Understanding Dr. Daniel Amen's 6 Types of ADD
Though the Diagnostic and Statistical Manual for Mental Disorders (DSM) identifies three subtypes for ADD/ADHD, there is another school of thought that proposes six distinct types of the disorder. Dr. Daniel Amen is a double-board certified psychiatrist, New York Times bestselling author, and one of the foremost experts regarding brain imaging and its application in everyday clinical practice. In addition, Dr. Amen has revolutionized the diagnosis and treatment of one of the most common childhood disorders today.
What is ADD and/or ADHD?
Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) are the psychological terms applied to those who meet the DSM IV diagnostic criteria for impulsivity, inattention, and/or hyperactivity. In general, ADD is used to describe those individuals that have attention deficit without the hyperactive and impulsive behaviors. The symptoms associated with ADD (or ADHD) often begin in childhood and continue into adulthood. They and can cause problems at home, school, work, and even in relationships.
Though the two terms are often used interchangeably, ADHD is the official name used by the American Psychiatric Association. The DSM-IV, therefore, describes three types of ADHD. These are:
- Inattentive ADHD (which many refer to as ADD) - marked by impaired attention and concentration
- Hyperative-impulsive ADHD - marked by hyperactivity without inattentiveness
- Combined ADHD - this is the most common type and involves all symptoms
For a diagnosis of ADD or ADHD, symptoms of the disorder must be present before the age of seven and must be present in more than one setting. This means, for example, that children that display hyperactivity and inattentiveness at home but are quite able to concentrate and are not hyperactive at school may not have ADHD. A person with ADHD will exhibit impairment at home as well as at school or at home and at work. Another important criteria for proper diagnosis of ADHD includes the presence of clear evidence that the symptoms interfere with function.
What Causes ADD and/or ADHD?
The question of what causes ADD and/or ADHD is still being investigated. Most researchers believe there is a genetic component. Ongoing research centers around the identificaton of genes which may make some susceptable to the disorder.
Other factors which may contribute to the development of ADD or ADHD are exposure to lead and the use of cigarettes, drugs, or alcohol by mothers during pregancy. Some also believe that food allergies and additives may also be linked to the disorder. While there is no evidence that food additives cause ADD or ADHD, some studies have shown that certain food colorings and additives may increase hyperactivity in some children.
In “Healing ADD” Dr. Daniel Amen describes a new approach to Attention Deficit Disorder and provides guidelines for choosing the proper treatment.
The 6 Types of ADD as Proposed By Dr. Daniel Amen
By using a combination of symptoms and brain scans, Dr. Daniel Amen proposes 6 different types of ADD. These are:
- Classic ADHD
- Inattentive ADHD
- Over-Focused ADHD
- Temporal Lobe ADD
- Limbic ADD
- Ring of Fire ADD
With each type Dr. Amen proposes that there is periodic impairment of the prefrontal cortex of the brain. His premise is that ADD and/or ADHD is not a single disorder and that this needs to be understood in order to truly know the disorder. Dr. Amen suggests that just as there can be many different conditions for a physical symptom (for example, chest pain) there are also various reasons for a symptom associated with ADD. A one size fits all approach to the disorder is, therefore, illogical and ineffective. This may also go a long way to explain why a treatment for ADHD may work well for one patient while worsening symptoms in another.
The 6 Types of ADD as Proposed by Dr. Daniel Amen
Common SPECT Findings
Hyperactivity, restlessness,and Impulsivity
Low prefrontal cortex activity during times of concentration
Tends to respond well to stimulant medications. Other treatment suggestions inclued a high protein diet, aerobic exercise, a supplement of L-Tyrosine, and possibly an anti-depressant.
Low Energy, Spacey, and/or Internal Preoccupation. Lacks hyperactivity but may have a difficult time focusing and often very scattered. Generally diagnosed later in life (if at all). More common in girls.
Low prefrontal cortex activity during times of concentration. Low cerebellar activity.
Same as Classic ADHD
May have symptoms of ADHD plus cognitive Inflexibility, a focus on negative thoughts or behavior,trouble shifting attention, a tendency to hold grudges, and be argumentative. May be oppositional and may tend to worry
High anterior cignulate activity. Low prefrontal cortex activity during times of concentration
Responds better to an antidepressant combined with a stimulant. Other possible treatments include the use of St. Johns Wart, high protein diet and aerobic exercise
Temporal Lobe ADD
May have symptoms of ADD Plus they are typically described as having a "short fuse," difficulty distinguishing between constructive criticim or correction and insults. May have difficutlty reading. May have dark thoughts, memory problems, and anger management issues. Often seen in families with learning disabilities.
Low temporal lobe activity. Low prefrontal cortex activity during times of concentration.
Responds better to antiseizure medications, possibly in combination with a stimulant. A high protein diet and aerobic exercise may also be useful as wel as the following supplements: GABA, Ginkgo Biloba, or Vitamin E
May have symptoms of ADD plus mild sadness that is typically chronic. Negativity, low engery, low self-esteem, irritability. Often socially isolated. May have poor appetite and sleep patterns. Treatment by use of stimulants alone may cause depressive symptoms.
High deep limbic activity. Low prefrontal cortex activity while at rest and during times of concentration.
Responds better to a stimulant and a antidepressant. Aerobic exercise and a diet of complex carbohydrates and proteins are indicated. The following supplements may also be useful: SAMe or L-Tyrosine
Ring of Fire ADD
May have symptoms of ADD plus extreme moodiness,oppositional behavior, angry outbursts, and inflexible. May talk excessively with rapid-fire thinking. May be sensitive to sounds and lights. Believed to be a cross between ADHD and bipolar disorder. Often worsened by stimulants.
Increased activity across the cortex. Intense ring of overactivity. May also have low prefrontal cortex activity (less common)
Responds better to anticonvulsants or antpsychotic medications.This may be in addition to a standard stimulant and an antidepressant. Aerobic exercise and a high protein diet are both indicated. The following supplements may also be useful: GABA or Omega-3, Zinc, Flax Seed Oil, and Serephos
Through the use of single photon emission computed tomography (SPECT), Dr. Daniel Amen provides a means of diagnosing ADD that includes brain imaging. According to his view, this techniques allows us to literrally see areas of the brain that work well, areas that work too hard, and areas that do not work hard enough. Knowing this information provides us with a blueprint of sorts, allowing us to then devise treatments that enhance the underactive areas and calm the overactive areas, thereby creating balance.
SPECT creates a colored picture of the chemical reactions and blood flow in different parts of the brain. In this way, patient's can actually see the disorder. This quite often makes acceptance of the condition easier as patient's begin to view the disorder in terms of physiology instead of psychology.
As our understanding of ADHD and/or ADD evolves, the definition of what it means to have the disorder will also change. ADHD is not what it used to be and at this time experts just don't agree regarding the nature of the disorder or appropriate treatment. Dr. Daniel Amen has devised a 6 type model of the disorder but is quite possible that more types may be identified in the future.
Criticisms Of the 6 Types of ADHD Proposed By Dr. Daniel Amen
Critics of the 6 types of ADD as proposed by Dr. Daniel Amen suggest that SPECT is a research tool that is quite useful for exploring brain function. It is not, however, proven to be a reliable diagnostic test for determining treatments for ADD and/or ADHD. The reliability of SPECT in depicting specific clinical problems and the needed treatment requires far more testing before it will be accepted by the psychiatric community. Most psychiatrist believe that it is premature to use SPECT clinically and criticize Dr. Amen for his use of brain imaging at the Amen Clinics for diagnosis and treatment. Dr. Amen's claims of being able to choose the best therapy based mainly on brain scans is criticized as being supported by anecdotal evidence and testimonial only.Further, many criticize the associated cost (which is several thousand dollars) of using the tool for emotional and behavioral issues when this is still considered by most to be experimental.