Vijai P. Sharma, Ph.D
A couple years ago, in this column I discussed the new scientific thinking that Attention Deficit Hyperactivity Disorder (ADHD or also referred to as ADD), is indeed a brain disorder. However, at that point, there was not much direct evidence to support the claim. There is now a breakthrough in research.
Brain image studies have begun to highlight the basis of attention deficit disorder in the abnormal activity of the brain. These studies also point out that the irregular activity in the different parts of the brain cause different types of attention deficit disorders and it can be seen in a brain scan called SPECT (Single Photon Emission Computed Tomography). At this point, a SPECT study provides the most revealing images of the brain blood flow and brain activity patterns during the time a person is asked to pay attention and concentrate.
According to the existing psychiatric diagnostic system, there are only three types of ADD: Inattentive type, Hyperactive type and the Combined type, which is both inattentive and hyperactive.
It now appears that there may be not three but six different types of ADD.
Dr. Daniel Amen has done a seminal work in taking thousands of brain scans highlighting the irregular activities of the brain. Some of those brain images can be seen in his book, "Healing ADD. The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD." I t may take a while before Amen's classification is independently confirmed by other scientists, but it has helped me to understand some characteristics of ADD patients that didn't fit into the existing system.
Here are the 6 types of ADD: 1. Classic 2. Inattentive 3. Overfocused 4. Temporal Lobe 5. Limbic and 6. "Ring of Fire."
A person, child or adult, with the Classic ADD type is most common and easier to identify than the others. He or she tends to be inattentive, distractible, disorganized, hyperactive, restless and impulsive. According to the existing psychiatric diagnostic system, it is similar to the Combined type, in which both the inattention and hyperactivity are prominent. Their brain scans explain why they are not able to concentrate.
When non-ADD people concentrate, the pre-frontal part of their brains, located underneath the forehead, becomes active. That's how it should be because the job of the pre-frontal part of the brain is to help us concentrate. Therein lies the problem. When Classic ADD type people concentrate, the prefrontal part of their brain, instead of becoming more active, becomes under active.
People with inattentive type ADD, the second most common type, often don't get professional attention. But, if they receive treatment, they are usually most responsive to it. They are often viewed as sluggish, slow, preoccupied, uninterested and poorly motivated, or simply, bored. Others often describe them as, "space cadets" or "daydreamers." They usually have trouble listening and registering the content when others talk to them.
When people with inattentive type ADD concentrate, there is a decrease in activity in the prefrontal brain, particularly the sides of the prefrontal brain. It is as if this area of the brain fails to connect with the rest of the brain. As regards the treatment, patients usually respond well to the psycho-stimulants. Along with medication, Dr. Amen also recommends a high protein and low carbohydrate diet for the classic and inattentive type ADD patients. He believes that such a diet helps.
People with overfocused type ADD, in addition to the problem of inattention and distractibility, have trouble shifting attention from one subject to another. Oppositional and argumentative from the outside, they worry excessively or senselessly. They have a strong tendency to get locked into negative thoughts and may hold grudges for a long time. They have difficulty in viewing other options and therefore may get locked into one course of action regardless of feedback to the contrary. Interestingly, Dr. Amen sometimes finds this pattern in the children and grandchildren of alcoholics.
As regards the brain activity of the overfocused type, their pre-frontal part of the brain, during concentration, is under active as in the first two types, but something else happens in their brain that sets them apart from the other types. The "Anterior Cingulate Gyrus," normally considered as the part of the emotional brain, is found to be overactive all the time, at rest as well as during concentration.
This particular part of the brain as labeled by Dr. Amen is the brain's "gearshift." It allows human beings to shift from thought to thought and subject to subject. Being over active and excited all the time, the Anterior Cingulate Gyrus doesn't do the job it's supposed to do, which results in a person being overfocused, much like getting stuck in a rut.
All three types of ADD discussed here involve the prefrontal part of the brain, which is the attention, concentration and monitoring organ of the brain. In a future article, I will discuss the remaining three types, which involve other parts of the brain.
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