Combined ADHD
Students with combined type have both inattentive traits and hyperactive-impulsive traits. This is the most common ADHD presentation.
What is ADHD Combined Type?
ADHD Combined Type means that a child or teen meets criteria for both inattentive symptoms and hyperactive-impulsive symptoms.
Students with combined type may struggle to pay attention and stay organized, while also being restless, talkative, and impulsive. Because they display challenges from both groups, combined type often impacts school, home, and social life more noticeably.
How Common is ADHD Combined Type?
In the United States, ADHD affects about 9–10% of children ages 4–17 [1].
The most common ADHD presentation in children and teens is the Combined Type. Estimates vary slightly, but studies report [2][3]:
- 60-70% Combined Type
- 20-30% Inattentive Type
- 10-15% Hyperactive-Impulsive Type
The majority of kids diagnosed with ADHD show a mix of both inattentive and hyperactive traits.
ADHD Factors
Parents often wonder "Where did this come from?" when their child is diagnosed with ADHD. The truth is, ADHD has multiple contributing factors, most of them biological and outside of anyone's control. Understanding these factors can help parents move past guilt and focus on support.
Research points to several influences that increase the likelihood of ADHD:
- Genetics: ADHD tends to run in families, with heritability estimated at 70–80% [4].
- Brain development: Differences in brain regions linked to attention and self-control, such as the prefrontal cortex and basal ganglia, are often seen in ADHD [5].
- Prenatal and birth factors: Premature birth, low birth weight, and prenatal exposure to alcohol, nicotine, or lead increase risk [6].
- Environmental influences: While not direct causes, stress, sleep problems, or inconsistent structure can make symptoms worse [7].
Every student's ADHD looks different. Coaching adapts to their mix of challenges, whether it's focus, energy, or both.
Coach Tanika
Every student's ADHD looks different. Coaching adapts to their mix of challenges, whether it's focus, energy, or both.
Common ADHD Myths
Parents often hear misleading explanations for ADHD. Here's what the science says:
"Sugar causes ADHD."
Sugar may affect short-term energy, but studies show it does not cause ADHD [8].
"Bad parenting is to blame."
ADHD is a neurodevelopmental condition. Parenting style doesn't cause ADHD, though structure and support help manage it [4].
"ADHD isn't real; kids just need discipline."
ADHD is recognized by the DSM-5 and backed by decades of research. It reflects real differences in brain functioning, not poor behavior [5].
"Kids outgrow ADHD."
Symptoms often shift with age, but ADHD persists into adulthood for 60–70% of individuals diagnosed in childhood [9].
Treatment Approaches
There's no one-size-fits-all treatment for ADHD. The best results often come from a combination of approaches that address both inattentive and hyperactive-impulsive symptoms.
Medication
Stimulant and non-stimulant medications are among the most researched treatments for ADHD. They can reduce core symptoms such as inattention, restlessness, and impulsivity, making it easier for children to benefit from other supports [10].
Cognitive Behavioral Therapy (CBT)
CBT helps children and teens with ADHD build skills to manage impulsivity, regulate emotions, and improve problem-solving. It focuses on identifying unhelpful thought patterns and practicing healthier responses. For many families, CBT is most effective when paired with parent involvement and school support [11].
Lifestyle Adjustments
Research shows that regular sleep, healthy nutrition, and consistent physical activity (especially aerobic and coordination exercises) improve focus and behavior [7].
Coaching
ADHD coaches work directly with students to turn daily challenges into manageable steps. Through daily check-ins, accountability, and skill-building, coaching helps students practice the organization, planning, and self-regulation that medication alone cannot teach.
What Coaching Can Help With
Combined type ADHD affects both focus and impulse control. Coaching gives students practical support for each challenge.
AtHome
Creating structure
Daily routines and time management to reduce overwhelm and keep schoolwork on track.
Breaking tasks into steps
Big assignments become manageable with small, clear actions students can actually follow through on.
Following through
Regular check-ins and accountability to help students finish what they start.
Managing energy
When to move, when to rest, and how to use physical activity to improve focus.
AtSchool
Remembering assignments
Tools and systems to track what's due, so deadlines don't sneak up.
Building emotional awareness
Recognizing frustration early and practicing responses before emotions take over.
Practicing "pause and wait"
Skills to slow down, think before acting, and reduce impulsive choices.
Finding what works
Trying different strategies, tracking what helps, and adjusting along the way.
ADHD Coaching
Children with combined type need steady support across both attention and behavior. A coach helps by:
Coach Micah
I partner with students so they don’t feel alone in their struggles. Together, we find ways to turn restless energy into steady progress.
“Highly recommend for any parent navigating ADHD with their teen”
“Coachbit has been a game-changer for our son with ADHD. It’s helped him build consistent routines for school and home. Something we struggled with for years. The daily check-ins and structure support his executive function skills in a way that actually sticks. He’s more organized, motivated, and confident. Highly recommend for any parent navigating ADHD with their teen!”
DSM-5 Diagnostic Criteria
Symptoms of: Hyperactive-Impulsive Type
- Often fidgets with or taps hands or feet, or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is inappropriate (in adolescents or adults, may be limited to feeling restless)
- Often unable to play or engage in leisure activities quietly
- Is often "on the go," acting as if "driven by a motor"
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has difficulty waiting their turn
- Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people's things without asking)
Symptoms of: Inattention Type
- Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- Often has difficulty sustaining attention in tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties.
- Often has difficulty organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.
- Often loses things necessary for tasks or activities (e.g., schoolwork, pencils, books).
- Is often easily distracted by extraneous stimuli.
- Is often forgetful in daily activities.
ADHD Screening Assessment
Wondering if your child may have Combined Type ADHD?
Our research-backed assessment uses the Conners-4®, a gold-standard tool trusted by psychologists and pediatricians worldwide.
Designed for children and teens ages 6 to 18, the assessment is conducted by our in-house psychometrist. You'll receive a detailed report that provides a clear picture you can share with your doctor or school.
References
[1] Centers for Disease Control and Prevention. (2019). Data & Statistics on ADHD. National Center on Birth Defects and Developmental Disabilities. Retrieved from https://www.cdc.gov/adhd/data
[2] Barkley, R. A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (4th ed.). Guilford Press.
[3] Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490–499. https://doi.org/10.1007/s13311-012-0135-8
[4] Faraone, S. V., & Doyle, A. E. (2001). The nature and heritability of attention-deficit/hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America, 10(2), 299–316.
[5] Shaw, P., et al. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences, 104(49), 19649–19654.
[6] Banerjee, T. D., Middleton, F., & Faraone, S. V. (2007). Environmental risk factors for ADHD. Acta Paediatrica, 96(9), 1269–1274.
[7] Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). Practitioner review: What have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry, 54(1), 3–16.
[8] Wolraich, M. L., Wilson, D. B., & White, J. W. (1995). The effect of sugar on behavior or cognition in children. JAMA, 274(20), 1617–1621.
[9] Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood. Journal of Abnormal Psychology, 111(2), 279–289.
[10] Banaschewski, T., et al. (2018). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 4(1), 18020.
[11] Antshel, K. M., & Barkley, R. A. (2008). Cognitive behavioral therapy for attention-deficit/hyperactivity disorder in children and adolescents: A review. Child and Adolescent Psychiatric Clinics of North America, 17(2), 421–437.
[12] DuPaul, G. J., & Stoner, G. (2014). ADHD in the Schools: Assessment and Intervention Strategies (3rd ed.). Guilford Press.
[13] Chronis-Tuscano, A., Clarke, T. L., O'Brien, K. A., et al. (2016). Integrated treatment targeting parenting and emotion regulation in families of children with ADHD. Cognitive and Behavioral Practice, 23(4), 443–459.
[14] Gapin, J. I., Labban, J. D., & Etnier, J. L. (2011). The effects of physical activity on attention deficit hyperactivity disorder symptoms: The evidence. Preventive Medicine, 52(S1), S70–S74.