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Types of ADHD: Making the Diagnosis

ADHD Diagnosis Based on Brain Scans -- An Alternative Approach continued...

Amen considers these to be the hallmark symptoms of ADHD:

  • Short attention span
  • Distractibility
  • Disorganization
  • Procrastination
  • Poor judgment and ability to plan ahead
  • Difficulty with impulse control

Based on these symptoms, and the use of brain scans to measure blood flow (SPECT), to highlight activity in the parts of the brain related to attention, short-term memory, and forethought, Amen described these six types of ADHD:

  • Type 1 -- Classic ADHD. Symptoms of ADHD, plus hyperactivity and impulsivity; responds well to stimulant medications
  • Type 2 -- Inattentive ADHD. Features of ADHD, but instead of hyperactivity, there is low energy; responds well to stimulant medications
  • Type 3 -- Overfocused ADHD. Symptoms of ADHD and negative thoughts and behaviors, such as opposition and arguing; tends to respond better to an antidepressant (such as Prozac) combined with a stimulant
  • Type 4 -- Temporal Lobe ADHD. The hallmark features of ADHD, plus irritability, aggressiveness, and memory and learning problems; responds better to antiseizure medications (like Neurontin) than to stimulants
  • Type 5 -- Limbic ADHD. Combines ADHD with depression and low energy and decreased motivation; responds better to stimulating antidepressants than to stimulants
  • Type 6 -- The Ring of Fire. Cross between ADHD and bipolar disorder; characterized by moodiness, aggressiveness, and anger. Anticonvulsants or newer antipsychotic medications tend to work better than stimulants.

How Did Amen Come Up With His Types of ADHD?

Amen has performed and analyzed thousands of single photon emission computed tomography (SPECT) brain scans on people with psychological problems. SPECT uses a radioactive dye to create a three-dimensional image of the blood flow and activity in the brain. It is typically used to diagnose medical conditions such as Alzheimer's disease, Parkinson's disease, and head injury. Amen says this type of scan also can provide doctors with more thorough information about ADHD and other psychological conditions.

SPECT scans don't themselves diagnose ADHD, but they can help fine-tune the diagnosis when considered together with the patient's medical history and psychiatric evaluation, according to Amen. He says these scans measure whether areas of the brain are working correctly, too much, or not enough. Knowing which areas of the brain are problematic in children with ADHD can help doctors focus treatments on those areas. SPECT also can identify how well a child's medication is working, according to Amen.

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