There are three presentations of attention-deficit hyperactivity disorder (ADHD) recognised in the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5TM):1
- Predominantly inattentive
- Predominantly hyperactive-impulsive
- Combined inattentive-hyperactive-impulsive.
Rates of ADHD presentations vary across studies.2-5 A worldwide meta-analysis of 86 studies in children and adolescents and 11 studies in adults indicated that the predominantly inattentive type of ADHD was the most common subtype in all samples, with the exception of pre-school children, in whom predominantly hyperactive-impulsive type was the most common (Figure).2*
The prevalence of ADHD presentations changes with patient age, according to preliminary evidence from a cross-sectional meta-analysis of 97 studies (n=175,800). Reproduced with kind permission.2
Other investigations have reported different ADHD presentation prevalence in children and adolescents:
- A study of 413 clinically referred children and adolescents with ADHD reported that 61% of participants were combined type, 30% were inattentive type and 9% were hyperactive-impulsive type.3
A US study recruited 107 clinically referred adult outpatients (aged 18–55 years) with ADHD and used structured interviews to determine ADHD presentation. Results indicated that 62% of the adults were combined type, 31% were inattentive type and 7% were hyperactive-impulsive type ADHD.5
Data obtained from clinically referred patients typically include a higher proportion of combined inattentive-hyperactive-impulsive individuals. It has been proposed that people meeting criteria for combined type ADHD may be more likely to be referred for clinical services.2
*These studies were conducted prior to publication of the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5TM)
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
- Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012; 9: 490-499.
- Faraone SV, Biederman J, Weber W, et al. Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: results from a clinically referred sample. J Am Acad Child Adolesc Psychiatry 1998; 37: 185-193.
- Gaub M, Carlson CL. Behavioral characteristics of DSM-IV ADHD subtypes in a school-based population. J Abnorm Child Psychol 1997; 25: 103-111.
- Wilens TE, Biederman J, Faraone SV, et al. Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. J Clin Psychiatry 2009; 70: 1557-1562.