Vijai P. Sharma, Ph.D
In a previous article, I discussed how the latest brain imaging studies are confirming that Attention Deficit Hyperactivity Disorder (ADHD or ADD) occurs because of faulty activity in the brain. As brain imaging techniques become more sophisticated, the nature and site of abnormal brain activity can now be more precisely identified. Such developments have led some scientists to believe that there may be several different kinds of ADD.
Dr. Daniel Amen, having studied thousands of brain images, identifies six different types of ADD. The three ADD types (type 1 to 3) discussed in the previous article were: Classic, Inattentive and over focused.
The remaining three ADD types (type 4 to 6) discussed in this article are the Temporal Lobe, Limbic and the "Ring of Fire." I will now describe each and discuss associated problems observed in the brain activity.
People with type 4, that is, the "temporal lobe ADD," does have inattention and impulsivity problems, but they may also have periods of unprovoked outbursts of anger. They tend to misinterpret innocent comments and remarks of others. They have a tendency to become increasingly irritable until they explode and then withdraw. Besides periods of "spaciness" and mental confusion, they also may have periods of panic or unexplained fear. They may be overly sensitive and somewhat paranoid. Studies show that in such individuals the prefrontal and temporal lobes of the brain show abnormal activity.
The temporal lobe is that part of the brain that sits behind the eye socket and under the temple on both sides of the skull. So we have a left temporal lobe and a right temporal lobe. He left temporal lobe is involved in reading, language processing and verbal memory. When there is abnormal activity in the left temporal lobe, a person may have reading difficulty, dyslexia or other language processing problems.
Right temporal lobe problems may involve such social skill problems as the inability to read people's facial expressions or the subtle changes in another person's voice and tones. Therefore, children with temporal lobe involvement may not have a clue about reading their parents' body language.
People with type 5, that is, the "limbic ADD," in addition to inattention, may have a tendency for moodiness, negativity, isolation and depression. They may also have a tendency for sleep problems (sleeping too little or too much) along with feelings of guilt, hopelessness and personal worthlessness. At present, they are likely to be mistaken as suffering from chronic depression.
The limbic system is also referred to as the "emotional brain." It is like a filter, an emotional filter if you will, through which we view others and ourselves and interpret the events that happen to us. Therefore, blame a faulty limbic system when you see someone who has "glass half empty" syndrome. Abnormal activity in the limbic system is also associated with decreased motivation and drive, sleep and appetite problems and mood disorder.
People with type 6, that is, the "ring of fire ADD", besides being inattentive and easily distracted, may have problems with anger and irritability. They may be oversensitive to light, noise and other stimulations and experience the emotional "highs" and "lows." They may also be highly inflexible, impulsive and aggressive.
In those with type 6, "ring of fire" ADD disorder, it seems as if the whole brain is on fire. There is too much activity going on across the brain in a "ring of fire" ADD patient. As a result they are often hyperactive, restless and impulsive. They may chatter constantly and give in to alcohol, adventure and excitement.
So, there we have the six types of ADD, which are accompanied by under activity or over activity in specific areas of the brain. All six types show reduced activity in the pre-frontal brain. In non-ADD individuals, this area of the brain shows increased activity during concentration. This may explain why ADD patients can't concentrate in spite of their best effort.
Many people with ADD, beside attention deficit, have a variety of emotional and behavioral difficulties. It now appears that such emotional and behavioral difficulties might be because of abnormal activity in other areas of the brain, notably in the temporal lobe (involved in the language, social skills and memory), limbic system (the emotional brain) or in multiple parts of the brain all at the same time.
It will take years before we can have precise and reliable information about the involvement of the brain in the ADD. In the future, it might be possible to select the medication that will precisely target the brain areas causing ADD. However, behavioral training, individual counseling and family education will still be required for a more satisfactory outcome.
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Dr. Vijai Sharma
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