Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental disorder that impacts millions of adults worldwide. The condition is characterized by pervasive patterns of inattention, hyperactivity, and impulsivity. This triad of symptoms has an onset during childhood and often persists into adulthood, affecting social, occupational, and academic functioning.
3 Official Types of ADHD in Adults
The official types of ADHD are described in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which is published by the American Psychiatric Association. Here are the three types:
1. Predominantly Inattentive Presentation
This presentation is defined by significant trouble with attention, organization, following instructions, and completing tasks. Individuals with this type typicallyhave less noticeable hyperactive or impulsive symptoms.
● Adult Symptoms:
Difficulty in maintaining focus, being easily distracted, forgetfulness, difficulty in completing tasks, problems with organization, a tendency to lose things, and problems with following conversations.
● Common Treatments:
Behavioral therapy, psychoeducation, and medications such as stimulant and non-stimulant drugs.
2. Predominantly Hyperactive-Impulsive Presentation
The hyperactive-impulsive type is marked by excessive fidgeting, talking, interrupting others, and impatience. Attention problems may be less prominent in this type.Particularly for this subtype, which is less common in adults, non stimulant drugs such as guanfacine and clonidine may be helpful, whlle they not typically helpful for the other subtypes of adult ADHD.
● Adult Symptoms:
Restlessness, difficulty sitting still, impatience, problems doing quiet activities, excessive talking, blurting out, interrupting, and problems waiting their turn.
● Common Treatments:
Behavioral therapy, parent and adult training (to develop coping strategies), and medication.
3. Combined Presentation
The combined type, as the name suggests, includes symptoms from both other types - inattentive and hyperactive-impulsive.
● Adult Symptoms:
A combination of symptoms from the inattentive and hyperactive-impulsive presentations. These can create significant challenges in many areas of life, including work, relationships, and day-to-day tasks.
● Common Treatments:
A multimodal approach that combines medication, behavioral therapy, psychoeducation, and lifestyle changes.
In a few words, ADHD often presents as restlessness, difficulty in focusing, poor organization skills, forgetfulness, and impulsive decision-making, impacting relationships, job performance, and daily life. Although frequently diagnosed in childhood, many adults live with the disorder, often unaware of its presence.
Dr. Daniel Amen's 7 Types of ADD or ADHD
However, as with many mental health conditions, ADHD does not manifest identically in all affected individuals, suggesting a more complex underlying structure. Psychiatrist Dr. Daniel Amen proposed a novel, more granular classification system comprising seven distinct types of ADHD, based on the results of thousands of brain SPECT (Single Photon Emission Computed Tomography) scans conducted at his clinics.
1. Classic ADHD
This is the most recognized type, characterized by inattention, distractibility, hyperactivity, disorganization, and impulsivity. It is thought to arise from reduced activity in the prefrontal cortex, a region responsible for executive functions such as decision-making and impulse control. Treatment for Classic ADHD often involves stimulant medications like Ritalin and Adderall, which increase dopamine and norepinephrine levels, improving attention and reducing impulsivity and hyperactivity.
2. Inattentive ADHD
This type is marked by inattention and easy distractibility but lacks the hallmark hyperactivity of Classic ADHD. This type, often seen in females, might involve reduced activity in the prefrontal cortex and low dopamine levels. Medications used to treat this type of ADHD include stimulant and non-stimulant drugs, which can increase dopamine levels and enhance focus.
3. Over-Focused ADHD
Individuals with this type display the classic symptoms of ADHD but also have difficulty shifting their attention. They tend to get stuck in negative thought loops and demonstrate excessive worrying. This subtype might be linked to increased activity in the anterior cingulate gyrus, a part of the brain that is responsible for attention allocation and shifting. Treatment options for this type of ADHD may include a combination of stimulant and non-stimulant medications. Of note, this symptom is often seen in one of the three subty[es described in the DSM V it is just not listed as a separate diagnostic category.
4. Temporal Lobe ADHD
This type is characterized by learning and memory problems, behavioral issues, and aggression. It might be associated with abnormalities in the temporal lobes and amygdala, areas of the brain involved in memory processing and emotional regulation. Potential treatments for Temporal Lobe ADHD include anticonvulsants, which can stabilize electrical activity in the brain, and neuronutrient therapy.
5. Limbic ADHD
This type presents as chronic low-level sadness, negativity, low energy, and low self-esteem, resembling a persistent mild depression. It's thought to be linked to overactivity in the limbic area, the emotional center of the brain. A combination of stimulant and antidepressant medications may be beneficial in treating this subtype.
6. Ring of Fire ADHD
This subtype is characterized by a broad range of severe and often unpredictable symptoms. It might be due to generalized overactivity across the brain, creating a 'ring of fire' effect on SPECT imaging. Management of this type may require a multidimensional approach that includes medication, dietary changes, neurofeedback, and psychotherapy.
7. Anxious ADHD
This type encompasses the typical symptoms of ADHD with an added layer of anxiety or excessive worry. It is likely related to overactivity in the basal ganglia and the fear centers of the brain. Treatments may involve anxiolytic medications, which can reduce anxiety and stress, alongside stimulants.
The most important things to remember about the treatment of any type of ADHD is to work with a skilled clinician, obtain an appropriate diagnosis of some form of ADHD based on clinical signs and symptoms and work with your clinician, family, teachers or supervisors, coaches, etc and to focus on alleviation of your specific symptoms. If a medication is chosen as part of the teatment plan, monitoring for side effects and optimizing treatment specific to the individual. The truth is psychiatrists and other MH clinicians focus on this rather than treating a diagnosis. Academic Controversy Surrounding Dr. Amen's Seven Types of ADHD
The seven types of ADHD proposed by Dr. Daniel Amen have generated significant controversy within the academic community, primarily due to the lack of peer-reviewed research supporting the validity of these classifications. The debate surrounding Dr. Amen's work highlights the tension between innovation in psychiatric understanding and the need for rigorous scientific validation.
Criticisms and Concerns
A primary concern among critics is the heavy reliance on Single Photon Emission Computed Tomography (SPECT) imaging to identify and differentiate the seven types of ADHD. SPECT imaging, while useful in certain medical contexts, is not typically used in psychiatric diagnosis due to several limitations:
SPECT imaging is expensive, which raises concerns about accessibility and the potential for financial bias in research and treatment recommendations. It is typically not covered by medical insurance including Medicaid.
Compared to other imaging methods such as Magnetic Resonance Imaging (MRI) or functional MRI (fMRI), SPECT has a lower resolution, which may limit its ability to accurately capture the nuances of brain activity.
SPECT imaging exposes patients to ionizing radiation, which may pose health risks, particularly in children and adolescents who are the primary age group affected by ADHD.
Another Significant Concern
The lack of extensive clinical trials to validate the effectiveness of treatment strategies based on Dr. Amen's classifications. Critics argue that without such evidence, the broad application of these classifications may lead to misdiagnosis and inappropriate treatment, potentially causing more harm than benefit.
Despite these criticisms, proponents of Dr. Amen's classification system argue that it represents a progressive step towards a more comprehensive understanding of ADHD. They emphasize the potential benefits of this approach:
Dr. Amen's classifications take into account not only the core symptoms of ADHD but also the diverse cognitive, emotional, and behavioral manifestations of the disorder. This integrated perspective may lead to a more accurate and personalized diagnosis.
Targeted Treatment Strategies
By identifying distinctive subtypes of ADHD, clinicians may be better equipped to tailor treatment plans to address the unique needs of each patient, potentially improving outcomes and reducing the burden on healthcare systems.
Innovation in ADHD Research
Dr. Amen's work challenges conventional wisdom and encourages further research and exploration into the complexities of ADHD. This could ultimately lead to a deeper understanding of the disorder, the development of more effective treatments, and improved quality of life for those affected.
The academic controversy surrounding Dr. Amen's seven types of ADHD underscores the importance of robust scientific validation in advancing psychiatric knowledge. While his work has the potential to revolutionize our understanding of ADHD and improve patient care, it is crucial that future research thoroughly assesses the validity and effectiveness of these classifications before they are widely adopted in clinical practice.
Advice for Patients and Families
A diagnosis of ADHD can feel overwhelming, but it's important to remember that help is available and effective management is entirely possible. Here are some essential tips:
Get a Comprehensive Evaluation
If you suspect you or a loved one might have ADHD, seek a comprehensive evaluation from a healthcare provider skilled in the assessment of ADHD. This evaluation should include a thorough clinical interview, a medical history review, and when available, a review of old report cards and feedback from family members or close friends.
Personalize the Treatment
Treatment should be individualized based on the unique symptom profile, lifestyle, and personal preferences of the individual. A multimodal treatment approach is often the most effective for managing ADHD. This can include medication, psychotherapy, coaching, behavioral interventions, exercise, and nutritional guidance.
Understand as much as possible about ADHD. This knowledge will empower you to make informed decisions about all aspects of treatment and life management.
Consider joining an ADHD support group. Connecting with others who are facing the same challenges can offer emotional support, shared coping strategies, and a sense of community.
Maintain a Healthy Lifestyle
Regular physical activity, a healthy diet, sufficient sleep, and stress management techniques such as mindfulness or yoga can all help manage ADHD symptoms.
ADHD in adults is a complex, multifaceted disorder that requires a nuanced approach to diagnosis and treatment. The introduction of the seven types by Dr. Amen offers a fresh perspective, suggesting that a more individualized approach may be beneficial. Despite the controversy surrounding these classifications, they represent a step towards understanding the biological underpinnings of ADHD, potentially leading to more personalized and effective treatment strategies.
However, further research is crucial to validate and refine these classifications. In the meantime, individuals with ADHD and their families should focus on understanding the condition, advocating for comprehensive care, and working towards the best possible quality of life.
Remember, regardless of classification, every individual's experience with ADHD is unique. What's most important is finding the strategies and support that work best for you or your loved one