According to Dr. Daniel Amen, there are 7 types of ADHD.
7 Types of ADHD – SPECT scans
Dr. Amen — a board-certified child, adolescent, and adult psychiatrist — has been studying brains with SPECT scans for over 25 years. His body of his research is truly impressive with over 80,000 scans done at his clinics, and nearly 20,000 of these done on people with ADHD symptoms.
SPECT (“single photon emission computed tomography”) is a nuclear medicine study that evaluates blood flow and activity patterns to different parts of the brain. It helps identify what areas are under-active, normo-active, and/or over-active. Dr. Amen found — consistent with other research at the time — that a majority of people with ADHD symptoms had decreased prefrontal activity when they tried to concentrate their attention. But he soon realized that ADHD was not one thing caused by one abnormality in the brain. He saw many different patterns of activity that matched symptoms discovered on his questionnaires (about 80% of the time you could predict the scan if you took a detailed history). As a result, he has identified 7 types of ADHD.
7 Types of ADHD
Here is thumbnail sketch of the 7 types of ADHD:
(Here I will only be providing the symptoms and scans of each type. But stay tuned for future blogs where I will expand upon their description from other keen observers, as well as begin to talk about the different modes of treatment that work best with each type.)
- Type 1: Classic ADD – These brains are generally normal at rest, but during concentration show underactivity in the prefrontal cortex, cerebellum, and basal ganglia. These people tend to show symptoms of inattentiveness, distractibility, impulsiveness, hyperactivity and restlessness, and disorganization. This is the most common type and is captured as the character Tigger in Winnie the Pooh.
- Type 2: Inattentive ADD – Here the brain scan looks just like that of above, and the symptoms are mostly the same but without the symptoms of hyperactivity and restlessness. These people tend appear more dreamy or “spaced-out.” This archetype is Winnie himself.
- Type 3: Overfocused ADD – When the brain scan shows increased activity of the anterior cingulate gyrus during rest and concentration, and the classic triad of decreased activity in the prefrontal cortex, cerebellum and basal ganglia during concentration, we see the following symptoms: obsessiveness, excessive worrying, trouble shifting attention, often stuck in negative thought patterns or behaviors, and often argumentative and oppositional. They may or may not be hyperactive. This is Rabbit.
- Type 4: Temporal Lobe ADD – In addition to the classic ADD brain findings, this group has either decreased or increased activity in the temporal lobes at rest and during concentration. People with this brain pattern of activity usually have symptoms of inattentiveness, distractibility, disorganization, irritability, short fuse, mood instability, memory issues, and frequently have learning disabilities. This group may or may not be hyperactive.
- Type 5: Limbic ADD – This type has scans that show the classic triad as well as increased limbic activity (thalamus and hypothalamus) at rest and during concentration. In addition to being inattentive, easily distracted, and disorganized, they also show low energy levels, chronic low grade sadness, feeling so hopelessness and worthlessness. They tend to see things in a negative light and are frequently more socially isolated. They may or may not be hyperactive. This is personified by Eeyore.
- Type 6: Ring of Fire ADD – The SPECT findings of this type show patchy increased activity across the cortex but epecially in the parietal lobes, temporal lobes, cingulate gyrus, and the prefrontal cortex. These findings are present at both rest and during concentration, and often worse during concentration. In addition to the primary symptoms of inattentiveness, distractibility, and disorganization, these people are usually irritable, over-sensitive, oppositional, and show cyclical moodiness.
- Type 7: Anxious ADD – In addition to decrease prefrontal cortex and cerebellar flow during concentration, these brains have increased activity in the basal ganglia during rest and during concentration. In addition to the classic symptoms, these people show anxiety, tension, a tendency to predict the worst, and often freeze in test-taking situations. This is Piglet.
The 7 types of ADHD helps us understand the overlapping co-morbidities
This is certainly not the only typing system for ADHD, but I am finding it enormously helpful. Each type requires a different set of “further explorations” into other challenges the person might face. And it helps me customize an approach to helping alleviate the dysfunctional symptoms.
Take Home: ADHD is not one thing. The 7 types of ADHD is a very useful lens — based on actual patterns of brain activity — through which to understand challenges of attention, self-regulation, and executive function (A/SR/EF). This approach is a great start toward tailor fitting the various holistic treatment options to the unique challenges of the individual.
In the following weeks, I will go through each of the types in more detail using other lenses. I will then use these descriptions as a springboard into exploring the various factors that disrupt A/SR/EF. I will then follow that up with the many different kinds of interventions that can help re-regulate A/SR/EF.
Chris White MD
Providing Holistic ADHD Care to Families in Need