Need help for ADD

Dear Jen,

You have really touched a nerve with me. I cannot tell you how often I run up against the same problem. It reminds me of all the fervor years ago about whether alcoholism was a disease or not. What happened then is everyone seemed to have an opinion, and most of it was based on very little except passion and prejudice. That is what is happening right now with Attention Deficit Disorder. Say the word among a group of people and watch the blind and ignorant passion begin. Very few people know about the new research that has been coming out in the last few years. Dr. Amen is by and away the leader in that field. He has pioneered a diagnostic procedure by using SPECT scans, which is a brain imaging tool that shows how the brain is functioning and proves the diagnostic condition of ADD and which type it is.

Most people barely know about the two types of ADD that were known years ago or that adults can have the disorder. Hardly anyone is aware that Dr. Amen has delineated four other types of the disorder in his book "Healing ADD-The Six Types." I would really recommend it to you because with so much misinformation, even in the professional community, the client now has to become educated enough to educate the professional. Great system, eh? I am going to include in this missive two articles I have written on the subject. One is before Dr. Amen's research and the other is after. I hope this helps.

Attention Deficit Disorder (ADD) and Attention Deficit Disorder with Hyperactivity (ADHD) occur as a result of neurological dysfunction in the prefrontal cortex part of the brain. This is the newest part of our tri-brain system in evolutionary terms. It is the part of our brain that has executive functions. The functions of this brain deals 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
13. empathy.

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
14. social and test anxiety.

The exact neurological problem with ADD is unknown. 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 be brought to bear their full cognitive capacity.

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 we are so over stimulated that it is hard to find the car. People with ADD feel this way almost all the time.

There are four recommended courses of treatment for someone with ADD or ADHD:

1. Antidepressants

   
   

2. Stimulants

   
   

3. A combination of antidepressants and stimulants

   
   

4. Learning relaxation, stress management, organizational and socializing skills.

Physicians often give an antidepressant such as Wellbutrin, which tends to calm the limbic system and increase dopamine, a neurotransmitter. In my experience this can be helpful, but stimulants 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 as well. A combination of an anti-depressant and a stimulant seems to work best. The fourth treatment should always be included as part of treatment whether or not chemotherapy is used.

Another form of treatment is naturopathic. From what I understand, this approach uses a combination of diet and supplements and is extremely varied and different for each individual. My experience with this option is limited and at present I am studying the efficacy with a chiropractic colleague. I am looking forward to impressive results.

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 or over Alcoholism being 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 and benefits and the severity of the problem. Most medication difficulties 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 with ADD.

True ADHD with hyperactivity is rather easy to diagnose. However, only in the last ten years was the ADD passive type recognized. This diagnosis is hard to spot and often is characterized by a general 'spaciness' and inability to track. It also used to be common knowledge that children were the only ones to suffer from this disorder and that once they turned 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. Almost the right drug, but wrong dose! Most people do not grow out of the disease. Interestingly enough, even hard-core Methadrine addicts thrive if they are put on a small dose of Ritalin - and it does not reactivate the addictive process.

Dr. Daniel G. Amen is the acknowledged leader 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.

In "Healing 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 have much in common but also differ 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.

1. 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.
2. Inattentive 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.
3. Over focused ADD exhibits the same problems and symptoms of the prefrontal cortex as with classic and inattentive ADD, but the difference is that the sufferer is over focused, and often cannot break away from a thought or behavior. This is because the cingulated area of the brain is overactive and often locks a person into self-destructive, negative, or repetitive behavior. Often a stimulant will cause temper problems. 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 are the same as the first two types of ADD.

4. Temporal 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. Treatment is often with a stimulant and an anti-convulsant such as Depecote. All other treatment is the same except that supplements such as GABA, ginkgo biloba, or vitamin E can be used.
5. Limbic ADD is when the limbic area of the brain is also affected in addition to the prefrontal cortex. This ADD has the symptoms of inattentive ADD, but a significant proportion of depression is also present. A stimulant and a depressant are indicated. Aerobic exercise is needed, but often a complex carbohydrate and protein mixed diet is also indicated. The supplements SAMe or L-tyrosine are used.
6. 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 drug like Respiridal is often called for. Dietary and Exercise treatment is the same as in the inattentive type. The supplements GABA or omega-3 are also possibly needed. Other supplements that have been found helpful with ADD in general are Zinc, Flax seed oil, and Serephos.

I hope this helps. Good luck.

Jef Gazley, M.S. www.asktheinternetherapist.com