Brain Diagnostics and ADHD

Pet scan, SPECT scans, and qEEGs are being used by some psychiatrist to diagnose and treat ADHD. Using these types of diagnostic brain studies, researchers are able to see the part of the brain that is faulty in ADHD and they can also monitor the brain's response to ADHD treatment and medication.

Dr. Daniel Amen is probably the most well known proponent of brain imaging for diagnosing ADHD. Dr. Amen reports that by performing a SPECT scan he can, based on images of brain blood flow, diagnose the type of ADHD that a person has and determine to what medicine the person will best respond.

Dr. Amen's use of SPECT scans is only now being explored as a viable method for diagnosing and treating patients. From the studies that I have read, it appears that observing the areas of the brain where brain flows during tasks that require concentration can attain valuable information. EEGs also provide valuable information about brain activity and are considerably less expensive than SPECT scans.

Dr. Amen has garnered a bit of controversy because he has proposed a classification of ADHD types that is not widely used or accepted. He has divided ADHD into subgroups based on the parts of the brain that are most injured. The six types that he describes are: 1) Classic hyperactive, 2) Inattentive, 3) Over focused, 4) Temporal, 5) Limbic, and 6) Ring of Fire.

The Classic hyperactive and the Inattentive type, according to Dr. Amen, have problems only in the prefrontal cortex (PFC). All the other types have problems in the PFC and in various other part of the brain. The Temporal type has abnormal temporal lobe activity and is thought to be the result of a head injury. The Overfocused type has an overactive cingulate system that makes them overly negative or obsessive compulsive. The Limbic type involves the limbic area of the brain and is accompanied by depression.

The Ring of Fire type, which is according to Dr. Amen the most severe type of ADHD (even though the name sounds like a circus act), has the misfortune of having their whole brain involved in problematic blood flow. All of Dr. Amen's subtypes respond to the stimulants and some of the subtypes require added antidepressants, or antipsychotic, or anti-convulsants.

It is not surprising that all the types except the Classic and Inattentive type require additional medication. Dr. Amen has reported that 40% of his patients have had a head injury and that most of his ADHD patients also have a diagnosis of anxiety, bipolar disorder, oppositional defiance disorder (ODD), obsessive-compulsive disorder, or depression. It is pretty clear to me that any of those other diagnosis when combined with the ADHD is going to give a different SPECT scan picture. Is having Limbic ADHD really any different than having ADHD and depression?

I believe that it is important to identify and treat all the comorbidities seen in ADHD and for this I applaud Dr. Amen but I think it is unnecessary to give ADHD with depression, or ADD with obsessive-compulsive disorder, a new name.

There is probably a benefit to brain imaging. The benefit, I believe, is in it's ability to guide the clinician in determining what medicine or treatment is most appropriately diminishing the disabling symptoms of ADHD.

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2 comments:

  1. I am extremely sensitive to stimulants and they seem to make this "crossed wire" as I call it. I had been diagnosed as severe pms or pmdd put on Wellbutrin and thought I would blow my brians out had I not gotten off of it. I am now on Serotonin and an anti anxiety as needed (not offend but feeling the need for more lately)... I have been very depressed and at times a bit manic but hate to label myself as bi-polar and don't want to even talk about that with my physician I do not see a pyschiatrist because I hate the idea of being medicated. I did use marijuana to self medicate for about 1 year and it worked I guess but I tested positive for a pre employment drug test and then stopped. Nothing seems to really remedy my depression and argumentativeness. Losing touch with people because I am afraid to be around others especially my family

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  2. It is hard to get the medicines to work just right. Intuniv is a non-stimulant that helps ADHD and sometimes helps argumentative or oppositional behavior. Good luck and hang in there!!

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