add in adultsassets.a4m.com/assets/webcasts/webcast_pdfs/2013-07-23... · 2013-07-23 · sleep...
TRANSCRIPT
ADD in
Adults
Daniel G. Amen, MD
Amen Clinics, Inc.
NYC, DC, Atlanta, SF, Newport Beach, Bellevue
www.amenclinics.com
Myth #1 ADD is the designer disease
of the new century
ADD described for over 100 years
Stimulants used for ADD since 1937
Ritalin introduced in 1951
ADD is increasing in the population
Myth #2
ADD is caused by
bad parent and teachers
ADD Myth #3
ADD is overdiagnosed
Estimated 6-10% ADHD or ADD
Only 2-3% being treated
ADD remains vastly underdiagnosed,
especially ADDw/oH and females
ADD Myth #4 People w/ADD just need to try harder
ADD Myth #5 ADD is only a "minor" disorder
35% never finish high school
43% unRx, agg. ADHD boys arrested
Up to 50% of prison pop w/ADD or LD
52% of ADD adults abuse substances
75% w/interpersonal problems
ADD Myth #6
Everybody outgrows ADD
At least 50% of children w/ADD have
symptoms into adulthood
Many have never been diagnosed
For many leads to serious problems and
misdiagnoses
Criteria Common To All Types
Short attention span for routine tasks
Distractibility
Organizational problems (space & time)
Difficulty with follow through
Poor internal supervision
Short Attention Span
For regular, routine, everyday tasks
Usually say, “I can pay attention if I’m
interested.”
Need adrenaline filled subjects to pay
attention
Others say they don’t seem to listen
Distractibility
Tend to hear, smell, see, feel, and taste more
than others
Hypersensitive to environmental stimuli
Poor PFC activity cannot inhibit sensory info
Need clothes, food, room, etc. just right in
order to feel comfortable and focus
Disorganization
Time -- frequently late, takes longer than
predicted to do projects
Space -- desk, book bag, room, files
Projects -- haphazard approach
Mind – many internal conversations
Poor Follow Through
Multiple interests
Will do a project only as long as there is
intense interest
May do many things 50-80% done then stop
Often gets distracted by other things
Poor Internal Supervision
Problems with long term goals
The moment is what matters
Takes a crisis management approach to life
Problems processing ideas/thinking through
consequences before words or actions
Consequences do not matter as much
First 12 Yrs -- ADD colicky babies
hyperactive/sensitive
often unrecognized in girls
symptoms include short attention span,
distractibility, poor handwriting, poor
organization, interrupts frequently,
underachievement
sleep problems/bedwetting
Adolescence -- ADD
often unrecognized, hyperness outgrown
presents with impulse control disorders or
school underachievement
symptoms include short attention span,
distractibility, poor handwriting, poor
organization, interrupts frequently,
underachievement
sleep problems
Adolescence -- ADD
school failure, often leads to depression
impulse control problems
teen pregnancy
substance abuse
runaways
legal problems
wrong crowd
driving problems
Adults -- ADD job failure/changes
multiple relationships
moves
impulse control problems
driving issues
excitement seeking
sleep problems
sexual problems
Causes of ADD
Genetics
Brain trauma, esp. left frontal lobe
Prenatal toxic exposure
Oxygen deprivation
Brain infections
Environmental toxins
Food allergies
Seven ADD Types
1. Classic ADD
2. Inattentive ADD
3. Overfocused ADD
4. Limbic ADD
5. Temporal Lobe ADD
6. Ring of Fire ADD
7. Anxious ADD
Type 1. Classic ADD
Short attention span (routine matters)
Distractibility
Disorganization
Procrastination
Poor internal supervision
Type 1. Classic ADD
Restlessness, hyperactivity
Constant motion, trouble sitting still
Talkativeness
Impulsivity
Lack of forward thinking
Type 1. Classic ADD Treatment
Higher protein diet
Exercise
Ritalin/Concerta/
Metadate/Daytrana
Adderall/Vyvanse
Dexedrine
Provigil/Nuvigil
Strattera
EPA fish oil
Green tea
Rhodiola
Ginseng
Ashwaghanda
L-tyrosine
Phenylalanine
Iron
Zinc
Type 2. Inattentive ADD
Short attention span (routine matters)
Distractibility
Disorganization
Procrastination
Poor internal supervision
Type 2. Inattentive ADD
Spacey
Daydreams
Seems internally preoccupied
Sluggish
Low Motivation
Type 2. Inattentive ADD Treatment
Higher protein diet
Exercise
Ritalin/Concerta/
Metadate/Daytrana
Adderall/Vyvanse
Dexedrine
Provigil/Nuvigil
Strattera
EPA fish oil
Green tea
Rhodiola
Ginseng
Ashwaghanda
L-tyrosine
Phenylalanine
Iron
Zinc
“Mr.. Osborne, may I be excused? My brain is full.”
Type 3. Overfocused ADD
Trouble shifting attention, looks like
cannot pay attention
Worrier
Tends to hold grudges
Gets stuck on thought patterns
Type 3. Overfocused ADD
Can get stuck in patterns of behavior
(ritualistic behavior)
Upset if things do not go your way
Often argumentative or oppositional
Tends to be seen when there are
overfocused family members
Type 3. Overfocused ADD
Treatment
EPA/DHA fish oil
Less protein, increased simple & complex
carbohydrate diet
Intense aerobic exercise
SSRI often with a stimulant
5HTP, Saffron, B6 + L-tyrosine
Type 4. Limbic ADD
Inattentive
Sad, moody, irritable
Many negative thoughts (ANTs)
Low motivation, finds little pleasure
Sleep/appetite problems
Social isolation
Type 4. Limbic ADD
Treatment
EPA fish oil
SAMe
Balanced diet
Exercise can be very helpful
Buproprion or Effexor (if cingulate also
present)
Type 5. Temporal Lobe ADD
Frequent headaches
Too sensitive to others
External aggression
Internal aggression
Learning struggles
Inattention
Emotional instability
Memory problems
Periodic anxiety
Illusions/shadows
Type 5. Temporal Lobe ADD Treatment
Mood Stability
Anti-epileptic meds
Neurontin
Lyrica
Lamictal
Depakote
Dilantin
Memory
ACEI
Aricept, Exelon
Namenda
Mood stability
GABA, B6, fish oil
Memory
Blood flow -- gingko, vinpocetine
Acetylcholine – acetyl-l-carnitine,
huperzine A
Membrane – PS
Antioxidant – NAC
Blood sugar -- alpha lipoic acid
Type 6. Ring of Fire ADD
Overactivity throughout
the cerebral cortex,
especially in the
lateral prefrontal cortex
parietal lobes
temporal lobes
anterior cingulate gyrus
Type 6. Ring of Fire ADD
May be a bipolar
equivalent
easily distracted
too many thoughts
often very hyper
hyperverbal
oppositional
aggressive
hypersensitive to light,
sound, taste, touch
moodiness
cyclic behavioral
changes
Paul – ADHD, Overfocused Issues
Concentration vs 10mg of Adderall
Crashes PFC
Paul – ADHD, Overfocused Issues
Concentration vs 10mg of Adderall
Lessens Ring of Fire
Type 6. Ring of Fire ADD
Treatment
EPA/DHA fish oil
GABA, 5HTP, L-tyrosine
Higher protein, lower simple carbs
Anticonvulsants (Neurontin, Depakote,
Lamictal, etc.)
New, novel antipsychotic meds (Risperdal,
Zyprexa, etc.)
Type 7. Anxious ADD
Inattentive
Easily distracted
Anxious, nervous
Tense
Physical stress symptoms
Predicts the worst
Social anxiety
Struggles with times tests
Type 7. Anxious ADD Treatment
EPA/DHA fish oil
Magnesium, Relora, Holy Basil, l-theanine, l-
tyrosine
Higher protein, lower simple carbs
Desipramine, imipramine, Strattera
Combination ADD Types
Aggression -- common the have
decreased PFC, decreased temporal
lobes, and increased cingulate
Overfocus and limbic -- ACA issues
Any can go together
Often need combination treatments
Effectively Treating ADD Education
Support
Medications – understand types
Supplements – understand types
Lifestyle changes (diet, exercise, limiting video
games)
Parent training
School or work interventions
Dark Side of ADD
Suicide – more common than most know
Risk factors – impulsivity, failure, loss,
moves, social alienation, breakups
Physical, sexual and emotional abuse more
common
Obesity, diabetes
Alzheimer’s
A Family Illness
ADD increases divorce
Evaluate family members
Include family members in evaluation and
follow up
Summary
ADD is real
ADD affects adults in many different ways
ADD is brain illness and needs brain healing
Think about ADD in difficult relationships
Optimize brain function for improved life
function
Daniel G. Amen, MD
www.amenclinic.com
Amen Clinics, Inc. NYC
DC
Atlanta
Newport Beach, CA
SF
Bellevue