advanced treatment technologies to treat a variety of brain-based medical disorders such as ADHD, Autism Spectrum Disorder, PTSD, anxiety, panic disorder, depression, insomnia, and more. Using a combination of brain map-guided neurofeedback and sometimes neurostimulation, our Medical Director creates customized treatment protocols to address each patient's needs.

Brain Mapping

To develop our individualized treatment plans, we first complete a qEEG brain map analysis for each patient. Brain mapping helps us identify which specific regions or networks of the brain are dysregulated linked to symptoms.

To collect this data, 19 sensors are placed around the scalp in areas of the brain responsible for language, focus, memory, executive functioning, social/emotional understanding and behavioral/emotional regulation. The 19 sensors measure and record brainwave activity that is processed through a normative database of neurotypical individuals.

When we compare the patient's results with those of neurotypical individuals, we can identify regions or networks of the brain that are dysregulated and causing symptoms. This information also allows us to determine how these areas are dysregulated so that we can develop specific treatment protocols that help improve brain functioning and reduce symptoms.

Neurofeedback

During neurofeedback training/treatment, sensors are once again placed on the scalp. The sensors record and display instantaneous brainwave activity visually in real-time on a computer screen with simultaneous auditory feedback as well.

During neurofeedback sessions, the patient is seeing the results of how their brain is working and with this information, they learn to improve their brainwave activity by guiding it toward healthier, more appropriately functional brainwave patterns.

We do not administer any drugs or perform invasive procedures during this process. Instead, the patient is improving their own brain functioning, guided by visual and auditory feedback.

Neurostimulation

As an adjunct to neurofeedback, we may also use neurostimulation guided by qEEG brain map findings to gently stimulate the brain into healthier functional patterns. In our experience, some patients may benefit even more from neurofeedback if we also use neurostimulation. We have found this particularly helpful for lower-functioning children on the Autism Spectrum.

Contact The Drake Institute Today!

In the last forty years, Drake has helped thousands of patients with various disorders such as autism, ADHD, PTSD, anxiety, panic disorder, depression, insomnia, migraine headaches, irritable bowel syndrome, and hypertension reduce or resolve their symptoms and thereby achieve a better quality of life. Call us at 1-800-700-4233 or fill out the free consultation form to get started.

 

[i] https://www.hopkinsmedicine.org/health/conditions-and-diseases/adhdadd

[ii] https://add.org/adhd-combined-type/

[iii] https://psychcentral.com/adhd/adhd-combined-type

[iv] https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/

[v] https://chadd.org/about-adhd/overview/

[vi] https://www.cdc.gov/ncbddd/adhd/diagnosis.html

[vii] https://childmind.org/article/do-kids-outgrow-adhd/

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“David F. Velkoff, M.D., our Medical Director and co-founder, supervises all evaluation procedures and treatment programs. He is recognized as a physician pioneer in using biofeedback, qEEG brain mapping, neurofeedback, and neuromodulation in the treatment of ADHD, Autism Spectrum Disorders, and stress related illnesses including anxiety, depression, insomnia, and high blood pressure. Dr. David Velkoff earned his Master’s degree in Psychology from the California State University at Los Angeles in 1975, and his Doctor of Medicine degree from Emory University School of Medicine in Atlanta in 1976. This was followed by Dr. Velkoff completing his internship in Obstetrics and Gynecology with an elective in Neurology at the University of California Medical Center in Irvine. He then shifted his specialty to Neurophysical Medicine and received his initial training in biofeedback/neurofeedback in Neurophysical Medicine from the leading doctors in the world in biofeedback at the renown Menninger Clinic in Topeka, Kansas. In 1980, he co-founded the Drake Institute of Neurophysical Medicine. Seeking to better understand the link between illness and the mind, Dr. Velkoff served as the clinical director of an international research study on psychoneuroimmunology with the UCLA School of Medicine, Department of Microbiology and Immunology, and the Pasteur Institute in Paris. This was a follow-up study to an earlier clinical collaborative effort with UCLA School of Medicine demonstrating how the Drake Institute's stress treatment resulted in improved immune functioning of natural killer cell activity. Dr. Velkoff served as one of the founding associate editors of the scientific publication, Journal of Neurotherapy. He has been an invited guest lecturer at Los Angeles Children's Hospital, UCLA, Cedars Sinai Medical Center-Thalians Mental Health Center, St. John's Hospital in Santa Monica, California, and CHADD. He has been a medical consultant in Neurophysical Medicine to CNN, National Geographic Channel, Discovery Channel, Univision, and PBS.”

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