Ring of Fire ADD: Symptoms, Causes, & Treatment

What Is Ring of Fire ADD?

Ring of Fire ADHD is #6 of Dr. Amen’s 7 types of ADHD. It is named after the “ring of fire” pattern seen in brain SPECT imaging (Single Photon Emission Computed Tomography) and is characterized by the most intense and chronic symptoms of all types.¹ Dr. Amen describes this type of ADHD as having sensory sensitivities, irritability, rapid and increased speech, and racing thoughts.

A SPECT scan is a nuclear imaging test that uses a radioactive tracer that can reveal the level of blood flow in various organs.² Using a SPECT scan on the brain and looking at this blow flow can evaluate parts of the brain that are underperforming, overperforming, or working as they should.³ Dr. Amen believes that by using SPECT imaging, treatment can be more targeted by tailoring it to the specific subtype of ADHD that an individual has.

Here are Dr. Amen’s seven types of ADHD:

1. Classic ADD
2. Inattentive ADD
3. Over-Focused ADD
4. Temporal Lobe ADD
5. Limbic ADD
6. Ring of Fire ADD (“ADD plus”)
7. Anxious ADD

Using brain imaging to diagnose ADHD is cautioned against by the majority of medical professionals, and a thorough evaluation of symptoms is needed to diagnose ADHD correctly. One reason for this is that other mental health concerns may overlap with what is observed on brain imaging; for example, depression may also lead to deficits in attention.⁴

Ring of Fire ADD Vs. Ring of Fire ADHD

When describing the seven types of ADHD, Dr. Amen uses the term ADD instead of ADHD. According to Dr. Amen, not all types of ADHD have hyperactivity, which is why ADD is used instead.¹ ADD is an outdated term because the current diagnostic manual, the DSM-5, uses the term ADHD. Most people in the mental health field use ADHD as the most up-to-date term.

Is Ring of Fire ADD an Official Diagnosis?

Although Dr. Amen has identified 7 types of ADHD, including Ring of Fire ADHD, they are not recognized as formal diagnoses in the current DSM-5 and are not officially recognized by the medical and mental health community. The currently recognized diagnosis of ADHD contains 3 subtypes: inattentive, hyperactive-impulsive, and combined. If an individual has the symptoms of Ring of Fire ADHD, they would most likely meet the criteria for hyperactive-impulsive type ADHD.

Ring of Fire ADD Symptoms

Individuals with Ring of Fire ADHD have heightened activity in many parts of the brain, according to brain imaging SPECT scans completed by Dr. Amen. Symptoms of this type of ADHD include more common symptoms of ADHD as well as symptoms specific to this subtype. This type of ADHD is sometimes referred to as “ADD plus” due to being “the most intense of the 7 types of ADD”.⁵

Common symptoms of Ring of Fire ADD include:

• Racing thoughts
• Sensory overload
• Rejection sensitive dysphoria
• Emotional dysregulation
• Impulsivity
• Irritability
• Pressured speech
• Times of increased talkativeness
• Inflexible thinking
• Appearing anxious

Ring of Fire ADD Vs. Bipolar Disorder

Ring of Fire ADHD and bipolar disorder may appear to have an overlap in symptoms, but there are key differences between the two. Some of the commonalities between them are racing thoughts, pressured speech, impulsivity, and mood changes. The difference between ADHD and bipolar disorder is that with ADHD, the behavioral difficulties tend to remain consistent. In contrast, bipolar disorder symptoms occur on a cycle. These differences can be observed both in brain imaging data and symptom presentation.¹

It is important to note that it is possible for an individual to have both ADHD and bipolar disorder. Recent data has revealed that 1 in 13 adults with ADHD also had bipolar disorder, and 1 in 6 adults with bipolar disorder were also diagnosed with ADHD.⁷

What Causes Ring of Fire ADD?

The majority of medical professionals describe ADHD as a type of neurodivergence. However, Dr. Amen believes Ring of Fire ADHD may be due to allergy, infection, or inflammation in the brain.¹ Current research does not confirm the stance that inflammation may play in ADHD.

When to Seek Professional Support

No matter the type of ADHD an individual has, seeking professional support is important in helping manage symptoms of ADHD. A professional can help you sort out which treatment route you would like to take, whether it be medications, therapy, or natural remedies for ADHD.

An online therapist directory can help you start your search by filtering for providers who specialize in ADHD. Alternatively, there are many online ADHD treatment services that make finding a therapist or psychiatrist who specializes in ADHD easy and affordable.

Ring of Fire ADHD Treatment

Treatment for Ring of Fire ADHD is tailored to the specific needs that arise from this type’s unique symptoms. Dr. Amen’s treatment recommendations for this type of ADHD include supplements, exercise, anticonvulsants, blood pressure medications, and therapy to challenge automatic negative thoughts.⁵ Although stimulant medications are often used to treat ADHD, Dr. Amen believes that stimulant medication alone can make Ring of Fire ADHD worse due to the brain already being overstimulated.⁸

Dr. Amen’s treatment recommendations for ADHD differ from the majority of ADHD experts. Most experts believe that adult ADHD should be treated with behavioral therapy, lifestyle adjustments, and, at times, medication.

Treatment options that Dr. Amen recommends for Ring of Fire ADHD include:

• Elimination diet: Because this type of ADHD is believed to be due to an allergy or inflammation, an elimination diet can help identify the allergen, according to Dr. Amen.
• Supplements: A variety of supplements are recommended by Dr. Amen, such as L-tyrosine for ADHD, 5-HTP, and GABA, to boost the neurotransmitters serotonin and GABA.⁹ Omega-3 fatty acids may also be recommended as they have been shown to be helpful for some ADHD symptoms.¹⁰
• Exercise: 30-45 minutes of exercise can reduce ADHD symptoms.⁵ According to Dr. Amen, regular physical activity can help to decrease hyperactivity.
• Medication: Dr. Amen recommends anticonvulsants and blood pressure medications, as he believes they help “calm overall hyperactivity”.⁵ Most psychiatrists do not agree with Dr. Amen. Instead, stimulants are the most widely prescribed medication for ADHD. They work by acting on the neurotransmitters dopamine and norepinephrine in the brain and helping to regulate attention.

Effective treatment options for ADHD include:

• Cognitive behavioral therapy (CBT): CBT for ADHD can help with negative thinking patterns that an individual may have, as well as behavior modification such as learning time management, organization skills, social skills, and more.
• Medication: A variety of medications for ADHD may be used, with stimulants being the most widely prescribed. Stimulants work by acting on the neurotransmitters dopamine and norepinephrine in the brain and helping to regulate attention. Other medications, such as non-stimulants and antidepressants, may also be prescribed.
• Lifestyle adjustments: In addition to therapy and medication, many lifestyle adjustments can help manage ADHD symptoms. Healthy changes include increasing daily exercise and hydration, improving sleep hygiene, eating an ADHD-friendly diet, and practicing mindfulness.