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Attention Deficit Disorder Association

Amen: An Answer to ADD/ADHD?
By Rheba Estante

Dr. Daniel Amen, founder of the Amen Clinics, built his practice on the premise that brain scans can reveal the presence of ADD/ADHD.  According to his Web site, a brain scan can indicate how brain activity improves in the pre-frontal cortex in response to proper ADD/ADHD medication.  A collection of images on www.amenclinics.comoffers a glimpse of the possible effect of pharmaceutical drugs on an ADD/ADHD brain.  Amen is an Assistant Professor of Psychiatry and Human Behavior at the University of California, Irvine in addition to running his clinics, writing books, and speaking on neuroscience to a variety of audiences around the world. To date, the Amen Clinics are one of the few places people can have a brain scan done upon request. Despite his busy schedule, Dr. Amen was able to answer a few questions on ADD/ADHD and its impact for adults who are diagnosed late in life.

1. What does having ADD/ADHD mean to the average adult who doesn't know much about brain function and anatomy?

They are more likely to struggle at work, in their relationships and with their health if they do not get it properly treated.
2. How would you explain the biology and neurology of an ADD/ADHD diagnosis to an adult who has never heard of the condition?

ADD/ADHD is an inherited disorder that is associated with lower activity in the front part of the brain, called the prefrontal cortex or PFC.  Low activity in the PFC is associated with poor judgment, lack of forethought and planning and reduced impulse control.
3. How can getting a diagnosis be a positive thing for an adult? 

Getting a proper diagnosis and treatment for ADD/ADHD can radically change someone’s life.  I have seen people double or triple their income once they can focus and follow through on tasks.  Their relationships often get better and their work life tends to significantly improve, as does their health.
4. There are different forms of ADD/ADHD. How do you distinguish which type a person has?
We use clinical histories and brain SPECT imaging to help us understand our ADD/ADHD patients and what brain type they may have.  A long time ago, I described 6 different types of ADD.  Three had already been described in the scientific literature:

  • Classic ADD: short attention span, hyperactivity and impulsivity.
  • Inattentive ADD: primarily short attention span.
  • Overfocused ADD, where ADD and getting stuck on negative thoughts go hand in hand.
I added,
  •  Limbic ADD, to show the connection between ADD and Depression.
  • Temporal Lobe ADD, often seen post brain injuries and in learning disabilities
  • Ring of Fire ADD, where the brain looks diffusely hyperactive, often associated with cyclic mood changes as well.

5. Explain the significant differences in brain scans of ADD/ADHD brains under proper medication.  What do the colors on the scan mean?

With medication, in the classic and inattentive types we see low activity or blood flow in the PFC and cerebellum, in the back bottom part of the brain.  The low activity is seen as holes on the SPECT scans.  With treatment the holes fill in.  The colors do not mean anything; it is the shape that is significant.
6. Why are nutrition and acupuncture insufficient to raise the dopamine and norepinephrine levels in a brain to where they should be to prevent the negative effects of ADD/ADHD?

There are indeed studies that show nutritional interventions can treat ADD effectively. 

See: Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, Haagen TA, Rommelse NN, Buitelaar JK. Lancet. 2011 Feb 5;377(9764):494-503.

My opinion is that physicians are too quick to use medications without considering other options.  I have never personally seen acupuncture treat ADD effectively.
7. What is ADD/ADHD specific therapy and coaching?  How does it differ from traditional psychotherapy for non-ADD/ADHD people?

This type of therapy can be very helpful.  It is hands on and teaches people with ADD/ADHD the skills of daily living, such as organization, that they often struggle with.


8. In a nutshell, what are the unique physiological characteristics of ADD/ADHD brains?

Simply put, ADD/ADHD is decreased activity in the PFC and cerebellum that gets worse with concentration.  This applies to the classic and inattentive types.  The other 4 types are more complicated.
9. There is a lot of information on the Web about non-prescription treatments for ADD/ADHD. What advice would you give to consumers to avoid being misled or being put in harm's way by misinformation?

Look at the scientific evidence behind specific treatments.  There is a wonderful website at www.naturalstandards.comthat gives scientific evidence rating for natural treatments.  To say there is no science behind natural treatments is misleading; compounds such as fish oil and zinc do have evidence that they can be helpful.  In my experience, many patients would rather start with natural treatments, and if they do not work then try medication.
10. What are the serious consequences of not treating ADD/ADHD for an adult who has lived life without proper diagnosis and treatment?  There are stories about higher rates of relationship and work problems in ADD/ADHD sufferers.  Are there other negative consequences that are part of the condition?

In the past few years, I have thought a lot about this question.  People get divorced and lose their jobs more frequently.  They are more likely to have trouble with their children and they are more likely to be obese.  Of morbidly obese people, 40% meet the diagnostic criteria for ADD/ADHD.

Rheba Estante is a San Francisco based writer who works in higher education.  She is also pursuing a Master’s degree in Counseling Psychology at Golden Gate University.  Known for her compelling articles featuring women’s lifestyle and health issues, she locates and interviews industry leaders like Dr. Amen for ADDA’s E-News, the Potrero View newspaper, and for the SF Women's Health Examiner for  Learn more about her work on LinkedIn.

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