The DSM-V indicates that there are three presentations of ADHD:
- Predominantly Hyperactive/Impulsive presentation
- Predominantly Inattentive presentation
- Combined presentation
These presentations manifest themselves in different problem areas, and are associated with varying levels of difficulty. For example, a child with the Predominantly Inattentive presentation (commonly referred to as A.D.D) experiences difficulty with tasks that require focusing and maintaining attention to detail or following instructions. Forgetfulness, being easily distracted, and having trouble organising and following instructions are all characteristics of Predominantly Inattentive presentation that disrupt daily activity.
Children with the Predominantly Hyperactive/Impulsive presentation,are characterised as displaying the following hyperactive behaviour patterns: fidgeting, running about at inappropriate times, talking excessively, and having trouble enjoying leisure activities quietly. Individuals with Predominantly Hyperactive/Impulsive presentation, also experience problems related to impulsivity that can be manifested as blurting out answers or interrupting conversations. These characteristics affect behaviour in various social settings and are disruptive and inappropriate for the individual’s developmental level. Such problems may result in the individual being more at risk of injury or accidents due to impulsive actions. For example, a child may dash across a road without checking for traffic.
Children with the Combined presentation. experience an assortment of traits from both of the other ADHD presentations. Therefore, they are more prone to problems rooted in both presentations. Research focusing on the validity of the ADHD subtypes found children with the Combined presentation to have more externalizing behaviour problems (e.g., aggression, delinquency, and hyperactivity), and a higher level of functional impairment in social and scholastic domains, than children with the other presentations of ADHD.
Clearly, it is important for researchers and clinicians to distinguish between the three subtypes when evaluating family systems, as the behaviours and problems typical of each subtype could affect the child and family differently. Unfortunately, most ADHD research studies have not discriminated between diagnostic subtypes.