ADD, or attention deficit disorder, is the outdated term for ADHD (attention deficit hyperactivity disorder). In 1987, the American Psychological Association discontinued the use of the term ADD and instead replaced it with ADHD. However, in modern times both terms are thrown about and sometimes this can cause major confusion. In a modern context, ADD is used to describe inattentive attention deficit hyperactive disorder, which is a subtype of ADHD.
ADD/ADHD is characterized by hyperactivity and a lack of impulse control and attention. However these symptoms can vary by the individual and not all the symptoms must be present to diagnose ADD/ADHD. In fact, there are several different types of ADD/ADHD and understanding these different types is a crucial aspect in developing an effective treatment plan. But first, let’s take a look at the basics of ADD/ADHD.
ADD/ADHD is usually diagnosed in children and is diagnosed more in boys. In fact, according to the Centers for Disease Control and Prevention, it is estimated that 6.4 million American children are diagnosed every year. Although ADD/ADHD is more frequently diagnosed in boys, recent studies suggest that ADD/ADHD affects both boys and girls at a similar rate, however it is not as frequently diagnosed in girls because ADD/ADHD affects the sexes differently. ADD/ADHD can have a number of symptoms depending on the type of ADD/ADHD and the sex of the individual. Possible symptoms of childhood ADD/ADHD can include:
- Constant fidgeting or motion
- Interrupting others
- Difficulty playing quietly
- Trouble listening
- Easily distracted
- Can’t finish a task before starting another
- Talks a lot
ADD/ADHD can also affect adults and it is estimated that about 13 million of Americans are affected by ADHD. Any adult with ADD/ADHD was once a child with ADD/ADHD that went undiagnosed until adulthood. Usually adults with ADD/ADHD receive a diagnosis after experiencing problems in the workplace or with their personal relationships. Possible symptoms of ADD/ADHD in adults can include:
- Perpetual lateness
- Easily distracted
- Emotional outbursts
- Intent focus on things they find interesting
- Inability to focus on things they find boring
- Trouble with personal relationships
- Trouble in the workplace
- Have a hard time starting challenging tasks
- Issues with establishing priorities
Additionally, ADD/ADHD can affect women differently than men. Studies have shown that men tend to externalize their symptoms and, for this reason, they are easier to recognize and diagnose. However, women tend to internalize many of their symptoms, which makes it harder for them to get a diagnosis and the care they need. Possible symptoms of women with ADD/ADHD can include:
- Appearing “scatterbrained”
- Low tolerance to stress
- Work hard to gain approval
- Over committing
- Hypersensitive to stimuli
- Trouble with time management
Types of ADD/ADHD
In 2013, psychiatrist and nuclear brain imaging specialist Dr. Daniel G. Amen released a book titled, Healing ADD: The Breakthrough Program that Allows You to See and Heal the 7 Types of ADD that provided insight on the different variations of ADD/ADHD. His book identifies, examines, and explains the different types of ADD/ADHD and discusses a multitude of treatment approaches. However, Dr. Amen adopts the term ADD, rather than ADHD because he believes ADD is a more appropriate term for the condition.
Being a neuropsychiatrist, Dr. Amen also promotes the use of functional neuroimaging as a diagnostic tool. One commonly used functional neuroimaging techniques is SPECT scanning. SPECT stands for Single Photon Emission Computed Tomography and shows cerebral blood flow, which is another way of saying it shows brain activity. Simply stated, SPECT scans show psychiatrists where the brain is working well, too hard, or too little. By learning about brain activity, psychiatrists can further differentiate the seven types of ADD and make better decisions regarding treatment.
According to Dr. Amen, the seven types of ADD/ADHD are as follows:
- Classic ADD
- Inattentive ADD
- Over-focused ADD
- Temporal Lobe ADD
- Limbic ADD
- Ring of Fire ADD (ADD Plus)
- Anxious ADD
Dr. Amen’s definition of classic ADD is the form of ADD that aligns with what most people call ADHD. People with classic ADD are generally inattentive, easily distracted, disorganized, hyperactive, unable to sit still, and impulsive. SPECT scans have determined that people with classic ADD lack blood flow in the prefrontal cortex, cerebellum, and basal ganglia. Because the basal ganglia is associated with the production of dopamine, the usual treatment for classic ADD deals with increasing dopamine levels.
Individuals with inattentive ADD do not suffer from hyperactivity, but are easily distracted, sluggish, slow moving, and lack motivation. Because this form of ADD doesn’t cause behavioral problems, it is usually diagnosed later in life. It is also more commonly seen in females. Individuals with inattentive ADD also have reduced blood flow to their prefrontal cortex which causes low levels of dopamine. Thus, their treatment is similar for those with classic ADD and focuses on increasing the levels of dopamine in the brain.
Those with overfocused ADD display all the symptoms of classic ADD, but also have difficulty shifting their attention to new topics and a habit of becoming stuck in negative thought loops. They also demonstrate obsessive behavior, worry excessively, are inflexible, and frequently exhibit argumentative behavior. Those with overfocused ADD lack both serotonin and dopamine, thus their treatment revolves around boosting their serotonin and dopamine levels.
People affected with temporal lobe ADD exhibit symptoms of classic ADD coupled with irritability, a quick temper, aggression, dark thoughts, mood instability, and mild paranoia. They may also have learning or memory problems. People affected with temporal lobe ADD have reduced brain activity in their prefrontal cortex, as well as irregularities in their temporal lobes. Treatment for temporal lobe ADD is centered around combatting the temporal lobe irregularities by regulating neuronal activity. Treatment may take a variety of forms and is usually dictated by an individual’s symptoms.
Limbic ADD combines classic ADD symptoms with chronic sadness that is not depression, negativity, low energy, feelings of hopelessness of worthlessness, and low self-esteem. Limbic ADD is caused by increased activity in the limbic region of the brain. The limbic region is responsible for controlling moods. People with limbic ADD also have reduced activity in their prefrontal cortex. Treatment for limbic ADD can include supplements, antidepressants, and lifestyle changes.
Ring of Fire:
Ring of fire ADD is the name given to individuals who, in short, have an overactive brain. Overactivity in the cerebral cortex and other parts of the brain cause all the classic symptoms of ADD in addition to being extremely easily distracted, angry, irritable, and overly sensitive to stimuli such as noise, light, and touch. Individuals with ring of fire ADD tend to be highly inflexible, very verbal, argumentative, and moody. Treatment usually consists of reducing the hyperactivity in the brain.
Individuals with anxious ADD exhibit the classic symptoms of ADD, but with additional feelings of anxiety and tension. They also can exhibit physical symptoms of stress such as headaches, stomachaches, and freezing in anxiety-inducing situations. They also tend to worry and anticipate the worst in every situation. Individuals with anxious ADD have increased activity levels in their basal ganglia, which is oppositional to every other type of ADD. Treatment for anxious ADD includes increasing GABA and dopamine levels while promoting relaxation.
With all these variations of ADD, it is also possible to have a combination case. In fact, ADHD combined type is the most commonly occurring type of ADHD. To be diagnosed with a combination case of ADD, your child will need to have six of more symptoms from the various lists and these symptoms must be present for more than six months. Also, symptoms should have been present before the age of twelve and must occur in various settings. Individuals will also be diagnosed with a severity level of mild, moderate, or severe.
Because ADD/ADHD can cause problems with daily functioning and personal relationships, the earlier the diagnosis is made, the better. To effectively diagnose ADD/ADHD, our ADD/ADHD psychiatrists at NJ Family Psychiatry and Therapy use a unique ADD/ADHD testing process to determine the best treatment. Although ADHD cannot be cured, many patients experience significant progress through the use of specialized ADHD treatment.
This testing process begins with intake. Intake usually occurs over the phone. When you call NJ Family Psychiatry and Therapy, our friendly office staff with determine how we can best meet your child’s needs. Our office staff will explain the services we offer as well as payment methods. Then an appointment will be made for the first of four 1 hour ADD/ADHD evaluation sessions.
At NJ Family Psychiatry and Therapy, we understand that ADD/ADHD is often a complex disorder that can be have a range of symptoms. As such, we offer a thorough evaluation process to design an individualized treatment plan that will address your child’s specific case of ADD/ADHD.
During the first evaluation session, we will begin with a comprehensive assessment. This assessment will produce quantitative results about which symptoms your child exhibits to determine which type of ADD/ADHD they have. During the first session, our ADD/ADHD psychiatrists will also conduct a T.O.V.A, or Test of Variables of Attention, to measure your child’s attention and impulsivity.
During the second and third evaluation sessions, our psychiatrists will conduct EEG brainwave analysis. This test will monitor the electrical activity of the brain to locate the area of the brain where the ADD/ADHD symptoms are occurring. This will help us to better understand your child’s case and develop a treatment plan that will be more effective.
At the fourth and final evaluation session, our psychiatrists will discuss your child’s test results, as well as their treatment recommendations moving forward. We dedicate an entire session to explain everything and provide you will all the information to make an educated decision for your child. We also want to give you enough time and encourage you to ask any questions you may have so that we can address any of your concerns. The next step, should you decided to take it, is to schedule a follow-up session to begin treatment.
Treatment for your child’s ADD/ADHD can take a number of forms. Your child’s individual treatment plan will depend on a number of factors, but could take the form of medication, talk therapy, behavioral therapy, and lifestyle changes such as implementing a diet and exercise program. When starting ADD/ADHD treatment is important to realize that one course of action does not always work perfectly for everyone. As such, we will adjust your child’s treatment plan as needed to make sure they are receiving the highest level of quality care.
If you believe your child may be affected with ADD/ADHD, schedule a consultation with our ADD/ADHD psychiatrists at NJ Family Psychiatry and Therapy today!