One of the difficulties in diagnosing ADHD is that it can present in so many different ways, and that can lead to people not recognising when a child or adult has the disorder. The diagnostic literature defines three types of ADHD: impulsive/hyperactive, where someone is “driven by a motor” and acts without thinking; inattentive, dreamy, “away with the fairies” and almost lethargic in their manner; and the combined type. However, even within these three types of ADHD there are huge differences in the symptoms people display. So when t I came across an article about psychiatrist Dr. Daniel Amen, author of Healing ADD, I was intrigued. Dr Amen uses a controversial form of brain scanning called SPECT to diagnose ADHD in his patients, and he is convinced that rather than there being three types there are actually seven. He also suggests that each type should be treated in a different way, and that the accepted ways of treating ADHD might not be the best therapy depending on the type.
There’s currently no evidence to back up Dr Amen’s findings but the idea that there may be multiple types of ADHD would certainly help to explain why children with the condition can display such different combinations of symptoms.
The seven types Dr Amen says he has identified are:
1. Classic ADD
Dr Amen’s Classic ADD is the hyperactive/impulsive ADHD of DSMV, with symptoms including short attention span, distractibility, disorganisation, procrastination, restlessness, hyperactivity, and poor impulse control.
Dr Amen suggests that when a person with Classic ADD tries to concentrate, there is decreased activity in the front part of the brain, especially in the inferior orbital prefrontal cortex.
Dr Amen’s treatment for this type of ADD is to boost dopamine either with stimulating medications like Ritalin or Concerta, or with stimulating supplements, like rhodiola, green tea, ginseng, and L-Tyrosine. A high protein diet can also help.
2. Inattentive ADD
This is the accepted Inattentive ADHD – people with this type have the hallmark symptoms of a short attention span, distractibility, disorganisation, and procrastination—but they’re not hyperactive or terribly impulsive, and may be more introverted. This type of ADHD is more common in girls, who are often not diagnosed until later because they have fewer behaviour problems.
As with Classic ADD, Inattentive ADD is also associated with low activity in the prefrontal cortex and is treated in the same way – by boosting dopamine, switching to a higher protein diet, and using stimulating supplements or medication.
3. Over-Focused ADD
With this type, there’s too much activity going on in the anterior cingulate gyrus, which is the brain’s gear-shifter, allowing you to move from thought to thought, idea to idea; to be flexible. This part of the brain is also involved in error detection; in other words, it helps you know when something is wrong. When the cingulate gyrus works too hard, it causes you to get stuck, worry and hold grudges. You may get upset if things don’t go your way; you may be argumentative, oppositional, and see all kinds of things wrong in situations and people.
This group of patients experiences too much activity in the anterior cingulate and too little activity in the underside of the frontal lobe because of low levels of both serotonin and dopamine. Dr Amen suggests that treatment for this type of ADHD should not involve stimulants. Instead he recommends supplements that boost both serotonin and dopamine, such as 5-HTP, saffron, L-Tryptophan, and inositol or medication (he uses selective serotonin reuptake inhibitors (SSRIs)).
4. Limbic ADD
Limbic ADD is a combination of dysthymia, or chronic low-level sadness, and ADD. People with this type of ADHD have too much activity in the limbic, or emotional, part of the brain and low activity in their frontal lobes. Dr Amen treats this type of ADHD with stimulating supplements like SAM-e or medications like Wellbutrin to boost the brain and enhance mood. Exercise, fish oil, and diet are also recommended.
5. Temporal Lobe ADD
People with Temporal Lobe ADD have Classic ADD symptoms, plus temporal lobe difficulties such as learning and memory problems, mood instability, irritability, and temper problems.
Dr Amen’s recommended treatment for this type of ADHD is supplements or medications to boost GABA, which stabilizes the temporal lobes, as well as medication to boost dopamine. This ADD type also responds well to a higher protein diet and healthy fats.
6. Ring of Fire ADD
In the Ring of Fire type of ADHD, the entire brain is overactive, leading to moodiness, excessive distractibility, overactive thoughts and sensitivity to lights, sounds, and touch. Dr Amen describes it as “like ADHD plus”.
He says that eight out of ten patients with this type of ADHD respond poorly to stimulants. He believes this type of ADHD may be caused by allergies, inflammation, or an infection, so patients are put on elimination diets to see if allergies may be involved. He also uses supplements or medications that boost both GABA and serotonin.
7. Anxious ADD
A patient with this type of ADHD has the hallmark symptoms of impulsiveness, hyperactivity and inattentiveness, as well as extreme anxiety, tension, and nervousness. Someone with Anxious ADD may hate speaking in public, and probably freezes when carrying out timed tasks.
In this type of ADHD there is too much activity in an area of the brain called the basal ganglia. Dr Amen’s treatment for this type of ADD includes deep relaxation techniques as well as supplements to boost GABA and dopamine. Hypnosis, meditation, and biofeedback can also be helpful. Stimulants alone usually make a patient with this type more anxious.
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So there you have Dr Amen’s Seven Types of ADHD. As I said before, there is no evidence to back up his findings, and his use of SPECT scans to diagnose ADHD is very controversial. But it certainly makes for interesting reading, and could perhaps shed some light on why ADHD presents in so many different ways. What do you think?
You can read the article in full at www.additudemag.com
