Attention, Doctors: What We Call Attention-Deficit Disorder Is Actually Six Different Conditions. and One-Drug-Fits-All Therapy Isn't Right for Any of Them

Newsweek, February 26, 2001 | Go to article overview

Attention, Doctors: What We Call Attention-Deficit Disorder Is Actually Six Different Conditions. and One-Drug-Fits-All Therapy Isn't Right for Any of Them


Sam was 12 when he came to my office with a difficult case of attention-deficit disorder. He'd had four years of the kind of care that gives ADD treatment a bad name. After his initial diagnosis at 8, Sam was given Ritalin, a standard stimulant. He got all the side effects--emotionalism, anxiety, sleeplessness--and none of the benefits. When another stimulant produced the same results, Sam's parents stopped all medication and told him to "just try harder." Maybe he'd grow out of his social problems, disruptiveness and disorganization at school. That didn't work, either.

Then his mother read my 1998 book, "Change Your Brain, Change Your Life," which applies brain science to everyday life. She brought Sam to our clinic. After taking his history and doing a noninvasive brain scan, I diagnosed him with ADD, to be sure--but a kind of ADD largely ignored by doctors. Sam has what I call "overfocused ADD," one of several variants of the disorder. Sam did need medication to get better, but he needed the right medication. As we balanced his brain, his behavior improved.

Unfortunately, ADD is generally treated as a single disorder. Our research, which has yet to win broad acceptance, suggests that there are six distinct types of ADD, each with its own treatment options. Used by themselves, standard treatments such as Ritalin can actually make four of these types worse.

Most doctors who treat ADD make the diagnosis based on symptoms. They rarely look at brain function, which--with three ADD children of my own--I came to regard as critical. While directing a large clinic in Fairfield, Calif., I began using an imaging technique called SPECT, which measures brain blood-flow and activity patterns. Over the past 11 years we've built a database of 10,000 brain images related to behavioral problems.

Right away we saw that the ADD brain is different. Typically, when people with ADD try to concentrate there is decreased activity (rather than the expected increase) in the part of the brain that helps with sustained attention, short-term memory and forethought. In theory, stimulants increase brain activity in this region. But in looking at our ADD patients, we found different brain patterns; those who departed from the norm were the ones for whom traditional ADD treatment did not work. Eventually, we classified these differences into six distinct types.

Type 1: Classic ADD--primary ADD symptoms (distractibility, disorganization) with hyperactivity, restlessness and impulsivity. It is usually recognized early and can best be treated with stimulant medications such as Adderall or Ritalin. …

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