This has not yet gained acceptance, although it may be measurable by objective biomarkers. Regardless of the typing of ADHD-I, ADHD-HI, and ADHD-C based on observed symptoms, there is a typing based on the different EEG patterns measured ⇒ ADHD subtypes according to EEG. The occasional forms described further are unlikely to represent true subtypes and are mentioned only for the sake of completeness. While the ADHD-HI subtype is likely to be merely an early form of the mixed type, Sluggish Cognitive Tempo ( SCT) is increasingly emerging as an independent disorder. The literature primarily names 3 subtypes of ADHD: The ADHD-I type (1.1.), the ADHD-HI type (see 1.2.) and ADHD-C (see 1.3). ADHD-HI/ADHD-C and ADHD-I as stress phenotypes Functional differences of nerve conduction pathways in the brain (?) Only theta frontal midline (FMT) increased Theta posterior increased, alpha and beta decreased Delta and theta increased, beta decreased Beta overactivated (“Overactivated” ADHD-HI) Theta frontal increased, beta decreased (ADHD-HI with hyperactivity and impulsivity in hypoactive EEG) Exaggerated and flattened endocrine stress responses of subtypes Hyperactivity, impulsivity: dopamine excess in the PFC Hyperactivity, impulsivity: dopamine deficiency or excess in the striatum Neurophysiological and endocrine differences of the subtypes ADHD subtypes according to internalizing / externalizing symptoms ADHD adult subtype pair according to Reimherr ADHD with oppositional behavior disorder (?) ADHD-C without reward deficits and without inhibition deficits ADHD-C with inhibition deficits and reward deficits ADHD-C with inhibition deficits, without reward deficits ADHD-C - mixed type of ADHD-HI and ADHD-I Decreased norepinephrine depletion in ADHD-HI? Deficient HPA axis disconnection in ADHD-HI Flattened cortisol stress response in ADHD-HI Neurophysiological peculiarities in ADHD-HI ADHD-HI: predominantly hyperactive/impulsive subtype Sluggish Cognitive Tempo (SCT) - stand-alone disorder Increased cortisol stress response in ADHD-I 4 We know quite a few affected persons who report a clear change of subtype. The subtype expression of the affected person is not necessarily stable over the whole life. These are neurophysiologically reflected in the cortisol stress response. The learned way of dealing with stress (role model)ĭetermine which subtype an ADHD sufferer develops.The personal way of processing stress (Bis/Bas) as a phenotypic stress response, and.We consider the ADHD subtypes as different (psychological) forms of reaction to one and the same genetic / neurological source of disturbance, where essentially the personality traits are Since stress-induced neurotransmitter releases (especially norepinephrine) appear to parallel these subtype-specific cortisol responses to acute stress, this may explain some differences of ADHD-HI/ADHD-C and ADHD-I. The most relevant difference is the endocrine response to acute stress. To date, few truly reliable distinguishing criteria are known. The causes and neuro(physio)logical processes are very similar in all subtypes. The question of whether the subtypes differ by different (genetic) causes or neuro(physio)logical processes has been studied many times. In adults, a sex-independent frequency distribution of subtypes was found, from: However, because SCT appears to be closely related and highly comorbid to ADHD, we have devoted a separate page to SCT: ⇒ SCT - Sluggish Cognitive Tempo. SCT is no longer considered a subtype of ADHD. The ADHD-HI, ADHD-I, and ADHD-C subtypes have been shown to be valid, whereas the evidence for a subtype of hyperkinetic disorder of social behavior is insufficient 1 The latter is considered (rightly in our opinion) as a comorbidity according to DSM. The ICD distinguishes between Simple Activity and Attention Disorder (F90.0) and Hyperkinetic Disorder of Social Behavior (F90.1), for which a social behavior disorder is additionally required. In adults with ADHD, attention problems may also remit significantly or disappear, although they remit considerably less frequently than hyperactivity problems: ⇒ ADHD in adults. ADHD-C could therefore be referred to as ADHD-HI type in later development. This is probably mainly due to the fact that inattention symptoms can only be reliably diagnosed from this age. The pure ADHD-HI type is usually diagnosed up to the age of 6, 7 years at the longest, exceptionally up to 14, 15 years. In ADHD, the subtypes ADHD-HI (predominant hyperactivity), ADHD-C (attention problems and hyperactivity in equal measure) and ADHD-I (predominant inattention) are distinguished.
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