Attention Deficit Disorder is a complex condition that is not well
understood at the present time by many clinicians and the general
public. New information is being discovered rapidly however. Dr.
Amen is one of the pioneers in this field and this article is meant
to summarize his work.
Attention Deficit Disorder (ADD) and Attention Deficit Disorder
with Hyperactivity (ADHD) occur as a result of neurological dysfunction
in the prefrontal cortex of the brain. This is the newest part of
our tri-brain system in evolutionary terms. It is the part of our
brain that performs executive functions. The functions of this brain
deal with 1) attention span, 2) perseverance, 3) judgment, 4) organization,
5) impulse control, 6) self-monitoring and supervision, 7) problem
solving, 8) critical thinking, 9) forward thinking, 10) learning
from experience, 11) ability to feel and express emotions, 12) interaction
with the limbic system, and 13) empathy.
is a problem with this part of the brain, a number of skills that
many human beings take for granted would not be available in any
optimal way. The following are problems that develop when the prefrontal
cortex is affected. 1) Short attention span, 2) distractibility,
3) lack of perseverance, 4) impulse control problems, 5) hyperactivity,
6) chronic lateness and poor time management, 7) disorganization,
8) procrastination, 9) unavailability of emotions, 10) misperceptions,
11) poor judgment, 12) trouble learning from experience, 13) short-term
memory loss, and 14) social and test anxiety.
The exact neurological
problem with ADD is unknown at this time. However SPECT scans, single
photon emission computed tomography, which measures cerebral blood
flow and metabolic activity patterns, has noted that when someone
with ADD concentrates, their prefrontal lobe activity decreases
significantly. This essentially means that under stress and concentration
someone with these disorders cannot bring to bear their full cognitive
It is theorized
that our usual ability to screen out and attend to stimuli of our
choice is impaired with these individuals. I like to think of it
as going to the mall during the summer. It is too bright and there
are too many people around, but it is not overwhelming. However,
at Christmas time after a couple of hours at the mall people are
so over-stimulated that it is hard to find the car. People with
ADD feel this way almost all the time.
There are five
recommended courses of treatment for someone with ADD or ADHD. Physicians
often give an antidepressant such as Wellbutrin and Strattera, which
tends to calm the limbic system and increase dopamine, a neurotransmitter.
In my experience as a therapist, this can be helpful but stimulants,
the second course, seem to do a better job. Stimulants given in
small doses, so the mood alteration is minimal, act in a paradoxical
manner. This means that instead of accelerating a person they help
to focus and calm them while still allowing the prefrontal lobe
to remain active. They also seem to increase dopamine. This neurotransmitter
is negatively affected with people suffering from ADD. The third
regimen, a combination of an anti-depressant and a stimulant, seems
to work best for most people suffering from most forms of ADD. The
fourth treatment consists of teaching relaxation, stress-management,
organizational, and socializing skills. This should always be included
as part of treatment whether or not medication is used.
Another form of treatment is the naturopathic approach. Due to my
background I cannot adequately discuss this method, and as yet am
not sufficiently familiar with the treatment to be able to measure
its efficacy. At the present time, supplements, vitamins and chiropractic
care seem to be effective as an adjunct to stimulants.
There are numerous
misconceptions about Attention Deficit Disorder and a lot of emotional
fervor about the diagnosis. It reminds me of the debate over Prozac
several years ago or whether or not Alcoholism is a disease or a
moral defect. It is understandable that people worry about giving
young children a mood-altering drug. However, any time medication
is considered as an approach, the physician needs to carefully assess
both the costs the benefits and the severity of the problem. Most
medication difficulties with ADD result from mismanagement. When
the appropriate amount of medication is used with ADD the benefits
are immense and the cost is minimal. A person’s life changes
dramatically for the better. It is as if for the first time a person
can think clearly and their self-esteem soars.
There is still
a tendency in this country to feel that people need to pull themselves
up by the bootstraps regardless of the severity of the problem.
They are often blamed for their own illness. This happens a lot
True ADHD with
hyperactivity is rather easy to diagnose. However, only in the last
ten years was ADD inattentive type recognized. This diagnosis is
hard to spot and often is characterized by a general spacyness and
inability to track conversations. It also used to be common knowledge
that children were the only ones to suffer from this disorder and
that once they became 14 they grew out of it. What is more common
is that in the normal course of experimentation with drugs and alcohol
a person with this disorder finds amphetamines and becomes addicted
to them. Almost the right drug, wrong dose! Most people do not grow
out of the disease. Interestingly enough, even with hard-core Methadrine
addicts, if they are put on a small dose of Adderall, 20- 30 mg.
of sustained release 1-2 times a day, they thrive and it does not
reactivate the addictive process.
Dr. Daniel G.
Amen is one of the acknowledged leaders in the field for the study
of Attention Deficit Disorder. He has expanded the classifications
of this condition within the last two years from the standard two
types of Hyperactive and Inattentive by adding four more distinct
types of ADD. He has done this by exhaustive research and has been
aided by the SPECT scan, which is a sophisticated brain scanning
tool that measures and clearly shows what part of the brain is most
active. What is most impressive about his work is that he stresses
the need for a multi-treatment approach. This includes attention
to diet, exercise, vitamins, supplements, traditional psychotropic
drugs, and behavioral techniques.
ADD” Dr. Amen lists the six types of ADD as 1) Classic hyperactive,
2) Inattentive, 3) Over focused, 4) Temporal, 5) Limbic, and 6)
Ring of Fire. Each of these types has much in common, but also differences
in symptoms and treatment.
All of the types
of ADD have as their primary feature periodic impairment of the
prefrontal cortex of the brain and dopamine involvement. Classic
ADD is characterized by both hyperactivity and inattentiveness.
It is usually quite easy to treat by a combination of a high protein
diet, aerobic exercise, a stimulant such as Adderall or Ritalin,
and possibly the supplement of L-Tyrosine. Often an anti-depressant
is used as well.
ADD lacks the hyperactivity, but people who suffer from it have
a difficult time focusing and are often very scattered. As with
the classic type the prefrontal cortex is involved. The treatment
for inattentive ADD is usually exactly the same as the classic type.
ADD exhibits the same problems and symptoms of prefrontal cortex
as with classic and inattentive ADD, but the difference is that
the sufferer of over focused often cannot break away from a thought
or behavior. This is because the cingulate system of the brain is
overactive and often locks a person into self-destructive, negative,
or repetitive behavior. Often a stimulant will cause temper problems
if used alone. Therefore, it is usually helpful to have the person
take an anti-depressant first and only later to add the stimulant.
Another possible treatment is to use St. Johns Wort, a natural herbal
anti-depressant, but it is important not to use both a traditional
and an herbal anti-depressant at the same time. The other forms
of treatment such as diet and exercise is the same as the first
two types of ADD.
is still characterized by problems with the prefrontal cortex, but
the temporal area of the brain is often affected. This could be
from a previous head injury, but not necessarily. All the symptoms
remain the same, but often extreme bouts of anger are also included.
The treatment for this type is usually a stimulant and an anti-convulsant
such as Depecote. All other treatment is the same except the following
supplements can be used: GABA, Ginkgo Biloba, or Vitamin E.
Limbic ADD is
when the limbic area of the brain is also affected in addition to
the prefrontal cortex. This type of ADD has the symptoms of inattentive
ADD, but a significant amount of depression is also present. A stimulant
and an anti-depressant are indicated. Aerobic exercise is needed,
but often a complex carbohydrate and protein mixed diet is indicated.
The following supplements are used: SAMe or L-tyrosine.
Ring of Fire
ADD is a very disorganized and severe form of ADD that is a combination
of all the other types. The entire brain is lit up on a SPECT scan.
In addition to the standard treatment of a stimulant and an anti-depressant,
an anti-psychotic like Respiridal is often called for. Dietary and
exercise treatment is the same as in inattentive type. The following
supplements are possibly needed: GABA or Omega-3. Other supplements
that have been found helpful with ADD in general are Zinc, Flax
seed oil, and Serephos.
Disorder is a neurological dysfunction that has no known cure at
the present time. However, the good news is that effective treatment
is available and following the protocol can improve how a person
feels and functions more dramatically than many psychiatric conditions.
What I find so attractive about the work of Dr. Amen is that he
treats the whole person. He stresses the need for appropriate psychotropic
medication, but also believes that a clinician needs to pay attention
to diet, exercise, and behavioral strategies to fully address ADD.
© 2003 Jef Gazley, M.S. www.asktheinternettherapist.com