a girl shouting, holding her hands on her cheeksResearchers from Oregon Health & Science University suggest a new way of classifying children’s attention-deficit hyperactivity disorder (ADHD). Currently, children with ADHD can be classified as predominantly inattentive, predominantly hyperactive-impulsive, or a combination of both called combined presentation. The new study challenges these types, instead proposing three ADHD classifications based on children’s temperament and brain activity. The findings could help in providing targeted interventions to children with ADHD.

Intending to classify children with ADHD in a more meaningful way, the researchers evaluated children ages seven to 11 years—247 with ADHD and 190 without ADHD. Parents answered questions about their children’s temperaments, physical activity levels, friendliness, and emotional response. The researchers grouped the children based on their temperaments.

They identified three ADHD types: mild ADHD, surgent ADHD, and irritable ADHD. Mild ADHD has the typical ADHD symptoms of inattention and impulsivity, but children in this category have a similar temperament to that of children without ADHD. Surgent ADHD is characterized by exuberance and a high level of activity. Irritable ADHD is linked with anger, fear, and sadness. For children with irritable ADHD, the brain’s amygdala and interior insula, which regulates emotions, are partially unsynchronized, resulting in communication difficulties between the two regions.

Both surgent and irritable ADHD are stable groups; over 70% of the children originally classified with surgent or irritable ADHD remained in those classifications a year later. Irritable ADHD was linked to the later development of mood or anxiety disorders more than the other forms of ADHD were.

The study’s work is only preliminary, but it does demonstrate that it is possible to use these new classifications for diagnosis. Because these ADHD types are based more on biology than symptoms, they could help researchers understand ADHD’s underlying causes.

This research is published in JAMA Psychiatry.

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