Questionnaire for ADD

Dear PP,

There are a number of questionnaires and most of them are sufficient to diagnose ADD. Unfortunately, I cannot include them in this message, but can suggest to you which one I feel is the best. Dr. Amen is by far the leader in this field. His book - Healing ADD-The Six Types - is the standard text for this problem and includes his ADD test in the book. He also suggests a SPECT scan, which is a brain scan that delineates what type of ADD a person has. This is a very effective way to tell whether an individual has it or not, but is rather expensive and usually not needed for more simple forms of the disease. From the little you have shared about your children, it sounds as if they have the "Inattentive" type. If that is all it is, any expert in the field will be able to treat the condition without the SPECT. I am including below a couple of articles that I have written on the subject, which I hope will give you more information.

Attention Deficit Disorder (ADD) and Attention Deficit Disorder with Hyperactivity (ADHD) occur as a result of a 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 controls executive functions. The functions of this brain deal with: attention span, perseverance, judgment, organization, impulse control, self-monitoring and supervision, problem solving, critical thinking, forward thinking, learning from experience, ability to feel and express emotions, interactions with the limbic system and empathy.

Whenever there is a problem with this part of the brain, a number of skills that many human beings take for granted are not be available in an optimal way. The following are problems that develop when this part of the brain is affected: short attention span, distractibility, lack of perseverance, lack of impulse control, hyperactivity, chronic lateness and poor time management, disorganization, procrastination, lack of emotion, misconceptions, poor judgment, trouble learning from experience, short-term memory loss, as well as social and test anxiety.

The exact neurological link with ADD is unknown. However, SPECT scans (Single Photon Emission Computed Tomography) which measure cerebral blood flow and metabolic activity patterns, have shown that when someone with ADD concentrates, their prefrontal lobe activity decreases significantly. This essentially means that when under stress or concentrating, someone with this disorder cannot use all of there mental faculties.

It is theorized that our usual ability to screen out and attend to the stimuli of our choice is impaired for 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 overwhelmingly so. However, at Christmas time after a couple of hours at the mall, we are so over-stimulated that we can't even find our 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. 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.




2. Stimulants given in small doses so the mood alteration is minimal, act in a paradoxical manner. This means that instead of exciting a person, stimulants help them to focus and calm down while still allowing the prefrontal lobe to remain active. They also seem to increase the availability of dopamine as well.




3. The combination of an anti-depressant and a stimulant is also possible. This seems to work best.



4. The fourth treatment consists of teaching relaxation, stress-management, as well as organizational and social skills. This should always be included as part of the treatment whether or not chemotherapy is used.

There is another form of treatment that is naturopathic. From what I understand, this approach uses a combination of diet and supplements, although its effects vary for each individual. My experience with this option is limited and at present I am studying its efficacy with a colleague who is a chiropractor. I am looking forward to impressive results.

There are numerous misconceptions about ADD and a lot of emotional fervor about the diagnosis. It reminds me of the debate over Prozac, or the one about 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 difficulties with medication 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, and for the better. It is as if for the first time, a person can think clearly, causing their self-esteem to soar. 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 their problems. They are often blamed for their own illness, and this happens a lot with ADD.

True ADHD with hyperactivity is rather easy to diagnose. However, only in the last ten years has the passive ADD type been recognized. This diagnosis is hard to spot and is often characterized by a tendency to "space-out" and the inability to track. It was once believed that children were the only ones to suffer from this disorder and that once they turned 14 they grew out of it. It was also believed that in the normal course of experimentation with drugs and alcohol, a person with this disorder will usually turn to amphetamines and become addicted. Almost the right drug, but the wrong dosage! In reality, most people do not grow out of the disease. In addition, even if hard-core Methadrine addicts are put on a small dose of Ritalin and thrive, it does not reactivate the addictive process.

Once again, Dr. Daniel G. Amen is the acknowledged leader in the field of Attention Deficit Disorder. In the last two years, he has expanded the classification of ADD types from the standard Hyperactive and Inattentive by adding four more distinct types of ADD. He has done this through exhaustive research with the help of a SPECT scan. 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 therapy.

In his book Healing ADD, Dr. Amen lists the six types of ADD:

1. Classic hyperactive
2. Inattentive
3. Over-focused
4. Temporal
5. Limbic
6. Ring of Fire.

Each of these types has many similarities and differences in their symptoms and treatment. One of the primary features for all of these is the periodic impairment of the prefrontal cortex and the involvement of dopamine.

1. Classic ADD is characterized by both hyperactivity and inattentiveness. It is usually quite easy to treat through a combination of a high protein diet, aerobic exercise, a stimulant such as Adderall or Ritalin and possibly the supplement L-Tyrosine. An anti-depressant is often used as well.

2. Inattentive ADD lacks the hyperactivity factor, but people who suffer from it have a difficult time focusing and are often very scattered. The treatment for the Inattentive type is usually the same as the one used for the Classic type.

3. People with Over-focused ADD exhibit the same problems and symptoms in the prefrontal cortex as those with the Classic and Inattentive type. The only difference is that those who suffer from this type become over-focused, and tend to have difficulty breaking away from a thought or behavior. This is because the cingulated area of the brain is over-active, locking a person into self-destructive, negative, or repetitive behaviors. Treating it with stimulants will often cause temper problems. Thus, it is usually helpful to have a person take an anti-depressant first and only add a stimulant later. Another possible treatment is to use St. Johns Wort, a natural herbal anti-depressant. However, it is important not to use both a traditional and an herbal anti-depressant at the same time. Other forms of treatment such as diet and exercise can also be used, just as in 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 also affected. This could be from a previous head injury, although not necessarily. All the symptoms are similar to the other ADD types, but for this type, extreme bouts of anger are also a characteristic. Treatment often involves the use of stimulants and an anti-convulsant drug, such as Depecote. Supplements such as GABA, ginkgo biloba, or vitamin E can also be used. Otherwise, the same treatments indicated above in the other types remain an option.

5. In Limbic ADD, 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. Stimulants and a depressant are treatment options. Also, aerobic exercise is highly recommended, as is a mixed diet of complex carbohydrates and protein. Supplements such as SAMe or L-tyrosine can also be used.
6. Ring of Fire ADD is a very disorganized and severe form of ADD that is actually a combination of all the other types. In fact, the entire brain is lit up on a SPECT scan. In addition to the standard treatment of stimulants and an anti-depressant, an anti-psychotic drug like Respiridal is often called for. Dietary and exercise treatments similar to the ones used with the Inattentive type is also recommended. Supplements such as GABA, omega-3, Zinc, Flax seed oil, and Serephos are also known to be helpful.

I hope that this helps.

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