Understanding ADD

Understanding ADD

By

Dr. David Koehn

The following synopsis on Attention Deficit Disorder (ADD) is based on G. Amen, MD, a child and adult psychiatrist, a nuclear brain imaging specialist, and a New York Times bestselling author. His books include the groundbreaking Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD, and the revised and updated version called Healing ADD: The Breakthrough Program That Allows You to See and Heal the 7 Types of ADD, which was published in 2013.

Dr. Amen is also the founder of 10 Amen Clinics across the U.S. At these clinics, patients have a SPECT brain scan to diagnose the type of ADD they have. They are then able to receive targeted treatment. SPECT stands for single-photon emission computed tomography, and it shows how the blood flows through the brain. [Note: As you read this electronic newsletter, there are several hyperlinks that if you click on them, take you to more material on that topic.]

The standard way for assessing and diagnosing attention deficit hyperactivity disorder (ADHD) used by mental health professionals in the United States is the Diagnostic and Statistical Manual for Mental Disorders (DSM). It identifies three presentations of ADHD: 

• Attention-deficit/hyperactivity disorder, combined presentation. 
• Attention-deficit/hyperactivity disorder, predominantly inattentive presentation. 
• Attention-deficit/hyperactivity disorder, predominantly hyperactive-impulsive presentation. 

However, using SPECT scans on tens of thousands of patients, Dr. Amen has identified seven types of ADD. Dr. Amen uses the term ADD, rather than ADHD, as he feels ADD is more reflective of the condition. When a person has been diagnosed with an ADD type, Dr. Amen uses a combination of prescription medication, supplements, and lifestyle changes to treat the condition. Each type of ADD has its own treatment recommendations. A quick simple self-assessment for ADD can be found by going to the following link. You will receive feedback to include a report on the results with recommendations. Another tool used by psychologists to identify further evidence of ADD issues is the Connor’s Performance Test.

Important Note: Functional neuroimaging, such as SPECT scans, are considered a helpful tool for researchers. They have been invaluable in understanding the neurocircuitry (activity in the brain) of various psychiatric conditions. However, mainstream psychiatrists do not generally believe they are a valid technique to use for regular clinical diagnosis.

Critics of Dr Amen's claim that he uses the scans to support the marketing of his procedures and products. Dr. Amen's particular ADHD sub-types and his package of recommendations are not broadly established and reflect his particular biases. With these caveats, here are his ways of approaching the condition. 

Dr. Amen’s Types of ADD and His Treatment Recommendations:

Type 1. Classic ADD (ADHD)

Symptoms include being inattentive, distractible, disorganized, hyperactive, restless, and impulsive. Procrastination can also be an issue.

People with classic ADD have reduced blood flow in the brain area of the prefrontal cortex, cerebellum, and the basal ganglia. The basal ganglia helps produce dopamine. 

The goal of the treatment is to increase dopamine levels.

• Dopamine levels can be boosted with either stimulant medication, such as Adderall® or Concerta®, or with stimulating supplements, such rhodiola, green tea, or ginseng. Also used is amino acid L-tyrosine, as it is a building block of dopamine.

• Exercise is encouraged as it boosts dopamine.
• A fish oil supplement that is higher in EPA than DHA, for example a 60:40 ratio, is recommended.
• A diet that is higher in protein and lower in carbohydrates is encouraged.

Type 2. Inattentive ADD 

Symptoms include being inattentive and easily distracted (but not hyperactive), sluggish, slow moving, with low motivation. Are often described as space cadets, daydreamers, and couch potatoes. This type is more common in girls than boys, and is often diagnosed later in life because these people do not have behavior problems. People often think of this group as not very smart.

People with inattentive ADD have reduced activity in the prefrontal cortex as well as low levels of dopamine. Treatment is the same as Type 1.

Type 3. Overfocused ADD

Classic ADD symptoms, plus trouble shifting attention, frequently get stuck in loops of negative thoughts or behaviors, obsessive, excessive worrying, and inflexible. Have frequent oppositional and argumentative behavior. 

People with overfocused ADD have a deficiency of serotonin and dopamine. The goal of treatment is to increase both of these neurotransmitters. (Neurotransmitters are the nerve’s chemical messengers.) Dr. Amen explains that because people with this ADD type become more worried and anxious when taking stimulant medication, he tries supplements first. Only if they are not effective will he prescribe medication.

• Supplements are used to boost dopamine, such as L-tryptophan. 5-HTP is used as an antidepressant. Others are saffron and inositol, which increase focus and mental clarity.
• Antidepressant medication examples are Effexor®, Pristiq®, or Cymbalta®. 
• Neurofeedback is also recommended. (Neurofeedback teaches people to regulate their brain function.)
• People who have this ADD type do not do well on a high protein diet as it can prompt mean behavior.

Type 4. Temporal Lobe ADD 

Classic ADD symptoms plus being irritable, quick-tempered and aggressive, and having dark thoughts, mood instability and mild paranoia. Might see or hear things that are not there. Learning and memory problems may be present.

People with temporal lobe ADD have irregularities in their temporal lobes and less activity in the prefrontal cortex part of the brain.

The goal of treatment is to soothe neuronal activity and stop nerve cells from over-firing or firing unpredictably.

• Treatment includes the amino acid GABA to help to calm the nerve cells. 
• A magnesium supplement helps with anxiety.
• Anticonvulsant medications can help stabilize moods. 
• Gingko or vinpocetine can assist with learning and memory issues. 
• A ketogenic diet, which is a diet that is higher in protein, may be recommended.

Type 5. Limbic ADD 

Classic ADD symptoms plus chronic low-level sadness, but not depression. Negativity, "glass half-empty syndrome," low energy, and frequent feelings of hopelessness and worthlessness. This includes low self-esteem.

People with limbic ADD have excessive activity in the limbic section of the brain, which is where moods are controlled. They have reduced activity in the prefrontal cortex either when relaxing or focusing on a task.

• Dr. Amen says DL-phenylalanine (DLPA), L-tyrosine, and SAMe (S-adenosylmethionine) are the most effective supplements. 
• An antidepressant, Wellbutrin® or imipramine, might be prescribed.
• Exercise, fish oil, and an appropriate diet are also recommended. 
• An elimination diet, where dairy, sugar, wheat and corn are eliminated from the diet for three weeks, will help to determine if the person has these food sensitivities.

Type 6. Ring of Fire ADD 

A more extreme version of Classic ADD, plus being extremely distractible, angry, irritable, and overly sensitive to noise, light, clothes and touch. Are often inflexible, extremely verbal, oppositional, and have cyclic moodiness. 

People with ring of fire ADD have an overactive brain. There are excessive amounts of activity in the cerebral cortex and other areas of the brain. 

• Treatment begins with an elimination diet if it appears a food allergy might be present. 
• Stimulants alone could make symptoms increase. GABA, 5-HTP, and L-tyrosine supplements help to increase GABA and serotonin levels.
• Medications that might be prescribed are an anticonvulsant, and blood pressure medication like guanfacine or clonidine to help reduce hyperactivity.

Type 7. Anxious ADD 

Classic ADD symptoms plus feeling anxious and tense. Experience physical stress symptoms like headache and stomachache, freeze when in situations that cause anxiety, and anticipate the worst.

People with anxious ADD have high levels of activity in the basal ganglia, which aid in making dopamine. This differs from the majority of the other ADD types, which have low activity in this part of the brain.

The goal of treatment is to help with relaxation and increase GABA and dopamine levels.

• Supplements that have a calming effect are L-theanine, relora, magnesium, and holy basil.
• Stimulants taken on their own can cause more anxiety. However, helpful medications to lower anxiety are the tricyclic antidepressants imipramine or desipramine. 
• Neurofeedback can help lower anxiety and calm the prefrontal cortex.

It is possible to have more than one type of ADD. For example, a common combination is over-focused, limbic and anxious types.

Dr. Amen believes that understanding the distinctions and complexities of each of these seven subtypes allows for more effective diagnosing and treatment for children and adults with ADHD. 

To reiterate, you can learn more about Dr. Amen’s approach in his book, Healing ADD: The Breakthrough Program That Allows You to See and Heal the 7 Types of ADD. Furthermore, Additudemag.com is a tremendous resource on ADD. Make sure you sign up for their newsletter.