This article describes the three presentations of ADHD: Inattentive, Hyperactive-Impulsive, and Combined. It also introduces the concept of Sluggish Cognitive Tempo (SCT).
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the "Single Source of Truth" for diagnostic classification. The newest version, published in 2013 by the American Psychiatric Association, outlines three primary presentations of Attention-Deficit/Hyperactivity Disorder (ADHD: formerly known as ADD):
Three Presentations of ADHD
1. Inattentive ADHD Presentation
2. Hyperactive-Impulsive ADHD Presentation
3. Combined ADHD Presentation
(4). Sluggish Cognitive Tempo (SCT)
There is another related diagnosis that is being researched and shows great promise in terms of eventually becoming an official diagnosis in future versions of the DSM: Sluggish Cognitive Tempo. I'll describe all four diagnoses below.
1. Inattentive Presentation ADHD
You know the kid who stares out the window of the classroom and never quite turns their assignments in on time? Or the adult who chronically loses keys, misplaces their phone, and has four sets of glasses because they can't locate their pair and keep buying replacements? That's the Inattentive presentation of ADHD.
"Inattentive ADHD put simply, means your brain is rubbish at choosing what you focus on. It’s the daydreaming type of ADHD, not the can’t-sit-still type. It’s not that you can’t focus at all. You can focus alright, just not always on what you need to focus on." - Tim Beshara
Some of the most common symptoms of the Inattentive presentation of ADHD are poor attention to details, unintentionally tuning people out when spoken to, lack of follow-through, and being forgetful. The Inattentive presentation of ADHD is more common in females and tends to be the least diagnosed type. Often children with this type fall through the cracks of the school system because they don't display the types of behaviors that bring them into the spotlight of teachers.
2. Hyperactive-Impulsive Presentation ADHD
The Hyperactive presentation of ADHD is the kid in class who is constantly in motion- fidgeting, leaving their seat to whisper to friends, and is impatient for his or her turn in games. This type is what most people think of when they hear the term "ADHD."
"I was a hyper kid so I didn't want to play baseball and wait for the ball to come to me, I wanted to play a sport where I could go to the ball."- Former Celtic Player Shane Larkin
Some common symptoms of the Hyperactive presentation of ADHD are not being able to sit still, being difficult to keep up with, and interrupting others frequently. This is the second most common presentation of ADHD, and it is more frequently diagnosed in boys than in girls. Unlike kids with Inattentive ADHD, kids with Hyperactive ADHD are often in the spotlight at school because they have difficulty following classroom rules. It can be difficult at times to tell the difference between someone with the Hyperactive presentation and someone with Oppositional Defiant Disorder (ODD).
3. Combined Presentation ADHD
Not surprisingly, ADHD, Combined presentation is a combination of symptoms of the Inattentive Type and the Hyperactive Type. This is the most common presentation of ADHD and features aspects of hyperactivity such as impulsivity and restlessness as well as aspects of inattentiveness such as difficulty sustaining focus and disorganization.
(4). Sluggish Cognitive Tempo
Sluggish Cognitive Tempo (or SCT) is an emerging and somewhat controversial potential related diagnosis of ADHD. Even the name is hotly debated- many see it as pejorative (I agree) and prefer the moniker Concentration Deficit Disorder (CDD). Russell Barkley, a well-respected ADHD researcher, believes that this is the fourth type of ADHD (or a separate diagnosis entirely) and he created a scale to measure it. It is characterized by drowsiness, daydreaming, and lack of energy. Only time (and research) will tell if there is enough evidence to give this diagnostic validity.