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
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Attention Deficit Disorder with Hyperactivity
“Classic” ADHD
(Pre-Frontal Cortex Area of the Brain)
Either (1) or (2)
- 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
- 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)
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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.
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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.
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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.
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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.
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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
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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
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Right Brain/Left Brain ADD Questionnaire
- Are you better at remembering faces than names?
- 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?
- Are you better at thinking of ideas if you’re left alone to concentrate, rather than working with a group?
- Do you rely mostly on pictures to remember things, as opposed to names and words?
- Do you have especially acute hearing?
- 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?
- Do you tend to put yourself down a lot?
- When you’re asked to spell a word, do you “see” it in your head rather than sound it out phonetically?
- When you’re studying a subject, do you prefer to get the “big picture” as opposed to learning a lot of facts?
- Are you good with puzzles and mazes?
- 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?
- Were you considered a late bloomer?
- Did you need to like your teacher to do well in his/her class?
- Are you easily distracted to the point that you find yourself day-dreaming a lot?
- Are you a perfectionist to the point that it gets in the way of trying new things?
- Are you ultra-competitive, hating to lose more than most people do?
- Are you good at figuring people out? Do others tell you that you’re good at “reading” people?
- Is your handwriting below average or poor?
- Were you a late walker, or have other delayed motor skills as a child?
- 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.
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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
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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
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