ADHD Subtypes

A recent study published in JAMA Psychiatry suggests that there are three core types of ADHD, those groups delineated by both behavior and brain scan markers.

The searchers analyzed 1,154 brain scans of children and adolescents, then grouped them according to their neurological profiles. In doing so they discovered that alongside the existing two main ADHD categories used for diagnosis purposes—predominantly inattentive and predominantly hyperactive and/or impulsive—there’s also a third ADHD subtype that seems to be defined by emotional dysregulation and/or difficulty responding to emotions in a controlled manner.

That latter category of symptoms, oriented around emotions and a significant difficulty managing them, has long been associated with ADHD, but hasn’t previously been branched off into its own category. The researchers found that this third subtype stands apart from the other two even more than they stand apart from each other; the brains of those who fit into this third ADHD category have 45 abnormal areas that show up in brain imaging, while those in the other two categories only have 26.

Those abnormal areas are in parts of the brain related to mood management and the regulation of emotional responses and motivation. It’s suspected this is why people with category three ADHD display their subset of symptoms: emotional regulation is just a lot more difficult for them because of how their brains are set up.

There are existing labels for people who suffer this kind of dysregulation, including disruptive mood dysregulation disorder, or DMDD, and oppositional defiant disorder. But many doctors are hesitant to apply these labels because they can be stigmatizing, especially for children.

Many of the children who might have diagnostically fit within those categories, though, may also fit well within this new ADHD category, which could make diagnosis and treatment easier, considering that ADHD diagnoses are pretty common these days (one in nine US children have been thus diagnoses), and because there are several common and attainable treatments for those with ADHD (compared to those who have those other labels).

There’s some evidence that stimulant treatments like Adderall and Vyvanse might not be as effective for people who fall into this third ADHD category, because of how their symptoms manifest. That said, there’s a chance this new category makes it into the next edition of the DSM-5 psychiatric diagnostic manual, which would make further research, and more effective treatment options, a lot more likely.