Types of ADHD

Dr. Amen’s 7 Types of Attention Deficit Disorder

Dr. Daniel Amen posits that there are 7 types of ADD (or ADHD) — each with its own unique symptoms, brain function, neurotransmitter activity, and treatment strategies.

A depiction of the many different kinds of adhd and the other comorbid conditions that frequently accompany it.
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Treating the 7 Types of ADD, and The Science of SPECT

As the founder of six Amen Clinics, I bring a multidisciplinary approach to diagnosing and treating brain-based disorders — including attention deficit disorder (ADHD or ADD) and coexisting conditions. For more than 20 years, I've used SPECT brain scans (along with other diagnostic techniques) to develop individual, targeted treatment plans for each patient. Early on, I discovered through brain SPECT patterns that attention deficit is not a single or a simple disorder. There are many types of ADD.

An image of a brain impacted by ADHD and related conditions like anxiety, depression, OCD or learning disabilities.
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Understanding the 7 Types of ADD

ADD, anxiety, mood disorders, autism, and other conditions are not single or simple disorders. They all have multiple types. ADD affects many areas of the brain — the prefrontal cortex and cerebellum primarily, but also the anterior cingulate, the temporal lobes, the basal ganglia, and the limbic system. The 7 types of ADD that I studied are based around three neurotransmitters — dopamine, serotonin, and GABA.

Dr Amen's 7 Types of ADD
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The 7 Types of ADD

  • Type 1: Classic ADD
  • Type 2: Inattentive ADD
  • Type 3: Overfocused ADD
  • Type 4: Temporal Lobe ADD
  • Type 5: Limbic ADD
  • Type 6: Ring of Fire ADD
  • Type 7: Anxious ADD

[Webinar Replay: What Are the 7 Types of ADHD?]

A woman texting while driving and showing signs of classic ADD with lack of focus, forgetfulness, and disorganization.
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Type 1: Classic ADD

This is the easiest type to spot of the 7 types of ADD: Primary symptoms are inattentiveness, distractibility, hyperactivity, disorganization, and impulsivity. Scans of the brain show normal brain activity at rest, and decreased activity, especially in the prefrontal cortex, during a concentration task. People with Classic ADD have decreased blood flow in the prefrontal cortex, cerebellum, and the basal ganglia, the last of which helps produce the neurotransmitter dopamine.

Women with ADHD running through the woods because exercise triggers dopamine creation in the ADD brain.
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How Do You Treat Classic ADD?

The goal of treatment here is to boost dopamine levels, which increases focus. I do it with either stimulating medications — Ritalin, Adderall, Vyvanse, Concerta — or stimulating supplements like rhodiola, green tea, ginseng, and the amino acid L-tyrosine. Getting lots of physical activity also helps increase dopamine, as does taking fish oil that is higher in EPA than DHA.

A man with inattentive ADHD plays with a model airplane at work because he is easily distracted.
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Type 2: Inattentive ADD

This type, as well as Classic ADD, have been described in The Diagnostic and Statistical Manual (DSM) of Mental Disorders since 1980. Inattentive ADD is associated with low activity in the prefrontal cortex and low dopamine levels. Symptoms are short attention span, distractibility, disorganization, procrastination. People with this type are not hyperactive or impulsive. They can be introverted and daydream a lot. Girls have this type as much as, or more than, boys.

A pharmacist discusses treatment options with an adult with inattentive ADHD who needs help focusing, getting organized, and maintaining attention.
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How Do You Treat Inattentive ADD?

Inattentive ADD is usually responsive to treatment. It is often possible to change the course of a person's life if he or she is properly treated. The goal, as with Classic ADD, is to boost dopamine levels. I use the supplements like the amino acid L-tyrosine, which is a building block of dopamine. Take it on an empty stomach for maximum effect. I often also prescribe a stimulant like Adderall, Vyvanse, or Concerta. I put patients on a high-protein, lower-carbohydrate meal plan, and I have them exercise regularly.

[Free Download: Your In-Depth Guide to Inattentive ADHD]

A man with overfocused ADHD stares out a window because he has trouble shifting his attention.
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Type 3: Overfocused ADD

Patients with overfocused ADD have all of the core ADD symptoms, plus great trouble shifting attention. They get stuck or locked into negative thought patterns or behaviors. There is a deficiency of serotonin and dopamine in the brain. When the brain is scanned, you see that there's too much activity in the area called the anterior cingulate gyrus, which is the brain's gear shifter. This overactivity makes it difficult to go from thought to thought, task to task, and to be flexible.

A doctors shows brain scans to a patient with over-focused ADD ADHD.
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How Do You Treat Over-Focused ADD?

The goal is to boost serotonin and dopamine levels in the brain. Treatment is tricky. People with Over-Focused ADD get more anxious and worried on a stimulant medication. I use supplements first — L-tryptophan, 5-HTP, saffron, and inositol. If supplements don't help with symptoms, I prescribe Effexor, Pristique, or Cymbalta. I avoid higher-protein foods with this type, which can make patients mean. Neurofeedback training is another helpful tool.

A man with ADHD and anger issues breaks a pencil
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Type 4: Temporal Lobe ADD

Of the 7 types of ADD, temporal lobe ADD has core ADD symptoms along with temporal lobe (TL) symptoms. The TL, located underneath your temple, is involved with memory, learning, mood stability, and visual processing of objects. People with this type have learning, memory, and behavioral problems, such as quick anger, aggression, and mild paranoia. When the brain is scanned, there are abnormalities in the temporal lobes and decreased activity in the prefrontal cortex.

An example of the medication used to treat temporal lobe ADD, which is also treated with magnesium.
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How Do You Treat Temporal Lobe ADD?

I use the amino acid GABA (gamma-aminobutryic acid) to calm neuronal activity and inhibit nerve cells from overfiring or firing erratically. Taking magnesium — 80 percent of the population are low in this mineral — helps with anxiety and irritability. Anticonvulsant medications are often prescribed to help with mood instability. For learning and memory problems, I use gingko or vinpocetine.

A woman with limbic ADD puts her head in her hands due to chronic low-level sadness and ADHD.
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Type 5: Limbic ADD

This type looks like a combination of dysthymia or chronic low-level sadness and ADD. Symptoms are moodiness, low energy, frequent feelings of helplessness or excessive guilt, and chronic low self-esteem. It is not a mood disorder. This type is caused by too much activity in the limbic part of the brain (the mood control center) and decreased prefrontal cortex activity, whether concentrating on a task or at rest.

A fish oil capsule used to treat symptoms of low-level sadness associated with limbic ADD.
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How Do You Treat Limbic ADD?

The supplements that work best for this type of ADD are DL-phenylalanine (DLPA), L-tryosine, and SAMe (s-adenosyl-methionine). Wellbutrin is my favorite medication for this type of ADD. Researchers think it works by increasing dopamine. Imipramine is another option for this type. Exercise, fish oil, and the right nutrition plan will help a person with Limbic ADD better manage symptoms.

A woman with ring of fire ADD with her head in her hands due to symptoms including sensitivity to noise, light, touch; periods of mean, nasty behavior; unpredictable behavior; talking fast; anxiety and fearfulness.
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Type 6: Ring of Fire ADD

Ring of fire ADD symptoms include: hypersensitivity to the environment — especially noise, light, touch; periods of oppositional behavior; unpredictable moods; talking fast; worrying and obsessiveness.

Patients with ring of fire ADD don't have an underactive prefrontal cortex, as with Classic and Inattentive ADD. Their entire brain is overactive. There is too much activity across the cerebral cortex and many of the other parts of the brain. I call ring of fire "ADD plus." In brain scans, it looks like a ring of hyperactivity around the brain.

A woman with ring of fire ADD chops up fresh vegetables for a healthy diet to treat symptoms.
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How Do You Treat Ring of Fire ADD?

Stimulants, by themselves, may make ring of fire ADD symptoms worse. I start out by eliminating any trigger foods, then slowly reintroducing them, if I suspect an allergy is involved, and boost the neurotransmitters GABA and serotonin through supplements and medication, if necessary. I prescribe GABA, 5-HTP, and L-tyrosine supplements. If I prescribe medication, I start with one of the anticonvulsants. The blood pressure medicines guanfacine and clonidine may be helpful, calming overall hyperactivity.

A man with anxious ADHD looks stressed out, anxious, and worried about something on his computer.
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Type 7: Anxious ADD

People with this type have hallmark ADD symptoms, and they are anxious, tense, have physical stress symptoms like headaches and stomachaches, predict the worst, and freeze in anxiety-provoking situations, especially where they may be judged. When the brain is scanned, there is high activity in the basal ganglia, large structures deep in the brain that help produce dopamine. This is the opposite of most types of ADD, where there is low activity in that region.

A woman with anxious ADD takes a calming supplement to treat her symptoms of stress and worry.
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How Do You Treat Anxious ADD?

The treatment goal is to promote relaxation and boost GABA and dopamine levels. ADD stimulants, taken alone, make patients more anxious. I first use a range of "calming" supplements — L-theanine, relora, magnesium, and holy basil. Depending on the patient, I prescribe the medications imipramine or desipramine to lower anxiety. Neurofeedback also works to decrease symptoms of anxiety, especially to calm the prefrontal cortex.

[Why Anxiety Disorder Is So Often Misdiagnosed]

Daniel Amen, M.D., is a member of the ADDitude ADHD Specialist Panel.

3 Related Links

  1. 1) Daniel Amen is about the only person in the US who uses these type of scans to diagnose ADHD.
    2) there are only 3 rules of ADHD mentioned in the DSM V
    3) one of his centers placed a 4 year old patient of mine on 2 psychotropic medications based on a PET scan, without the prescribing psychiatrist ever actually seeing the patient.
    4) why does Additude continue to endorse Dr. Amen’s theories when they are not endorsed by mainstream medical professionals?
    Deborah A. Sedberry MD

      Founder of Amen Clinics
      Double Board-Certified Psychiatrist
      Distinguished Fellow of the American Psychiatric Association

      Can you provide your credentials? and the State(s) you are Board Certified in?

      I am just a mother who has been studying ADHD for over 10 years (now know was ADD with two types ADD or combined type (to include Hyperactivity, this information is helpful for medical coding purposes that follow the new ICD-10 rules).

      Dr. Amen’s books and tools have helped our family more than mainstream medicine ever did with our daughter. Yet then again mainstream medicine has only recently started to recognize that girls exhibit symptoms differently than their male counterparts … almost like they have a different type. I am also taking a wild guess that the parents of the four-year-old were not satisfied with the treatment they were receiving from you if the sought out the Amen Clinics. Plus you never stated what the 3 prong approach was that Dr. Amen clinic used/recommended during treatment and what was the outcome.

      Considering my now 5-year-old is on a high blood pressure medicine and has been for over a year to control impulsivity (inappropriate use of medication that is starting to gain mainstream medical approval). Because they couldn’t give him a stimulant due to other medical issues this could be considered risky as well. Making a broad statement without detailed supporting information to envoke fear or prove a point is not helpful and I would expect better of a board-certified physician.

  2. What if someone shows (severe) signs of all of them?
    I was officially diagnosed with ADHD/ADD in December 2017. I was 37. I have had successful results with medication….to a certain degree. I know I live with depression (undiagnosed) and I’ve been looking into getting further clarity on my mental health issues but after reading this article I’m seriously wondering if I’m not a really strong cocktail of all 7 types. If that’s possible, how do I treat this?
    I’m not upset or ashamed of my condition. I just know this isn’t the core. This is supposed to be a part of who I am, not who I am but, unfortunately, that’s not what my reality is yet. Any tips are welcome.

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