ADD/ADHD – Diagnostically Challenging – Try Brain Imaging


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Diagnosing ADD Using Brain imaging – Hank Grebe

Attention Deficit Disorder, or ADD, now officially named Attention Deficit Hyperactive Disorder, or ADHD, is a complex, neuro-biological behavioral impairment that alters a person’s functioning and impinges on all aspects of his immediate and often greater environment.

ADD/ADHD – Statistically Hard to Pin Down

ADD, described as a growing health problem, is a widespread genetic disorder causing episodic changes in behavior. The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), 2000, that 3%-7% of school-aged children have ADHD.

Back in 2001, Daniel Amen M.D., reported in his book, Healing ADD, that approximately 17 million people in the United States have ADD. A rough figure used today, mentioned in Delivered from Distraction, 2006, by Edward Hallowell, M.D., is that 5-8% of the US population have ADD, out of which 10 million ‘sufferers’ are adults.

True figures remain unavailable due to poor initial assessments, lack of recognition of the disorder, and imprecise diagnostic testing methods. However, according to Hallowell, the above percentages do correspond with those published in other countries.

US government statistics support Amen’s claim that awareness of the prevalence of this disorder is growing given that ADD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5.5% per year from 2003 to 2007.

Standard ADD/ADHD Behavior Types

The renowned and prominent behavioral symptoms of ADD are impulsivity, distractibility, and restlessness. The DSM-IV-TR  lists 3 ADD behavior types – inattentive, impulsive, and hyperactive which can combine to form sub-types:

  • Sub-type 1 is the combined type – inattentive, impulsive and hyperactive.
  • Sub-type 2 is the predominantly inattentive type of ADD.
  • Sub-type 3 is the predominantly hyperactive impulsive type of ADD.

ADD and ADHD: Diagnostically Challenging

To underscore the difficulty involved in providing an accurate diagnosis of this neuro-biological disorder, the DSM-IV-TR lists a set of 18 symptoms from which a person needs to consider each one’s frequency of occurrence, duration and intensity. By selecting only six of these symptoms, a person may qualify as having ADD. A more accurate assessment requires a battery of tests and a detailed personal history.

Also to be considered, diagnostic definitions and tests focus on the pathological inadequacies of this disorder creating a partial character assessment. Batteries of tests tend to ignore the many positive traits associated with ADD; thus, any diagnosis results in a negative list of undesirable behaviors.

Reliable Diagnostic Methods Needed

Despite years of research, there are still medical practitioners who maintain that they ‘don’t believe’ in the existence of ADD. As  Hallowell points out “ADD is not a religious principle: it is a medical diagnosis derived from such solid evidence as genetic studies, brain scans, and worldwide epidemiological surveys.”

According to Hallowell, brain imaging studies such as MRI (magnetic resonance imaging) prove the existence of this disorder. Brain scans have revealed significant differences  in the sizes of four regions in the brain: the corpus callosum, the basal ganglia, the frontal lobes and the cerebellar vermis.

Differences in the corpus callosum can indicate ADHD: Image by Life Science Databases

The reduced volumes in these areas explain many typical ADD symptoms.  A narrower-than-normal corpus callosum,  a band of fibers that synthesizes and controls information flow between the brain’s two hemispheres, can account for  OCD (oppositional conduct disorder), fixations, and difficulties in coping with transitions. The basal ganglia, a group of nuclei, partially regulates moodiness and impulsivity. The frontal lobes control organization skills, time management, and decision making, and the cerebellar vermis controls balance and coordination.

Brain Imaging Techniques

Besides MRI, another type of brain imaging study, qEEG, (quantitative electroencephalogram) testing brave waves,  has been found to be 90% accurate in its diagnosis of ADD but as Hallowell points out, “it is not definitive by itself.”

SPECT (single photon emission tomography) a type of functional brain-imaging technique allows experts to examine and define ADD more accurately by evaluating blood flow patterns in the brain. Daniel Amen, a California-based physician, and advocate for 3D SPECT, uses this type of nuclear medicine in his medical practice to diagnose different types of ADD. Amen has been using this type of nuclear medicine study since the early 1990s and through his own and joint SPECT studies, has identified up to 6 different types of ADD.

Diagnosing ADD/ADHD

Despite popular misconceptions, ADD is not a mental illness. ADD, and now ADHD, are a combination of identifiable traits in need of recognition, correct diagnosis, and treatment. The many diagnostic tools available to doctors are increasing, as research continues into this complex neurological condition.

ADHD brain differences: Image courtesy of NIMH


Amen, D. Healing ADD. The Berkley Publishing Group, Penguin Group (USA) Inc. 375 Hudson Street, New York. (2001).

American Psychiatric Association: DSM-IV-TR: Current Manual.

Hallowell, E., Ratey, J. Delivered From Distraction. Ballantine Books, Random House, New York. (2006).

CDC – Centres for Disease Control and Prevention. ADHD Data and Statistics. Accessed November 10, 2011.

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