3 ADHD subtypes and their unique symptom presentations

Think you can’t have ADHD without being hyperactive? Think again.

side view of a colorful chameleon on a branch

A large portion of society has these false beliefs that people with ADHD are always hyper, that we don’t have the capacity to focus on anything, and — the worst misconception of all — that we’re constantly getting distracted by squirrels. (If you know, you know.)

Let’s clear up these misconceptions and shed some light on the facts, shall we?

Common misconceptions about ADHD

Put a finger up for each misconception you’ve heard a variation of:

  • “But you’re not fidgety at all. There’s no way you have ADHD.”
  • “It’s definitely not ADHD because he sits still and focuses for hours when he’s playing video games.”
  • “You can’t have ADHD because you read books all the time.”
  • “ADHD? Impossible – you have a college degree!”

And now you have four fingers up… don’t you?

Looking at these statements, I can’t help but feel that ADHD gets a bad rap. For many, one image comes to mind when they hear “ADHD”: a primary school-aged boy bouncing off the walls — someone like Dennis the Menace or Calvin from Calvin and Hobbes. But why does this happen so frequently?

GIF. Calvin and Hobbes dancing

ADHD stereotypes in our society

This limited, stereotypical view of ADHD — in the medical field and within larger society — is a big reason why so many ADHDers without the cliché presentation (i.e. most of us) end up undiagnosed or even misdiagnosed for years - decades in some cases.

ADHD is multifaceted. Not only do stereotypes and misconceptions dismiss an entire set of symptoms we struggle with, but they also serve as gatekeepers to the formal diagnosis and support we deserve. 

Fun facts (ADHD edition)

Rather than draw attention to the falsities, let’s check the facts:

  • You don’t need to be hyperactive to have ADHD. 
  • Hyperactivity doesn’t have to be physical. You can have internal or mental hyperactivity, too.
  • Hyperfocusing on a beloved hobby doesn’t mean that you can focus on everything else, nor does it mean that you can’t have ADHD.
  • Being accomplished or organized doesn’t mean that you can’t have ADHD.

ADHD in the DSM-5

ADHD subtypes

Let’s explore the official diagnostic criteria as outlined by the American Psychiatric Association (APA) in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). The DSM-5 lists 18 symptoms for an ADHD diagnosis, categorized as predominantly inattentive or predominantly hyperactive-impulsive.

It differentiates between 3 different presentations of ADHD: 

  1. Predominantly inattentive (PI; ADHD-PI)
  2. Predominantly hyperactive-impulsive (HI; ADHD-HI)
  3. Combined type (C; ADHD-C)

Official diagnostic criteria

According to the DSM, at least 6 of the symptoms below must occur frequently for children to receive a diagnosis; 5 for adolescents and adults. Presenting symptoms from only one category results in a respective diagnosis. Combined type is diagnosed if at least 6 symptoms from both categories are present. (6 inattentive and 6 hyperactive-impulsive)

ADHD symptoms. Left column: inattentive. Symptoms: Struggles to give close attention to details or makes ‘careless’ mistakes, difficulty sustaining attention, does not appear to listen, struggles with following instructions, unorganized, avoids or dislikes tasks requiring sustained mental effort, frequently misplaces things, easily distracted, forgetful in daily activities. Right column: hyperactive-impulsive. Symptoms: fidgets with hands or feet or squirms in chair, difficulty remaining seated, runs or climbs excessively [kids]; extreme restlessness [adults], difficulty engaging in quiet activities, acts as if driven by a motor, physically and/or mentally, talks excessively, blurts out answers, difficulty waiting or taking turns (impatience), interrupts or intrudes upon others
This graphic was based on the official DSM-V entry for ADHD.

Other factors that affect formal diagnoses:

  • Age of onset: Symptoms must’ve been present before age 12 (Though, this is starting to work its way out of the criteria)
  • Pervasiveness: Evidence of symptoms in two or more settings (e.g. work, home life, school, relationships)
  • Impairment: Symptoms must “reduce the quality of social, academic or occupational functioning”

What’s the difference between ADD and ADHD?

ADD is the same thing as ADHD (kind of)

As research has increased our understanding of ADHD over the years, it’s had several name changes, along with their respective new definitions, to reflect that knowledge. However, many people (including some practitioners) still use the term “ADD”, which can be confusing when searching for information. So, which one is correct?

Going through changes

ADD (Attention Deficit Disorder) was the formal name between 1980 and 1987. During that period, patients were diagnosed with “ADD with or without hyperactivity”. Nowadays, “ADHD” is an umbrella term and the three subtypes reflect the ways in which it manifests. 

Bigmouth tv show opening song with lyrics, “we’re going through changes” on the screen while a girl walks on a sidewalk
Who else heard the Bigmouth theme playing in their head? Just me? 

ADHD subtypes vs. ADHD presentations

Ready for another change?

The 3 ADHD subtypes are now widely referred to as “presentations” of ADHD. While “subtype” gives the impression of a distinct category that you either fit into or not, “presentation” reflects the fluidity of ADHD traits. Over the course of a lifetime — depending on the dynamics of life’s circumstances — ADHD symptom presentation in a single individual can change. Some may take a backseat, while others take on more prominent roles. 

ADHD symptom manifestation

Symptom example: hyperactivity

Take hyperactivity for example: physically hyperactive children often learn to control their urges to move as they mature. Alternatively, they may learn to channel it into more socially accepted forms of movement. For many of us, symptoms tend to manifest more inwardly, as opposed to the stereotypical externalized hyperactivity.

Example: in some adults, hyperactivity may be present, but it may not be physical at all. Perhaps they instead have a hyperactive mind: always thinking, thoughts flying in 8 different directions, lying awake at 3 a.m. and questioning that one thing they said in a conversation 4 months ago…

Masking our ADHD in a neurotypical society

Growing up in a neurotypical world, we learn to develop coping mechanisms to alleviate our struggles, often at great cost to our mental and emotional energy. ADHDers call this kind of behavior “masking”, which we adopt to fit in with others. The inordinate amount of effort this takes usually stays hidden, unless we reach a point of burnout. (Spoiler alert: we always do.)

One of my personal masking behaviors that went unnoticed until sh*t hit the proverbial fan?

Planners, planners, planners!

I’m usually the one to remind others of important appointments — but only because I check my calendar obsessively! I kid you not - I was once on the verge of a meltdown because my partner ‘tidied’ away my analog planner and couldn’t remember where he'd put it. (Thank goodness for digital tools. They may have saved my marriage.)

Women and hormones

And let's not forget the effect of hormones on ADHD… Many women only receive a formal diagnosis in midlife at the onset of perimenopause or menopause as the changes in their hormone levels exacerbate their ADHD symptoms. 

Final thoughts: let go of ADHD imposter syndrome

The DSM-5 is a useful tool for diagnoses, but it isn’t the ‘be all and end all’ of the ADHD experience. ADHD has many layers that can't be depicted by a single page in a big book. Within one ADHD individual, their symptoms can present differently depending on age, circumstances, coping tactics, etc. Even the formal definitions and diagnostic criteria change over time! Not to mention, emotional components - such as emotional dysregulation - don’t appear in the official list of symptoms at all... and we all know how hard it can be to regulate emotions with ADHD, am I right?

So, next time you hear another ADHD stereotype or misconception, and you maybe start questioning the validity of your neurodivergence, know this:

It’s okay to let go of the ADHD imposter syndrome. Rest assured that you can absolutely have ADHD, even if you don’t present like this boy: 

Dennis the menace playing with false teeth in the bathroom mirror. He opens the jaw, snaps it shut and a few teeth fall into the sink and down the drain, his eyes widened in surprise - oops!

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