By Julie Le Franc, Psychoanalytic Psychotherapist & Psychologist
ADD/ADHD is an adult problem, too ...
Not all Attention Deficit Disorder children are growing out of their problems as they reach adulthood and many are going untreated as they learn to adapt to their problems.
A significant proportion of people may be plagued with anxiety, impulsivity, an inability to concentrate or focus on their work and have trouble in sustaining relationships or employment. Often these adults may present with depression, panic attacks, obsessive-compulsive disorders, eating disorders or addictions without any link being made to their undiagnosed ADD.
Daniel Amen, MD., is a Clinical Neuroscientist, Adult and Child Psychiatrist and Internationally recognised expert in the fields of the brain and behaviour and ADD. In his book “Healing ADD: The breakthrough program that allows you to see and heal the six types of ADD” he uses SPECT brain imaging to define the six distinct types (or variations) each with its own treatment options. 1
Type 1: Classic ADD with primary symptoms (distractibility, disorganisation) with hyperactivity, restlessness and impulsivity. It is usually recognised early and can best be treated with stimulant medications.
Type 2: Inattentive ADD with primary ADD symptoms with low energy and motivation. It can be diagnosed later in life and people with this condition are often labelled as lazy or spacey. Like Type 1, according to Dr Amen it responds well to stimulant medication.
Type 3: Over focussed ADD with primary ADD symptoms with cognitive inflexibility and difficulty with shifting attention. Sufferers often display negative thoughts and behaviours. They worry, bear grudges and are argumentative. This type is often seen in families with addiction problems or obsessive-compulsive tendencies. Stimulants used alone usually make this type worse; patients really focus on what bothers them. For this type of ADD, Dr Amen prescribes an anti-depressant, Effexor XR, when ineffective, then a selective serotonin-reuptake inhibitor (SSRI) such as Prozac, combined with a stimulant.
Type 4: Temporal lobe ADD is marked by primary ADD symptoms with a short fuse, periods of anxiety, memory problems, and difficulty reading. There may be a history of head injury, or a family history of learning or temper problems. Taken alone, stimulants usually make these people more irritable. Dr Amen effectively treats Type 4 ADD with a combination of anti-seizure drugs like Neurotin, Topamax or Lamictal and a stimulant.
Type 5: Limbic ADD involves primary ADD symptoms, together with mild sadness, low energy, low self-esteem, irritability, social isolation, and poor appetite and sleep patterns. Stimulants alone often exacerbate the moodiness and irritability. Dr Amen prescribes a stimulating antidepressant.
Type 6: Ring of fire ADD features primary ADD symptoms with extreme moodiness, anger outbursts, inflexibility, fast thoughts, and excessive talking. Patients tend to be sensitive to sounds and lights. Dr Amen gave this variant its name because of the intense ring of over-activity that he saw in the brains of affected people. This is ADD with Bipolar features, often a manic quality that is difficult to manage. This type is usually made much worse by stimulants, according to Dr Amen. He reports that his patients have done much better on anticonvulsants, combined with SSRI or a new antipsychotic medication such as Risperdal or Zyprexa (Amen, 2001).
Adult ADD patients are not only often depressed but also anxious. Clinical experience of Ritalin or dexamphetamine is that they are good anxiolytics and if Ritalin is not tolerated then try dexamphetamine as they are not the same.
ADD has clear biological roots and made worse by diet and has serious psychological and social consequences when left untreated. Diagnostic Guidelines using DSM-IV. Psychological and psychosocial treatments that include life management skills (e.g. organisation, time management, etc.,), anger management, stress management, symptom management and education can all be helpful. Treatment planning considerations must take into account the course of the disorder, phase of treatment, age of the patient, intellectual and academic issues, and family.
Treatment does not make ADD sufferer’s different people. It removes the barriers hindering them from being the people they already are. Knowing which ADD type the patient has is critical to establishing an effective treatment plan. Still, finding the right professional for evaluation and treatment is critical to the healing process.
Amen, Daniel, G. (2001). Healing ADD: The breakthrough program that allows you to see and heal the six types of ADD. New York: Berkley Books.
For more information contact Julie Le Franc, 0407385005