Understanding Dr. Daniel Amen's 7 Types of ADD

Dr Amen's 7 Types of ADD. Rubber Ball Productions/Getty Images

Daniel G. Amen, MD, is a child and adult psychiatrist, a nuclear brain imaging specialist, and a New York Times bestselling author. His books include the groundbreaking Healing ADD: The Breakthrough Program That Allows You to See and Heal the 7 Types of ADD, which was published in 2013. 

Dr. Amen is also the founder of 10 Amen clinics across the United States. At these clinics, patients have a single-photon emission computerized tomography (SPECT) brain scan to diagnose the type of attention-deficit/hyperactivity (ADHD) they have, enabling them to receive targeted treatment.

A SPECT scan shows how the blood flows through the brain.

The Standard Method of Diagnosing ADHD

The standard means of assessing and diagnosing ADHD used by mental health professionals in the United States is to use the criteria established in the Diagnostic and Statistical Manual for Mental Disorders (DSM), which identifies three presentations of ADHD: 

  • Attention-deficit/hyperactivity disorder, combined presentation 
  • Attention-deficit/hyperactivity disorder, predominantly inattentive presentation 
  • Attention-deficit/hyperactivity disorder, predominantly hyperactive-impulsive presentation

Amen Has Identified 7 Types of ADD

Using SPECT scans on tens of thousands of patients, Dr. Amen has identified seven types of ADD. Dr. Amen uses the term ADD, rather than ADHD, as he feels ADD is more reflective of the condition.

When a person has been diagnosed with an ADD type, Dr. Amen uses a combination of prescription medication, supplements, and lifestyle changes to treat the condition.

Each type of ADD has its own treatment recommendations. 

Neuroimaging in Psychiatry

Functional neuroimaging, such as SPECT scanning, is considered a helpful tool for researchers. It has been invaluable in understanding the neurocircuitry (activity in the brain) of various psychiatric conditions. However, mainstream psychiatrists do not generally believe they are a valid technique to use for regular clinical diagnosis.

Critics of Dr. Amen's claim that he uses the scans to support the marketing of his procedures and products.

Amen's Types of ADD

Dr. Amen's particular ADHD sub-types and his package of recommendations are not broadly established and reflect his particular biases. With these caveats, here are Dr. Amen’s types of ADD and his treatment recommendations:

Type 1. Classic ADD (ADHD)

Symptoms include being inattentive, distractible, disorganized, hyperactive, restless, and impulsive. Procrastination can also be an issue.

People with classic ADD have reduced blood flow in the brain area of the prefrontal cortex, cerebellum, and the basal ganglia. The basal ganglia help produce dopamine. 

The goal of the treatment is to increase dopamine levels in the following ways:

  • Either using stimulant medication, such as Adderall® or Concerta®, or using stimulating supplements, such as Rhodiola, green tea, or ginseng. The amino acid L-tyrosine is also used, as it's a building block of dopamine.
  • Exercise is encouraged because it boosts dopamine.
  • A fish oil supplement that's higher in omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). For example, a 60:40 ratio is recommended.
  • A diet that's higher in protein and lower in carbohydrates is encouraged.

    Type 2. Inattentive ADD 

    Symptoms include being inattentive and easily distracted (but not hyperactive), sluggish, and slow moving, with low motivation. People with inattentive ADD are often described as space cadets, daydreamers, and couch potatoes. This type is more common in girls than boys and is often diagnosed later in life because these people don't have behavior problems.

    People with inattentive ADD have reduced activity in the prefrontal cortex as well as low levels of dopamine. Treatment is the same as for Type 1.

    Type 3. Overfocused ADD

    Overfocused ADD includes classic ADD symptoms, plus trouble shifting attention, frequently getting stuck in loops of negative thoughts or behaviors, obsessive, excessive worrying, inflexibility, and frequent oppositional and argumentative behavior.

    People with overfocused ADD have a deficiency of serotonin and dopamine. The goal of treatment is to increase both of these neurotransmitters, the nervous system’s chemical messengers. Dr. Amen explains that because people with this ADD type become more worried and anxious when taking stimulant medication, he tries supplements first. He prescribes medications only if supplements aren't effective. Treatment includes:

    • Supplements are used to boost dopamine, such as L-tryptophan. 5-Hydroxytryptophan, a naturally occurring amino acid known as 5-HTP, is used as an antidepressant. Other supplements include saffron and inositol, which increase focus and mental clarity.
    • Antidepressant medication examples are Effexor®, Pristiq®, or Cymbalta®. 
    • Neurofeedback is also recommended. It teaches people to regulate their brain function.
    • People who have this ADD type do not do well on a high protein diet as it can prompt mean behavior.

    Type 4. Temporal Lobe ADD 

    This type includes classic ADD symptoms plus being irritable, quick-tempered and aggressive, and having dark thoughts, mood instability, and mild paranoia. People with this type might see or hear things that are not there and learning and memory problems may be present.

    People with temporal lobe ADD have irregularities in their temporal lobes and less activity in the prefrontal cortex part of the brain.

    The goal of treatment is to soothe neuronal activity and stop nerve cells from over-firing or firing unpredictably. Treatment includes:

    • The amino acid gamma-aminobutyric acid (GABA) to help to calm the nerve cells.
    • A magnesium supplement helps with anxiety.
    • Anticonvulsant medications can help stabilize moods. 
    • Gingko or vinpocetine can assist with learning and memory issues. 
    • A ketogenic diet, which is a diet that is higher in protein, might be recommended.

    Type 5. Limbic ADD 

    This type includes classic ADD symptoms plus chronic low-level sadness, but not depression. Negativity, "glass-half-empty syndrome," low energy, frequent feelings of hopelessness and worthlessness, and low self-esteem are other symptoms of this type.

    People with limbic ADD have excessive activity in the limbic section of the brain, which is where moods are controlled. They have reduced activity in the prefrontal cortex both when relaxing or focusing on a task. Treatment includes:

    • DL-phenylalanine (DLPA), L-tyrosine, and SAMe (S-adenosylmethionine) are the most effective supplements. 
    • An anti-depressant, Wellbutrin® or imipramine, might be prescribed.
    • Exercise, fish oil, and an appropriate diet are also recommended. 
    • An elimination diet, where dairy, sugar, wheat, and corn are eliminated from the diet for three weeks, will help to determine if the person has these food sensitivities.

    Type 6. Ring of Fire ADD 

    This is a more extreme version of Classic ADD, plus being extremely distractible, angry, irritable, and overly sensitive to noise, light, clothes, and touch. People with this type are often inflexible, extremely verbal, oppositional, and have cyclic moodiness. 

    People with a ring of fire ADD have an overactive brain. There are excessive amounts of activity in the cerebral cortex and other areas of the brain. Treatment includes:

    • Beginning with an elimination diet if it appears a food allergy might be present. 
    • Stimulants alone could make symptoms increase. GABA, 5-HTP, and L-tyrosine supplements help to increase GABA and serotonin levels.
    • Medications that might be prescribed are an anticonvulsant and blood pressure medication like guanfacine or clonidine to help reduce hyperactivity.

    Type 7.  Anxious ADD 

    Anxious ADD includes classic ADD symptoms plus feeling anxious and tense, physical stress symptoms like a headache and stomachache, freezing when in situations that cause anxiety, and anticipating the worst.

    People with anxious ADD have high levels of activity in the basal ganglia, which aid in making dopamine. This differs from the majority of the other ADD types, which have low activity in this part of the brain.

    The goal of treatment is to help with relaxation and increase GABA and dopamine levels. Treatment includes:

    • Supplements that have a calming effect, like L-theanine, relora, magnesium, and holy basil.
    • Stimulants taken on their own can cause more anxiety. However, helpful medications to lower anxiety are the tricyclic antidepressants imipramine or desipramine. 
    • Neurofeedback can help lower anxiety and calm the prefrontal cortex.

    Having More Than One Type is Common

    It's possible to have more than one of these types of ADD. For example, a common combination is overfocused, limbic, and anxious types.

    Dr. Amen believes that understanding the distinctions and complexities of each of these seven subtypes allows for more effectively diagnosing and treatment for children and adults with ADHD.

    A Word From Verywell

    Always consult your doctor before making any changes to your own treatment. He or she needs to be aware of every supplement and medication you're taking in order to be alert for potential interactions or problems with other conditions you may have.