Attention Deficit Disorder (ADD/ADHD)

This first type of ADD is usually evident early in life. As babies, they tend to be colicky, active, and wiggly. As children, they tend to be restless, noisy, talkative, impulsive, and demanding. Their hyperactivity and conflict-driven behavior gets everyone’s attention early on. Classic ADD is often called ADHD, with an emphasis on the hyperactive behavior trait. At Amen Clinics, we do not use the term ADHD exclusively because not all the ADD types are hyperactive.

Parents of these kids are often tired, overwhelmed, and even embarrassed by the behavior of their non-stop and hard-to-control children. Classic ADD tends to be more frequently seen in boys. Even as adults, those with this type of ADD tend to have a great deal of energy and a preference for physical activity rather than a more sedentary lifestyle.

Common Symptoms in Classic ADD include:

• Inattentive
• Easily distracted
• Disorganized
• Impulsive
• Poor follow-through
• Trouble listening when others talk to them
• Making careless mistakes/poor attention to detail
• Forgetfulness and losing things
• Being fidgety and restless
• Difficulty awaiting their turn
• Act as though driven by a motor
• Being noisy
• Talking excessively
• Interrupting others

Classic ADD SPECT scan findings often show normal activity at rest, but during concentration there tends to be decreased activity in the underside of the prefrontal cortex as well as in the cerebellum and basal ganglia. The latter are structures deep in the brain that produce dopamine, a neurotransmitter that is critical for motivation, attention, and setting the body’s idle speed.

Inattentive ADD is the second most common type of ADD. Those suffering with this type are usually quiet, more introverted, and appear to daydream a lot. They may be labeled as unmotivated—even slow or lazy. Inattentive ADD is common but is often missed because children with this type tend to have fewer behavioral problems. They don’t draw the negative attention to themselves as do those with Classic ADD.

Common Symptoms in Inattentive ADD Include:

• Trouble focusing
• Being easily distracted
• Disorganized
• Poor follow through
• Trouble listening when others talk to them
• Problems with time management
• Tendency to lose things
• Making careless mistakes; poor attention to detail
• Forgetfulness
• Excessive daydreaming
• Complaints of being bored
• Appearing unmotivated or apathetic
• Being tired, sluggish, or slow moving
• Appearing “spacey” or preoccupied

Inattentive ADD is the perfect example of why the general term “ADHD” does not fit all ADD types. If clinicians and parents are looking for hyperactivity to reach a diagnosis, those with this type, which does not have hyperactivity, may be left untreated and go on living life below their true potential.

SPECT scan findings of Inattentive ADD show normal activity at rest, but during concentration there tends to be decreased activity in the underside of the prefrontal cortex, cerebellum, and basal ganglia.

In order to focus, it is necessary to be able to shift your attention as needed. People suffering with Overfocused ADD have most of the ADD features, but rather than not being able to pay attention, they have difficulty shifting their attention; they become hyper-focused on certain things while tuning out everything else. These folks tend to get stuck or locked into negative thought patterns and behaviors. This type of ADD is often found in substance abusers as well as the children and grandchildren of alcoholics.

Common symptoms in Overfocused ADD

• Core symptoms of ADD
• Excessive or senseless worrying
• Getting stuck in loops of negative thoughts
• Being oppositional and argumentative
• Tendency toward compulsive behaviors
• Difficulty identifying options
• Excessive worrying
• Tendency to hold grudges
• Difficulty shifting attention from one thing to the next
• Tendency to hold onto their own opinion and not listen to others
• Needing to have things done a certain way or they get upset
• May or may not be hyperactive

Overfocused ADD SPECT scan findings show increased activity at rest and during concentration in the anterior cingulate gyrus (the brain’s “gear-shifter”), as well as decreased activity in the underside of the prefrontal cortex, cerebellum, and basal ganglia.

People with this type of ADD have the hallmark features of ADD plus symptoms associated with temporal lobe problems, such as issues with learning, memory, mood instability, aggression, temper outbursts, and sometimes, even violence. It is not unusual to see this type of ADD in people who have had head injuries.

Common symptoms in Temporal Lobe ADD

• Core symptoms of ADD
• Memory problems
• Auditory processing issues
• Irritability
• Episodes of quick temper
• Periods of spaciness or confusion
• Periods of panic and/or fear for no reason
• Visual changes such as seeing shadows or objects changing shape
• Episodes of déjà vu
• Sensitivity or mild paranoia
• Headaches or abdominal pain of uncertain origin
• History of head injury
• Dark thoughts (may involve suicidal or homicidal thoughts)
• Possible learning disabilities
• May or may not be hyperactive

Temporal Lobe ADD SPECT scan findings show decreased activity (and occasionally increased) activity in the temporal lobes at rest and during concentration, as well as decreased activity in the underside of the prefrontal cortex, cerebellum, and basal ganglia during concentration.

In Limbic ADD, the prefrontal cortex is underactive during concentration while the deep limbic area—which sets your emotional tone, controlling how happy or sad you are—is overactive. Depression is also associated with overactivity in the deep limbic area, yet a person’s developmental history in addition to some subtle differences on SPECT scans (between Limbic ADD and depression) helps us differentiate between the two conditions so we can choose the best course of treatment to resolve symptoms.

Common Symptoms in Limbic ADD

• Core symptoms of ADD
• Moodiness
• Negativity
• Low energy
• Frequent irritability
• Tendency for social isolation
• Feelings of hopelessness
• Perceived helplessness
• Feelings of guilt
• Loss of interest in things
• Sleep changes (too much or too little)
• Chronic low self-esteem
• May or may not be hyperactive

Limbic ADD SPECT scan findings typically show increased deep limbic activity at rest and during concentration. There is also decreased activity in the prefrontal cortex, cerebellum, and basal ganglia during concentration.

In Ring of Fire ADD, there is a pattern of overall high activity in the brain. Those with this type tend to have difficulty “turning off” their brains and typically feel overwhelmed with thoughts and emotions. This type tends to get much worse on stimulant medications alone. Ring of Fire ADD can be related to some form of allergy, infection, or inflammation in the brain, or it can be related to bipolar disorder. There are some subtle differences between Ring of Fire ADD and bipolar disorder in the scan data as well as some differences in the presentation of a person’s symptoms. For instance, we have found that the kids with Ring of Fire ADD tend to have their problems all the time whereas bipolar kids tend to cycle with their mood and behavior problems. Adults with bipolar disorder have episodes of mania or hypo-mania, whereas adults with Ring of Fire ADD do not—their behavior issues tend to be consistent over long periods of time.

Of note: It is possible to have both conditions—in fact some research studies suggest that as many as 50% of those with bipolar disorder also have ADD.

Common Symptoms in Ring of Fire ADD

• Core symptoms of ADD
• Sensitive to noise, light, clothes, or touch
• Cyclic mood changes (highs and lows)
• Inflexible rigid thinking
• Oppositional
• Demanding to have their way
• Periods of mean, nasty, or insensitive behavior
• Periods of increased talkativeness
• Unpredictable behavior
• Periods of increased impulsivity
• Grandiose or “larger than life” thinking
• Rapid speech
• Racing thoughts
• Appears anxious or fearful
• Irritability
• May or may not be hyperactive

SPECT Findings

Ring of Fire ADD SPECT scan findings show patchy increased activity in many areas of the brain, which looks like a “ring” of overactivity. We have found that there is some variability in Ring of Fire patterns from individual to individual. In differentiating between bipolar disorder and Ring of Fire ADD, it is important to consider the SPECT scan data in addition to the patient’s clinical history.

With Anxious ADD, there is low activity in the prefrontal cortex while there is overactivity in the basal ganglia, which sets the body’s “idle speed” and is related to anxiety. The ADD symptoms in people suffering with this type tend to be magnified by their anxiety. Treatment for people with Anxious ADD often includes both calming and stimulating the brain.

Common Symptoms in Anxious ADD

• Core symptoms of ADD
• Frequently anxious or nervous
• Physical stress symptoms such as headaches
• Tendency to freeze in social situations
• Dislikes or gets excessively nervous speaking in public
• Predicts the worse
• Conflict avoidant
• Fear of being judged

Anxious ADD SPECT scan findings show increased activity in the basal ganglia at rest and during concentration. Additionally, there is decreased activity in the prefrontal cortex and cerebellum during concentration.