I just read some of Amyleigh's thread and it brought up something that I'm wondering about. I didn't want to hijack her thread so I thought I'd start my own. Thanks, Amy. :)

Okay, so they classify impulsivity and inattention into two different categories, right? But I noticed they lump impulsivity and hyperactivity together. This confuses me.

I've never been hyperactive. Ever. In fact, sometimes I wish I had just a touch of it because basically I'm like a slug who finds a warm, comfy blanket, and never wants to leave if I'm left to my own devices.

But on the other hand, I am regularly impulsive. I make decisions on the spur of the moment. And usually to my own detriment. And I'm talking big problems with impulsivity. Like, I'm very ashamed to admit this, but I did go through quite a phase of promiscuity. (I'm not ready to go into any details about this yet, so please don't ask, but I'm trying to make a point). And one day I say I'm going to do something, and the next I change my mind. Or I change my mind 25 times a day. It's entirely frustrating.

But I also know that I'm hugely inattentive. In a great, great number of ways.

I'm pretty positive that I got diagnosed with ADD-Inattentive. But here is where my confusion lies. If I'm not hyperactive AT ALL, would I still qualify as ADD hyperactive/impulsive, due to my impulsivity? Or does my lack of hyperactivity completely disqualify me from that diagnosis?

When I got diagnosed last week, my psychiatrist did not mention any subclass. She just told me that I have ADD. I plan to ask her at my upcoming appointment in a few weeks, but that's a long time away and I'd like to hear your thoughts.

Ya'll seem very knowledgeable. :) What do you think?

hi lynette,

the primarily hyper/impulsive subtype is unbelievably rare in adults....like...less than 2% i think. so you're probably not that. you could well be like the vast majority of adhd people and be 'combined', which means you meet criteria in both sets of symptoms..the inattentive ones and the h/i ones. that's what the majority of adhd people are.

also, it's a myth that hyper=super energy all of the time, too. i still have considerable hyperactivity as an adult and it looks different than as a kid. well...i'd like to think it does mostly:o what i mean is that i'm not completely physically out of control all of the time. i also oscillate between being physically very still and mentally hyperactive (which appears to others like i'm just totally zoned out) because i'm caught up in the maelstrom of internal bombardment of thoughts i'm trying to make sense of/organize/navigate and being incapable of sitting still and moving, moving, moving and being bombarded by external stimuli. in both cases i react to whatever crops up...impulsively. on medication that's semi-balanced to just tend to get spacey/scattered and be overall extremely fidgety.

the upshot here is that the inattentive symptoms are things most people with hyper/impulsive symptoms have as well (as an example, i meet all of the inattentive criteria as well as the h/i ones). that's what 98+% of us have in common. with being combined vs. primarily inattentive...of course your doctor will be able to tell you given your personal medical history...but i'd suggest that your impulsivity (promiscuity is one expression of that) points to combined.

do you fidget or tap or need something to fiddle with, especially when you're expected to sit or pay attention to something? do you seem to have millions of thoughts to sort through in general? or, like, do you skip from thought to thought to thought, sometimes without forming any fully?

i do all of those things and they're expressions of the 'h' ;)

I'm combined and I have to definitions for my impulsiveness.
One is the spontaneous, giving little thought about what I say, do or purchase. There's also an impulsiveness or compulsion to eat too much.
The second one is the inattentive kind where I'm not bothered enough to think about the consequences of something, but it doesn't happen as quickly as it would when I have a hyperactive day.

Peri, I found your response to be EXTREMELY helpful. I never thought about "mental hyperactivity" before. And that fits me to a T. My body may never move, but my mind never stops!!!

And it's funny that you asked me if I fidget all the time, because at the exact moment that I read that, my foot was tapping a mile a minute! :D And yes, yes, my own thoughts bombard me one after the other! It's ridiculous! And it's enlightening to know that those are attributable to hyperactivity.

Thank you so much! You really have taught me a lot!

I'm combined and I have to definitions for my impulsiveness.
One is the spontaneous, giving little thought about what I say, do or purchase. There's also an impulsiveness or compulsion to eat too much.
The second one is the inattentive kind where I'm not bothered enough to think about the consequences of something, but it doesn't happen as quickly as it would when I have a hyperactive day.

Fractured, I can definitely relate to the spontaneous purchasing and overeating, as well as the inattentive thing.

It is all making sense to me. Thank you!

thanks and you're most welcome; glad to be of help:D

since you saw yourself so much in what i wrote in that last paragraph i have one further suggestion:

i know there are many, many other things that hyperactivity presents as and i just cited the ones i recall that pertain to me. ginnie posted a much longer list once and i might be of interest to you to see the fullest version. she's a friendly sort, so you might want to ask her if she can point you to the post or source of the list.

best wishes:)

Also, it's not unusual for people with the predominantly inattentive type to have 1 or 2 hyperactive/impulsive traits. I'm ADHD-PI, but I figit a LOT (leg constantly bouncing up and down, etc). The hyperactive/impulsive aspect of ADHD requires a number of such traits and there are some people diagnosed with ADHD-PI simply because their hyperactive/impulsive traits don't reach the required DSM-IV criteria.

Another thought I had was that impulsiveness can have a lot of different causes. It's possible, for example, for a person with ADHD-PI to be impulsive for some reason other than the usual ADHD-related reasons.

I'm one of those Inattentive but impulsive ones, but this means I'm technically combined. I score 8/9 for inattention, 3/3 for impulsivity but 3/6 (I think, it was half anyway) for hyperactivity, and I know that was just that I fidget a fair bit and my mind is quite "hyper"

I think it's because if you are really hyperactive you are impulsive too, but it doesn't work the other way round so you can be inattentive and impulsive but not hyperactive, but you can't be hyperactive without a fair amount of impulsivity, unless someone out there can prove me wrong?

Also, it's not unusual for people with the predominantly inattentive type to have 1 or 2 hyperactive/impulsive traits. I'm ADHD-PI, but I figit a LOT (leg constantly bouncing up and down, etc). The hyperactive/impulsive aspect of ADHD requires a number of such traits and there are some people diagnosed with ADHD-PI simply because their hyperactive/impulsive traits don't reach the required DSM-IV criteria.

Another thought I had was that impulsiveness can have a lot of different causes. It's possible, for example, for a person with ADHD-PI to be impulsive for some reason other than the usual ADHD-related reasons.

I think it's possible for PI to have up to five h/i symptoms.

I think it's possible for PI to have up to five h/i symptoms.

I'm just out of the PI then :D

I'm externally reacting hyperactive. What this means to me is that I'm not really aware of my body and simply react. When I'm at home alone, I'm like a slug, I can sit for hours in the same position unaware. When I'm with friends and doing something active like sports, I can go and go for hours because I forget about my body. Then I come home and pass out on the sofa.
I think the problem is many people including me relate hyperactivity to someone like Ty Pennington and people doing mountain biking, climbing mountains etc.

Also I think that the more inattentive you are, the more energy you spend on going through your day, and you deplete more energy and don't have enough left over to go running or bouncing about. Too tired to be hyperactive.

I'm hyperactive and hypoactive. Never in between.

I'm just out of the PI then :D

The DSM-V guidelines for adults are even less stringent: 4 hyperactive/impulsive and/or 4 inattentive symptoms. Plus there are four more h/i symptoms added to the list. So under that list I seem to have three more h/i than I have now.

Also I think that the more inattentive you are, the more energy you spend on going through your day, and you deplete more energy and don't have enough left over to go running or bouncing about. Too tired to be hyperactive.

I am glad you said this because it put something I've been struggling with into words.

The DSM-V guidelines for adults are even less stringent: 4 hyperactive/impulsive and/or 4 inattentive symptoms. Plus there are four more h/i symptoms added to the list. So under that list I seem to have three more h/i than I have now.

Hey do you know what they are? I can't seem to find them :/ I'm probably just not searching right :)

Hey do you know what they are? I can't seem to find them :/ I'm probably just not searching right :)

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=383#


Diagnostic Criteria for Attention Deficit/Hyperactivity Disorder

The disorder consists of a characteristic pattern of behavior and cognitive functioning that is present in different settings where it gives rise to social and educational or work performance difficulties. The manifestations of the disorder and the difficulties that they cause are subject to gradual change being typically more marked during times when the person is studying or working and lessening during vacation.
Superimposed on these short-term changes are trends that may signal some deterioration or improvement with many symptoms becoming less common in adolescence. Although irritable outbursts are common, abrupt changes in mood lasting for days or longer are not characteristic of ADHD and will usually be a manifestation of some other distinct disorder.
In children and young adolescents, the diagnosis should be based on information obtained from parents and teachers. When direct teacher reports cannot be obtained, weight should be given to information provided to parents by teachers that describe the child’s behavior and performance at school. Examination of the patient in the clinician’s office may or may not be informative. For older adolescents and adults, confirmatory observations by third parties should be obtained whenever possible.

A. Either (1) and/or (2).
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities. Note: for older adolescents and adults (ages 17 and older), only 4 symptoms are required. The symptoms are not due to oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.
(a) Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (for example, overlooks or misses details, work is inaccurate).
(b) Often has difficulty sustaining attention in tasks or play activities (for example, has difficulty remaining focused during lectures, conversations, or reading lengthy writings).
(c) Often does not seem to listen when spoken to directly (mind seems elsewhere, even in the absence of any obvious distraction).
(d) Frequently does not follow through on instructions (starts tasks but quickly loses focus and is easily sidetracked, fails to finish schoolwork, household chores, or tasks in the workplace).
(e) Often has difficulty organizing tasks and activities. (Has difficulty managing sequential tasks and keeping materials and belongings in order. Work is messy and disorganized. Has poor time management and tends to fail to meet deadlines.)
(f) Characteristically avoids, seems to dislike, and is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework or, for older adolescents and adults, preparing reports, completing forms, or reviewing lengthy papers).
(g) Frequently loses objects necessary for tasks or activities (e.g., school assignments, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile telephones).
(h) Is often easily distracted by extraneous stimuli. (for older adolescents and adults may include unrelated thoughts.).
(i) Is often forgetful in daily activities, chores, and running errands (for older adolescents and adults, returning calls, paying bills, and keeping appointments).
2. Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities. Note: for older adolescents and adults (ages 17 and older), only 4 symptoms are required. The symptoms are not due to oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.
(a) Often fidgets or taps hands or feet or squirms in seat.
(b) Is often restless during activities when others are seated (may leave his or her place in the classroom, office or other workplace, or in other situations that require remaining seated).
(c) Often runs about or climbs on furniture and moves excessively in inappropriate situations. In adolescents or adults, may be limited to feeling restless or confined.
(d) Is often excessively loud or noisy during play, leisure, or social activities.
(e) Is often “on the go,” acting as if “driven by a motor.” Is uncomfortable being still for an extended time, as in restaurants, meetings, etc. Seen by others as beingrestless and difficult to keep up with.
(f) Often talks excessively.
(g) Often blurts out an answer before a question has been completed. Older adolescents or adults may complete people’s sentences and “jump the gun” in conversations.
(h) Has difficulty waiting his or her turn or waiting in line.
(i) Often interrupts or intrudes on others (frequently butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission, adolescents or adults may intrude into or take over what others are doing).
(j) Tends to act without thinking, such asstarting tasks without adequate preparation or avoiding reading or listening to instructions. May speak out without considering consequences or make important decisions on the spur of the moment, such as impulsively buying items, suddenly quitting a job, or breaking up with a friend.
(k) Is often impatient, as shown by feeling restless when waiting for others and wanting to move faster than others, wanting people to get to the point, speeding while driving, and cutting into traffic to go faster than others.
(l) Is uncomfortable doing things slowly and systematically and often rushes through activities or tasks.
(m) Finds it difficult to resist temptations or opportunities, even if it means taking risks (A child may grab toys off a store shelf or play with dangerous objects; adults may commit to a relationship after only a brief acquaintance or take a job or enter into a business arrangement without doing due diligence).
B. Several noticeable inattentive or hyperactive-impulsive symptoms were present by age 12.
C. The symptoms are apparent in two or more settings (e.g., at home, school or work, with friends or relatives, or in other activities).
D. There must be clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Specify Based on Current Presentation
Combined Presentation: If both Criterion A1 (Inattention) and Criterion A2 (Hyperactivity-Impulsivity) are met for the past 6 months.
Predominately Inattentive Presentation: If Criterion A1 (Inattention) is met but Criterion A2 (Hyperactivity-Impulsivity) is not met and 3 or more symptoms from Criterion A2 have been present for the past 6 months.
Predominately Hyperactive/Impulsive Presentation: If Criterion A2 (Hyperactivity-Impulsivity) is met and Criterion A1 (Inattention) is not met for the past 6 months.
Inattentive Presentation (Restrictive): If Criterion A1 (Inattention) is met but no more than 2 symptoms from Criterion A2 (Hyperactivity-Impulsivity) have been present for the past 6 months.

Oh thanks very much! From that it seems I have 8 out of 13 Hyperactive/Impulsive and 8 out of 9 Inattentive. I'm not well versed on what it is in DSM-IV is it? Well apart from the age it has to appear by (wasn't it about 6 or 7 before?) and is there now a distinction between ADHD in adults and children?

DSM-IV criteria:


DSM-IV Diagnostic Criteria for ADHD

The year 2000 Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) provides criteria for diagnosing ADHD.

The year 2000 Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR) provides criteria for diagnosing ADHD. The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained health care providers to diagnose or treat ADHD.
DSM-IV Criteria for ADHD
I. Either A or B:


Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

Inattention


Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
Is often easily distracted.
Is often forgetful in daily activities.



Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Hyperactivity


Often fidgets with hands or feet or squirms in seat.
Often gets up from seat when remaining in seat is expected.
Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
Often has trouble playing or enjoying leisure activities quietly.
Is often "on the go" or often acts as if "driven by a motor".
Often talks excessively.

Impulsivity


Often blurts out answers before questions have been finished.
Often has trouble waiting one's turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games).



Some symptoms that cause impairment were present before age 7 years.
Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
There must be clear evidence of significant impairment in social, school, or work functioning.
The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Based on these criteria, three types of ADHD are identified:


ADHD, Combined Type: if both criteria 1A and 1B are met for the past 6 months
ADHD, Predominantly Inattentive Type: if criterion 1A is met but criterion 1B is not met for the past six months
ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion 1B is met but Criterion 1A is not met for the past six months.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

For the record, I have 8-9 of inattentive in both lists, and 6 h/i in the DSM-IV list.

In the DSM-V list, I have 10 h/i, I think.