Are There 3 Types of ADHD?
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- čas přidán 25. 03. 2024
- Here I briefly describe why the mental health professions no longer recognize three types of ADHD in our diagnostic and statistical manual (the DSM5) and its criteria for diagnosing ADHD. While it was previously thought that there might be three types of ADHD (inattentive, hyperactive-impulsive, and combined), since 2013 the field refers to these as presentations. This is because there are not three qualitatively different types or forms of ADHD, there is just one. But it can vary at any given time point in whether one set of symptoms (inattention, hyperactive, impulsive) is more or less prominent than another. But people can move across the presentations based on their age and circumstances, so they are neither permanent nor qualitatively different types of ADHD.
For more on this topic, see my books:
Taking Charge of ADHD: The Complete Authoritative Guide for Parents (4th ed.) published in June 2020). Guilford.com
Taking Charge of Adult ADHD (4th ed.) (Published October 2021). Guilford.com
Treating ADHD in Children and Adolescents: What Every Clinician Needs to Know. (Published May 2022). Guilford.com
ADHD: A Handbook for Diagnosis and Treatment (2015).. Guilford.com
The three types thing always annoyed me, because it never seemed accurate to myself or my family members and friends diagnosed with ADHD, so it's personally satisfying to me that you made this video
I have three types of adhd, and they always come and go in the same sequence:
1) unmedicated hyperactive like a child
2) medicated productive like a CEO
3) addicted strung out like a junkie
What do you mean by number three? Can you go into more detail? Do you mean that when your meds wear off you’re scatterbrained again? I always feel like my brain is mush when the meds wear off.
@@blastypowpow Same. I forget to turn on my copingmechanisms and am my most scatter brained right then and there
Love your comment. So accurate.
I'd love to hear more about how the comorbidity of ADHD and CDS presents itself, because it is not uncommon for them to go hand in hand.
I was diagnosed with Predominately Inattentive but I felt like I had more hyperactive symptoms than what was screened at the time. Combined just seems like the most accurate, presenting each side at different times.
I wear the same cardigan almost every day bc its my "work' sweater
there's also "Quiet BPD" which looks like Inattentive ADHD. Normal BPD is very impulsive and loud, which looks like Hyperactive ADHD. If you ask me, the inattentive and quiet types are the worst, because no one can recognize the suffering of it.
Sooooooooooo true inattentive (quiet BPD ) is the hell
There's also the over diagnosis of BPD and rejection/underdiagnosis of ADHD due to a variety of reasons, plus the treatment and management of BPD which is entirely different than ADHD.
I was missed for ADHD (and autism) as a child despite it being noticed by educators (caretakers who stigmatized both/were heavily in denial because of the social/mental health opinions at the time) yet had no issues receiving a BPD diagnosis due to unstable emotions when the inability to manage the wrongly diagnosed conditions finally blew up. Learning more and more about how ADHD manifests and seeing all of these presentations about how complex ADHD really is and can mimic other disorders has been so illuminating. I wish there was more info in every day life rather than people having to persue this kind of info because it was missing when they really needed it so people could get the help they really need as early as possible.
I have never come across this as a topic. You are saying borderline personality disorder leads to inattentiveness overall, but not enough to meet criteria for ADHD inattentive type.
@@ilikeshinyobjektsare you using BPD To abbreviate borderline personality disorder?
@@carloscontreras3633 I mean quiet BPD looks like inattentive ADHD, but they're not the same because BPD is caused by trauma, and ADHD is born.
Thank you thank you thank you thank you thank you thank you thank you thank you thank you thank you to infinity. I'm so sick of people misunderstanding this. Hopefully this can help gain some traction and people will finally leave the outdated way of looking at this in the past where it belongs.
I've been on board with what Russell's saying for a while now. But I imagine it's pretty tough to change public perception. Though if more awareness would be raised of Cognitive Disengagement Syndrome, public perception could shift more easily?
I have this cds , do you have any?
@@mrchips.9245 I'm honestly not a 100% sure! I've been diagnosed with AuDHD, and that is probably a correct assessment. It's this 'being disengaged from the world' kind of thing which is confusing for me (and others I think), because a lot of disorders can lead to disengagement from the world in some sense or another. You'd probably know better, but I guess what's diagnostic for CDS is a *particular way* of being disengaged
@@captainzork6109what is the treatment for this syndrome you are describing.
I am even more confused now. I watched the CDS vs ADHD differentiation videos and based on that my symptoms indicate ADHD rather than just CDS.
I do have issues with impulsivity (neuropsych testing showed this too), but not the ones in the DSM 5 about talking too much or intruding on people. It's rather things like spending, persistent problems with delayed gratification that interferes with daily life, getting locked into "hyperfocus" (aka perseveration and definitely not a "superpower" to me), binge eating, time blindness, fidgeting, mental hyperactivity and restlessness, among others.
But in the DSM 5 I only meet the Inattentive ones and 1-2 of the hyperactive ones, which wouldn't be enough for sub clinical combined. So what the heck do I have?
Whatever it is, treatment for ADHD especially stimulant medication is very effective. It has changed my life. I am worried that a change in understanding inattentive ADHD will leave people like me stranded without treatment.
That's because the DSM symptoms are based on which hyperactivity symptoms are most easily/commonly observable in children. Nobody has created a separate list of symptoms for adults. "Driven by a motor" makes absolutely no sense as an adult being asked which symptoms apply to you, but if you've ever seen a hyperactive 4yo just KEEP GOING for hours, after they have worn out all of their siblings, classmates, teachers and parents, it is an hilariously apt description and most parents who have observed this understand it immediately.
The impulsive symptoms in adults would probably be more as you describe - trouble sticking with longer term goals, significant difficulty in reducing unwanted/addictive behaviours e.g. smoking, gambling, internet use; unreliability in relationships, trouble with time management, trouble avoiding distraction, delayed gratification issues absolutely, talking too much can be a symptom though not everyone has it, or unusual speech patterns e.g. seeming to switch topics for no reason in the middle of a sentence, emotional dysregulation, fidgeting, starting a million projects/hobbies never finishing them, chasing dopamine/adrenaline etc.
Most adults don't constantly get up out of their seats, climb furniture, bother others, verbally stim, refuse to take turns etc because those are things we develop coping mechanisms to mask. Probably 5/9 of the current DSM hyperactive symptoms don't make sense to look at when applied to adults and while some doctors will bend the definitions and say things like "If you just FEEL restless then it counts" some won't. So you'd only end up subclinical if you happened to hit exactly all of the other four, and it sounds like you personally don't.
@@amypeggs9606 Yeah that's exactly it. The symptoms you listed actually reflect my experience.
But if all that's true and our classification of ADHD changes to exclude Inattentive-only without updating the criteria to reflect more appropriate hyperactive/impulsive symptoms for adults, people like myself will get left in the dust because we will no longer technically qualify for an ADHD diagnosis.
I don't really care what the label is as long as I get the care and support that I need. So this is something I am concerned about and I hope they take it into consideration when updating the DSM.
The DSM is not a manual for diagnosing people, so it's not the end all be all. If you really want to know, you need a specialist who knows how to assess those disorders. Also, Russell Barkley has a video on comorbitity of ADHD with CDS
i'm inattentive and impulsive. too tired to be hyperactive, but i fidget and adjust my posture a lot.
You are describing me
This makes so much more sense to me! My symptoms have definitely varied according to different phases of life, and my cycle....!
i think i know what he means there are days where i have only problems with inatention and concentration there are days where i have only problems with hyperactivity and impulsivnes and there are days where i have only problems with hypoactivity and lethargy 🤔
And sometimes days when you have both simultaneously. Which is fun.
7 types of ADHD according to Dr. Amen! 🙄 I've watched his videos and he honestly annoys me. Why does he insist on making these false claims?
Never trusted him. Not saying he’s not helpful but is not a scientist imo
Berkeley has a video on all the that do not work without medication first. Rather try anything/EVERYTHING before you try ADHD medication is very old mindset.
@@tintinquarantino2896I’m not opposed to medication, at all.
That said, you absolutely should go through the CBT process as the results have shown to be as good/better than medication.
Medication is more satisfying as the immediate gratification of it feels way better, but if you get diagnosed and ONLY get CBT or ONLY get medication, then some meaningful time in the future, stop doing CBT or stop taken medication. - the long-term impact of CBT is better.
The combination of both is obviously ideal, but I, quite often, see people get medication and say “fk it” to CBT. - which l, imo, is a bad mindset.
Thanks so much for your videos
I have only ADHD-I symptoms. But I don't have the CDS symptoms. That's a completely different list. So I dont have anything??
There is a slight communication error that keeps hindering us, Hyperactive ADHD can be cognitive too, that’s were the “old Inattentive” diagnosis came from. So if your mind is constantly racing but you’re sitting still, you usually get the Inattentive diagnosis, but it is an inward/internal Hyperactivity.
Hope this helps, and stay strong!😊✨
will certainly look deeper into it
Hi Dr Barkley, I've been wondering for a while now is there any research on the effectiveness of DBT for ADHD? It has helped me significantly. (*Not as a replacement for meds)
He covered it in his video posted on Feb 24, 2024 😊 DBT made light-years of improvements for me as well!
@@megzin00 Thanks heaps! I'll check that out
More great content, Dr. B.
👏🏽👏🏽👏🏽Thank you for regulating Dr Barkley!
thank you so much-- I have learned so much and feel so much now that I know I am not crazy--
Pleaaaase
Make a video about slow processing speed that is combined with adhd
ditto, I really think I have slow processing speed on top of dysfunctional executive functions
@@aaheemas
Medications help with it ??
@@hebaabdelaziz5365I'm haven't been diagnosed with adhd that's why I said my executive functions are dysfunctional, so I can't be on any medication for it to know.
I believe he did, but it was many yrs ago. Search for it
@@peterf9360can you guide me i could not find it
I thought I was only inattentive, then I answered most of the non-stereotypical questions about hyperactivity with 'yes'. Didn't put me in combined, but was surprising.
Hmm. I have all my age had traits of inattentive presentation of ADHD, and it does not really vary. But I don't think I fit the cognitive disengagement syndrome - only things applicable from those symptoms are daydreaming (and what to me seem just different ways to observe that) and forgetfulness (which I think is pretty much covered by the inattentive representation of ADHD). I have at least 6 of the inattentive presentation symptoms of ADHD, and really only 2-3 of the hyperactive symptoms. Autism and inattentive representation of ADHD really is a combination so spot on for me that I don't really what I have if not those.
I was diagnosed 2 yrs ago with the “combined” one. Age 46 at the time. My thoughts/mind is hyperactive. I zip from one subject to another to another. My daughter who has the inattentive ADHD gets lost in our conversations.
I daydream all the time. I find this really confusing with it constantly changing from ADD, to ADHD, back to ADD with combined types, to ADD with subtypes.
My ADHD can’t focus on this. 😂
I was diagnosed with 314.01 (ADHD Combined Type); that's when The DSM-4 was primarily used.
Do people really care about outfits someone who helps ADHD people as much as you do? Thank you Dr Barkley
I was diagnosed in 2022 at the age of 38 with an ADHD Combined Type in the UK.
I’ve been on the NHS waiting list for a while, how long did you have to wait?
Thanks Russell. Could you please add a link to the other video? Either in the comments or towards the end of the video? CZcams allows you to add links to other videos at specific times which appear as a box on top of your video. Thank you.
I was diagnosed with ADHD Inattentive Presentation. But I think I only match one or two symptoms in the Hyperactivity list (fidgeting and feeling restless).
According to this presentation, I would be likely considered CDS instead. However, some of the characteristics there don’t sound like me at all either 🤔 (e.g. I’m rarely sleepy or lethargic, and can never take naps or go to sleep easily).
i believe he uploaded a video that talked about anemia and adhd? any have that link?
Another Amazing Video! Thank you. 🇦🇺👴🏻
I am curious. I was diagnosed as a teenager and re diagnosed a few years ago. I was without medication and relying mostly on tobacco and coping mechanisms. When I quit smoking and went though several weeks of extreme stress I began having blackouts and short bursts of amnesia. I finally have medication again and seem to be do far far better. Have you ever heard of this before?
@russellbarkleyphd2023
Dr. Barkley,
Thanks for making this long overdue video. These three DSM-5 subtypes have always been a big source of confusion for me. Now I finally get it! Why couldn't someone else have just said that? :)
8:08
ADHD is one thing!
I want to get diagnosed so badly but I just dont know what exactly it is that I have, and the waters seem so muddy and I don't know if I have enough fsith in the system to diagnose me properly (I'm in the UK, mental health and psychiatric care sucks here... NHS care takes years on waiting lists and private clinics only want your money). Its really getting me down because whatever is wrong with me it has had/has a really significant impact on my life 😔 but I'm getting so tired of it 😔
I've done deep dives on ADHD, CDS, ASD, AvPD... these tick the most boxes for me but I none of them explain everything, and sometimes I have contradictory things that suggest it can't be this or that. My depression is getting so bad now and I'm just so unbelievably fed up with living like this 😔 I wonder if I was to get.properly diagnosed would anyrhing actually chanhe... maybe medication would help me, but if it doesnt, then what? It feels so hopeless. I'd give it a go but I just dont know where to start. ADHD with CDS ticks an awful lot of boxes for me, I think, but psychiatrists dont even agree on CDS being a real thing and I'm pretty sure the NHS doesn't acknowledge it... so whats the point? 😅 I just dont know what to do.
Hyperactivity and impulsiveness were screamed out of me as a young boy. I jump 10 feet when my mom yells my name. (Have some pitty she has ADHD too, and teachers screamed at me too. They have no excuse)
My mum didn't get diagnosed until after I did, and I was 40. She'd come into my room, yelling about me not tidying it up, sitting there doing nothing and what not, even though I had been engaged in something, usually reading. I still feel 'antsy' any time I'm relaxing with a hobby, especially if there's mess around.
Also, some of those teachers may have also had ADHD. If they were undiagnosed, I have similar sympathy for them. Even diagnosed, I struggle to rein in my temper some days. The thought of trying to manage a classroom full of kids fills me with dread.
Can you please help me with something? It's a big ask but please I'm helpless. My father doesn't understand what ADHD is. He found videos online that ADHD is not real. I'm capable. I'm smart. Until 12 I had aced all the tests in school. I'm in a rut now. My father thinks stimulant medications have side effects. I want to go abroad, use medication and study. Can you please make a video explaining why medication is important and how ADHD symptoms affect someone's life? Please Dr Russell.
I'm having the same problem with my husband. My son has ADHD and his doctor diagnosed him since he was a child but my husband never believed in that and refused to give him any medication. Now my son is 20 and has many problems. Depression, anger, mood swing...
interestingly I was diagnosed as ADD as a kid simply because I'm just low energy in general so my hyper activity was not presenting obviously. meanwhile I still get in trouble for bumping my leg up and down.
So if someone maxes out the Inattention symptoms, none or very mild hyperactive symptoms, then it’s CDS?
Basically, yes. You might want to watch Barkley's other lectures on the topic in order to get a full picture.
My programmer instinct started tingling here: if you make 3 categories but real world data does not fit neatly in those, you might need different abstractions: either less categories or a lot more. With less categories you might lose expressivity: "You have ADHD." "Okay but she and I have totally different symptoms!" With more you are going to be more accurate, but less easily marketable: "You have EDS, inattentivity, executive function problems and 16 others." "Uh oh, doctor, maybe."
I work with 'I have ADHD, and it causes x y and z in me. Other people with ADHD will present differently, but that can be due to genetics, environment, medications and factors we're not even aware of yet.'
What about the fMRIs?
My guess is there no consensus from psychologists on this subject
I'm learning about ADHD and am confused about combined presentation diagnosis. Here is my current understanding:
- A person with 5 inattentive and 0 hyperactive symptoms meets the requirements for a potential "inattentive presentation ADHD" diagnosis.
- A person with 0 inattentive and 5 hyperactive symptoms meets the requirements for a potential "hyperactive presentation ADHD" diagnosis.
- A person with 5 inattentive and 5 hyperactive symptoms meets the requirements for a potential "combined presentation ADHD" diagnosis.
- A person with 4 inattentive and 4 hyperactive symptoms does not meet any presentation requirements and does not meet the requirements for any ADHD diagnosis.
Is this true? The last person with a total of 8 ADHD symptoms does not meet the DSM requirements? Just making sure I understand how this is supposed to work.
If you substitute 4 or less for the zeros above, then your understanding is correct. The diagnosis of the presentations does not require that one symptom dimension be zero when the other is five or vice versa. Just that it be 4 or less. And, yes, someone with 8 total symptoms may not technically qualify for the diagnosis but if they experience impairment in major life activities and score above the 93rd percentile on an ADHD rating scale, we encourage clinicians to diagnose them anyway. It is, after all, a dimensional not a categorical disorder. Be well.
@@russellbarkleyphd2023 Thank you very much! I used 0 as an example to highlight the fact that someone with 5 total symptoms may meet the requirements, but someone with 8 total symptoms may not. But like you clarified, there is more to the diagnosis than these symptom categories. Thanks!
Based on the content in your video, I wonder if a future DSM will simply combine the two lists for diagnosis purposes, but keep a loose categorization/separation of symptoms purely for distinction of presentations (which may still be useful to understand the patient's difficulties or suggest treatment options/strategies).
According to CHADD 11% of children have ADHD. Keith Conners, father of ADHD, estimated real diagnosis rate in kids at 2-3%.
US rate of 11% caused by:
1) Pharma pill pushing
2) Careless docs
3) Worried parents
4) Harried teachers
5) Marketing
6) Advertising campaigns - Ty Pennington Adam Levine. It is cool and de rigeur to have ADHD. Well it isn't.
How on earth can something jump from 3% in 1980, which I would count as a fair diagnosis rate, to 11% in 2010 and higher now? When the DSM says 5%? I could even accept 5%. Children's brains haven't changed since 1980. A 6 year old boy or girl in 1980 behaves the same as today. @@russellbarkleyphd2023
I've always felt like the hyperactivity aspect of my ADHD is more of an impulse control issue. It's why I NEVER drink alcohol. 😅
I think there should be a fourth sub-category: People diagnosed with ADHD-I that are on the autistic spectrum ("high-functioning", high-masking individuals). Overlaps between boths disorders are considerable, AuDHD people do benefit from ADHD meds, too.
Why do medical records record the presentation as your official diagnostic code for insurance, etc. considering your presentation can change (even throughout the month especially for women)?
Also, we need to treat ADHD as a neurological illness and not a psychological. We don't do this Parkinson and we shouldn't do it with ADHD.
Of course we need psychological support cause it effects our behavior and well beeing.
The hardest part of my diagnosis at 40 was the realisation that my 'limitations' weren't going away. The diagnosis definitely helped, but it didn't fix much. Meds helped, too.
I just turned 30 and I feel like I have gotten more hyperactive.
If It’s not Types, then it must be Severity.
❤❤❤
In my opinion...ADHD is a spectrum like autism...as i fit in few criterias but my son has the most of the symptoms
🙏💜💜💜💜💜💜💜🙏🙏🙏
You should advertise this video with one of those horribly stupid instagram ads about “what adhd type are you” and a cartoon of a brain with “ring of fire” and etc. Those are infuriating. If you click they don’t even give you a quiz that tells you where you fit in their ridiculous imaginary typology. I
hates themmmmmmm!
It's bullshit. I've seen adverts saying Ring of Fire ADHD. Perhaps Johnny Cash had it or now if you are shy and suffer from social anxiety you have it. I blame Instagram and Tiktok for this. Diluting what it really is. It is making a mockery of it all.
First commenter! 😊
🏆
Beat me by mere seconds!
@@nnylasoR I'm late as usual but lets fight about it and get thrown out of class lol.
Did he lose his password to the account with the big lectures?
What do you think of Dr. Amens 7 types of ADD/ADHD. Do you find any validity to those claims? He states there are 7 different types of ADD and according to activity in the brain, you can categorize people in those subtypes.
I dont know dr barkleys opinion on the man, but I do quite like Dr. Amens seven types. I identify very much with type 3 overfocused.
I can substantiate my view that "ADHD" is neither 'genetic' nor a 'disorder' nor an "attention deficit'. I'm sure, many of the adult ADHD 'suffferers' would raise their hand. 1000s of comments can't be wrong. Russ has given true value to the community but it is time to move on. We gotta help those who have the potential to be outstanding but have not been able to execute their potential.
"Type" or "presentation", who cares, it's just semantics.
Stop tossin' and learn to meditate.
Based.