DIFFERENT TYPES OF ADD/ADHD

ADD/ADHD

Different Types

 Over the years, I have attended many workshops on Attention Deficit Disorder (ADD) and Attention Deficit Hyperactive Disorder (ADHD). The following is a compilation of different questionnaires and handouts on ADD/ADHD I have collected. Much of the following is from Dr. Daniel Amen and his experiences treating ADD/ADHD.

 

 

DIFFERENT TYPES OF ADD/ADHD

Daniel Amen

 

 

Differential Diagnosis                                                        page 2

(What else could it be?)

 

ADD with Hyperactivity                                                    page 3

“Classic”  ADHD

Prefrontal Cortex

 

ADD without Hyperactivity                                              page 4

“Couch Potato”

Prefrontal Cortex

 

ADD Over-focused Type                                                    page 5

“Stuck” Type

Cingulate System

 

ADD Depressive-Type                                                        page 6

“Negative/Dark” Type

Limbic System

 

ADD Explosive Type                                                           page 7

“Angry” Type

Temporal Lobe

 

Typical Problems with Each Type                                   page 8

 

Suggestions to try for each type                                      page 9

 

Right Brain/Left Brain ADD Characteristics                page 10&11

 

Right Brain/Left Brain ADD Questionnaire                  page 12

 

Right Brain/Left Brain ADD Scoring Sheet                   page 13

 

 

ADD/ADHD Differential Diagnosis

What else could it be?

 

 

Psychiatric Conditions:                                               Environmental:

Language and Learning Disability                                Unsafe/Disruptive Learning Environment

Bipolar Disorder                                                                  School Curriculum/Child Mismatched

Tourette’s Syndrome                                                          Family Dysfunction

Oppositional Defiant Disorder                                         Poor Parenting

Conduct Disorder                                                                Child Abuse/Neglect

Major Depression                                                                Food Allergies

Anxiety Disorders                                                               Environmental Allergies

Pervasive Developmental Disorder                                Teacher/Child Personality Clash

Auditory Processing Disorder

Dyslexia

Autism or Asperger’s

Schizophrenia

Post-Traumatic Stress Disorder

Mild Mental Retardation

Head Injuries or Brain Trauma

Drug Abuse

 

Living/Social/Parenting/Personality:

Low Self Esteem

Poor Social Skills

 

Medications:

Anticonvulsant

Antihistamines

Decongestants

 

General Medical Conditions:

Hypothyroidism

Severe Anemia

Lead/Mercury/Heavy Metal Exposure or Poisoning

Chronic Illness

Hearing/Vision Impairment

Fetal Alcohol Syndrome

 

Neurologic Conditions:

Sleep Disorders

Seizure Disorders

 

 

 

2

 

 

 

Attention Deficit Disorder with Hyperactivity

“Classic” ADHD

(Pre-Frontal Cortex Area of the Brain)

 

 

Either (1) or (2)

 

  1. Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

 

Inattention:

 

____ 1.  Often fails to give close attention to details or makes careless mistakes in schoolwork,                  work, or other activities

____ 2.  Often has difficulty sustaining attention in tasks or play activities                                                    ____ 3.  Often does not seem to listen when spoken to directly

____ 4.  Often does not follow through on instructions and fails to finish schoolwork, chores, or                     duties in the workplace (not due to oppositional behavior or failure to understand                             instructions)

____ 5.  Often has difficulty organizing tasks and activities

____ 6.  Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental                         effort (such as schoolwork or homework)

____ 7.  Often loses things necessary for tasks or activities (e.g., toys, school assignments,                                       pencils, books, or tools)

____ 8.  Is often easily distracted by extraneous stimuli

____ 9.  Is often forgetful in daily activities

 

 

  1. Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

 

Hyperactivity:

 

____ 1.  Often fidgets with hands or feet or squirms in seat

____ 2.  Often leaves seat in classroom or in other situations in which remaining seated is                                       expected

____ 3.  Often runs about or climbs excessively in situations in which it is inappropriate                                       (in adolescents or adults, may be limited to subjective feelings of restlessness)

____ 4.  Often has difficulty playing or engaging in leisure activities quietly

____ 5.  Is often “on the go” or often acts as if “driven by a motor”

____ 6.  Often talks excessively

 

Impulsivity:

 

____ 7.  Often blurts out answers before questions have been completed

____ 8.  Often has difficulty awaiting turn

____ 9.  Often interrupts or intrudes on others (e.g., butts into conversations or games)

 

3

Attention Deficit Disorder without Hyperactivity

“Couch Potato”

(Pre-frontal Cortex Area of the Brain)

 

 

Six (or more) of the following symptoms are indicative of ADD without hyperactivity.

 

____ 1.  Difficulty with sustained attention or erratic attention span

____ 2.  Easily distracted by extraneous stimuli

____ 3.  Excessive daydreaming

____ 4.  Disorganized

____ 5.  Responds impulsively or without thinking

____ 6.  Problems completing things

____ 7.  Doesn’t seem to listen

____ 8.  Shifts from one uncompleted activity to another

____ 9.  Often complains of being bored

____ 10.  Often appears to be apathetic or unmotivated

____ 11.  Frequently sluggish or slow moving

____ 12.  Frequently spacey or internally preoccupied

 

 

The onset of these symptoms often become apparent later in childhood or even adolescence.  The brighter the individual, the later symptoms seem to become a problem.  The symptoms must be present for at least six months and not be related to a depressive episode.  The severity of the disorder is rated as mild, moderate, or severe.

 

Even though these children have many of the same symptoms of the people with ADHD, they are not hyperactive and may, in fact, be hypoactive.  Girls are frequently missed because they are more likely to have this type of ADD.  In addition, they may: daydream excessively, complain of being bored, appear apathetic or unmotivated, appear frequently sluggish or slow moving or appear spacey or internally preoccupied – the classic “couch potato.”  Most people with this form of ADD are never diagnosed.  They do not exhibit enough symptoms that “grate” on the environment to cause people to seek help for them.  Yet, they often experience severe disability from the disorder.  Instead of help, they get labeled as willful, uninterested, or defiant.

 

As with the ADHD subtype, brain studies in patients with ADD, inattentive subtype reveal a decrease in brain activity in the frontal lobes of the brain in response to an intellectual challenge.  Again, it seems that the harder these people try to concentrate, the worse it gets.  ADD, inattentive subtype is often very responsive to stimulant medications listed above, at a percentage somewhat less than the ADHD patients.

 

 

 

 

 

 

 

 

 

4

ADD Over-Focused Type

“Stuck” Type

(Cingulate Area of the Brain)

 

 

Six (or more) of the following symptoms are indicative of ADD over-focused (1 and 2 are needed to make the diagnosis.

 

____ 1.  Difficulty with sustained attention or erratic attention span

____ 2.  Easily distracted by extraneous stimuli

____ 3.  Excessive or senseless worrying

____ 4.  Disorganized or super-organized

____ 5.  Oppositional, argumentative

____ 6.  Strong tendency to get locked into negative thoughts, having repetitive thoughts

____ 7.  Tendency toward compulsive behavior

____ 8.  Intense dislike for change

____ 9.  Tendency to hold grudges

____ 10.  Trouble shifting attention from subject to subject

____ 11.  Difficulties seeing options in situations

____ 12.  Tendency to hold on to own opinion and not listen to others

____ 13.  Tendency to get locked into a course of action, whether or not it is good for the person

____ 14.  Needing to have things done a certain way or you become very upset

____ 15.  Others complain that you worry too much

 

 

People with ADD, over-focused subtype, tend to get locked into things and they have trouble shifting their attention from thought to thought.

 

This subtype has a very specific brain patter, showing increased blood flow in the top, middle portion of the frontal lobes.  This is the part of the brain that allows you to shift your attention from thing to thing.  When this part of the brain is working too hard, people have trouble shifting their attention and end up “stuck” on thoughts or behaviors.

 

This brain pattern may present itself differently among family members.  For example, a mother or father with ADD over-focused subtype may experience trouble focusing along with obsessive thoughts (repetitive negative thoughts) or have compulsive behaviors (hand washing, checking, counting, etc.), the son or daughter may be oppositional (get stuck on saying no, no way, never, you can’t make me do it), another family member may find change very hard for them.

 

This pattern is often very responsive to new “anti-obsessive antidepressants,” which increase the neurotransmitter serotonin in the brain.  I have nicknamed these medications as my “anti-stuck medications.”  These medications include Prozac, Pail, Zoloft, Anafranil, and Effexor.

 

 

 

 

 

 

 

5

 

ADD Depressive Type

“Depressed” Type

(Limbic Area of the Brain)

 

 

Six (or more) of the following symptoms are indicative of ADD depressive subtype (1 and 2 are needed to make the diagnosis).

 

____ 1.  Difficulty with sustained attention or erratic attention span

____ 2.  Easily distracted by extraneous stimuli

____ 3.  Moodiness

____ 4.  Negativity

____ 5.  Low energy

____ 6.  Irritability

____ 7.  Social isolation

____ 8.  Hopelessness, helplessness, excessive guilt

____ 9.  Disorganization

____ 10.  Lowered interest in things that are usually considered fun

____ 11.  Sleep changes (too much or too little)

____ 12.  Forgetfulness

____ 13.  Chronic low self-esteem

 

 

It is very important to differentiate this subtype of ADD from clinical depression.  This is best done by evaluating the symptoms over time.  ADD, depressive subtype, is consistent over time and there must have been evidence from childhood and adolescence.  It does not just show up at the age of 35 when someone is going through serious stress in life.  It must be a pattern of behavior over time.  Major depressive disorders tend to cycle.  There are periods of normalcy which alternate with periods of depression.

 

The medications used for ADD, depressive subtype, include standard antidepressants, such as Tofranil (imipramine), Norpramin (desipramine), and Pamelor (nortryptiline), the newer antidepressants such as Prozac and Wellbutrin (buprion), and the stimulants.  Clinically, I have been very impressed with the ability of stimulants to help this subtype of ADD.  This is why it is very important to differentiate this subtype from primary depressive disorders.

 

 

 

 

 

 

 

 

 

 

 

 

 

6

ADD Explosive Type

“Angry” Type

(Temporal Lobe Area of the Brain)

 

 

Six (or more) of the following symptoms are indicative of ADD violent, explosive (1 and 2 are needed to make the diagnosis.

 

____ 1.  Difficulty with sustained attention or erratic attention span

____ 2.  Easily distracted by extraneous stimuli

____ 3.  Impulse control problems

____ 4.  Short fuse or periods of extreme irritability

____ 5.  Periods of rage with little provocation

____ 6.  Often misinterprets comments as negative when they are not

____ 7.  Irritability builds, then explodes, then recedes, often tired after a rage

____ 8.  Periods of spaciness or confusion

____ 9.  Periods of panic or fear for no specific reason

____ 10.  Visual changes, such as seeing shadows or objects changing shape

____ 11.  Frequent periods of deja vu (feelings of being somewhere before even though you

never have)

____ 12.  Sensitivity or mild paranoia

____ 13.  History of a head injury or family history of violence or explosiveness

____ 14.  Dark thoughts, may involve suicidal or homicidal thoughts

____ 15.  Periods of forgetfulness or memory problems

 

 

In my clinical experience, temporal lobe symptoms are found in approximately 10-15% of patients with ADD.  Temporal lobe symptoms can be among the most painful.  These include periods of panic or fear for no specific reason, periods of spaciness or confusion, dark thoughts (such as suicidal or homicidal thoughts), significant social withdrawal, frequent periods of deja vu, irritability, rages, and visual changes (such as things getting bigger or smaller than they really are).  Temporal lobe dysfunction may be inherited or it may be caused by some sort of brain trauma.

 

Temporal lobe symptoms associated with ADD are often very responsive to anti-seizure medication, such as Tegretol or Depakote.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

Typical Problems with Each Type

ADD With and Without Hyperactivity

The Pre-Frontal Area of the Brain

 

Area of the Brain Affected                        Typical Problem

Focus                                                                           Short attention span

Attention span                                                             Distractibility

Judgment                                                                     Impulsivity

Impulse control                                                            Procrastination

Organization                                                                Poor organization and planning

Planning                                                                      Lying

Critical thinking                                                           Misperceptions

Forward thinking                                                         Poor judgment

Internal supervision                                                     Social and/or test anxiety

Unavailability of emotions

 

ADD Over-Focused Type

The Cingulate Area of the Brain

 

Area of the Brain Affected                              Typical Problems

Allows shifting of attention                                           Worrying

Helps the mind move from idea to idea                                    Holds onto hurts from the past

Gives the ability to see options                                     Becoming stuck on thoughts-(obsessions)

Cognitive flexibility                                                      Becoming stuck on behaviors-(compulsions)

Helps you go with the flow                                           Argumentativeness

Oppositional behavior

Addictive behaviors

(alcohol abuse, eating disorders, chronic pain)

 

ADD With Depression

The Limbic Area of the Brain

 

Area of the Brain Affected                             Typical Problems

Sets the emotional tone of the mind                             Moodiness, irritability, clinical depression

Stores highly charged emotional memories                  Increased negative thinking

Modulates motivation                                                   Perceive events in a negative way

Controls appetite and sleep cycles                                Decreased motivation

Promotes bonding                                                        Flood of negative emotions

Directly processes the sense of smell                            Appetite and sleep problems

Modulates libido                                                           Social isolation

Decreased or increased sexual responsiveness

 

ADD Explosive Type

The Temporal Area of the Brain

 

Area of the Brain Affected                              Typical Problems

Abnormal perceptions

Understanding and processing language                      Hallucinations

Short term memory                                                     Amnesia

Long term memory                                                      Feelings of déjà vu

Auditory learning                                                         Ja mais vu

Complex memories                                                      Periods of panic or fear for little reason

Visual and auditory images                                          Periods of spaciness or confusion

Excessive religiosity

Visual distortions

Rage outbursts

 

8

Suggestions to Try for Each Type

 

ADD/ADHD Type Suggestions:

Rx #1:  Clear focus on how you want to live

Rx #2:  Focus on the penguins in your life, notice the behavior of others you like (Fat Freddy)

Rx #3:  Have meaning, purpose, stimulation, and excitement in your life to prevent shut down

Rx #4:  Medications include stimulants, such as Ritalin, Cylert, Adderall, Desoxyn, or Dexedrine

 

 

ADD Over-Focused Type Suggestions:

Rx #1:  Notice when you’re stuck, distract yourself and come back to the problem later

Rx #2:  Don’t try to convince someone else who is stuck, take a break and come back to them later

Rx #3:  Write out options and solutions when you feel stuck

Rx #4:  Seek the counsel of others when you feel stuck (often just talking about feeling stuck will

Open new options for you)

Rx #5:  Medications include Prozac, Paxil, Zoloft, Effexor, Anafranil, Luvox, Serzone

 

 

ADD Depressive Type Suggestions:

Rx #1:  Every thought matters!  Kill the ANTs in your mind

Rx #2:  The limbic system is involved with bonding, surround yourself with people who provide

Positive bonding

Rx #3:  Great smells

Rx #4:  Medications include Norpramin, Tofranil, Wellbutrin, and other anti-depressants

 

 

ADD Explosive Type Suggestions:

Rx #1:  Strive for wonderful experiences

Rx #2:  Improve your ability to use words

Rx #3:  Sing whenever/wherever you can

Rx #4:  Listen to a lot of music

Rx #5:  Move in rhythms

Rx #6:  Medications include Depakote, Tegretol, Neurontin, Dilantin, and other anti-convulsants

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

Right Brain/Left Brain ADD Questionnaire

 

  1. Are you better at remembering faces than names?

 

  1. When you’re presented with a toy or piece of furniture to assemble, are you likely to discard the printed directions and figure out how to build it yourself?

 

  1. Are you better at thinking of ideas if you’re left alone to concentrate, rather than working with a group?

 

  1. Do you rely mostly on pictures to remember things, as opposed to names and words?

 

  1. Do you have especially acute hearing?

 

  1. Do you cut the labels out of clothes? Do you favor garments that are especially soft and well worn, finding most clothing too rough or scratchy?

 

  1. Do you tend to put yourself down a lot?

 

  1. When you’re asked to spell a word, do you “see” it in your head rather than sound it out phonetically?

 

  1. When you’re studying a subject, do you prefer to get the “big picture” as opposed to learning a lot of facts?

 

  1. Are you good with puzzles and mazes?

 

  1. Can you imagine things well in three dimensions? In other words, can you visualize a cube in your mind, rotate it, and view it from every angle without difficulty?

 

  1. Were you considered a late bloomer?

 

  1. Did you need to like your teacher to do well in his/her class?

 

  1. Are you easily distracted to the point that you find yourself day-dreaming a lot?

 

  1. Are you a perfectionist to the point that it gets in the way of trying new things?

 

  1. Are you ultra-competitive, hating to lose more than most people do?

 

  1. Are you good at figuring people out? Do others tell you that you’re good at “reading” people?

 

  1. Is your handwriting below average or poor?

 

  1. Were you a late walker, or have other delayed motor skills as a child?

 

  1. When you’re in a new place, do you tend to find your way around easily? 12

 

Right Brain/Left Brain ADD Questionnaire

 

Scoring Page

 

 

The more yes responses you have, the more to the right you or your child will be on my left-right brain continuum.

 

In general:

0-4   yes answers indicate you’re very left-brained

5-8   yes answers indicate you’re somewhat left-brained

9-12  yes answers indicate you’re whole brained

13-16  yes answers indicate you’re somewhat right-brained

17-20  yes answers indicate you’re very right-brained

 

Again, while this is not a scientific test, it will give you a general understanding of your brain dominance.

 

 

Note:  If you’re working with a preschooler or kindergartener who doesn’t yet have full letter recognition, you can use the following exercise to give you an early indication of his/her brain dominance.  This is a fun activity and can give you a clue as to how right-brained and visual your little one really is.

 

 

Activity:  On a piece of plain white paper, draw seven circles of approximately the same size in a straight line across the page.  Randomly use three or four different colored markers or crayons so that the sequence might be:  green, blue, red, red, yellow, green, yellow.  Instruct your child to study the circles for at least twenty seconds, until he/she feels confident he can remember them.

 

Remove the paper and ask your child to name the colors from left to right, and then right to left.  The results may surprise you!  Most children with ADD will be able to do this by hyper-focusing and using their visual memory.  Notice whether your child closes his eyes or looks upward, and indication that he/she is getting a picture of those colored circles in his/her mind.

 

 

 

 

 

 

 

 

 

 

 

 

 

13

Right Brain ADD/ADHD Characteristics

 

 

Learns better when moving

 

Stress ball, different textures on desk

 

Quiet place for learning

 

Relevant, hands on, interactive, practical learning

 

Show the child the end picture – fill in the pictures

 

Reading – Scan – get ending – fill in the pictures

 

Make a picture in his/her head, then create

 

Color, pictures movies and cartoon to fill in the story

 

“Touch math” – money counting, using beads, abacus

 

Can you see what I am saying?

 

Are you getting the picture?

 

Let me show you what I mean?

 

Problem solving – picture books

 

Paying attention – sequence of pictures on desk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10

 

Left Brain ADD/ADHD Characteristics

 

 

Sequential and logical, analytical and reliable

 

Uncomfortable with change

 

Live in an auditory world – storage in words

 

Routines and rules

 

They have to hear things to learn them – Laugh and Learn

 

Literal interpretation of world

 

Need step by step instructions

 

Must run through everything verbally to make sense

 

Talk to themselves as they take notes

 

Look away during lessons to process

 

Oral tests, report giving, lessons audio taped (for later listening)

 

Jingles, songs, poems

 

Big projects into small steps

 

Tell me about it?  Can you hear that?

 

Problem solving – storybooks to solve a problem

 

Tell me a story

 

Paying attention – words to be said – put on desk

 

 

 

 

 

 

 

 

 

 

 

11