About Attention Deficit Disorder (continued)

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 as to 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 with ADD.

True ADHD, which the same as ADD 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 administered 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 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 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 antidepressant is used as well.

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.

Over-focused ADD shares the same problems and symptoms of the prefrontal cortex with classic and inattentive ADD, but the difference is that the sufferer of this type of ADD 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 antidepressant first and only later to add the stimulant. Another possible treatment is to use St. Johns Wort, a natural herbal antidepressant, but it is important not to use both a traditional and an herbal antidepressant at the same time. The other forms of treatment such as diet and exercise is the same as the first two types of ADD.

Temporal ADD is still characterized by problems with the prefrontal cortex, but the temporal area of the brain is 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 antidepressant 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. The entire brain is lit up on a SPECT scan. In addition to the standard treatment of a stimulant and an antidepressant, an anti-psychotic like Abilify 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.

Attention Deficit 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 Amen protocol can improve how a person feels and functions more dramatically than with 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.