Types of ADHD

Are There Really 7 Types of ADD?

Controversy surrounds Dr. Daniel Amen’s 7 types of ADD — each with its own unique ADHD symptoms, brain function, and neurotransmitter activity. What do you think of his theories and methodologies?

A depiction of the many different kinds of adhd and the other comorbid conditions that frequently accompany it.
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“One Treatment Does Not Fit Everyone”

As the founder of six Amen Clinics, I bring a multidisciplinary approach to diagnosing and treating brain-based disorders including attention deficit disorder and coexisting conditions. For more than 20 years, I've used SPECT brain scans (along with other diagnostic techniques) to develop individual, targeted treatment plans for each patient. Early on, I discovered through brain SPECT patterns that attention deficit is not a single or a simple disorder.

An image of a brain impacted by ADHD and related conditions like anxiety, depression, OCD or learning disabilities.
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My ADD Is Not Your ADD

ADD, anxiety, mood disorders, bipolar disorder, autism, and other conditions are not single or simple disorders. They all have multiple types. ADD affects many areas of the brain — the prefrontal cortex and cerebellum primarily, but also the anterior cingulate, the temporal lobes, the basal ganglia, and the limbic system. The 7 types of ADD that I studied are based around three neurotransmitters — dopamine, serotonin, and GABA.

A woman texting while driving and showing signs of classic ADD with lack of focus, forgetfulness, and disorganization.
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Classic ADD

This is the easiest type to spot of the 7 types of ADD: Primary symptoms are inattentiveness, distractibility, hyperactivity, disorganization, and impulsivity. Scans of the brain show normal brain activity at rest, and decreased activity, especially in the prefrontal cortex, during a concentration task. People with Classic ADD have decreased blood flow in the prefrontal cortex, cerebellum, and the basal ganglia, the last of which helps produce the neurotransmitter dopamine.

Women with ADHD running through the woods because exercise triggers dopamine creation in the ADD brain.
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Treating Classic ADD

The goal here is to boost dopamine levels, which increases focus. I do it with either stimulating medications — Ritalin, Adderall, Vyvanse, Concerta — or stimulating supplements like rhodiola, green tea, ginseng, and the amino acid L-tyrosine. Getting lots of physical activity also helps increase dopamine, as does taking fish oil that is higher in EPA than DHA.

A man with inattentive ADHD plays with a model airplane at work because he is easily distracted.
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Inattentive ADD

This type, as well as Classic ADD, have been described in The Diagnostic and Statistical Manual (DSM) of Mental Disorders since 1980. Inattentive ADD is associated with low activity in the prefrontal cortex and low dopamine levels. Symptoms are short attention span, distractibility, disorganization, procrastination. People with this type are not hyperactive or impulsive. They can be introverted and daydream a lot. Girls have this type as much as, or more than, boys.

A pharmacist discusses treatment options with an adult with inattentive ADHD who needs help focusing, getting organized, and maintaining attention.
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Treating Inattentive ADD

Inattentive ADD is usually responsive to treatment. It is often possible to change the course of a person's life if he or she is properly treated. The goal, as with Classic ADD, is to boost dopamine levels. I use the supplements like the amino acid L-tyrosine, which is a building block of dopamine. Take it on an empty stomach for maximum effect. I often also prescribe a stimulant like Adderall, Vyvanse, or Concerta. I put patients on a high-protein, lower-carbohydrate diet, and I have them exercise regularly.

A man with overfocused ADHD stares out a window because he has trouble shifting his attention.
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Over-Focused ADD

Patients with this type have all of the core ADD symptoms, plus great trouble shifting attention. They get stuck or locked into negative thought patterns or behaviors. There is a deficiency of serotonin and dopamine in the brain. When the brain is scanned, you see that there's too much activity in the area called the anterior cingulate gyrus, which is the brain's gear shifter. This overactivity makes it difficult to go from thought to thought, task to task, and to be flexible.

A doctors shows brain scans to a patient with over-focused ADD ADHD.
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Treating Over-Focused ADD

The goal is to boost serotonin and dopamine levels in the brain. Treatment is tricky. People with Over-Focused ADD get more anxious and worried on a stimulant medication. I use supplements first — L-tryptophan, 5-HTP, saffron, and inositol. If supplements don't help with symptoms, I prescribe Effexor, Pristique, or Cymbalta. I avoid a higher-protein diet with this type, which can make patients mean. Neurofeedback training is another helpful tool.

A man with ADHD and anger issues breaks a pencil
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Temporal Lobe ADD

Of the 7 types of ADD, this type has core ADD symptoms along with temporal lobe (TL) symptoms. The TL, located underneath your temple, is involved with memory, learning, mood stability, and visual processing of objects. People with this type have learning, memory, and behavioral problems, such as quick anger, aggression, and mild paranoia. When the brain is scanned, there are abnormalities in the temporal lobes and decreased activity in the prefrontal cortex.

An example of the medication used to treat temporal lobe ADD, which is also treated with magnesium.
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Treating Temporal Lobe ADD

I use the amino acid GABA (gamma-aminobutryic acid) to calm neuronal activity and inhibit nerve cells from overfiring or firing erratically. Taking magnesium — 80 percent of the population are low in this mineral — helps with anxiety and irritability. Anticonvulsant medications are often prescribed to help with mood instability. For learning and memory problems, I use gingko or vinpocetine.

A woman with limbic ADD puts her head in her hands due to chronic low-level sadness and ADHD.
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Limbic ADD

This type looks like a combination of dysthymia or chronic low-level sadness and ADD. Symptoms are moodiness, low energy, frequent feelings of helplessness or excessive guilt, and chronic low self-esteem. It is not a mood disorder. This type is caused by too much activity in the limbic part of the brain (the mood control center) and decreased prefrontal cortex activity, whether concentrating on a task or at rest.

A fish oil capsule used to treat symptoms of low-level sadness associated with limbic ADD.
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Treating Limbic ADD

The supplements that work best for this type of ADD are DL-phenylalanine (DLPA), L-tryosine, and SAMe (s-adenosyl-methionine). Wellbutrin is my favorite medication for this type of ADD. Researchers think it works by increasing dopamine. Imipramine is another option for this type. Exercise, fish oil, and the right diet will help a person with Limbic ADD better manage symptoms.

A woman with ring of fire ADD with her head in her hands due to symptoms including sensitivity to noise, light, touch; periods of mean, nasty behavior; unpredictable behavior; talking fast; anxiety and fearfulness.
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Ring of Fire ADD

Patients with this type don't have an underactive prefrontal cortex, as with Classic and Inattentive ADD. Their entire brain is overactive. There is too much activity across the cerebral cortex and many of the other parts of the brain. I call it "ADD plus." Symptoms include sensitivity to noise, light, touch; periods of mean, nasty behavior; unpredictable behavior; talking fast; anxiety and fearfulness. In brain scans, it looks like a ring of hyperactivity around the brain.

A woman with ring of fire ADD chops up fresh vegetables for a healthy diet to treat symptoms.
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Treating Ring of Fire ADD

Stimulants, by themselves, may make symptoms worse. I start out with an elimination diet, if I suspect an allergy is involved, and boost the neurotransmitters GABA and serotonin through supplements and medication, if necessary. I prescribe GABA, 5-HTP, and L-tyrosine supplements. If I prescribe medication, I start with one of the anticonvulsants. The blood pressure medicines guanfacine and clonidine may be helpful, calming overall hyperactivity.

A man with anxious ADHD looks stressed out, anxious, and worried about something on his computer.
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Anxious ADD

People with this type have hallmark ADD symptoms, and they are anxious, tense, have physical stress symptoms like headaches and stomachaches, predict the worst, and freeze in anxiety-provoking situations, especially where they may be judged. When the brain is scanned, there is high activity in the basal ganglia, large structures deep in the brain that help produce dopamine. This is the opposite of most types of ADD, where there is low activity in that region.

A woman with anxious ADD takes a calming supplement to treat her symptoms of stress and worry.
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Treating Anxious ADD

The treatment goal is to promote relaxation and boost GABA and dopamine levels. ADD stimulants, taken alone, make patients more anxious. I first use a range of "calming" supplements — L-theanine, relora, magnesium, and holy basil. Depending on the patient, I prescribe the medications imipramine or desipramine to lower anxiety. Neurofeedback also works to decrease symptoms of anxiety, especially to calm the prefrontal cortex.