An Article on ADD/ADHD In Response to Dr. Amen's Theory

February 4, 2010

By Dr. Allen Novian

As I have been trying to correct some minor formatting issues with my ADD/ADHD article which was posted in December, I decided to repost it as an article, as opposed to a series of blogs. This way, the graphics will be displayed. This article gives you information about Attention Deficit Disorder with and without the Hyperactive component.

Attention Deficit Disorder

Attention Deficit Disorder is a complex condition that is often misunderstood at the present time by many clinicians and the general public. New information is being discovered almost daily and it is often difficult for medical doctor and counselors to understand and keep up with the information so how can busy parents or adults dealing with ADD keep up well your answer is by reading this document.  I have compiled a summary of the most recent findings and understandings of ADD taken mostly from Dr. Amen’s research and clinical expertise.  Dr Amen is one of the pioneers in this field and this article is meant to summarize his work and introduce you to the various types of holistic treatment including Neurofeedback to help you or your child heal.

 

The Prefrontal Cortex: The Most Evolved Brain System

Views of the Prefrontal Cortex

dorsal lateral prefrontal cortex outside view

  

inferior orbital prefrontal cortex
outside view


 

inferior orbital prefrontal area inside view

 

Functions and Problems

Attention Deficit Disorder (ADD) and Attention Deficit Disorder with Hyperactivity (ADHD) occur as a result of neurological dysfunction in the prefrontal cortex of the brain. This is the newest part of our tri-brain system in evolutionary terms. It is the part of our brain that performs executive functions. The functions of this brain deal with 1) attention span, 2) perseverance, 3) judgment, 4) organization, 5) impulse control, 6) self-monitoring and supervision, 7) problem solving,  critical thinking, 9) forward thinking, 10) learning from experience, 11) ability to feel and express emotions, 12) interaction with the limbic system, and 13) empathy.

 

Whenever there is a problem with this part of the brain, a number of skills that many human beings take for granted would not be available in any optimal way. The following are problems that develop when the prefrontal cortex is affected. 1) Short attention span, 2) distractibility, 3) lack of perseverance, 4) impulse control problems, 5) hyperactivity, 6) chronic lateness and poor time management, 7) disorganization, procrastination, 9) unavailability of emotions, 10) misperceptions, 11) poor judgment, 12) trouble learning from experience, 13) short-term memory loss, and 14) social and test anxiety.

The exact neurological problem with ADD is unknown at this time. However SPECT scans, single photon emission computed tomography, which measures cerebral blood flow and metabolic activity patterns, has noted that when someone with ADD concentrates, their prefrontal lobe activity decreases significantly. This essentially means that under stress and concentration someone with these disorders cannot bring to bear their full cognitive capacity.

 

It is theorized that our usual ability to screen out and attend to stimuli of our choice is impaired with these individuals. I like to think of it as going to the mall during the summer. It is too bright and there are too many people around, but it is not overwhelming. However, at Christmas time after a couple of hours at the mall people are so over-stimulated that it is hard to find the car. People with ADD feel this way almost all the time.

 

6 Types of Treatment

There are six recommended courses of treatment for someone with ADD or ADHD.

1)    The first type of treatment that physicians often give are an antidepressant such as Wellbutrin and Strattera, which tends to calm the limbic system and increase dopamine, a neurotransmitter. In my experience as a therapist, this can be helpful but stimulants often have some pretty significant side-effects and need to be monitored carefully.

 

2)    The second course, seem to do a better job. Stimulants given in small doses, so the mood alteration is minimal, act in a paradoxical manner. This means that instead of accelerating a person they help to focus and calm them while still allowing the prefrontal lobe to remain active. They also seem to increase dopamine. This neurotransmitter is negatively affected with people suffering from ADD.

 

3)    The third regimen, a combination of an anti-depressant and a stimulant, seems to work for most people suffering from most forms of ADD.

 

4)    The fourth treatment consists of teaching relaxation, stress-management, organizational, and socializing skills. This should always be included as part of treatment whether or not any other type of treatment is used.  If you have a need for this type of treatment, I recommend you contact Katherine Parker at          210-415-2542.  She is a teacher and educational consultant who’s specialty is helping children with ADD or ADHD to organize their thoughts and behaviors so they can improve their home and school life.

 

5)    The fifth form of treatment is the naturopathic approach. Due to my background I cannot adequately discuss this method,  However, according to the research and the clinicians I know who use this type of treatment, at the present time, supplements, vitamins and chiropractic care seem to be effective as an adjunct to stimulants or other types of treatment.

 

6)    The final type of treatment that Dr Amen recommends and the one I specialize in is using Neurofeedback to treat the various forms of ADD or ADHD.  I agree with Dr Amen who states in his book Healing ADD (pg 266-267) “in my experience with Neurofeedback and ADD, many people are able to improve their reading skills and decrease their need for medication.  Also, Neurofeedback has helped to decrease impulsivity and aggressiveness.  It is a powerful tool, in part because we are making the patients part of the treatment process and giving them more control over their own physiological processes.”

 

Dr Amen goes onto state that “in my clinical experience it [Neurofeedback] is a powerful and exciting treatment and we are yet to see its full development.”  I could not agree more.  Every year I continue to see and implement in my office new techniques and software to help children and adults who battle the symptoms of ADD or ADHD.

 

Misconceptions

There are numerous misconceptions about Attention Deficit Disorder and a lot of emotional fervor about the diagnosis. It reminds me of the debate over Prozac several years ago or whether or not Alcoholism is a disease or a moral defect. It is understandable that people worry about giving young children a mood-altering drug. However, any time medication is considered as an approach, the physician needs to carefully assess both the costs the benefits and the severity of the problem. Most medication difficulties with ADD result from mismanagement. When the appropriate amount of medication is used with ADD the benefits are immense and the cost is minimal. A person’s life changes dramatically for the better. It is as if for the first time a person can think clearly and their self-esteem soars.  However, it is my professional opinion that these same positive effects can be obtained with fewer possibilities of side-effects through the use of Neurofeedback.

 

There is still a tendency in this country to feel that people need to pull themselves up by the bootstraps regardless of the severity of the problem. They are often blamed for their own illness. This happens a lot with ADD.

 

True ADHD with hyperactivity is rather easy to diagnose. However, only in the last ten years was ADD inattentive type recognized. This diagnosis is hard to spot and often is characterized by a general spacyness and inability to track conversations. It also used to be common knowledge that children were the only ones to suffer from this disorder and that once they became 14 they grew out of it. What is more common is that in the normal course of experimentation with drugs and alcohol a person with this disorder finds amphetamines and becomes addicted to them. Almost the right drug, wrong dose! Most people do not grow out of the disease. Interestingly enough, even with hard-core Methadrine addicts, if they are put on a small dose of Adderall, 20- 30 mg. of sustained release 1-2 times a day, or treated with Neurofeedback they thrive and it does not reactivate the addictive process.

 

Types of ADD

Dr. Daniel G. Amen is one of the acknowledged leaders in the field for the study of Attention Deficit Disorder. He has expanded the classifications of this condition within the last eight years from the standard two types of Hyperactive and Inattentive by adding four more distinct types of ADD. He has done this by exhaustive research and has been aided by the SPECT scan, which is a sophisticated brain scanning tool that measures and clearly shows what part of the brain is most active. What is most impressive about his work is that he stresses the need for a multi-treatment approach. This includes attention to diet, exercise, vitamins, supplements, traditional psychotropic drugs, Neurofeedback, and behavioral techniques.

 

In “Healing ADD” Dr. Amen lists the six types of ADD as 1) Classic hyperactive, 2) Inattentive, 3) Over focused, 4) Temporal, 5) Limbic, and 6) Ring of Fire. Each of these types has much in common, but also differences in symptoms and treatment. I will discuss the usual way that each of these types of ADD are treated but it is important to know that Neurofeedback has been shown to be effective in treating each of these types of ADD.  If you want to know more please review the information on my website or give me a call (210-831-1282) and I would be glad to answer any questions you may have regarding Neurofeedback.

 

In order to understand the Neurofeedback part of this section you will need to first understand some basic neurology.  Don’t get worried this isn’t as difficult as it sounds.  The first thing you need to understand is that the brain is divided into 4 lobes:  the occipital lobe, the parietal lobe, the temporal lobe, and the frontal lobe.  The prefrontal cortex where most types of ADD are located is comprised of the forehead or most forward part of the frontal lobe of the brain.

 

Before moving on to the discussion of the types of ADD and their treatment you will need to understand the functions and features of brainwaves.  These can best be summarized using the following chart.

 

 

Types/Bands of Brainwaves

When scientists first measured brainwaves they found that they were connected to different mind states, or states of consciousness. Since then they have divided the brainwaves into four predominant speed ranges, or types. The brain is constantly emitting nearly every type of brainwave. However, based on the strength of certain bands of brainwaves a person can be said to be “in” a certain brainwave or band.

 

Wave 

 Frequency 

Mental State/Sub-Categories (bands)

Beta

 15Hz – 38Hz

Individuals in this state are Fully Awake and Generally Alert.

 

Low Beta

 15 – 20 Hz

Can increase mental abilities, IQ, and mental focus.High Beta (20 – 38Hz) – Can increase alertness, but may also produce agitation.

 

SMR

 12Hz – 15Hz

SMR (sensorimotor rhythm) is related to body motion. Increasing this can result in increased focus, improved attentive abilities.

 

Alpha

 8Hz – 12Hz

Most people experience this state just after waking and right before sleep. 

This band is ideal for Relaxation, Stress Relief, Self Hypnosis, stimulation of the Immune System and Accelerated Learning.

 

Theta

 3Hz – 8Hz

Most people enter into this state during light sleep or extreme relaxation.

 

Low Theta

 3 – 5 Hz

This band is ideal for Meditation and Sleep Replacement.Additionally, research has shown that the suppression of this band can improve concentration and attention, as well as reduce hyperactivity.

 

High Theta

5 – 8 Hz

This band is ideal for Improved Sleeping Patterns, Treatment of Insomnia and Creative Visualization.

 

Delta

0.2Hz – 3Hz

This state is experienced during deep, dreamless, non-REM sleep. 

Delta is the slowest band of brainwaves. While in Delta the body is healing itself and resetting internal clocks.

This band is ideal for Accelerated language retention and stimulating the release of growth hormone.

 

As mentioned earlier, all of the types of ADD have as three primary features: 1) periodic impairment of the prefrontal cortex of the brain, 2) ineffective brainwave activity, and 3) dopamine involvement. Classic ADD is characterized by both hyperactivity and inattentiveness. It is usually quite easy to treat by a combination of a high protein diet, aerobic exercise, a stimulant such as Adderall or Ritalin, and possibly the supplement of L-Tyrosine. Often an anti-depressant is used as well.  Neurofeedback can also be used to treat this type of ADD by enhancing beta brainwaves and to decrease theta brainwaves in the prefrontal cortex.

 

Inattentive ADD lacks the hyperactivity, but people who suffer from it have a difficult time focusing and are often very scattered. As with the classic type the prefrontal cortex is involved. The treatment for inattentive ADD is usually exactly the same as the classic type.

 

Overfocused ADD exhibits the same problems and symptoms of prefrontal cortex as with classic and inattentive ADD, but the difference is that the sufferer of over focused often cannot break away from a thought or behavior. This is because the cingulate system of the brain is overactive and often locks a person into self-destructive, negative, or repetitive behavior. Often a stimulant will cause temper problems if used alone. Therefore, it is usually helpful to have the person take an anti-depressant first and only later to add the stimulant. Another possible treatment is to use St. Johns Wort, a natural herbal anti-depressant, but it is important not to use both a traditional and an herbal anti-depressant at the same time. However, Neurofeedback can be used in combination with traditional or herbal anti-depressants.  In order to treat Overfocused ADD with Neurofeedback alpha brainwaves are enhanced over part of the prefrontal cortex know as the anterior cingulate gyrus.  The other forms of treatment such as diet and exercise is the same as the first two types of ADD.

 

Temporal ADD is still characterized by problems with the prefrontal cortex, but the temporal area of the brain is often affected. This could be from a previous head injury, but not necessarily. All the symptoms remain the same, but often extreme bouts of anger are also included. The treatment for this type is usually a stimulant and an anti-convulsant such as Depecote. As with the other types of ADD, temporal ADD can be treated with Neurofeedback by enhancing SMR brainwaves and suppressing theta brainwaves over the affected temporal area.  All other treatment is the same except the following supplements can be used: GABA, Ginkgo Biloba, or Vitamin E.

 

Limbic ADD is when the limbic area of the brain is also affected in addition to the prefrontal cortex. This type of ADD has the symptoms of inattentive ADD, but a significant amount of depression is also present. A stimulant and an anti-depressant are indicated. Neurofeedback is also useful in enhancing beta brainwaves and suppressing theta brainwaves over the left prefrontal area.  Aerobic exercise is needed, but often a complex carbohydrate and protein mixed diet is indicated. The following supplements are used: SAMe or L-tyrosine.

 

Ring of Fire ADD is a very disorganized and severe form of ADD that is a combination of all the other types. The entire brain is lit up on a SPECT scan. In addition to the standard treatment of a stimulant and an anti-depressant, an anti-psychotic like Respiridal is often called for in treating this type of ADD. Neurofeedback focuses on enhancing SMR brainwaves over the parietal and lateral prefrontal areas while also enhancing high alpha brainwaves over part of the prefrontal cortex know as the anterior cingulate gyrus. Dietary and exercise treatment is the same as in inattentive type. The following supplements are possibly needed: GABA or Omega-3. Other supplements that have been found helpful with ADD in general are Zinc, Flax seed oil, and Serephos.

 

Summary

Attention Deficit Disorder is a neurological dysfunction that has no known cure at the present time. However, the good news is that effective treatment is available and following the protocol can improve how a person feels and functions more dramatically than many psychiatric conditions. What I find so attractive about the work of Dr. Amen is that he treats the whole person. He stresses the need for appropriate psychotropic medication and/or Neurofeedback, but also believes that a clinician needs to pay attention to diet, exercise, and behavioral strategies to fully address ADD.  I couldn’t agree more and I encourage you to find healing clinicians in each of these areas.  If you need help with ADD email me or give me a call.

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