Welcome to the world of
Where landing is learned in
What do people think of when
they hear “AD/HD?
Not a real disorder
Disorder of childhood
Due to poor parenting/ lack of discipline
Boys have it more often than girls
Ritalin is like cocaine and causes
It is an excuse to not take responsibility for
What are the characteristics of
Doesn’t live up to potential
And…..just plain dumb
What is AD/HD?
AD/HD is a disorder of attention and
impulse control with specific DSM criteria.
Itis defined by a set of 18 symptoms and
to dx ADD, you must have at least 6.
IT is also known as:
The common core features of
Poor sustained attention to tasks
Impaired impulse control
Impaired delay of gratification
Excessive activity and physical restlessness
These core features must be:
Usually appear before the age of seven
Last longer than six months
Create a significant handicap in at least
two areas of a person’s life:
• Social settings
How does this translate into
Fails to pay close attention to details
Makes careless mistakes
Can’t stay on task
Doesn’t seem to listen when spoken to
Constantly losing or forgetting important
Blurts out answers
Difficulty awaiting their turn
What is the difference between
ADD and AD/HD?
The correct disorder is currently termed
By current DSM-IV definition, ADD does
not technically exist
Rather, it is called AD/HD
It is important to note that one can have
AD/HD without having the “H”.
This still falls under that AD/HD umbrella term
Who gets AD/HD?
Approximately 4-6% of the U.S. population
Initially, it was thought that boys got
AD/HD more often than girls
However, it is now understood that gender
differences changes how the disorder is
Thus, girls are less likely to be referred for a
diagnosis because they often do not fit the
“stereotype” of AD/HD
What is the etiology of AD/HD?
are currently several public
misconceptions about the cause of AD/HD
Due to Food allergies
Excessive sugar intake
What is the etiology of AD/HD?
Ad/HD is now considered to be a
• This has the largest contribution to causing AD/HD
• There is a 25-35% probability of it occurring in
within a family
• Compared to the 4-6% probability of it occurring in
the general population.
Thereare environmental risk factors that
may increase the likelihood of AD/HD
Difficulty during pregnancy
Prenatal exposure to alcohol and tobacco
Low birth weight
Increased body lead levels
Postnatal injury to the prefrontal regions of the
Pathophysiology of AD/HD
AD/HD has been shown to have problems in the
catecholamine rich fronto-subcortical brain
This is supported by the fact that stimulant
medications are often effective.
A 10 year NIMH study also showed that those
with AD/HD has a 3-4% smaller brain than those
They also demonstrated that this was not due
to medication use.
What does this mean?
These areas of the brain that have been
found to be affected by AD/HD are those
that control the executive functions of life.
Activation of other brain regions
Allowing the brain to do routine and creative
Executive functions of the brain
Working memory and recall
Holding facts in mind while manipulating
Accessing facts stored in long term memory
Activation, arousal and Effort
Thinking before acting or speaking
Using self-talk to control one’s behavior and
direct future actions
Complex problem solving
Taking an issue apart
Analyzing the pieces
Reconstructing and organizing them into new
The types of AD/HD
The classic division of AD/HD was”
Predominantly Inattentive type
Predominantly hyperactive-impulse type
A new Classification
There is now a greater breakdown into six
subclasses of AD/HD:
Cingulate System Hyperactivity
Limbic System Hyperactivity
Basal ganglia hyperactivity
Temporal lobe system dysfunction
The Combined Type
Identified early in life
More often diagnosed in boys
Low dopamine levels in the basal ganglia
Decreased activity in the prefrontal cortex and
Review of brain structures
Nutritional help for combined type:
High protein, Low carbohydrate diet
• This type of diet has a stabilizing effect on
blood sugar levels
• Refined carbohydrates negatively impact
dopamine levels in the brain
This is where cultural/family problems
has complicated ADHD
More quick grab meals such as Pop tarts,
frozen waffles, pancakes and even cereal
leads to more refined carbs in the diet.
The “couch potato”
Later childhood / early adolescent onset
Brighter the individual, the later the
Often appear “hypoactive”
Unmotivated and apathetic
Inattentive type continued
Most of those with inattentive adhd are
It is due to decreased brain activity in the
frontal lobes of the brain.
The harder the person tries to concentrate,
the worse the ADHD gets.
This type of ADHD also benefits from the
high protein, low carb and low fat diets.
Cingulate System Hyperactivity
The “hyper focuser”
This type has been found to have an increase in
blood flow to the top and middle portions of the
This is the part of the brain that allows you to
shift your attention from thing to thing
Can present in many ways:
Stimulant medication makes this type of ADHD
SSRI’s are commonly used because this subtype
has been found to have lower levels of serotonin.
This will often present as:
Nutritional support for Cingulate system
Carbs contain I-tryptophan
This is an amino acid that is a building block
for serotonin production
A high protein, low carb diet makes this type
worse because it contains larger amino acids
These larger AA more successfully compete to
getting into the brain.
Limbic System Hyperactivity
The limbic system is in the center of
emotional tone (how negative or
positive you are)
Motivation & drive
Sleep and appetite cycles
Bonding mechanism for connecting
If the limbic system is overactive:
Severe PMS (PMDD)
Our limbic system needs fat to operate
Recommended that patients increase their
omega-3 fatty acid intake
This is best form because increasing other
fats can lead to other health problems that
complicate the disorder.
Basal Ganglia Hyperactivity
The basal ganglia integrates our
feelings, thoughts and movements.
It helps to shift and smooth our motor
Nutritional support for basal ganglia
Often associated with Hypoglycemia
• Eat a well-balanced diet and often during the
• Avoid high glycemic index foods
• Eliminate caffeine (promotes anxiety)
• Eliminate alcohol (withdrawal can induce
Herbs such as Kava kava and valerian
along with B6 have calming effects on the
Temporal Lobe Type
Panic or fear for no reason
Spaciness and confusion
Significant social withdrawal
Temporal Lobe Dysfunction
Temporal lobe problems may be inherited,
however, this is the type that can be
associated with brain trauma.
nutritional support is purely
A decrease in phosphatidal serine causes
severe memory problems. Supplementation
may be recommended.
Normal Brain ADHD brain
Image of ADHD
The Picture on the Left is a PET scan of a Normal brain.
The Picture on the Right is a PET scan of an ADHD brain
Gender differences and ADHD
referred samples estimate that
ADHD affect boys 10:1 over girls.
Community samples say that ratio is 2:1.
However, recent studies have
demonstrated that girls express ADHD
different than boys.
Females with ADHD:
Fewer conduct problems than males
• This is thought to be why females are not
referred for evaluation as often.
Tend to have more internalizing disorders
• Females with ADHD compared to Females
without ADHD show increased:
Episodes of self-injury
Mood disorders (25%)
Substance abuse and addictions
40% abuse alcohol
20% abuse illicit drugs
50% tobacco addiction
Learning disabilities (20%)
Oppositional defiant disorder
ADHD and eating disorders
Eating temporarily increases our serotonin
Short-lived, so must eat again to maintain
Binging and purging is a form of stimulation ,
which is often craved in those with ADHD
Obsessing about weight and controlling one’s
exercise and eating habits provides a
mechanism to focus the brain on something
and gives a sense of control.
What’s it like to have ADHD?
One giant paradox.
Superfocus and then space out when I least
Project confidence and feel incredibly
Perform at a very high level and feel
incompetent while doing so.
Time becomes mixed up
• It seems that everything happens at once
• Causes frustration and inner turmoil
• Can’t prioritize
It’s not all bad though…
Original, out of the box thinking
Remarkable persistence, resilience,
Warm-hearted and generous behavior
Ability to multitask like no other.
“The best way to think of ADD is not as a
mental disorder but as a collection of traits
and tendencies that define a way of being
in the world.”
There is some positive to it, and some
negative to it.
It is only when the negative becomes
disabling that it becomes a disorder
The ultimate goal of tx, is to turn the
disability into an asset.
Ellison, P. Myths and Misconceptions about AD/HD: Science over
Quinn, P. et.al. Gender Differences of AD/HD.
Booth, B. Et al.: Myths about AD/HD. Metro Area Adult ADHD
Network of Detroit. www.addconsults.com
Richardson, W. The Link between ADD/ADHD and Eating
Disorders: Self Medicating with Food. www.addconsults.com
Hallowell, E. Delivered from Distraction.
Amen, D. The Amen Clinic. www.brainplace.com and