If someone could peek inside your brain, show you where it was wasn鈥檛 working properly, then provide some straightforward solutions that would improve your mental health, would you take them?
I would. Having battled for as long as I can remember with what I strongly suspect to be attention deficit hyperactivity disorder, I鈥檓 all for applying the latest in neuroscience, health and nutrition to make life a little easier. And as the recent surge in ADHD diagnoses in many countries suggests, a growing number of people probably feel the same way.
But I want to be sure that whatever is on offer is backed by solid evidence.
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That brings me to an idea about ADHD put forth by , 鈥淎merica鈥檚 most popular psychiatrist鈥�, according to his website. Amen has appeared on shows ranging from Dr. Phil to The Kardashians and written more than 30 books, including 10 New York Times bestsellers. He has clinics in 11 locations across the US.
Anyone who has been in my position will have come across his claims: that he can diagnose 鈥� and treat 鈥� seven different types of ADHD with what he believes is a radical new approach to the brain and mental health.
There is only one problem 鈥� members of the broader scientific community think it鈥檚 bunk. 鈥淚 know of no expert, defined by a track record of peer-reviewed scientific publications鈥� who agrees with Dr Amen,鈥� says , a neuroscientist and clinical psychologist who is also president of the .
Ouch. So what exactly is Amen claiming?
According to the fifth and latest edition of the , psychiatry鈥檚 main tool for identifying and categorising mental health conditions, there are three 鈥減resentations鈥� of ADHD: predominantly inattentive, predominantly hyperactive-impulsive and combined, in which a person has both inattentive and hyperactive symptoms. These are not considered to be different 鈥渢ypes鈥� of ADHD, says Faraone, because symptoms may change over time.
Amen and those who work with him argue for a wider array of subtypes of attention deficit disorder (preferring the title and diagnostic criteria from the third edition of the DSM). These include classic, inattentive, overfocused, temporal lobe, limbic, ring of fire and anxious. Each has a slightly different collection of symptoms and requires a different treatment regimen. For people treated at Amen鈥檚 clinics, those regimens usually include a combination of lifestyle changes, prescription medication and supplements, which he also sells through .
In a recent email exchange with 快猫短视频, Amen said that he identified these seven types 鈥渂ased on what I saw clinically and on imaging鈥�.
The imaging he is talking about is a method called single-photon emission computed tomography (SPECT). In SPECT, a radioactive substance is injected into the blood to track blood flow in the brain as a way of measuring neural activity. It produces colourful, 3D images that show alarming 鈥渉oles鈥� where brain activity is low and bright hotspots where activity is unusually high 鈥� as compared with brain scans from people without ADHD. According to Amen鈥檚 website, more than 200,000 people have been scanned at his clinics so far.
Amen believes that such scans can help us understand what is going on inside the brain in ADHD and that these kinds of scans should be used more widely in psychiatry in general. 鈥淧sychiatry without imaging is like cardiology without imaging, which seems a bit insane,鈥� he says.
Amen says he uses SPECT imaging as an add-on to the standard method of diagnosing ADHD, which is based on standardised questionnaires combined with detailed interviews with the individual and someone close to them. 鈥淟et鈥檚 be clear鈥� I never use SPECT by itself to diagnose anything,鈥� he says. 鈥淚 use it in the context of a good detailed clinical history. Our patients are interviewed for two hours, fill out 25 pages of information, take checklists, and neuropsychological testing,鈥� he says.
It certainly seems sensible to consider the brain in diagnosis, so why isn鈥檛 anyone doing it? The short answer is that they are. There is a huge amount of research in biological psychiatry into how brain structure and activity relate to common conditions, including ADHD. In 2013 the US Food and Drug Administration (FDA) , which measures patterns in the brain鈥檚 electrical activity, as an aid to standard assessment in children. Yet even this is . The problem isn鈥檛 that no one is looking at the brain, but that the scientific community isn鈥檛 yet convinced doing so adds anything useful for diagnosis.
A researchers, published in 2020, concluded that while there are some overall differences between groups of people with and without ADHD, 鈥渢he differences are typically small and do not dramatically differ between people with ADHD and those with other disorders鈥�.
In 2021, Amen and colleagues published a peer-reviewed study showing that from brains of those without.
The issue is, being able to find differences across large samples doesn鈥檛 mean that scanning an individual brain helps with diagnosis. The jury is still very much out on that.
鈥淪PECT scanning has not been shown to be useful for guiding treatment. It has not been FDA approved for either diagnosing ADHD or guiding the treatment,鈥� says Faraone.
Similar , too, with similar results. In short, there are currently no biological tests that can be used to diagnose ADHD, Faraone says.
As for the seven types of ADHD, when asked for research to back his claims, Amen points to a 1998 paper he wrote in the now-defunct journal Primary Psychiatry. The paper isn鈥檛 available online and Amen didn鈥檛 have an emailable copy to share with 快猫短视频 at the time of writing. To our knowledge, nothing more recent has been published on the seven types.
More to the point, it is unclear to me why those seven categories would even be useful. All of those versions of AD(H)D are already diagnosable using the current DSM or the criteria. 鈥淥verfocused ADD鈥� and 鈥渓imbic ADD鈥�, for example, seem to be just rebranded versions of hyperfocus and emotional instability, both well-known features of ADHD. I would argue 鈥淩ing of fire ADD鈥�, the symptoms of which include 鈥減eriods of mean, nasty, or insensitive behaviour鈥�, is just impulsivity and emotional instability 鈥� with a sprinkle of stigma and judgement.
When put to Amen that his seven types are covered by the existing categories, he says, 鈥淚 agree and have said so for decades. You could argue that it is just categorizing the co-morbidity, or another way to frame what is going on with the patient. It is my way of helping people understand what is going on with them.鈥�
I can see the appeal, of course. It has been bewildering and more than a bit unsettling trying to get to grips with the more mercurial aspects of my own mind, especially at a time when ADHD is getting so much attention 鈥� much of it sneering and dismissive.
But unless these ideas and the evidence for them are properly scrutinised and shown to make a genuine difference to diagnosis or to benefit people with ADHD, it is cold comfort and I, for one, will pass.
