Different Types of ADHD

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The Different Types of Attention Deficit Hyperactivity Disorder

hyperactive-adhd-graphic

The diagnosis of "Attention Deficit Hyperactivity Disorder" is very broad, including several different types of ADHD. This is the reason that one child with ADHD may look much different than another. One may be quiet and inattentive, while the other is loud and hyperactive - but both are diagnosed with ADHD.

What are these "different types of ADHD" ?

inattentive-adhd-graphic

And in each article we will discuss the best targeted alternative treatment strategies for each of these five types of Attention Deficit Hyperactivity Disorder.

Different Types, or Styles, of ADHD

Research literature, recent books, and common sense, all point to the fact that there are different types, or styles, of ADHD. In the past we referred to Attention Deficit Disorder: Inattentive Type, or Impulsive/Hyperactive Type, or a Combined Type. Today the diagnostic differences are a bit less clear, but the reality doesn't change.

Daniel Amen and Healing ADHD bookDr. Daniel Amen has written a great book on the subject, titled "Healing ADHD:The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD" where he uses his SPECT scans of patient's brain activity to help in making his six classifications. His classifications include these "Types" ...

1. Classic ADD - Inattentive, distractible, disorganized. Perhaps hyperactive, restless and impulsive.

2. Inattentive ADD - Inattentive, and disorganized.

3. Over-focused ADD - Trouble shifting attention, frequently stuck in loops of negative thoughts, obsessive, excessive worry, inflexible, oppositional and argumentative.

4. Temporal Lobe ADD - Inattentive and irritable, aggressive, dark thoughts, mood instability, very impulsive. May break rules, fight, be defiant, and very disobedient. Poor handwriting and trouble learning are common.

5. Limbic System ADD - Inattentive, chronic low-grade depression, negative, low energy, feelings of hopelessness and worthlessness.

6. Ring of Fire ADD - Inattentive, extremely distractible, angry, irritable, overly sensitive to the environment, hyperverbal, extremely oppositional, possible cyclic moodiness.

Dr. Daniel Amen - What You Need to Know About ADD

Best selling author, Dr. Daniel Amen on ADD - as seen on The Wellness Hour with Randy Alvarez

Here at the ADD ADHD Information Library our classifications are a bit different, and are based more on our clinical observation and experiences. Our classifications are based on the classic children's stories of Winnie the Pooh and his friends in the Hundred Acre Wood.

  • Winnie the Pooh Type - Inattentive, distractible, disorganized. He's nice, but lives in a cloud.
  • Tigger Type- Inattentive, impulsive, hyperactive, restless, bouncy.
  • Eeyore Type - Inattentive, with chronic low-grade depression.
  • Piglet Type - Trouble shifting attention, excessive worry, easily startled.
  • Rabbit Type - Trouble shifting attention, inflexible, argumentative.
  • Troubled Type ADHD - Irritable, aggressive, impulsive, defiant, disobedient. Learning problems.

Each of these types of ADHD (using either Amen's system or ours) will have different treatment needs and approaches.

ADHD Inattentive Type

Winnie the Pooh has ADHD

inattentive-adhd-type-jpgWinnie the Pooh is the classic picture of Inattentive ADHD. Although Pooh is very lovable, loyal, and kind, he is also inattentive, sluggish, slow-moving, unmotivated. He is a classic daydreamer with brain fog. In other works we have called this "Space Cadet" style ADHD.

People with this type of Inattentive ADHD are:

  • Easily distracted
  • Have short attention spans to a task that is not interesting, or is hard
  • Daydreaming when others are talking to him/her
  • Always looking for things that they have just put down somewhere...
  • Always late
  • Easily bored

Inattentive ADHD Explained

Normally in the brain the prefrontal cortex will speed up activity when there is work to concentrate on. But with this type of inattentive ADHD the prefrontal cortex actually slows down when placed under a work load, like reading or doing homework.

This part of the brain looks normal when "at rest," but actually looks like it is starting to fall asleep when asked to "go to work." This makes it very hard to pay attention to school work, get homework done, listen to the teacher, clean your room, and so on.

We have actually observed this hundreds of times with subjects on an EEG. When at rest, the brainwave activity is pretty normal. But once the subject is asked to read, or to do a math worksheet, the subject's brainwave activity begins to look like the subject is falling asleep. And often times they do fall asleep! This sure makes school hard for these students!

Winnie the Pooh style inattention is seen more in girls than in boys.

It responds well to stimulants, such as ritalin and adderall, but other interventions like Attend and diet work well also, and without the side effects.


We have much more on Inattentive Type (Winnie the Pooh Type) ADHD for you, including an in-depth look at some alternative treatment strategies.



Classic Hyperactive ADHD

Tiggers Like to Bounce... Bouncin' is What Tiggers Do Best!

We call this bouncy type of ADHD "Tigger Type" for good reason. This classic form of ADHD is characterized by bouncy-hyperactive-adhd-jpg

  • Inattention
  • Impulsivity
  • Hyperactivity
  • Restlessness
  • Disorganization

This type of ADHD reminds us of Tigger from the Winnie the Pooh stories.

Dr. Daniel Amen refers to this type of ADHD as "Classic ADHD" for good reasons. When you think about someone who has Attention Deficit Hyperactivity Disorder, this is the classic picture that you think of.

Someone with this type of ADHD typically:

  • Is easily distracted
  • Has a LOT of energy
  • Is hyperactive
  • Can't sit still very long
  • Is fidgety
  • Talks a LOT, and can be LOUD
  • Is very impulsive, does not think before he acts
  • Has trouble waiting his turn in line, or in games
  • and more...

Tigger Type ADHD results from UNDER-ACTIVITY in the Prefrontal Cortex, both when at rest, and when performing concentration tasks.

This type of ADHD is most often seen in males, and can respond well to stimulants.


We have more in-depth information about ADHD with Impulsivity-Hyperactivity for you to learn, including alternative treatment strategies.



Over-Focused ADHD

Rabbit Tends to His Garden... and don't bother him.

The least flexible character in all of the stories of Winnie the Pooh and Christopher Robin has got to be Rabbit.

Oh, he can get a lot of things done, and he's the one character who will be prepared when winter comes, but he has a very hard time shifting from one activity to another. He is absolutely "task oriented" and is focused to whatever that task might be.

over focused adhdThe person with "Over-Focused ADHD" is much the same.

He has trouble shifting attention from one activity to another, and he frequently "gets stuck" in loops of negative thoughts.

He can be obsessive, and very inflexible. He can also be oppositional and argumentative to parents.

He may be like a "bull dog" and not give up until he gets his way, or until his worn-out parents finally say, "yes," to his 100th request for something. His parents are often worn-out, worn-down, fed-up, and ready to break.

Parenting a child like this is hard.

Someone with "Over-Focused ADHD" is like Rabbit, in that he:

  • May worry a LOT, even over things that don't really matter much
  • Can be very oppositional to parents
  • May like to argue
  • May be somewhat compulsive about the way things ought to be done
  • Will have a very hard time shifting from one activity to another
  • Always wants to have his way

The cause of this type of ADHD is an over-active Anterior Cingulate Gyrus. This part of the brain is over-active all of the time. And, to make things worse, when a "work load" is put on the brain, such as school work or a chore to be completed, there is the common ADHD symptom of decreased activity level in the Pre-Frontal Cortex.

In this type of ADHD some stimulants, and too much use of L-Tyrosine to increase dopamine production can actually make the problem of over-focus worse. So be careful what treatment intervention you choose.






Nervous, Anxious, Hypervigilant, and ADHD

Piglet is a great friend, but sure scares easily...

Piglet is that small, almost frail character from the Hundred Acre Wood. He is a great friend, and very loyal.

nervous worried anxious adhd like PigletBut he is always worried, nervous, and startles easily . Sometimes he is so nervous that he stutters. So it is with some kids with ADHD. In fact some estimate that 25% of kids with ADHD also have symptoms of anxiety or are excessively worried.

This style of ADHD is very similar to the Rabbit style, except that with "Piglet style" the child's mid-brain is so over-aroused that the child is hypervigilant and very easily startled.

He may be talking all of the time, and is probably touching everything in the room. And, this child is nervous or worried, or anxious. He has trouble shifting attention from one activity to another, and he frequently "gets stuck" in loops of negative thoughts.


Learn more about ADHD and Anxiety Worry, including alternative treatment approaches.

He can be obsessive, and very inflexible.



25% of People with ADHD are also Depressed

Eeyore is slow, and sad...

many with ADHD suffer from depression graphic of Eeyore"Thanks for Noticin' Me" says Eeyore...

He walks slowly. He looks sad. He doesn't accomplish much. He's just glad to be noticed. This is Eeyore, the stuffed donkey who is so often in need of his tail being pinned back on.

Those with this depressive type of ADHD are often:

  • Inattentive
  • Have a chronic sadness or low-grade depression
  • Seem to be negative, or apathetic
  • Have low energy levels
  • They just do not seem to care
  • They often feel worthless, or helpless, or hopeless.

This type of ADHD is called "Limbic System ADHD" by Daniel Amen. And for good reason.

SPECT scans show that when the brain is at rest, there is increased activity deep in the limbic system, in parts of the brain called the thalamus and hypothalamus. There is also decreased activity in the underside of the pre-frontal cortex.

When the brain is placed under a work load, as during a homework assignment, nothing changes. The over-active limbic system remains over-active, and the under-active pre-frontal cortex remains under-active.

many with ADHD are also depressedThis type of ADHD looks very much like a combination of ADHD and Depression.

Learn much more about ADHD and Depression, including a look at the recent research on ADHD, Depression, and Teenage Girls (Video).

Learn more about each of the DIFFERENT TYPES OF ADHD:



And to find an experienced therapist who provides counseling in Tehachapi for ADHD please give my office a call at (661) 972-5953.

Douglas Cowan, Psy.D., M.S. is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a skillful counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

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ADHD Inattentive Type

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ADHD Inattentive Type and Winnie the Pooh

Winnie the Pooh is the classic picture of "Inattentive ADHD." Although Pooh is very lovable, loyal, and kind, he is also inattentive, sluggish, slow-moving, unmotivated. He is a classic daydreamer with brain fog. In other works we have called this "Space Cadet" style ADHD.ADHD inattentive type picture

People with this type of ADHD are:

  • Easily distracted
  • Have short attention spans to a task that is not interesting, or is hard
  • Daydreaming when others are talking to him/her
  • Always looking for things that they have just put down somewhere...
  • Always late
  • Easily bored

Inattentive ADHD Neurology Explained

Normally in the brain the prefrontal cortex will speed up activity when there is work to concentrate on. But with this type of inattentive ADHD the prefrontal cortex actually slows down when placed under a work load, like reading or doing homework.

This part of the brain looks normal when "at rest," but actually looks like it is starting to fall asleep when asked to "go to work." This makes it very hard to pay attention to school work, get homework done, listen to the teacher, clean your room, and so on.

We have actually observed this hundreds of times with subjects on an EEG. When at rest, the brainwave activity is pretty normal. But once the subject is asked to read, or to do a math worksheet, the subject's brainwave activity begins to look like the subject is falling asleep. And often times they do fall asleep! This sure makes school hard for these students!

Winnie the Pooh style inattention is seen more in girls than in boys.

This inattentive ADHD may one day be considered to be a completely different disorder than impulsive-hyperactive ADHD or combined type ADHD. There are a lot of differences between them.

For example, the inattentive Pooh type ADHD responds only moderately well to the stimulant methylphenidate (Ritalin). In a recent study 20% had "day and night" improvement, and about 60% only somewhat improved. This is compared to the impulsive-hyperactive or combined types which showed over 90% really good improvements with methylphenidate. There are other significant differences too.

Here's a good resource developed by some researchers at Harvard to help improve working memory. Its a computer based program to improve working memory in children and teenagers.

Here are some of the questions from our Online ADHD screening tool (click here)that can help you clarify if the problem is Inattentive ADHD.

Answer every statement below by rating the behavior on a scale from one (1) to five (5).
(1) You have not noticed this behavior before.
(2) You have noticed this behavior a little, but it is not a significant problem.
(3) You have noticed this behavior, and see it fairly often.
(4) You have noticed this behavior, and see it almost daily or everyday.
(5) You have noticed this behavior, and it is really a big problem.

Section One:

_____ My child does not complete tasks or jobs that I give him to do.
_____ My child does not listen to me, or does not pay attention to me when I’m talking.
_____ My child daydreams a lot.
_____ It seems that we are always looking for things that my child has misplaced or lost.
_____ My child has poor concentration on tasks that are difficult, hard, or boring.
_____ My child changes from one play activity to another a lot, more than most kids his age.
_____ My child is easily distracted.
_____ My child often makes us late.
_____ Most of the time I am doing my child’s homework for him.
_____ After taking two hours to complete what should have been a 20 minute homework assignment, the next day my child loses his homework or fails to turn it in to his teacher.

_____ Add these scores up here. Scores of 10 to 24 are common.

Scores of 25 to 34 are in the "at risk" ranges, and scores of 35 or greater are at "high risk."

Alternative Treatment Strategy Specifically for Inattentive ADHD

Here is what we recommend for Winnie the Pooh types if you are trying to avoid using stimulant medications:

  • Use our recommended ADHD Eating Program
  • Begin using Essential Fatty Acid supplementation, preferably with Flax Seed Oil, or Borage Oil. There may be too much mercury in fish oils to use them these days, I can't say for sure, but be careful. The Omega Oils are very important and can be purchased in "bulk" and added to salad dressings, etc.
  • Get ATTEND to increase focus, attention span, and time on task. Start with 2 capsules per day and work up to 4 capsules per day in divided doses.
  • Also get MEMORIN for increased memory and concentration to task. Take 2 capsules per day in divided doses.



ATTEND is the single best alternative treatment that we know of. It is an excellent product with an excellent product guarantee. MEMORIN works well with ATTEND to increase memory and concentration for Inattentive types.

ATTEND contains:

  • L-Tyrosine, which is highly recommended,
  • GABA,
  • DL-Phenylalyne,
  • Ginko,
  • Pycnogenol and Grape Seed Extracts,
  • 5-HTP,
  • Pregnenolone,
  • DMAE,
  • and 60 other important ingredients including Essential Fatty Acids and Lipid Complexes.

See the ATTEND formula list.

MEMORIN contains additional Ginko, plus lots of Phosphatidyl Serine and other phosphatidyls, and additional pregnenolone, a naturally occurring memory hormone.

Back to "Different Types of ADHD" index


This book section: The Different Types of ADHD

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

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ADHD Impulsive Hyperactive Type

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Hyperactive ADHD - "Impulsive Hyperactive ADHD" is Classic

At the ADD ADHD Information Library we call this bouncy Impulsive Hyperactive type of ADHD "Tigger Type" for good reason. This classic form of impulsive and hyperactive ADHD is characterized by adhd with hyperactivity like tigger

  • Inattention - is easily distracted by "shiny" things, or pays attention but to the wrong thing at the wrong time;
  • Impulsivity - does things without thinking about the consequences, blurts out his thoughts, etc.;
  • Hyperactivity - has excessive activity levels for his age, always on the go unless really interested in something, really bouncy like Tigger;
  • Restlessness - does not like to sit still, wants to move around, happy feet and hands;
  • Disorganization - "Mom, where is my homework?"

Tiggers Like to Bounce... Bouncin' is What Tiggers Do Best!

This type of ADHD reminds us of Tigger from the Winnie the Pooh stories because Tigger is always moving, bouncy, active and on the go like he is "driven by a motor."

ADHD Hyperactive Kids : About ADHD Impulsive Hyperactive Type in Children, Teens, and Adults

From newideas.net the ADD ADHD Information Library. Learn about ADHD "Impulsive Hyperactive" Type with Doug Cowan, Psy.D. This classic type of ADHD, which we call Tigger Type ADHD is more common with males, and is characterized by inattention, impuls...


Impulsive Hyperactive ADHD

Someone with this type of ADHD typically:

  • Is easily distracted
  • Has a LOT of energy
  • Is hyperactive
  • Can't sit still very long
  • Is fidgety
  • Talks a LOT, and can be LOUD
  • Is very impulsive, does not think before he acts
  • Has trouble waiting his turn in line, or in games
  • and more...

Here's a good resource developed by some researchers at Harvard to help improve working memory. Its a computer based program to improve working memory in children and teenagers.

Tigger Type ADHD results from UNDER-ACTIVITY in the Prefrontal Cortex, both when at rest, and when performing concentration tasks.

Impulsive Hyperactive ADHD is most often seen in males.

Impulsivity, Hyperactivity, and Lack of Inhibition

The frontal lobes help us to pay attention to tasks, focus concentration, make good decisions, plan ahead, learn and remember what we have learned. The frontal lobes also help us to behave appropriately for a given situation. Emotional issues such as anger, frustration, and irritability that come on impulsively in some types of ADHD probably come from the pre-frontal cortex.

The inhibitory mechanisms of the cortex keep us from being hyperactive, from saying things out of turn, and from getting mad at inappropriate times, for examples. These inhibitory mechanisms of the cortex help us to "inhibit" our behaviors.

It has been said that 70% of the brain is there to inhibit the other 30% of the brain. When the inhibitory mechanisms of the brain aren't working as efficiently as they ought , then we can see results of what are sometimes called "dis-inhibition disorders" such as impulsive behaviors, quick temper, poor decision making, hyperactivity, and so on.

The limbic system is the base of our emotions and our highly vigilant look-out tower. If the limbic system is over-activated, a person might have wide mood swings, or quick temper outbursts. He might also be "over-aroused," quick to startle, touching everything around him, hyper-vigilant. A normally functioning limbic system would provide for normal emotional changes, normal levels of energy, normal sleep routines, and normal levels of coping with stress. A dysfunctional limbic system results in problems with those areas.

Attention Deficit Disorder might affect one, two, or all three of these areas, resulting in several different "styles" or "profiles" of children (and adults) with Attention Deficit Disorder.

Attention Deficit Disorder and the Reticular Activating System

  • What causes these various systems of the brain to get out of balance with Attention Deficit Hyperactivity Disorder individuals?
  • Why would these systems become under aroused or over aroused?
  • Is there one central system that controls or regulates these other systems?

The answer may be found with the Reticular Activating System. The Reticular Activating System is the attention center in the brain. It is the key to "turning on your brain," and also seems to be the center of motivation. The Reticular Activating System is connected at its base to the spinal cord where it receives information projected directly from the ascending sensory tracts. The brain stem reticular formation runs all the way up to the mid-brain.
the reticular activating system

The Reticular Activating System is a very complex collection of neurons that serve as a point of convergence for signals from the external world and from interior environment. In other words, it is the part of your brain where the world outside of you, and your thoughts and feelings from "inside" of you, meet. This Reticular Activating System is very capable of generating dynamic effects on the activity of the cortex, including the frontal lobes, and the motor activity centers of the brain.

Alternative Treatment Strategies Specifically for Hyperactive Impulsive "Tigger-Type ADHD"

Here is what we recommend for bouncy "Tigger-type" ADHD if you are trying to avoid medications, or just want to try a good alternative first and see how it works:

  • For best results use our Eating Program along with the nutraceuticals recommended below.
  • It is important to use the eating program even if you are using other interventions, such as medications, biofeedback training, or a combination of the nutraceuticals ATTEND, EXTRESS, and MEMORIN.
  • We also strongly recommend using Essential Fatty Acid supplementation (Omega Oils) even while using the nutraceuticals below. We do not recommend fish oils, but rather either a combination of flax seed oils and primrose oils, or the oils from "YES" (Your Essential Supplements).

We recommend at least a 30 to 60 day trial with the following nutraceuticals. And you are covered by the manufacturer's money back guarantee..

  • ATTEND for ADHD symptoms; 2 to 4 capsules per day in divided doses.

    ATTEND contains L-Tyrosine, which increases dopamine production. ATTEND also contains GABA, DL-Phenylalyne, Ginko, Pycnogenol and Grape Seed Extracts, 5-HTP, pregnenolone, DMAE, and more. This is an excellent product and we recommend giving it a good try. Learn more about ATTEND here at the ADHD Information Library.

  • EXTRESS for symptoms of impulsivity, temper, restlessness; 2 to 6 capsules per day in divided doses. We have seen this really help with impulsive temper outbursts and hyperactivity, especially when combined with ATTEND and a good eating program.

    EXTRESS contains GABA, DL-PA, 5-HTP, and St. John's Wort, and is an excellent mood stabilizer.

  • MEMORIN for increased focus and concentration to task. 1 or 2 capsules per day in divided doses. Just a small dose. Just a little bit for the Impulsive Hyperactive ADHD type. MEMORIN contains more ginko, plus lots of Phosphatidyl Serine and other phosphatidyls, DMAE, B vitamins and minerals, Ginkgo, targeted amino combinations, and homeopathic medicines.


Back to "Different Types of ADHD" index


This book section: The Different Types of ADHD

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

From the ADHD Information Library : "hyepractivity" is a common mis-spelling, and this article is a discussion on ADHD Impulsive Hyperactive Type

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ADHD and Depression

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ADHD and Depression - 25% with ADHD are also Depressed

many with ADHD suffer from depression image

ADHD comes in several different types, and depending on what parts of the brain are impacted there are different symptoms. One of the more common sub-types is ADHD with symptoms of Depression. As many as 25% of those diagnosed with ADHD are also depressed. This is due to the limbic system being overly active in this type of ADHD.

As with other types of ADHD we use characters from the Winnie the Pooh stories in the Hundred Acre Wood to describe a particular type of ADHD. In this type the character of Eeyore is the perfect example of ADHD with Depression.

"Thanks for Noticin' Me" says Eeyore. He walks slowly. He looks sad. He doesn't accomplish much. He's just glad to be noticed. This is Eeyore, the stuffed donkey who is so often in need of his tail being pinned back on.

Those with this depressive type of ADHD are often:

  • Inattentive
  • Have a chronic sadness or low-grade depression
  • Seem to be negative, or apathetic
  • Have low energy levels
  • They just do not seem to care
  • They often feel worthless, or helpless, or hopeless.

Teenagers and Depression: What Parents Need to Know

From newideas.net the ADD ADHD Information Library, and Doug Cowan, Psy.D., clinical editor. Many teenagers suffer from depression, and many diagnosed with ADHD also have depression. It is important for parents to understand depression in teenagers, ...

This type of ADHD is called "Limbic System ADHD" by Daniel Amen. And for good reason. SPECT scans show that when the brain is at rest, there is increased activity deep in the limbic system, in parts of the brain called the thalamus and hypothalamus. There is also decreased activity in the underside of the pre-frontal cortex.

When the brain is placed under a work load, as during a homework assignment, nothing changes. The over-active limbic system remains over-active, and the under-active pre-frontal cortex remains under-active.

many with ADHD are also depressedThis type of ADHD looks very much like a combination of ADHD and Depression.

Some have suggested that up to 25% of children with ADHD are also depressed or suffer from a mild depression called Dysthymic disorder. This may impact females more than males.

Alternative Treatment Strategies for Limbic System ADHD

  • For best results use our Eating Program along with the nutraceuticals recommended below. You must have a good eating program. You cannot eat junk and get feeling better.
  • We also strongly recommend using Essential Fatty Acid supplementation while using the nutraceuticals below. We no longer recommend fish oils as they may contain mercury. A combination of Flax Seed oils and Primrose oils are recommended.

Experts recommend DL-Phenylalyne (up to 600 mg per day for adults), 5-HTP, and B Vitamins and St. John's Wort (up to 600 mg per day for adults). We know how to make that work, and what we recommend includes what the experts recommend, plus even more powerful ingredients.

We recommend for Limbic System, or Eeyore style ADHD the following for adults. Children may be able to take less.

  • ATTEND for ADHD symptoms, take 2 capsules per day.

    The ATTEND contains GABA, DL-Phenylalyne, Ginko, Pycnogenol and Grape Seed Extracts, 5-HTP, pregnenolone, DMAE, and more. See the ATTEND ingredients list.

  • EXTRESS for symptoms of impulsivity, temper, restlessness, and anxiety take 2 capsules per day. The EXTRESS contains GABA, DL-PA, 5-HTP, and St. John's Wort, and is a good mood stabilizer.
  • DEPREX for symptoms of worry and depression, take 2 capsules per day. This is a very good product for the symptoms of depression, and has few or no side-effects. But if the depression is severe - go to a doctor today - right now! Only use alternative treatments for mild to moderate situations.

    The DEPREX contains more GABA, and just 2 capsules of DEPREX contain 320 mg of St. John's Wort and 420 mg of DL-Phenylalyne. It can be a good alternative to antidepressants.

With anyone who is showing symptoms of depression, please consult with a physician, and please consider that depression is a very serious condition in children, teens, or adults

Consult your doctor in ADHD and depression.

Back to "Different Types of ADHD" index


This book section: The Different Types of ADHD

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

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ADHD with Over-Focused and Rigid Thinking

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Over-Focused and Rigid Thinking, Perseveration in ADHD

ADHD comes in different types, including an over-focused and rigid type that can be almost obsessive. We use the characters in the Winnie the Pooh stories to describe the different types of ADHD. The least flexible character in all of the stories has got to be Rabbit, so we use him to describe over focused, rigid, and "stuck" ADHD.

Rabbit Tends to His Garden... and don't bother him.

Rabbit can get a lot of things done, and he's the one character who will be prepared when winter comes, but he has a very hard time shifting from one activity to another. He is absolutely "task oriented" and is focused to whatever that task might be. In fact, he is so focused that he cannot shift to do other things easliy. He "perseverates". This is a characteristic of certain types of ADHD.

over focused adhdThe person with "Over-Focused ADHD" is much the same. He has trouble shifting attention from one activity to another, and he frequently "gets stuck" in loops of negative thoughts.



He can be obsessive, and very inflexible. He can also be oppositional and argumentative to parents. He may be like a "bull dog" and not give up until he gets his way, or until his worn-out parents finally say, "yes," to his 100th request for something. His parents are often worn-out, worn-down, fed-up, and ready to break.

Parenting a child like this is hard.

Dr Russell Barkley - ADHD "Hyperfocus"

Dr Russell Barkley, Ph.D giving a lecture on ADHD at The Centre for ADHD/ADD Advocacy Canada (CADDAC). To view the full-length lectures, visit www.caddac.ca

Someone who perseverates with "Over-Focused ADHD" is like Rabbit, in that he:

  • May worry a LOT, even over things that don't really matter much
  • Can be very oppositional to parents
  • May like to argue
  • May be somewhat compulsive about the way things ought to be done
  • Will have a very hard time shifting from one activity to another
  • Always wants to have his way

Dr. Daniel Amen and his team have used SPECT brain scans to look at this "over focused and rigid" type of ADHD. They found that the cause of this type of ADHD is an over-active Anterior Cingulate Gyrus. This part of the brain is over-active all of the time. And, to make things worse, when a "work load" is put on the brain, such as school work or a chore to be completed, there is the common ADHD symptom of decreased activity level in the Pre-Frontal Cortex.

In this type of ADHD some stimulants, and/or too much use of L-Tyrosine to increase dopamine production can actually make the problem of over-focus worse. So be careful. Antidepressants may be a better ADHD medication for this type of ADHD.


Alternative Treatment Strategies for Over-Focused ADHD

For those who would like to try an "alternative treatment for ADHD" to see if one might work before considering a trial of medication, we would recommend that you consider this strategy for over focused ADHD:

  • For best results, try our ADHD Eating Program for 45 days along with the nutraceutical medicines recommended below.
  • We also highly recommend using Essential Fatty Acid supplementation - Omega Oils - added to cold foods like salads. We recommend a combination of flax seed oil and primrose oil to get both Omega 3s and 6s. We no longer recommend fish oils.

300 mg of St. John's Wort is recommended per day for these children, and 600 mg per day for adults, along with 5-HTP, and B Vitamins. To provide this, and much more, we recommend for Over-Focused, or Rabbit style ADHD the following amino acid based, homeopathic medicines for adults. Children can take less.

  • ATTEND for ADHD symptoms, take only 2 capsules per day;
  • EXTRESS for symptoms of impulsivity, temper, restlessness, and anxiety take 4 to 6 capsules per day;
  • DEPREX for symptoms of worry, take 2 capsules per day;

ATTEND contains:

  • GABA,
  • DL-Phenylalyne,
  • Ginko,
  • Pycnogenol and Grape Seed Extracts,
  • 5-HTP,
  • pregnenolone,
  • DMAE,
  • and over 60 other important ingredients including essential fatty acids, lipid complexes, and homeopathic medicines.

See the ATTEND ingredients list here.

EXTRESScontains:

  • GABA,
  • DL-PA,
  • 5-HTP,
  • St. John's Wort.

DEPREX contains:

  • more GABA,
  • lots more DL-Phenylalyne,
  • 5-HTP,
  • and just 2 capsules of DEPREX contain 320 mg of St. John's Wort.

Together these three products give the best over-all combinations for the alternative treatment of "over-focused ADHD."

Back to "adhd DIFFERENT types" index


This book section: The Different Types of ADHD

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

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ADHD with Anxiety, Worry, Hypervigilance

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Nervous, Anxious, Hypervigilant, and ADHD

ADHD comes in different types or styles, and depending on what areas of the brain are impacted there are a variety of symptoms. Some children and teens with ADHD are characterized for their seeming so agitated, nervous, or worried all of the time. They are easily startled or scared, and they are often thinking negative thoughts.

Once again we turn to the stories of Winnie the Pooh and friends at the Hundred Acre Wood to identify this particular type of ADHD. Pooh's friend Piglet is a good picture of these children and teenagers with this type of ADHD. Piglet is that small, almost frail character from the Hundred Acre Wood. He is a great friend, and very loyal.

ADHD with anxiety, worry, or hypervigilance is pictured as Piglet ADHDBut he is always worried, nervous, and startles easily . Sometimes he is so nervous that he stutters. So it is with some kids with ADHD.

This type of ADHD is very similar to the rigid and over-focused Rabbit type of ADHD, except that with "Piglet type of ADHD" the child's mid-brain is so over-aroused that the child is hypervigilant and very easily startled.

He may be talking all of the time, and is probably touching everything in the room. And, this child is nervous or worried, or anxious. He has trouble shifting attention from one activity to another, and he frequently "gets stuck" in loops of negative thoughts.

He can be obsessive, and very inflexible.

In this type of ADHD some stimulants, or too much use of L-Tyrosine to increase dopamine production can actually make the problem of over-focus worse. So be careful.

Interesting Videos on Other Possible Causes to Symptoms Similar to ADHD, Anxiety, and Worry from a variety of sources

ADHD OCD Anxiety Diagnosis? Brain Function Beyond Labels

www.corepsychblog.com ADHD Medication Dosage Strategies too often overlook this Important OCD-like presentation - Cognitive anxiety is the most frequently overlooked subset of ADHD and isn't in the current diagnostic manual - *the Paleolithic Bible* ...

Alternative Treatment Strategies for Piglet style ADHD

adhd specific treatment strategy ordering chart

  • For best results use our Eating Program along with the nutraceuticals recommended below. Eating the right foods is very important no matter what kind of treatment intervention is being used, but is absolutely critical when trying alternative medicines or treatments are they are not as potent as pharmaceutical medicines (of course they don't have the harsh side-effects either). Don't use as much caffeine in the protein shake as we recommend for other situations.
  • We also strongly recommend using Essential Fatty Acid supplementation (Omega Oils) while using the nutraceuticals below. We no longer recommend fish oils due to potential mercury content. The inexpensive way to do this is to use equal amounts of Flax Seed oil and Primrose oil to get the right combination of Omega 3s and 6s.

In addition, we recommend for Anxious, "Piglet" style ADHD the following for adults. Children can take less:

Together these two products give the best combination of homeopathic medicines, amino acids, vitamins and minerals, essential fatty acids, lipid complexes, and more, for the alternative treatment of Piglet style ADHD.

Back to "adhd DIFFERENT types" index


This book section: The Different Types of ADHD

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

ADHD with Anxiety, Worry, Hypervigilance

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Blood Test for Anxiety Disorders?

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When the Detroit Tigers placed pitcher Dontrelle Willis on the disabled list last Sunday (3/29/2009) with the diagnosis of "anxiety disorder" it was very interesting to me for two reasons:

First, because my nephew Casey Fien was trying to make the Tigers as a pitcher and we had just recently returned from a trip to spring training to follow the Tigers and watch Casey pitch and we have started following the Tigers very closely; and

Secondly, because of the reports that although Willis had not reported any symptoms of an anxiety disorder, he was diagnosed solely through the results of a blood test, according to news reports.

I must confess that I had never heard of a blood test for anxiety disorder, so I began looking around the internet for information to see if this was true, or if the Tigers were just trying to find a reason to put Willis on the DL so that they wouldn't have to pay all of the $11 million owed him for this season.

Here is what I discovered, and it may be helpful to you if you or your child with ADHD also has symptoms of anxiety, panic, rigid thinking, or OCD...

While WebMD doesn't know about any blood tests for anxiety disorder, they write: "Although there are no laboratory tests to specifically diagnose mental illness, the doctor may use various tests to make sure something else isn't causing the symptoms. If no other illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses."

Our local family practice doctor doesn't know anything about a blood test for anxiety disorders either.

However, over three years ago (January, 2006) a research team from Hebrew University in Israel announced the development of a blood test for anxiety disorders. The blood test looks for abnormally high levels of the neurotransmitter Acetylcholine (ACh) by measuring the levels of related enzymes. According to the website, "(the) team found more than a 90% correlation between people who were diagnosed with higher than usual anxiety by a psychologist and people with abnormal AChE, BChE and PON levels."

The entire 2006 article is here: http://www.isracast.com/article.aspx?ID=45 and it is worth the read. There is also a 2005 report on the research here: http://blogs.zdnet.com/emergingtech/?p=47

Hebrew University, through Yissum Research Development Company, which is the technology development company of the University, then applied for a patent on the blood test in April of 2006. They were just awarded the patent on February 24, 2009, which would mean that the test would be commercially available soon if not already.

The patent award is here: http://www.pharmcast.com/Patents200/Yr2009/Feb2009/022409/7494783_Anxiet... and it gives very detailed information about the test. How do you buy stock in this?

As of March, 2007, the University of Iowa was also developing a blood test for anxiety disorders based on the genetic profiles of individuals that they hoped would be commercially produced. Their study was publishes in the American Journal of Medical Genetics, and according to reports, "The team compared gene expression in lymphoblasts (immature white blood cells) culled from 16 participants with panic disorder and 17 participants without the disorder. The study found many genes were more expressed in people with panic disorder than in people without the condition. Similarly, the study found many genes were less expressed in people with panic disorder."

The entire 2007 article is here: http://psychcentral.com/news/2007/03/06/blood-test-for-panic-disorder/66...

Other blood tests focus on thyroid functioning and adrenal levels, both of which, if not functioning correctly, can cause anxiety related symptoms.

It will be interesting to see what 2009 will bring in the development of improved technologies to diagnose and treat anxiety disorders, as it will be interesting to follow the career of Dontrelle Willis. We wish him well.

Other Opinions on Anxiety Disorders and Diagnosis

How we help with anxiety, depression & mood disorders | Ame

Dr Daniel Amen discusses how the Amen Clinics can help with treating depression, anxiety attacks & other mood disorders. Please visit www.amenclinics.com for more information.

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Very Difficult ADHD

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There is another, more difficult type of ADHD that you should be aware of. There are no Winne the Pooh characters for this type of ADHD, as the creator of these children's stories would never have created a character with these challenging, difficult traits. This type of ADHD can be very severe, and will require significant treatment, and great patience on the part of the parents. It can involve dark moods, and intense anger.

The Temporal Lobes and ADHD

temporal lobes and adhd imagePeople with Temporal Lobe problems and ADHD can be very hard to live with. They can have gigantic mood swings, get very angry for almost no reason, and be nearly impossible to live with on a daily basis. The key to look for with this type of ADHD is anger outbursts for little or no reason, and that seem out of control.

Brain scans show that the temporal lobes are the problem. Decreased activity in the left temporal lobes causes problems with temper outbursts, aggressive behaviors, and even violence toward animals or other people. Temporal Lobe ADHD is characterized by:

  • Inattention, just like in other kinds of ADHD because during concentration there is a decrease in activity in the pre-frontal cortex;
  • Being easily irritated or frustrated;
  • Aggressive behaviors;
  • Dark moods, big mood swings;
  • Impulsivity;
  • Breaking rules, in trouble a lot, in fights a lot;
  • Defiant toward authority, disobedient toward parents and others;
  • Can't get along with others, can be anti-social or just in trouble a lot;
  • Often has terrible handwriting and problems learning;
  • You expect him to be arrested at any time.

Individuals with this type of ADHD are often treated with a combination of stimulants, like Ritalin, and anti-convulsants.

You can see that this type of ADHD looks very much like Bipolar Disorder. See our discussion on ADHD vs Bipolar Disorder. Research shows that about 15% of those diagnosed with ADHD actually have an early onset bipolar disorder. Physicians and therapists must be very careful in making their diagnosis.

Alternative Treatment : Temporal Lobe ADHD

For someone who wanted to try an alternative treatment approach to this type of ADHD, or an "additional treatment" approach, we would recommend considering the following - but don't let things get out of hand. Try it for 30 to 45 days and if it doesn't work, do something else. Some situations require strong medications.

  • GABA (an inhibitory nerortransmitter) to act as an anticonvulsant and anti-anxiety agent;
  • Phosphatidyl Serine (and other phosphatidyls), DMAE, Pregnenolone, and Ginko as memory enhancers to help with the learning problems;
  • Strange as it sounds, these people sometimes are helped by Ibuprofen in moderate doses. In fact, this may help in making a "kitchen diagnosis" of temporal lobe involvement.
  • Do NOT use St. John's Wort or Hypericum, as it could make things worse.

Using the VAXA nutraceutical product line, our recommended protocol would look like this:

  • ATTEND, 2 capsules per day
  • NEURAN, 4 capsules per day

Two capsules of the ATTEND contain GABA (33mg), and DL-PA (16mg) for mood stabilization, plus L-Tyrosine (67mg), Ginko (33mg), Phosphatidyl Serine (0.5mg) and other phosphatidyls (200mg) and DMAE (33mg) and Pregnenolone (8mg) for learning enhancement. There are over 70 total ingredients in ATTEND to help with learning, performance, and mood.

Four capsules of NEURAN contain GABA (240mg), and DL-PA (32mg) for mood stabilization. Consult your healthcare professional. As you can see, using the Neuran along with the Attend can enhance the mood stabilization components without adding either St. John's Wort or Hypericum, two ingredients that some experts believe could make the problem worse.

Together the Attend and Neuran can also enhance learning and memory, and therefore school performance or work performance.

This type of ADHD is very difficult. It may be early onset bipolar disorder in children, or bipolar disorder in an adult. It may be very serious, so please get a good diagnosis, be careful, and if you need to just skip to medication because the situation is so bad, do it. If things are bad, just do what you need to do to stabilize the situation.

Back to "adhd DIFFERENT types" index


This book section: The Different Types of ADHD

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Temporal Lobe ADHD

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What is the Worst Type of ADHD ?

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ADHD Questions from a Student Parent

What is the worst "type" of ADHD to have? Can any of the "types" be treated alone with alternatives? If I do not wish to medicate my child, what is the best alternative to go with? Please reply, I'm working on reserch paper; as well as information for my own children.

Thanks for writing to us at the ADHD Information Library.

What is the worst "type" of ADHD to have? I guess the "worst type" would be what I call the "troubled type" or what Dr. Daniel Amen calls the "Ring of Fire" type. (Or else it would be whatever type YOUR child has ;-) Any "type" of ADHD can be serious, or slight. Any type can be just a mild problem, or a severe problem. Think "spectrum".

But there is no question in my mind that when a child or teen, or adult, has ADHD with Temporal Lobe involvement that creates tremendous problems for that person and his family. Dark moods, angry outbursts, and other impulsive behaviors characterize this type of ADHD.

Can any of the "types" be treated alone with alternatives? Any of these types, except for the "troubled type" could be treated alone with alternatives. I just wouldn't recommend it for "Temporal Lobe type ADHD" as the alternatives take longer to work, and typically this type needs to be stabilized as soon as possible. If you insist on only using alternative treatments, we discuss this on the Temporal Lobe ADHD page. But please be very careful. Some situations just require medications.

If I do not wish to medicate my child, what is the best alternative to go with? I recommend (1) determining what "type" of ADHD is involved, (2) using our eating recommendations, (3) using the specific treatment recommendations with the VAXA formulas for they "type" of ADHD involved. If people can afford it, I also like EEG Biofeedback training, with talented providers, as another effective alternative treatment. And, finally, homeschooling is a great alternative treatment option if families can do that as well.

Good luck with your paper. Let me know if there are more resources that you might need, and feel free to use whatever is on any of our websites:
http://newideas.net
http://www.addinschool.com
http://www.add101.com

Doug Cowan

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Should ADHD be Divided Into Three New Disorders ?

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Is ADHD Conceptualized and Described Well?

Is it possible that in the near future we will throw away the way that we presently categorize ADHD, and replace it with something altogether new? Will we say "good-bye" to "inattentive type", "impulsive-hyperactive type", and "combined type" of ADHD as listed in the DSM-IV today? What will happen to Winnie the Pooh, Tigger, Rabbit, Piglet, and Eeyore as illustrations of the different types of ADHD? After recently hearing a lecture from Russell Barkley on the latest research into ADHD, I was convinced that changes need to be made in how we conceptualize, describe, and treat ADHD. But I am just not sure what changes need to be made. Based on the newest evidence it would seem though that:

  • Winnie the Pooh, Piglet, and Eeyore suffer from one common type of ADHD disorder;
  • And that Tigger and Rabbit suffer from a separate and distinct and different type of ADHD disorder;
  • And that there is a third distinct and separate disorder reserved for those with a co-morbid and combined ADHD and Oppositional Defiant Disorder.

What they have in common are:

  • Some degree of Inattention;
  • Some degree of frontal lobe involvement;
  • Some degree of working memory deficits and executive function impairment;
  • Problems at school;
  • Some degree of delayed brain development.

ADHD Types : Similarities and Differences

But there are so many more differences that the case will be strongly made that they are not both ADHD with slight differences, but rather that they are completely different neuro-biological disorders. Look at the table below:

Winnie the Pooh
Piglet and Eeyore

Inattentive ADHD

Tigger and Rabbit

Combined Type ADHD

Have a characteristically
"sluggish cognitive tempo"
Are characteristically impulsive and hyperactive, moving too fast
Daydreaming,
spacey, staring, not paying attention to what's going on
Paying attention to everything around them, and reacting to them all
A cognitive processing disorder An impulsive control disorder
Hypo-active Hyper-active
Slow moving
lethargic
passive
Fast moving
lacks inhibition
over active
Sluggish in behavior, cognition, and with motor activity Hyper in behavior, impulsive in cognition, fast motorically
Easily confused, brain fog, head in the clouds Aware of surroundings, knows what's happening
Slow information processing Normal speed information processing, but distracted
Prone to errors in school work due to accuracy problems and memory retrieval Prone to errors due to working too fast, distractions, lack of production or lose the work
Poor focus, and poor selective attention Attentive to everything, lacks ability to inhibit and focus on one thing until done
Not impulsive, so by definition not ADHD ? Impulsive
Hyperactive
Not disruptive to those around them Everyone knows who he is
Trouble quickly identifying what things are important or not. Impaired selective attention. Poor inhibition or perseverance to complete a task. Distracted as everything is important
Problems with retrieval of memory Problems with working memory
Like people, want friends, can make friends, but tend to be shy Lack social skills, impulsive, trouble making friends, not at all shy
They have NO inhibitory deficits, which is the core feature of ADHD They define inhibitory deficits, which is the core feature of ADHD
Little risk of co-morbid Oppositional Defiant Disorder Medium to high risk of Oppositional Defiant Disorder
Medium to High risk for Anxiety or Depression Medium risk for Anxiety or Depression
Come from families with high rates of Anxiety Disorders and Learning Disabilities Come from families with high rates of ADHD, drug and alcohol abuse and addiction, oppositional and conduct problems
Treatment Response to Ritalin is Moderate to Poor.
20% good, 65% moderate, 15% poor.
Treatment Response to Ritalin is Excellent.
92% positive
Good responders to social skills training. Makes them less shy. Poor responders to social skills training. Makes them more aggressive.
Good responders to cognitive behavioral therapies Poor responders to cognitive behavioral therapies
May respond well to Strattera, which may treat the anxiety as well as inattention. Stimulants make anxiety worse.
Good responders to "internal" therapies, or psychosocial interventions "Internal" therapies and psychosocial interventions are a waste of time and money
Tend more to be girls Tend more to be boys

So we will wait to see what the DSM-5 brings in terms of labels. Until then we will have to place Pooh Bear, Piglet, and Eeyore in one corner, with Tigger and Rabbit in another.

What about the co-morbid and combined duo of ADHD and Oppositional Defiant Disorder ? Why are they seen differently ?

Research shows that ADHD by itself is difficult, and ODD by itself is difficult. But when they appear together as one raging disorder, they are probably a distinct disorder - not a co-morbid combination of two disorders. And this single distinct disorder is potentially really bad. Take a closer look:

  • ADHD is persistent. ODD is persistent. But when they appear together in a child they are much more severe than when the child has just one or the other;
  • The families of children with BOTH ADHD and ODD tend to have more psychiatric problems themselves, such as alcoholism, drug abuse, antisocial personality disorder, or major depression;
  • Of those children diagnosed with BOTH ADHD and ODD : 20% will develop traits associated with being "a psychopath" as an adult. These are people who are calloused, unemotional, lack empathy for others, lack guilt or shame or remorse for crimes they have committed, have no conscience. They prey on other people. This starts early in life and persists into adulthood.
  • In every physiological measure of stress, this sub-group of children with BOTH ADHD and ODD have a lower response to stress than others do.
  • This sub-group of children with BOTH ADHD and ODD are a unique group to themselves. They are unique biologically, psychologically, and developmentally.

Therefore a strong case can be made that this sub-group should be seen and treated as a distinct diagnosis, not a combination of two diagnoses existing co-morbidly.

This book section: The Different Types of ADHD

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

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Women with ADHD : More Severe Symptoms than Men?

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Let’s begin by pointing out that we have recently written about ADHD and Depression in Teenage Girls, and have even produced a brief internet video on the topic. As reported in that article, females with ADHD tend to have the “inattentive” type of ADHD (what we refer to as Winnie the Pooh type), where males tend to have the “impulsive-hyperactive” type or a “combined type” of ADHD (what we refer to as Tigger type ADHD).

As a result, males tend to have more behavioral problems that go along with their ADHD, which leads to referrals from the classroom teacher to a physician where he can receive a diagnosis and treatment. Their female counterparts, however, tend to be inattentive in the classroom, without the behavioral problems, and as less likely to get a referral which might lead to a diagnosis and treatment.

As children mature into adolescence, the human brain matures. But the interesting thing about the brain is that the brain tends to mature from the back of the brain to the front of the brain, and the frontal lobes and pre-frontal cortex mature last. These brain areas are most associated with the “executive functions” of the brain, and their delays in maturity are associated with “inattentive ADHD.”

Since the female brain tends to achieve its full growth and maturity in the early 20’s, we see many females who had been diagnosed with inattentive ADHD seemingly “outgrow” it in young adulthood.

But what about those who don’t “outgrow” their ADHD? And what about those females who started off with “impulsive-hyperactive type” ADHD, or “combined type” ADHD? What is observed in adult years with these women?



What we know is that during the teenage years these girls with ADHD are at a much higher risk of developing depression, anxiety disorders, and eating disorders, than their peers without ADHD. And during the adults years, these problems remain.

Fred Reimherr, MD, is a professor of psychiatry at the University of Utah in Salt Lake City, where he heads up their Mood Disorders Clinic, and is active in research. He is also quite an outdoorsman and conservationist. He led a study on the effectiveness of Strattera on adult subjects, which was funded by Eli Lilly and Company, and some of his results were startling. At least until the research on adolescent girls with ADHD recently became available.

One of the “side note” findings of Reimherr’s team was that there seemed to be a lot of women with ADHD combined type out there who did not “outgrow” their symptoms, and were still greatly bothered by their ADHD.

Through the assessment process it was found that these women’s scores on various inventories were much higher, and much more severe, than were the scores found with men. These adult women with ADHD had more severe emotional symptoms, including much higher levels of anxiety and depression. The study did not report on eating disorders, but other studies on female adolescents have noted higher levels of eating disorders in young women with ADHD.

Dr. Reimherr noted that when physicians (and mental health professionals) are working with women who are being treated for either anxiety or depression (or we would add eating disorders), if they show symptoms that are not entirely consistent with anxiety or depression, such as displaying more irritability or mood instability than might be expected, the physician should at least consider the possibility of ADHD being at the root of the problem.

Other Opinions on Adult ADHD in Women

Women and Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder, or ADHD, makes people think of the young boy who can't sit still in class. But what about the young girl with ADHD who isn't so disruptive and doesn't get diagnosed? This report talks with three women who suf...

This book section: The Different Types of ADHD

Douglas Cowan, Psy.D., MFT is a licensed Marriage and Family Therapist in Tehachapi, CA who has been a counselor to children, teens, and adults helping them to overcome ADHD, find relief for depression or anxiety, and solve other problems in life since 1989. He served on the medical advisory board to the company that makes Attend and Extress from 1997 through 2011, and he is the Editor of the ADHD Information Library online resource at http://newideas.net/. His weekly ADHD Newsletter goes out to 9,500 families. Visit his website at http://DouglasCowan.me for more information on achieving greater health, personal growth, Christ-centered spirituality, stress management, parenting skills, ADHD, working out the stresses of being a care-giver to elderly parents and also being a parent to teenagers, or finding greater meaning in retirement years, Dr. Cowan can be a valuable resource to you.

Counselor counseling Tehachapi for ADHD, depression, anxiety, and more.

Douglas Cowan, Psy.D., MFT
27400 Oakflat Dr.
Tehachapi, CA 93561
(661) 972-5953

Adult ADHD in Women

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Uncaught exception thrown in shutdown function.

PDOException: SQLSTATE[HY000]: General error: 11 database disk image is malformed: INSERT INTO {watchdog} (uid, type, message, variables, severity, link, location, referer, hostname, timestamp) VALUES (?, ?, ?, ?, ?, ?, ?, ?, ?, ?); Array ( [0] => 0 [1] => php [2] => %type: !message in %function (line %line of %file). [3] => a:6:{s:5:"%type";s:19:"Deprecated function";s:8:"!message";s:83:"The each() function is deprecated. This message will be suppressed on further calls";s:9:"%function";s:27:"_drupal_shutdown_function()";s:5:"%file";s:47:"/home/devnew/public_html/includes/bootstrap.inc";s:5:"%line";i:3200;s:14:"severity_level";i:7;} [4] => 7 [5] => [6] => http://newideas.net/book/export/html/16 [7] => [8] => 52.90.142.26 [9] => 1711707432 ) in dblog_watchdog() (line 157 of /home/devnew/public_html/modules/dblog/dblog.module).