CHAPTER 3

The Amen Clinics Method for Assessing ADD and More

Our largest referral network at the Amen Clinics is from our own patients and their families. Over the last twenty-four years we have seen tens of thousands of patients from all fifty states and ninety-three countries. The reason people come from all over the world for our help is that our process is very different from our colleagues’ in mental health. We believe it is essential to thoroughly evaluate a person’s life and their brain before developing a treatment plan. “How do you know unless you look?” is a mantra we’ve been saying for more than two decades.

Our outcomes demonstrate the effectiveness of our method. Beginning in December 2010, we started to study every new patient who walked through our doors. We did our usual thorough assessment, but in addition, gave our patients standard assessment tools we could use in an outcome study, including the Quality of Life Inventory (QOLI), Brief Symptom Inventory (BSI), which measures nine different domains of psychological functioning, and the Beck Depression Inventory-II (BDI-II). We then called our patients at six weeks, three months, and six months after their assessment. At six months, our outcome research director, Melissa Jourdain, re-administered the QOLI, BSI, BDI-II, and asked our patients if they were better (better, same, worse) and how compliant they were (very, somewhat, not at all). We see complex patients. Of the first five hundred patients, on average they had 4.2 different diagnoses, such as ADD, depression, anxiety, and addictions, and they had seen 3.3 mental health or medical providers, and had tried six different medications. This was not an easy group to treat. After six months, 75 percent of our patients had improvements across all measures. Eight-five percent had an improved quality of life. You can read the whole study in the peer reviewed medical journal, Advances in Mind Body Medicine.

Here, I am going to give you an outline of our four-step method and help you also apply it to your life if you cannot come to one of our clinics.

Step One: We use our “Amen Clinics Four Circles” approach to get an in-depth understanding of your biological, psychological, social, and spiritual well-being through a detailed clinical history. Understanding the four circles helps us understand each individual we evaluate and it gives us important directions for treatment, which should also be within these four circles.

Step Two: We gather information on how your brain actually functions, through our work with brain SPECT imaging. We generally do two SPECT studies, including one at rest and one when performing a concentration task, typically the Conner’s CPT, a fifteen-minute test of attention and impulse control. For those who cannot get scanned we also use the Amen Clinics Brain Type Questionnaire to help predict what the SPECT study might look like. In addition, we have our patients take a computerized neuropsychological assessment to test different aspects of brain function, such as memory, mood, reaction time, and processing speed and efficiency.

Step Three: We measure your important health numbers, such as body mass index, height to waist ratio, and certain lab tests to make sure your body is functioning at its best (your brain and body are totally interconnected). All of this information, taken together, leads to a targeted plan to optimize your brain and your life.

Step Four: We also help you boost your brain’s reserve to be able to deal with whatever stresses may come your way in the future.

STEP ONE: AMEN CLINICS FOUR CIRCLES ASSESSMENT: BIOLOGICAL, PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL

When I was a first-year medical student at Oral Roberts University (ORU) in Tulsa, Oklahoma, our dean, Dr. Sid Garrett, gave us one of our first lectures on how to help people of any age for any problem. That lecture has stayed with me for the last thirty-five years. Dr. Garrett told us, “Always think of people as whole beings, never just as their symptoms.” He insisted that whenever we evaluated anyone, we should take into consideration the four circles:

At the Amen Clinics we use these four circles to take a balanced, comprehensive approach to assessment and healing. These principles have impacted my own life and career, and once you understand them, they can help you heal in the most balanced way possible.

DETAILED CLINICAL ASSESSMENTS

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Biological Factors

The first circle to evaluate is your biology: the physical aspects of your brain and body and how they function together. In order for your biology to operate at peak efficiency, its machinery (cells, connections, chemicals, energy, blood flow, and waste processing) needs to work right. The brain is like a supercomputer, with both hardware and software. Think of your biology as your hardware. Within the biology circle are factors such as your genetics, overall physical health, nutrition, exercise, sleep, and hormones, as well as environmental issues, such as toxins. When the brain’s biology is healthy, all of these factors work together in a positive way to maximize your success. When trauma, toxins, illness, or deficiencies affect your biology, you feel disrupted or out of synch and you are more likely to suffer with ADD symptoms.

For example, when you don’t get enough sleep, you have overall decreased blood flow to your brain, which disrupts thinking, memory, and concentration. Likewise, a brain injury hurts the machinery of the brain, causing you to struggle with depression, memory issues, and temper problems. When you eat a high sugar or simple carbohydrate diet, your blood sugar often becomes dysregulated, causing you to feel sluggish and foggy-headed.

DETAILED CLINICAL ASSESSMENTS

BIOLOGICAL

  • Brain health
  • Physical health
  • Nutrition
  • Exercise
  • Sleep
  • Hydration
  • Hormones
  • Blood sugar level
  • Supplements
  • Genetics (family history)
  • Toxins (environment mold, drugs, excessive caffeine, alcohol smoking)
  • Infections
  • Physical illness
  • Medication
  • Trauma/injuries
  • Allergies
GENETICS

Since ADD tends to run in families, it is important to get a good look at the family, starting with the grandparents, or even farther back if possible, from each side and learning as much as possible about the primary family members.

In the last two decades scientists have made progress in understanding the genetics of ADD. The pioneering works of David Comings, Florence Levy, and others have demonstrated a genetic component to this disorder. Specific gene sites implicated in ADD include the dopamine transporter gene on chromosome 5, and the D4 receptor gene on chromosome 11. Child psychiatrist Florence Levy from Australia found that 81 percent of identical twins (who share identical genetic material) had ADD, while fraternal twins (who have sibling genetic material) share ADD only 29 percent of the time.

Based on both my clinical experience and the medical literature, it is safe to conclude that a very high percentage of ADD is passed down genetically. In my experience, if one parent has ADD, then 60 percent of the offspring will have it as well. If both parents have ADD then 85 to 90 percent of the children will have it. Anyone who does this work over time has no doubt it is a genetic family disorder and that contributes to the high incidence of family dysfunction in ADD households. There are often multiple challenging people in an ADD family, not just one challenging child.

HEAD INJURY

I have also seen other factors involved in causing ADD. One of the most common is unrecognized head injury, especially to the front part of the brain. In my experience, many professionals and parents discount or ignore the impact of head injuries. They think that a person needs to have a significant loss of consciousness for a prolonged period of time in order for it to do damage. Our brain imaging work, as well as the work of others, is disproving this notion. More on head injuries in Chapter 13.

LACK OF OXYGEN OR TOXIC EXPOSURE

When the brain is exposed to a lack of oxygen or some toxic substance, it is much more likely to show symptoms of ADD. Lack of oxygen can happen with premature babies who have underdeveloped lungs, babies born with the cord wrapped tightly around their necks, and individuals after a drowning accident. Lack of oxygen causes a decrease in overall brain activity. Brain infections, such as meningitis or encephalitis, cause toxic inflammation in the brain and damage tissue. Clearly, fetal exposure to drugs, alcohol, and cigarettes also puts a child at risk for ADD and learning disabilities. Often mothers who use these substances during pregnancy are medicating their own struggles with depression, ADD, or anxiety. The babies inherit vulnerabilities to these problems and in addition experience toxicity to their brains.

In addition, exposure to pesticides, lead, mercury, mold, intrauterine smoking, and other toxins have been associated with ADD. This is very important to understand and evaluate, as the treatment response is generally poorer with a brain exposed to these toxins, and a different approach is often warranted.

MEDICAL PROBLEMS, MEDICATIONS

Certain medical problems, such as thyroid disease, can look like ADD. An overactive thyroid gland may look like Type 1 ADD (feeling hyperactive and inattentive), while an underactive thyroid may look like Type 2 ADD (feeling lethargic and inattentive) or Type 5 Limbic ADD (sad, lethargic, and unfocused). Likewise, certain medications, such as asthma medications, can make people feel and look hyperactive and inattentive. It is important for your doctor to assess the impact of medical problems on behavior.

HORMONAL INFLUENCES

Hormonal influences play a major role in ADD. ADD symptoms are generally worse around the time of puberty in both males and females. In females, ADD symptoms are also exacerbated in the premenstrual period and also around the time of menopause. A number of SPECT studies have shown an overall decrease in brain activity when estrogen levels are low. During perimenopause or menopause, many women who had only mild ADD before now look as if they have major ADD symptoms. Bio-identical estrogen replacement appears to have a positive effect on brain function.

DRUG ABUSE

It is key to assess for drug abuse when evaluating ADD. While ADD and drug abuse commonly occur together, drug abuse can masquerade as ADD. New onset ADD symptoms at the age of fourteen, for example, may signal marijuana abuse. Many drug abusers are not honest (due to feelings of shame or the fear of being found out), so I will frequently order a drug screen to be sure.

Drug screens are not foolproof, but I have found that just the act of ordering the drug screen is helpful. I generally say something like “I want to order a drug screen on you. I know you said that you weren’t using drugs, but people who do use drugs often won’t admit to it. I want to do a thorough evaluation of you and just want to make sure.” If a person says, “I don’t believe in drug screens. They are not reliable. I won’t do it,” that is generally a good indicator that he or she is using drugs. If he or she says, “No problem, I understand,” and willingly goes for the test, then it is generally a sign drug abuse is less likely. Of course, I have been fooled, so even if the patient agrees, I send the specimen to the lab.

POOR DIET

In the last thirty years our diet has changed dramatically. These days, children eat a diet high in simple carbohydrates (sugar, white bread, white-flour food products), poor in protein and healthy fat, and positively deficient in vegetables. Think about the great American breakfast. Morning time is often rushed especially when both parents work outside the home, and there is less time to fix a nutritious breakfast. Kids eat Pop-Tarts, sugar cereals, donuts, frozen waffles, pancakes, or muffins. Gone are the days of sausage and eggs (protein), and sugar is in. Try to find bread in the store without sugar or forms of sugar (corn syrup, high-fructose syrup, etc.). In my local supermarket, only one out of about thirty brands of bread available—a dark Russian rye bread—is made without any sugar. Your diet provides the fuel for the brain’s work. I have found that a diet high in simple carbohydrates makes attentional problems worse, especially for people vulnerable to ADD. Most ADD children and adults simply do better on a high-protein, low–simple-carbohydrate diet (much more on this later). A lack of protein causes a tremendous problem with focus throughout the day. If a person is vulnerable to ADD, a high-carbohydrate, low-protein diet typically makes their symptoms worse.

LACK OF EXERCISE

Exercise boosts blood flow to the brain. Unfortunately, children and teens get much less exercise than they did thirty years ago. With the advent of video and computer games children are spending more time indoors, doing activities which require little exertion. A sedentary lifestyle makes someone more prone to exhibit ADD symptoms. A study published in the journal Pediatrics showed that for every hour of TV a child watches each day—regardless of the content—the risk of having attention problems by age seven goes up 10 percent.

Psychological Factors

Psychological factors fall into the second circle. This includes how we think and talk to ourselves, the running dialogue that goes on in our minds, as well as our self-concept, body image, past traumas, overall upbringing, and significant developmental events. Being raised in a reasonably happy home, getting positive messages growing up, and feeling comfortable with our abilities and our bodies all contribute to psychological health. When we struggle in any of these areas, we are less likely to be successful. If we perceive ourselves as unattractive or less able than our peers, trouble starts to brew. If our thinking patterns are excessively negative, harsh, or critical, that will have a negative impact on our moods, anxiety levels, and ultimately on our ability to focus.

Developmental issues, such as being adopted or experiencing a significant loss or trauma as a child, are also significant. Children often believe that they are the center of the universe and so if something bad happens, such as if a mother gets cancer, a child may think it is her fault and spend the rest of her life racked with guilt. Past successes and failures are a part of this circle, as are hope and a sense of worth and personal power or control.

If children with ADD are not diagnosed or treated by the age of nine or so, they often experience significant psychological issues, related to feelings of inadequacy, insecurity, and even self-hatred. Many ADD kids have been in trouble every day of their lives, because of their issues with restlessness and impulse control.

DETAILED CLINICAL ASSESSMENTS

PSYCHOLOGICAL

  • Self talk
  • Self concept
  • Body image
  • Upbringing
  • Development
  • Past emotional trauma
  • Past successes
  • Past failures
  • Grief/loss
  • Hope
  • Generational histories and issues (i.e., immigrants, survivors of trauma, children or grandchildren of alcoholics)
  • Sense of worth
  • Sense of power or control
EARLY NEGLECT AND ABUSE

Both physical and emotional neglect and abuse contribute to ADD. The brain needs nurturing and appropriate stimulation to develop properly. When a baby is neglected or abused, the brain cannot develop properly and is put at great risk for learning and behavioral problems. An extreme example of neglect occurred during the late 1980s when thousands of Romanian orphans were raised without affection, touching, or nurturing, even though they had food. We have seen hundreds of these children at our clinics. Many of them have developed severe emotional, learning, and behavioral problems. Brain scans showed one of two patterns with these children: 1) overall decreased activity in their brains; without appropriate stimulation, the brain does not make the connections it needs to thrive, 2) overall increased activity, where the brain looks inflamed, either because the immune system is impaired or another insult occurred. Emotional or physical abuse causes a rush of stress hormones and chemicals that poison a baby’s or child’s brain. Stress hormones damage the memory centers, and chronic stress causes the brain to become hyperalert, leading to severe distractibility and an inability to filter out extraneous stimuli.

NEGATIVE SELF-TALK

Low self-esteem, self-doubt, and a lack of confidence can make some look as if they have ADD. Of course, having ADD makes one more prone to these problems. Negative self-talk often stems from having people talk in a negative way toward you. Type 5: Limbic ADD is often associated with excessive negativity.

LEARNED HELPLESSNESS

Psychologist Martin Seligman coined the term “learned helplessness” to describe what he saw in depressed patients. I often see this phenomenon in people with ADD. Learned helplessness occurs when a person tries to do something important, such as study for school, but performs poorly. Then she tries again, but it doesn’t work. She tries yet another time, but it still doesn’t work. Finally she gives up. This demoralization contributes heavily to ADD symptoms and, after a while, causes many people with ADD to give up trying.

The Social Circle

The social circle is the next step in a complete evaluation. It includes the current relationships and events in our lives. When we are in good relationships, experience good health, have a job we love, school we care about, and enough money, our brain tends to do much better than when any of these areas stress or trouble us. Stress negatively impacts brain function, and dealing with difficult events makes us more vulnerable to illness. Depression is often triggered by current stressful life events, such as school failure, marital problems, family dysfunction, financial difficulties, health problems, work-related struggles, or losses. Plus, the health and habits of the people you spend time with has a dramatic impact on your own health and habits.

In ADD families, the health habits of others are often not the best, because of the impulsivity that is often associated with it. There is a higher incidence of alcohol and drug abuse, smoking, and lifestyle illnesses like diabetes, hypertension, heart disease, and obesity. This is one of the reasons at the Amen Clinics we believe it is essential to evaluate everyone in the family who may have ADD.

DETAILED CLINICAL ASSESSMENTS

SOCIAL

  • Quality of current environment
  • Sense of connection to family, friends, and community
  • Health habits of friends and family
  • Relationships
  • Stresses
  • Health
  • Finances
  • Work, school
  • Current successes or failures
  • Information
SOCIAL SITUATION

Evaluating the current family and social situation is essential to get a complete picture of a person. Who is she living with? What are the relationships like? How is the financial health of the family? Are there any physical or emotional challenges? Is there alcohol or drug abuse in the home?

The Spiritual Circle

Beyond the biological, psychological, and social aspects of our lives, we are also spiritual beings. To fully heal and be your best, it is important to recognize that we are more than just our bodies, minds, brains, and social connections, and we must ask ourselves deep spiritual questions, such as:

What does my life mean?

What is my purpose?

Why am I here?

What are my values?

Do I believe in God or a Higher Power?

How does that manifest in my life?

What is my connection to past generations, future generations, and the planet?

Having a sense of purpose, as well as connections to past and future generations, allows us to reach beyond ourselves to affirm that our lives matter. Without a spiritual connection, many people experience an overriding sense of despair. Morality, values, and a spiritual connection to others and the universe are critical for many people to feel a sense of wholeness and connection, and a reason to get up in the morning and to take good care of themselves.

This is especially important for people with ADD. When they are in a job they love, or learning from a teacher they love, or living a life with meaning and purpose, their attention span and judgment seem better. Love is a drug. Research studies have shown that romantic love works in the same part of the brain as cocaine and Ritalin, boosting dopamine availability. In my experience, when my ADD patients have a deep sense of meaning, purpose, love, and passion for their lives, they are much more able to be successful. In counseling, I talk to my ADD patients about choosing jobs, partners, life missions that give them this deep sense of meaning and purpose. It just seems to work out so much better than choosing to be an accountant for the money when you really wanted to be a writer. Of course, one has to be reasonable with passion—if you cannot support yourself or your family with the job you love, adjustments likely will be needed.

DETAILED CLINICAL ASSESSMENTS

SPIRITUAL

  • Sense of meaning and purpose
  • Why does my life matter?
  • Connection to higher power?
  • Who am I accountable to?
  • Connection to past generations
  • Connections to future generations
  • Connection to planet
  • Morality
  • Values

STEP TWO: GET YOUR BRAIN ASSESSED

You can do a great job doing a “Four Circles” assessment and still not fully optimize your brain. You also need to understand how your brain functions. At the Amen Clinics, we have three ways to evaluate brain function:

Brain SPECT Imaging

As mentioned, at the Amen Clinics, we do a study called brain SPECT imaging, which looks at blood flow and activity patterns. SPECT gives a direct look at how the brain works.

In a scientific study we published last year, we found that getting a SPECT scan changed either the diagnosis or treatment plan in nearly eight out of ten patients. Having a scan helps us see more clearly what is happening in the brain that may be the cause of someone’s emotional and cognitive struggles, such as when the brain works too hard, not hard enough, or if it has patterns consistent with brain trauma or toxic exposure.

SPECT scans also help us see someone’s strengths and vulnerabilities. For example, if someone has a tendency toward impulse control problems, we are more likely to see low activity in the front part of the brain, called the prefrontal cortex. If he tends to be rigid and inflexible, we often see increased activity in an area of the frontal part of the brain called the anterior cingulate gyrus. Researchers from Japan found that brain blood flow in certain areas of the brain was positively correlated with both intelligence and creativity. Protecting the brain’s blood flow is critical to having a healthy mind.

Besides helping us make more complete diagnoses, SPECT helps lead us to direct treatment in the context of a Bio/Psycho/Social/Spiritual Assessment. Without a scan or another measure of brain function, it is like throwing medicated-tipped darts in the dark at someone’s brain.

At amenclinics.com you can see hundreds of brain SPECT scans and read over 2,800 scientific abstracts on SPECT for a wide variety of behavioral, mood, learning, and mental health issues. In the next chapter I will discuss our work with SPECT and ADD in detail.

Amen Clinics Brain Type Questionnaire

A long time ago I realized not everyone can get a scan, either because of cost or a lack of availability in your area. My books are translated into thirty languages, so if you read one in China or Brazil, odds are you’re not going to come to get a scan. So, based on thousands of scans, I developed a series of questionnaires to help people predict what their scans might look like if they could get one. The questionnaires are not as effective as getting the scans, especially when there are complex issues, but many people find them very helpful and they are used by thousands of mental health professionals around the world. Chapter 5 will explain how you can take “Amen Clinics ADD Type Questionnaire” on our website amenclinics.com/healingADDquestionnaire. Based on your answers, we give targeted recommendations, including science-based natural ways to boost the brain. Of course, it is important to talk to your health care provider about any recommendations.

24/7 Brain Gym Assessment

On our coaching website, BrainFit Life, at www.mybrainfitlife.com, we have a 24/7 Brain Gym, where you can test and work out your brain at any time. It starts with a sophisticated thirty-minute computerized assessment to determine the health of your brain. It measures mood, attention span, impulse control, memory, reaction time, and more. This is the same computerized neuropsychological test we use for assessments at the Amen Clinics. Based on your score, the program will give you exercises tailored to enhance your specific brain. Spending ten minutes a day in the 24/7 Brain Gym is a great way to optimize your brain.

STEP THREE: KNOW YOUR IMPORTANT NUMBERS

Another very important part of our assessment program is to know your important health numbers. You cannot change what you do not measure. Here is the list of the key numbers you should know about yourself:

  1. BMI
  2. Waist to Height Ratio
  3. Average hours slept each night, and an assessment of whether you have sleep apnea
  4. Blood pressure

1. BMI. BMI stands for “Body Mass Index,” a measure of your weight compared to your height. A normal BMI is between 18.5 and 25. Overweight is between 25 and 30, while obese is greater than 30. You can find a simple BMI calculator on the web. Knowing your BMI is important because being overweight or obese has been associated with less brain tissue and lower brain activity, and recently ADD has been associated with obesity, and it is not an association you want to keep. Plus, obesity doubles the risk for Alzheimer’s disease and depression. There are probably several mechanisms that create this result, including the fact that fat cells produce inflammatory chemicals and store toxic materials in the body. I want you to know your BMI, because it stops you from lying to yourself about your weight.

2. Waist to Height Ratio (WHtR). Another way to measure the health of your weight is the “waist-to-height ratio.” Some researchers believe this number is even more accurate than BMI. The WHtR is calculated by dividing waist size by height. For an example, a female with a 32-inch waist who is 5 feet, 10 inches (70 inches) would divide 32 by 70 to get a WHtR of 45.7 percent. To be healthy your waist size in inches should be less than half your height. So, if you are 66 inches tall, your waist should not be more than 33 inches. If you are 72 inches tall, your waist should not be more than 36 inches.

The WHtR is thought to give a more accurate assessment of health since the most dangerous place to carry weight is in the abdomen. Fat in the abdomen, which is associated with a larger waist, is metabolically active and produces various hormones that can cause harmful effects, such as diabetes, elevated blood pressure, and high cholesterol and triglyceride levels. You have to actually measure your waist size with a tape measure! Going by your pants size does not count, as many clothing manufacturers actually make their sizes larger than they state on the label so as not to offend their customers. In my experience, 90 percent of people will underestimate their waist circumference. Don’t lie to yourself.

3. The number of hours you sleep a night. One of the fastest ways to hurt your brain is to get less than seven or eight hours of sleep at night. People who typically get six hours of sleep or less have lower overall blood flow to the brain, which hurts its function. Researchers from the Walter Reed Army Institute of Research and the University of Pennsylvania found that chronically getting less than eight hours of sleep was associated with cognitive decline. Strive to get seven to eight hours a night. There are hypnosis audios to help you sleep on The Amen Solution website. Chronic insomnia triples your risk of death from all causes and is a common problem with people who have ADD.

4. Blood pressure. To keep your brain healthy, it is critical to know your blood pressure. High blood pressure is associated with lower overall brain function, which means more bad decisions. Here are the numbers you should know:

Below 120 over 80: optimal

120 to 139 over 80 to 89: prehypertension

140 (or above) over 90 (or above): hypertension

Check your blood pressure or have your doctor check it on a regular basis. If your blood pressure is high, make sure to take it seriously. Some behaviors that can help lower your blood pressure include losing weight, daily exercise, fish oil supplements, and, if needed, medication.

Get Key Laboratory Tests

Laboratory tests are the next set of important numbers to know. Here are the key lab test numbers you need to know:

These can be ordered by your health-care professional, or you can order them for yourself at websites, such as www.saveonlabs.com.

1. Vitamin D, zinc, and ferritin (blood test). ADD is thought of as a lack of dopamine being released from brain cells to help nerve cell communication. Inadequate amounts of or poor messages from dopamine are felt to lead to the difficulties with inattention, hyperactivity, and impulsiveness. Many of the medications for ADD are thought to slow the body’s recycling of dopamine between neurons, and make more dopamine available for use. One step that limits the amount of dopamine that is made by cells is controlled by a protein (called an enzyme) called tyrosine hydroxylase. One thing tyrosine hydroxylase needs to function well is enough iron. Approximately 80 percent of the global population is iron deficient. Another thing needed to encourage DNA to make the tyrosine hydroxylase protein is vitamin D. In northern climates, vitamin D deficiency is being considered an epidemic. In addition, zinc is needed to help vitamin D bind to DNA and prompt production of the tyrosine hydroxylase protein. Vitamin D deficiency also leads to a lack of absorption of calcium, iron, and zinc.

Testing your ferritin level (the earliest indicator of low iron), vitamin D 25-OH level (the best indicator of vitamin D status), and plasma zinc is an important first step. If you or your child’s levels are lower than high average, then they need to be improved (ferritin target of 100ng/ml, vitamin D target of 80ng/ml, and plasma zinc target of 100mcg/dl). Vitamin B6 daily may also be helpful.

2. CBC (Complete Blood Count, blood test). This test checks the health of your blood, including red and white blood cells. People with low blood count can feel anxious and tired, and they can have significant memory problems.

3. General metabolic panel with fasting blood sugar and lipid panel (blood test). This test checks the health of your liver, kidneys, fasting blood sugar, cholesterol, and triglycerides. Fasting blood sugar is especially important. Normal is between 70 to 90mg/dl; prediabetes is between 91 to 125mg/dl; and diabetes is 126mg/dl or higher. According to a large study from Kaiser Permanente, for every point above 85 patients had an additional 6 percent increased risk of developing diabetes in the next 10 years (86 = 6 percent increased risk, 87 = 12 percent increased risk, 88 = 18 percent increased risk, etc.). Above 90 there was already vascular damage and at risk for having damage to kidneys and eyes.

Why is high fasting blood sugar a problem? High blood sugar causes vascular problems throughout your whole body, including your brain. Over time, it causes blood vessels to be brittle and vulnerable to breakage. It leads not only to diabetes, but heart disease, strokes, visual impairment, impaired wound healing, wrinkled skin, and cognitive problems. Diabetes doubles the risk for Alzheimer’s disease.

Cholesterol and triglycerides are also important. Sixty percent of the solid weight of the brain is fat. High cholesterol is obviously bad for the brain, but having it too low is also bad, as some cholesterol is essential to make sex hormones and help the brain function properly. According to the American Heart Association, optimal levels are as follows:

If your lipids are off, make sure to get your diet under control, as well as taking fish oil and exercising regularly. Of course you should see your physician. Also, knowing the particle size of LDL cholesterol is important. Large particles are less toxic than smaller particles.

4. Thyroid panel (blood test). Abnormal thyroid hormone levels are a common cause of anxiety, depression, forgetfulness, confusion, and lethargy, and have been associated with ADD. Having low thyroid levels decreases overall brain activity, which can impair your thinking, judgment, and self-control, and make it very hard for you to feel good. Low thyroid functioning can make it nearly impossible to manage weight effectively. To know your thyroid levels, you need to know these figures:

There is no one perfect way, no one symptom or test result, that will properly diagnose low thyroid function or hypothyroidism. The key is to look at your symptoms and your blood tests, and then decide. Symptoms of low thyroid include fatigue; depression; mental fog; dry skin; hair loss, especially the outer third of your eyebrows; feeling cold when others feel normal, constipation; hoarse voice; and weight gain. Most doctors do not check thyroid antibodies unless the TSH is high. This is a big mistake. Many people have autoimmunity against their thyroid, which makes it function poorly, even while they still have a “normal” TSH. That’s why I think measuring the antibodies should also be part of routine screening.

5. C-reactive protein (CRP, blood test). This is a measure of inflammation. Elevated inflammation is associated with a number of diseases and conditions that are associated with mood problems, aging, and cognitive impairment. Fat cells produce chemicals that increase inflammation. A healthy range is between (0.0 to 1.0 mg/dl). This is a very good test for inflammation. It measures the general level of inflammation although it does not tell you what has caused this condition.

The most common reason for an elevated C-reactive protein is a poor diet. The second most common is some sort of reaction to food, either a true allergy, a food sensitivity, or an autoimmune reaction such as occurs with gluten. High CRP levels can also indicate hidden infections.

6. Free and total serum testosterone for adults (blood test). For both men and women, low levels of testosterone have been associated with low energy, trouble focusing, cardiovascular disease, obesity, low libido, depression, and Alzheimer’s disease.

Amen Clinics Four Circles Treatment: Biological, Psychological, Social, and Spiritual

Once you know the Four Circles, how your brain works, and your important numbers, treatment is directed toward optimizing the Four Circles:

STEP FOUR: BRAIN RESERVE

The last step in the Amen Method is to always work to boost your “brain’s reserve.” I coined this term after looking at tens of thousands of scans. Brain reserve is the extra cushion of brain function you have to deal with whatever stresses come your way. The more reserve you have, the better you can cope with stress, loss, hormonal swings, and aging.

Have you ever wondered why two people can be in exactly the same car accident and experienced the same impact and one person walks away unharmed, while the other has serious cognitive or emotional problems. In large part it’s due to how much brain reserve they had before the accident. Brain reserve starts before you’re even born. When you were conceived, if your mother ate well, took her vitamins, and wasn’t under a lot of stress, she was building your reserve. But, if she drank, smoked, or ate poorly, you likely started with less reserve. In the same way, throughout the rest of your life you are either building or depleting your reserve. Being raised in a loving, stable, healthy environment strengthened your reserve, while getting a concussion from playing contact sports or being chronically stressed or fed junk food drains your reserve. And, unfortunately, as we age, the brain becomes less and less active, making you more vulnerable to problems. By the time you have symptoms, your reserve is gone and your brain is struggling. But the really good news is . . . that no matter what your age . . . you can boost your reserve and make your brain look and feel younger.

You boost brain reserve by putting three strategies to work in your life.

  1. Brain envy. You have to truly want to have a better brain.
  2. Avoid anything that hurts your brain: Drugs, alcohol, environmental toxins, obesity, hypertension, diabetes, heart disease, sleep apnea, depression, negative thinking patterns, excessive stress, and a lack of exercise or new learning.
  3. Consistently do good behaviors that help your brain: A great diet, new learning, exercise, accurate thinking habits, stress management, and some simple supplements to nourish your brain.

To be at your best it is critical to put all of these pieces into place. Knowing and optimizing your Four Circles, testing and optimizing your brain, knowing and optimizing your important numbers, and boosting your brain’s reserve.

This is the approach that we use at the Amen Clinics that has brought us our success. I hope it helps you too.

OTHER THINGS TO LOOK FOR IN ASSESSING ADD

When ADD is present, these other problems should also be evaluated. Sometimes these problems are misdiagnosed as ADD, sometimes they occur with ADD.

Psychiatric/Adjustment Problems: Emotional and adjustment problems can masquerade as ADD, be a result of ADD, or occur together with ADD. Here are samples of the problems:

Adjustment Disorders or Family Problems: Temporarily, family problems or significant stress can cause a person of any age to have problems with concentration or restlessness. The difference between stress and ADD is history and duration of the difficulties. ADD is a long-standing problem that is relatively constant over time. The stress of long-term family problems can cause a child to look as though he or she has ADD. It must be determined, however, whether or not the serious family problems are a result of ADD in one or more of the family members.

Behavioral Problems Not Related to ADD: Some behavior problems have nothing to do with ADD. When parents have ineffective parenting skills, they can actually encourage difficult behavior in their children.

Depression: Depression may be confused with ADD, especially in children. Depressive symptoms include poor memory, low energy, negativity, periods of helplessness and hopelessness, social isolation, along with sleep and appetite changes. Many of these symptoms are also found in ADD. History is the key to proper diagnosis. ADD symptoms are generally constant over time, while depression tends to fluctuate. Many people with ADD experience demoralization (from chronic failure) and may indeed look depressed when ADD is the primary problem. Depression and ADD often occur together.

Manic-Depressive Disorder: Manic-depressive or “bipolar” symptoms may be similar to ADD. Both experience restless, excessive talkativeness, hyperactivity, racing thoughts, and impulsivity. The difference is usually found in the severity, consistency, and course of the symptoms. ADD remains constant; bipolar disorder fluctuates from highs to lows. People who have ADD are consistently distractible, restless, and impulsive. People with bipolar disorder will have periods of those symptoms, but they often fluctuate with depressive episodes and periods of relative calm or normalcy. The manic highs of bipolar disorder are not experienced by people with ADD.

Anxiety Disorders: Anxiety disorders can also present similar symptoms to ADD, including restlessness, hyperactivity, forgetfulness, and an inability to concentrate. Again, the key to proper diagnosis is history. As with depression and bipolar disorder, anxiety disorders tend to fluctuate; ADD symptoms are generally constant. Moreover, having ADD can breed symptoms of anxiety or nervousness. When your mind turns off in the face of stress, it can cause nervousness and fear in work, family, and social situations. It is common for people with ADD to experience significant anxiety from underachievement. These disorders also commonly run together.

Obsessive-Compulsive Disorder (OCD): OCD is marked by a person with obsessions (repetitive negative thoughts) and/or compulsions (repetitive negative behaviors), which interfere with their lives. People with OCD get “stuck” or “locked in” to negative thoughts or behaviors. In my clinical experience, there is a high percentage of people with ADD who also have features of OCD, especially if there is significant alcohol abuse in their family backgrounds. The overfocused subtype of ADD has many features in common with OCD, except serotonin enhancing supplements or medications by themselves often make Overfocused ADD worse. This type of ADD needs both serotonin and dopamine interventions.

Tic Disorders, Such as Tourette’s Syndrome: Tic disorders are more common among people with ADD. Tics are abnormal, involuntary motor movements (blinking, shoulder shrugging, head jerking), or vocal sounds (throat clearing, coughing, blowing, and even swearing). Tourette’s syndrome occurs when there are both motor and vocal tics that have been present for more than a year. Up to 60 percent of people who have Tourette’s also have ADD, and 40 to 50 percent of people with Tourette’s have OCD. There is a significant connection between ADD, OCD, and Tourette’s.

History of Physical, Emotional, or Sexual Abuse: Abuse in any form can cause learning and behavior problems. Certainly they can also occur together. Many clinicians see an increased incidence of abuse occurring in families with ADD. The increased level of frustration, impulse control problems, and anger found in ADD families causes them to be more at risk. An accurate, detailed history is necessary to distinguish between abuse and ADD. People who have been abused present more clearly symptoms of post-traumatic stress disorder (PTSD), such as nightmares, fearfulness, a tendency to startle easily, flashbacks, feelings of numbness or emotional restriction. Yet, many people who have ADD feel they have a form of PTSD from the chronic dysfunction they have experienced.

Medical Factors: Medical factors also need to be considered in fully evaluating ADD:

Learning/Developmental Problems: Learning disabilities occur in approximately 40 percent of people with ADD. Suspect the diagnosis of a learning disability whenever there is long-standing underachievement in school or at work. Medical evaluation and history, family and school history, and clinical observation best evaluate these disabilities. The diagnosis is confirmed by “psychoeducational” testing.

Psychoeducational testing evaluates three areas:

  1. IQ and cognitive style (look for discrepancies between verbal and performance scores)
  2. level of academic skill (standard achievement tests)
  3. evidence of specific learning disabilities or problems (such as auditory processing, reading, writing, social skills).
TREATMENT FOR LEARNING DISABILITIES

The specific treatments for learning disabilities are beyond the scope of the book. When they occur, it is important for the school system to assist with an assessment for special services or special education to evaluate the need for alternative learning strategies and academic accommodations.