The Amen Approach to ADD

Dr. Daniel Amen, author of Healing ADD, sits down with ADDitude to talk about diagnosing ADHD, his controversial use of SPECT scanning, and the “seven types of ADD.”

Dr. Daniel Amen

ADD is not a single or simple disorder. One treatment does not fit everyone with the condition.

— Dr. Daniel Amen

Daniel Amen, a double-board-certified psychiatrist and best-selling author, is perhaps America’s most in-demand psychiatrist. His methods, however, are frowned upon by some of his peers. As the founder and medical director of Amen Clinics, with six clinics coast to coast, Dr. Amen’s approach revolves around his controversial system called SPECT, or single-photon emission computed tomography, which tracks blood flow in the brain and shows areas of high and low activity. Amen says two scans — one taken at rest and one taken after a concentration test — along with a series of questionnaires and a clinical history, can paint an accurate picture of a person who has ADD. Amen claims his brand of psychiatry gives hope to those who have tried and failed with everything else.

“One of the biggest lessons I’ve learned through SPECT scanning is that ADD is not a single or simple disorder,” says Amen. “One treatment does not fit everyone with the condition.”

ADDitude caught up with Dr. Amen recently to ask him about his novel approach to diagnosing and treating ADD.

When you boil it down, can ADD be healed?

There's a specific reason the book is called Healing ADD. I've gotten a fair amount of grief for the title. It's like, "Oh, you can't cure ADD." The book isn't called "ADD Cure." Healing is a process. It's like my new program, Healing ADD at Home in 30 Days. If you do the things that I ask, you are going to be feeling — or your child is going to be feeling — so much better in 30 days that you're going to keep doing those things. It's not the “ADD cure,” but it's a process of making things better, which is the definition of healing.

When did your first learn about SPECT scans and why do you think they play such an important role in treating ADHD?

I went to my first lecture on brain SPECT imaging in 1991. SPECT looks at blood flow and activity in the brain. It looks at how the brain works. It shows us three things: areas of the brain that work well, areas of the brain that are low in activity, and areas of the brain that are high in activity.

I had been doing quantitative EEG before I started doing SPECT scans. We saw on our quantitative EEG studies that when people with ADD tried to concentrate, they got a surge of slow-wave activity in their frontal lobes — the harder they tried to concentrate, the worse things got for them.

After that first SPECT lecture, I headed to a hospital room where one of my patients named Sally was staying. She had tried to kill herself the night before. I was absolutely convinced she had ADD.

Sally had a son who had ADD. She was bright, but never finished college. She was disorganized and sought out conflicts. Sally didn't believe in ADD and didn't want to take the medication that I recommended for her. So, I said, "How about if I scan you?" And she said, "OK."

Several days later, when I put the scans on the table in her hospital room, she started to cry. She said, "You mean it's not my fault?" I said, "Yes. Having ADD is just like people who need glasses. People who need glasses aren't dumb, crazy, or stupid; their eyeballs are shaped funny. They need help getting focused." When she got it, she started, and stuck with, treatment and got better.

How is an MRI different than a SPECT scan?

An MRI is an anatomy study. It shows what the brain physically looks like. SPECT is a nuclear medicine study that looks at blood flow and activity in the brain. It's a functional study. To put it in concrete terms, an MRI shows you what the car engine physically looks like. The SPECT scan shows you how it works when you turn the engine on.

The hardest part about getting the SPECT scan is that it requires inserting a little tiny needle in a vein in your arm and injecting medicine into your arm that helps light up the brain when it is being scanned. It gives us beautiful 3D images of the brain.

How expensive is a SPECT scan, and does insurance cover it?

The cost of an evaluation at the Amen Clinics, which includes five different steps, is about $3,700. The cost of an individual SPECT scan is about $1,300. Insurance companies don't cover it because they categorize attention deficit as a behavior problem. They don't see it as a brain problem.

How many scans have you done to arrive at your ADD types?

At the Amen Clinics we've done nearly 87,000 SPECT scans on patients from 111 countries. These types aren’t something I thought up after seeing 50 patients at a research center. We do this every day. We find that when we know the ADD type, the right treatment can be helpful.

What did you learn from doing all those scans?

One of the most important early lessons I learned from SPECT imaging is that all psychiatric illnesses — ADD, anxiety, depression, addictions, autism, schizophrenia, bipolar disorder, PTSD — are not single or simple disorders in the brain. They all have multiple types.

If we look at two different patients who have ADD, one may have low activity in their brain, the other high activity. Do you think they'll both respond to the same treatment? No. The low-activity types tend to do better with stimulants. People with high activity in their brains often do worse with stimulants. So, over time, I realized I could break all of these scans down into different types of ADD.

It was around 2001 when I wrote my book Healing ADD, in which I talked about six different types of ADD. I just published the newly revised version of the book and added a seventh type. When you know the ADD type, you can target treatment specifically to that symptom cluster.

NEXT: The Seven Types of ADHD

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