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ADDitudeSlideShow

PublishedonADDitudeMag.com

The7TypesofADDandHowtoTreatEachOne
OneADHDexpertsaystherearemanytypesofADHD.Heexplainsthemhere,andoffershis
treatmentplansformanagingthem.
byDanielG.Amen,M.D.,doubleboardcertifiedpsychiatrist/photoscreditedtoAmenClinics

OneTreatmentDoesNotFitEveryone
AsthefounderofsixAmenClinics,Ibringamultidisciplinaryapproachtodiagnosingandtreatingbrainbased
disordersincludingattentiondeficitdisorderandcoexistingconditions.Forovertwentyyears,IveusedSPECT
brainscans(alongwithotherdiagnostictechniques)todevelopindividual,targetedtreatmentplansforeach
patient.Earlyon,IdiscoveredthroughbrainSPECTpatternsthatattentiondeficitisnotasingleorasimple
disorder.

MyADDIsNotYourADD
ADD,anxiety,depression,bipolardisorder,autism,andotherconditionsarenotsingleorsimpledisorders.
Theyallhavemultipletypes.ADDaffectsmanyareasofthebraintheprefrontalcortexandcerebellum
primarily,butalsotheanteriorcingulate,thetemporallobes,thebasalganglia,andthelimbicsystem.The7
typesofADDthatIstudiedarebasedaroundthreeneurotransmittersdopamine,serotonin,andGABA.

ClassicADD
Thisistheeasiesttypetospotofthe7typesofADD:Primarysymptomsareinattentiveness,distractibility,
hyperactivity,disorganization,andimpulsivity.Scansofthebrainshownormalbrainactivityatrest,and
decreasedactivity,especiallyintheprefrontalcortex,duringaconcentrationtask.Peoplewiththistypeof
ADDhavedecreasedbloodflowintheprefrontalcortex,cerebellum,andthebasalganglia,thelastof
whichhelpsproducetheneurotransmitterdopamine.

TreatingClassicADD
Thegoalhereistoboostdopaminelevels,whichincreasesfocus.Idoitwitheitherstimulatingmedications
Ritalin,Adderall,Vyvanse,Concertaorstimulatingsupplementslikerhodiola,greentea,ginseng,andthe
aminoacidLtyrosine.Gettinglotsofphysicalactivityalsohelpsincreasedopamine,asdoestakingfishoilthat
ishigherinEPAthanDHA.

InattentiveADD
Thistype,aswellasClassicADD,havebeendescribedinTheDiagnosticandStatisticalManual(DSM)of
MentalDisorderssince1980.Thistypeisassociatedwithlowactivityintheprefrontalcortexandlowdopamine
levels.Symptomsareshortattentionspan,distractibility,disorganization,procrastination.Peoplewiththistype
arenothyperactiveorimpulsive.Theycanbeintrovertedanddaydreamalot.Girlshavethistypeasmuchas,
ormorethan,boys.

TreatingInattentiveADD
InattentiveADDisusuallyresponsivetotreatment.Itisoftenpossibletochangethecourseofaperson'slifeif
heorsheisproperlytreated.Thegoal,aswithClassicADD,istoboostdopaminelevels.Iusethe
supplementsliketheaminoacidLtyrosine,whichisabuildingblockofdopamine.Takeitonanempty
stomachformaximumeffect.IoftenprescribeastimulantlikeAdderall,VyvanseorConcerta.Iputpatientsona
highprotein,lowercarbohydratediet,andIhavethemexerciseregularly.

OverFocusedADD
PatientswiththistypehaveallofthecoreADDsymptoms,plusgreattroubleshiftingattention.Theygetstuck
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orlockedintonegativethoughtpatternsorbehaviors.Thereisadeficiencyofserotoninanddopamineinthe
brain.Whenthebrainisscanned,youseethatthere'stoomuchactivityintheareacalledtheanteriorcingulate
gyrus,whichisthebrain'sgearshifter.Thisoveractivitymakesitdifficulttogofromthoughttothought,taskto
task,andtobeflexible.

TreatingOverFocusedADD
Thegoalistoboostserotoninanddopaminelevelsinthebrain.Treatmentistricky.PeoplewithOverFocused
ADDgetmoreanxiousandworriedonastimulantmedication.IusesupplementsfirstLtryptophan,5HTP,
saffron,andinositol.Ifsupplementsdon'thelpwithsymptoms,IprescribeEffexor,Pristique,orCymbalta.I
avoidahigherproteindietwiththistype,whichcanmakepatientsmean.Neurofeedbacktrainingisanother
helpfultool.

TemporalLobeADD
Ofthe7typesofADD,thistypehascoreADDsymptomsalongwithtemporallobe(TL)symptoms.TheTL,
locatedunderneathyourtemple,isinvolvedwithmemory,learning,moodstability,andvisualprocessingof
objects.Peoplewiththistypehavelearning,memory,andbehavioralproblems,suchasquickanger,
aggression,andmildparanoia.Whenthebrainisscanned,thereareabnormalitiesinthetemporallobesand
decreasedactivityintheprefrontalcortex.

TreatingTemporalLobeADD
IusetheaminoacidGABA(gammaaminobutryicacid)tocalmneuronalactivityandinhibitnervecellsfrom
overfiringorfiringerratically.Takingmagnesium80percentofthepopulationarelowinthismineralhelps
withanxietyandirritability.Anticonvulsantmedicationsareoftenprescribedtohelpwithmoodinstability.For
learningandmemoryproblems,Iusegingkoorvinpocetine.

LimbicADD
ThistypelookslikeacombinationofdysthymiaorchroniclowlevelsadnessandADD.Symptomsare
moodiness,lowenergy,frequentfeelingsofhelplessnessorexcessiveguilt,andchroniclowselfesteem.Itis
notdepression.Thistypeiscausedbytoomuchactivityinthelimbicpartofthebrain(themoodcontrol
center)anddecreasedprefrontalcortexactivity,whetherconcentratingonataskoratrest.

TreatingLimbicADD
ThesupplementsthatworkbestforthistypeofADDareDLphenylalanine(DLPA),Ltryosine,andSAMe(s
adenosylmethionine).WellbutrinismyfavoritemedicationforthistypeofADD.Researchersthinkitworksby
increasingdopamine.Imipramineisanotheroptionforthistype.Exercise,fishoil,andtherightdietwillhelp
apersonwithLimbicADDbettermanagesymptoms.

RingofFireADD
Patientswiththistypedon'thaveanunderactiveprefrontalcortex,aswithClassicandInattentiveADD.Their
entirebrainisoveractive.Thereistoomuchactivityacrossthecerebralcortexandmanyoftheotherpartsof
thebrain.Icallit"ADDplus."Symptomsincludesensitivitytonoise,light,touchperiodsofmean,nasty
behaviorunpredictablebehaviortalkingfastanxietyandfearfulness.Inbrainscans,itlookslikearingof
hyperactivityaroundthebrain.

TreatingRingofFireADD
Stimulants,bythemselves,maymakesymptomsworse.Istartoutwithaneliminationdiet,ifIsuspectanallergy
isinvolved,andboosttheneurotransmittersGABAandserotoninthroughsupplementsandmedication,if
necessary.IprescribeGABA,5HTP,andLtyrosinesupplements.IfIprescribemedication,Istartwithoneof
theanticonvulsants.Thebloodpressuremedicinesguanfacineandclonidinemaybehelpful,calmingoverall
hyperactivity.

AnxiousADD
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PeoplewiththistypehavehallmarkADDsymptoms,andtheyareanxious,tense,havephysicalstress
symptomslikeheadachesandstomachaches,predicttheworst,andfreezeinanxietyprovokingsituations,
especiallywheretheymaybejudged.Whenthebrainisscanned,thereishighactivityinthebasalganglia,
largestructuresdeepinthebrainthathelpproducedopamine.ThisistheoppositeofmosttypesofADD,where
thereislowactivityinthatregion.

TreatingAnxiousADD
ThetreatmentgoalistopromoterelaxationandboostGABAanddopaminelevels.ADDstimulants,
takenalone,makepatientsmoreanxious.Ifirstusearangeof"calming"supplementsLtheanine,relora,
magnesium,andholybasil.Dependingonthepatient,Iprescribethetricyclicantidepressantsimipramineor
desipraminetoloweranxiety.Neurofeedbackalsoworkstodecreasesymptomsofanxiety,especiallytocalm
theprefrontalcortex.

ForMoreInformation:
Learnmoreaboutthe7TypesofADD:
LearnabouttheAmenClinics
CheckoutHealingADDatHomein30Days
ListentoDr.Amen'spodcastonthe7TypesofADD
WatchDr.Amen'sTEDxtalkonSPECTimaging
ReadoneofDr.Amen's30booksincludingTheDanielPlan,ChangeYourBrain,ChangeYourLife,
MagnificentMindatAnyAge,andHealingADD.
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