Attention Deficit Disorder ADHD/ADD

It is uncommon for ADHD to present itself alone, and often there are other co-morbid conditions. These range from depression, anxiety, adjustment disorders, and substance abuse to neurological disorders such as tics, or rarely, Tourette’s. As a consequence, the assessment of ADHD symptoms cannot occur in a vacuum and must be considered as part of a comprehensive assessment process.

Any treatment plan for ADHD therefore must be based on a comprehensive diagnostic evaluation: the clinician should be able to document that the patient meets the criteria for a diagnosis of ADHD, being aware of possible concomitant medical or psychiatric conditions. This is where a medical doctor (MD) is of tremendous value. Symptom-based assessment is a framework for knowing how to help someone get better at day-to-day living. The real challenge of helping patients is to target the areas where they have problems. This is why all modern assessment tools focus on disruptions in clean-cut ‘domains’ or areas of life affected, and the degree of such impairments.

Daniel, G Amen, MD, a child and adult psychiatrist employed single-photon emission computerised tomography (SPECT) brain imaging to identify the type of ADHD his patients were presenting. What this has led to, is a list of seven sub-types of ADD, each requiring its own particular plan. It should be noted that this has not yet been made official by DSM-5.

• 1. Classic ADHD

  This is the most common and easily identified of the seven sub-types of ADD. Scans of the brain tend to show that the individual question will have normal activity at rest, and decreased activity when peak concentration is required. This is especially true within the prefrontal cortex area. Those who suffer from Classic ADD have decreased blood flow in the prefrontal cortex, cerebellum, and the basal ganglia – with the ganglia being the main producer of dopamine. Symptoms of Classic ADD include being inattentive, distractibility, disorganised, restless and impulsive. Procrastination can also be a major issue.

• 2. Inattentive ADD

  Inattentive ADD, along with Classic ADD has been known since the 1980s. Inattentive ADD is also associated with low activity in the prefrontal cortex and less than optimum dopamine levels. As such, symptoms can and do overlap to a significant degree with Classic ADD. These include, short attention span, distractibility, disorganisation, and procrastination. However, people who lie on this part of the ADD spectrum are not hyperactive or impulsive. Instead, they tend to be introverted and daydream a lot – often attracting the term ‘space cadets’ from uninformed observers.

• 3. Over-focused ADD

  Those who are diagnosed with over-focused ADD present with all the classic ADD symptoms. However, in addition to this, they also have great difficulty shifting their attention from one task to another. As a result, this can often see an individual get stuck – or locked – into negative thoughts patterns or behaviours. Other symptoms include obsessing, excessive worrying, being inflexible, and frequently becoming oppositional in conversations. This is due to the deficiency of serotonin and dopamine, which, when brought back to functional levels in the brain, often reverses many of these symptoms, entirely.

• 4. Temporal Lobe ADD

  This sub-type includes all of the classic ADD symptoms, but in addition, also presents with Temporal Lobe (TL) symptoms. The TL, located underneath your temple, is involved with memory, learning, mood stability, and visual processing of your environment. As such, people with this sub-type experience difficulty with learning, memory, and behavioural issues, such as being prone to anger, aggression and mild paranoia. As the issue, in this case, is the TL, the goal of treatment is to soothe neuronal activity and stop the nerve cells from over-firing or firing unpredictably.

• 5. Limbic ADD

  Again, this sub-type includes all the Classic ADD symptoms, but in addition, also presents with a chronic low-level sadness that underpins a person’s general demeanour and outlook on life. However, this is not to be interpreted as depression. It is more of a state of pessimism or a “glass half full.” Individuals on this part of the spectrum will experience low energy, recurring feelings of hopelessness and worthlessness, as well as self-esteem issues. These symptoms are caused by too much activity in the limbic part of the brain – the centre of mood control – and decreased activity in the pre-frontal cortex, whether at rest or in a state of attempted concentration.

• 6. Ring of Fire ADD

  This sub-type is regarded as a more extreme form of the Classic ADD variant. An individual on this part of the spectrum would present with all the usual core symptoms. In addition, they might also experience hypersensitivity to their environment – especially noise, light and touch. They might also go through extended periods where their interactions with others are rooted in oppositional behaviour (confrontation). They might also present with unpredictable moods, talk faster than normal, and be prone to excessive worrying and obsession. This is caused by excessive amounts of activity in the cerebral cortex and other areas of the brain.

• 7. Anxious ADD

  Anxious ADD includes all the core symptoms of Classic ADD. In addition, an individual with this diagnosis might be prone to feeling anxious, tense, and also present with physical symptoms such as headaches and stomach aches. They will often think the worst and can fall into a state of catastrophising. There is also the likelihood of them freezing in anxiety-provoking situations, especially when there is the potential that they might be judged. The scans used by Dr Amen on his patients often show high levels of activity in the basal ganglia – responsible for producing dopamine. This differs from other sub-types of ADD, which usually present with low levels of activity in this area.

• Myth 1: ADHD Isn’t a Real Condition

  There has been a lot of debate about the validity of ADHD as a legitimate mental health issue. But the truth of the matter is ADHD has been recognised by the National Institute of Health, Centres for Disease Control and the American Psychiatric Association as a medical condition. It’s not a fictionalised disorder, but in fact, a very common one amongst children.

• Myth 2: It’s a Male Only Condition

  Although the condition is more prevalent in boys than in girls – males are twice as likely to receive a diagnosis of ADHD – it’s not a male-only problem. With a few rare exceptions, mental health issues are rarely gender-specific. The reason for the misconception is how the symptoms manifest in each sex. Boys can be more hyperactive, while girls can appear more distant, making a diagnosis harder to make.

• Myth 3: All People with ADHA are Hyperactive

  Intense hyperactivity is seen as the defining trait of ADHD, but it’s only one symptom of a broader set of characteristics that point to the presence of the condition. In fact, there are several forms of ADHD. One variation known as ADD doesn’t involve any form of hyperactivity at all and is more centred around the attention span and retention of information.

• Myth 4: People with ADHD are Lazy

  One of the least compassionate assertions is that people with ADHD lack motivation and can’t apply themselves. The solution is often presented that they simply need to buckle down and focus more. The issue is that ADHD isn’t an attitude problem. It’s a neurological issue that affects attention-span and mental acuity.

• Myth 5: People with ADHD Can’t Focus (Ever)

  Even though one of the hallmarks of ADHD is the lack of focus, it doesn’t mean that focus is completely absent. There is a ‘deficit,’ but not a complete inability to concentrate at all. In fact, many sufferers are able to enter into a state of ‘hyperfocus.’ While academic pursuits may be a problem, an individual can lose themselves in creative activities.

• Myth 6: ADHD is just a Phase in Childhood

  Many people believe that ADHD is simply a stage of life. But as we’ve touched on, it’s not an attitude problem. The roots go much deeper. Although the symptoms may become easier to manage in adulthood, they never completely go away, although they become less pronounced and change in intensity.

• Myth 7: ADHD is Caused By Poor Parenting

  ADHD is not the result of environmental factors. It’s caused by an abnormality in brain chemistry. Since many of the symptoms are behavioural, it can be a logical assumption to make. But the condition never has or will be the result of what parents did or did not do for them children.

Whilst many people associate the term with children and adolescents, ADHD is not something people ‘grow out of’. The condition appears in patients before the age of twelve, persists for at least six months, and causes problems in at least two environmental settings, such as home and school (in other words, the condition is not environment-specific or related to trauma). While many children with ADHD no longer display symptoms when reaching adulthood, up to 50% of individuals have symptoms that persist into the adult years.

Without treatment, ADHD will stay with a person regardless of age, although it may seem to evolve or change as the patient makes lifestyle choices that accommodate their condition, believing them to be indistinguishable aspects of their personality. Someone with undiagnosed ADHD may find physical and active work more fitting as this doesn’t require an extended period of sitting down and as such their condition may have limited career prospects.

Many people with ADHD have experienced periods of their lives when they attempted to “self-medicate” for their problem behaviours with alcohol, illegal drug use, or other damaging factors. Research into ADHD has given us a greater insight into the condition, and as such a wide range of treatments are now available, some utilising cognitive therapies and others taking advantage of medications, an option made available by a psychiatrist’s ability to prescribe medications.

• CBT Therapy

  The National Institute of Clinical Excellence (NICE Guidelines) considers cognitive behavioural therapy (CBT) based therapy to be an important complementary treatment for adults with ADHD, as it contributes to an improvement in symptoms and can be used effectively alongside other therapies such as relaxation and stress management.

  CBT may be a good choice for adults with ADHD when:

  • Your preference is not to have drug treatment.
  • You aren’t satisfied with drug treatments you’ve tried in the past.
  • You find it difficult to take medication.
  • Your symptoms are mild to moderate rather than severe.
  • You are concerned you may misuse the substance based on a history of substance misuse.

  A variety of CBT techniques such as verbal self-instructions, problem-solving strategies, cognitive modelling, self-monitoring, self-evaluation, and self-reinforcement can be helpful in treating children with ADHD. Although a wealth of research has been conducted using these different types of cognitive-behavioural interventions, no clinically important changes have yet been demonstrated on either behavioral measures or academic performance in children with ADHD.

  Recent research by psychologists has also demonstrated that CBT for adults with ADHD is ‘highly effective’. As psychological treatment of ADHD is very much in its infancy, this is a rather tall claim. The early and relatively methodologically unsound studies of psychological treatment did however consistently show improvement in symptoms, improvement in skills and improvement in productivity. Dr. Becky Spelman is an advocate for improving executive functioning and quality of life, rather the solely focusing on symptom reduction.

• Medication

  With regards to ADHD, a number of medication options are available. Randomized Controlled Trials have consistently demonstrated the effectiveness of stimulants to reduce the level of ADHD symptoms in children and adults suffering from ADHD. Many patients with adult ADHD (or any attentional disorder for that matter) will enter therapy either thinking about medication or currently taking medication. Any psychological treatment, therefore, has to help them integrate the experience of taking a pill to assist with focus and restraint. Naturally, some people find it difficult to take medications routinely and others have been unsatisfied with the progress of medication-only treatments.

  The end goal of psychiatric intervention is to improve the lives of patients. For children, this could mean allowing them to take advantage of the opportunities ahead of them in education. For adults, it may widen their suitability in job markets and open up career opportunities that were previously never considered.

At the Private Therapy Clinic, we use a psychometric screening tool, such as the CAARS Conners Adult ADHD Rating Scale, in combination with a clinical interview that explores the patient’s interactions and behaviour in various areas of their life, including their personal life, their relationships with their family members and close friends, and their academic and work performance. By exploring these three crucial areas of life, our psychologist or psychiatrist acquires the information necessary to make a clear diagnosis.

Our detailed assessment has two essential elements: during the first contact, the adult or child in question, and their guardian or parent if relevant, is invited to discuss their concerns and worries with the practitioner. Working together for a period of up to two hours, the Psychologist and client explore their family and personal history using a proven assessment tool.

In the case of children with suspected ADHD/ADD, their carer is also asked to arrange for a teacher or other professional at the school to fill out a detailed questionnaire and return it to our office. The material gathered in the questionnaire is further examined in the context of the information acquired during the first session.

While ADHD can often be treated effectively without medication, in some cases medication can help—often in the short term—to manage problem behaviours. In these cases, one of our Child or Adult Psychiatrists can provide a prescription.

Psychological Assessment

Time required: 90 minutes
Assessment and report fee: £640

Psychiatric Assessment

Time required: 75 minutes
Assessment and report fee: £745
£250 for follow up appointment including prescription
£90 if the client wants a repeat prescription outside of the session

If you would like to talk to someone about an ADHD assessment either in London or online, please get in touch with the Private Therapy Clinic on Whatsapp message at: +447434585472, email, chat bot or book online to arrange an appointment.

Understanding.org. (2019) 8 Common Myths About ADHD.Retrieved on 11th February, 2020 from, https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/add-adhd/common-myths-about-adhd
Healthline. (2019) Debunking 5 Common Misconceptions About ADHD.Retrieved on 11th February, 2020 from, https://www.healthline.com/health/mental-health/adhd-myths-debunked#1
WebMD. (2019) Adult ADHD Myths and Fact.Retrieved on 11th February, 2020 from, https://www.webmd.com/add-adhd/adult-adhd-myths-acts#1
Very Well Mind (22nd Nov 2019) Understanding Dr. Daniel Amen’s 7 Types of ADD. Retrieved on 18th June 2021 from, https://www.verywellmind.com/understanding-dr-daniel-amens-6-types-of-add-20466
ADDitude (19th Mar 2021) Dr. Amen’s 7 Types of Attention Deficit Disorder. Retrieved on 18th June 2021 from, https://www.additudemag.com/slideshows/7-types-of-add-adhd-amen/