How ADHD Is Diagnosed

How Brain Imaging Changes Everything — Or Not

SPECT imaging measures the brain’s healthy activity. How is this helpful in diagnosing and treating ADHD? Here, Dr. Amen explains how he uses brain imaging to pinpoint ADHD challenges — and solutions.

A depiction of an ADHD brain image and the new discoveries in that area of research.
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What Does Brain Imaging Tell Us?

There are a variety of brain imaging techniques. SPECT imaging captures blood flow and activity in the brain to study brain function. It’s different from a CAT scan or an MRI, which are anatomy studies that investigate the brain's structure or how it physically looksSPECT looks at how the brain works.

Think of a car engine. An MRI will show you what it looks like. A SPECT scan will show how it functions. SPECT basically tells us three things — whether the brain is exhibiting healthy activity, too little, or too much.

A radiologist reads brain imaging results.
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How Do You Know Unless You Look

Almost all psychiatric diagnoses are made by taking clinical histories and looking for symptom clusters. This is the way people were diagnosed a hundred years ago. SPECT brain imaging adds real biological information that helps deepen our understanding of various disorders.

At Amen Clinics, we have seen patterns associated with various types of ADHD, anxiety, mood disorders, PTSD, and traumatic brain injuries. There is no way to really know about the health of your brain unless you look at it and observe how it functions.

A doctor talks to her patient about how treatment should be tailored to her needs through brain imaging.
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Treatment Should Be Targeted to Individual Brains, Not Symptom Clusters

If you tell a doctor, “I’m sad," she’ll probably diagnose you with a mood disorder and give you medicine for it. But this model is not very effective. The outcomes in psychiatry are no better than they were in 1950. Why? Because it doesn't target treatment to people's individual brains — it targets it toward large groups with similar symptoms. SPECT scans help doctors see the underlying biology of each individual brain, giving physicians more information.

[Free Guide: How Is ADHD Diagnosed?]

A lonely man is treated for his symptoms, instead of what his brain shows that it needs.
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Imaging Completely Changes the Discussion

In my opinion, imaging completely changes the discussion around mental health. After looking at their scans, patients often see that their problems are medical, not moral. SPECT decreases shame and guilt and increases compliance — one of the main reasons I got hooked on imaging more than 20 years ago. Imaging also increases the family’s understanding of the condition, along with compassion and forgiveness. We have nothing else in psychiatry to decrease stigma that is this powerful and this immediate. What if mental health were really brain health?

Friends are jogging, knowing that keeping their body healthy keeps their brains healthy — a concept supported by brain imaging.
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Imaging Reveals More Than Mental Health

Brain imaging — like SPECT scans — can show us more than just mental health issues. For example, more than 200 studies now show that, as the number on the scale goes up, the function and size of your brain goes down. That should scare the fat off anyone! I coined a term called "The Dinosaur Syndrome" to drive this point home. Big body, little brain — you are going to become extinct if you don’t focus on getting healthy.

A doctor explains to her patient that early treatment is key, and brain imaging helps the patient accept that ADHD is a biological condition.
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Early Treatment Is Key

Treatment works best early, not late. If you don’t admit you may have a problem, you can’t do anything to solve it. Since imaging helps to break denial, it helps patients start tackling problems like ADHD, alcoholism, drug abuse, and dementia as early as possible — and it shows a doctor what exactly he needs to target when rehabilitating someone's brain.

Brain scans show that you can improve your brain.
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You Can Improve Your Brain

Brain rehabilitation is possible. You are not stuck with the brain you have, and you can make it better. Studies have shown that brains can improve their levels of function by starting  a “brain smart” program — healthy eating, supplements, physical activity, brain-training exercises, and medication. This improvement is visibly reflected in SPECT scans — imaging shows us that you can literally change your brain, and change your life.

[Free Download: What Every Thorough ADHD Diagnosis Includes]

Needing radar to land a plane is a good analogy to needing brain scans to improve ADHD symptoms and health.
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Do I Need a Scan? Think Radar

When people ask me if they need a scan, I tell them to think about the need for radar when landing a plane. If the day is sunny, you don’t need radar. You can see the runway. If a mental health issue is straightforward and responds nicely to treatment, you don’t need a scan. But if it is raining at the airport with thunder and lightning, radar can save your life. Likewise, if your case is complex, or you have failed multiple treatments, imaging can make treatment much safer.

A grandfather holds a young girl on his shoulders — both are the right age for brain imaging.
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At What Age?

If treatment is ineffective, we scan patients as young as 5 or 6. On the other hand, you’re never too old for a SPECT scan. You can improve your brain at any age.

A doctor evaluates his patient for ADHD by talking with her. Diagnosis requires more than just brain imaging.
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Diagnosis Is Always More Than a Scan

Scans help doctors decrease stigma, increase compliance, and provide targets to go after with treatment — be it supplements, medication, neurofeedback, or other treatments. But at Amen Clinics, scans are never used by themselves to make a diagnosis. A good doctor will use the scans in conjunction with detailed clinical histories, where we gather biological, psychological, social, and spiritual information. The SPECT results have to be put in the context of a person’s life.

A doctor explains the potential risks and rewards of SPECT brain imaging.
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Safety of SPECT Imaging

Some people reasonably express concern over the radiation involved with a SPECT study. SPECT is a nuclear medicine procedure that uses radio-isotopes to look at living brain activity. The radiation exposure is equivalent to one brain CT or one-third of an abdominal CT. It is considered a safe procedure by the American Academy of Neurology. I have had 11 scans over the years. Last year in the U.S., millions of nuclear medicine procedures were performed. I think the risk of a SPECT scan is significantly overshadowed by the reward. An ineffectively treated psychiatric problem is likely much more harmful than the small amount of radiation.

A woman is happy because she got brain imaging and it changed her life.
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Change Your Brain, Change Your Life!

At Amen Clinics, we believe a scan is an important step to understanding your brain, and once you understand your brain, you can start to work toward improving it. In our experience, people with ADHD can dramatically decrease the need for medication if they implement the right brain-healthy habits in their lives. It doesn’t mean they won’t need medication, but, odds are, they’ll need less of it.

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