Welcome to part four of the series of articles where I explain some of the details of the seven types of ADD. Type 4 is also called Temporal Lobe ADD. The temporal lobes are the part of the brain near your temple area and behind your eyes. Temporal lobes have a lot to do with emotionality, memory, learning, mood stability and visual processing of objects. So, when we run a brain map (qEEG), we look for different patterns, and Type 4 is one of those patterns that we look for. As with all the other ADD types, we correlate the qEEG findings with the patient’s clinical history. Although moodiness, agressiveness and memory problems are notable with Type 4 ADD, the best way to determine the type of ADHD is by using patient history and brain mapping (QEEG) in order for the ADD/ADHD classifications to be more accurately determined.
Type 4, is also called Temporal Lobe ADD. “Temporal Lobe ADD is commonly associated with learning and behavioral problems. It is often seen in people with ADD who struggle with mood instability, irritability, dyslexia, and memory problems. Associated with domestic violence and suicidal thoughts, this type of ADD can ruin a family.”  When we have a temporal lobe issue, we can have somebody that’s maybe morally rigid in their view of the world. They might have unpredictable moods. They might be angry. These kids kind of struggle to get to know people and have relationships, so they may interpret comments towards them as negative even when they’re not. They tend to have a darker, negative view of the world. They may have had a history of head trauma, which could be a full-blown concussion even a mild head injury.
HEAD TRAUMA ASSOCIATED WITH TYPE 4 – TEMPORAL LOBE ADD
The temporal lobes, prefrontal cortex, and cingulate gyrus are the most vulnerable brain areas to damage by virtue of their placement within the skull. They are the most heavily involved parts of the brain in terms of thinking and behavior. Just like a computer, you can’t expect the brain to work the same after it has been dropped. The skull is very hard and the brain is very soft.
Traumatic brain injury (TBI) has a profound effect on injured individuals and their families. Cognitive deficits caused by TBI interfere with work, relationships, leisure, and activities of daily living, exacting a personal and economic cost that is difficult to quantify. 
Often times, patients deny having had any head injuries and so I have to get out my “Head Injury Checklist”. Once filled out, both the patient and I can see all the various times a head injury may have occurred. If you would like to review and fill out my “Head Injury Checklist”, you can do so by clicking on the button below.
“Receptive language, being able to receive and understand speech and written words, requires temporal lobe stability. The dominant temporal lobe helps to process sounds and written words into meaningful information. Being able to read in an efficient manner, remember what you read, and integrate the new information relies heavily on the dominant temporal lobe. Problems here contribute to language struggles, miscommunication, and reading disabilities.”
Emotional stability is heavily influenced by the temporal lobes of the brain. “The ability to consistently feel stable and positive, despite the ups and downs of everyday life, is important for the development and maintenance of consistent character and personality. Optimum activity in the temporal lobes enhances mood stability, while increased or decreased activity in this part of the brain leads to fluctuating, inconsistent, or unpredictable moods and behaviors.” Some specific temporal lobe symptom are; headaches and abdominal pain, illusions, periods of anxiety for little reason, hypersensitivity to others, and memory and reading problems. One of the hallmarks of Temporal Lobe ADD is aggression. one can have both external aggression (toward others and objects) and internal aggression (toward oneself: suicidal thoughts or attempts). Dr. Amen notes: “frequently, stimulants, such as Ritalin or Adderall, make this ADD type worse if they are given without anticonvulsant medication to stabilize temporal lobe function. They cause people to be irritable and sometimes more aggressive. Stabilizing the temporal lobes with anticonvulsant medications, such as Lamictal, Depakote, or Neurontin can literally rescue a life from despair, hatred, and self-loathing. After the temporal lobes are treated, a stimulant medication may be very helpful for concentration.
NOTABLE ATTRIBUTES OF TYPE 4 ADD*
- Memory problems
- Learning problems
- Auditory processing issues
- Periods of quick temper with little provocation
- Misinterprets comments as negative when they are not
- Irritability tends to build, then explodes, then recedes, often tired after a rage
- Periods of spaciness or confusion
- Periods of panic and/ or fear for no specific reason
- Visual changes, such as seeing shadows or objects changing shape
*Amen, Daniel G.. Healing ADD Revised Edition: The Breakthrough Program that Allows You to See and Heal the 7 Types of ADD 4
DIFFERENTIATING TYPE 4 TEMPORAL LOBE ADD FROM TEMPORAL LOBE EPILEPSY
Dr. Amen states, “I am often asked how to differentiate Type 4 Temporal Lobe ADD from temporal lobe epilepsy. This can be challenging. Both disorders are due to abnormal activity in the temporal lobes. Both disorders are helped with anticonvulsant medication. Temporal Lobe ADD may be a combination of a variant of temporal lobe epilepsy that is comorbid with ADD. In order for the diagnosis to be Temporal Lobe ADD there needs to be long-standing core ADD symptoms in addition to the temporal lobe symptoms. Many people with TLE do not have ADD symptoms and so would not fall into the Temporal Lobe ADD category.”
HELPFUL TREATMENT TIPS
In Type 4 cases we work with supplements that boost the brain’s production of gamma-Aminobutyric acid (γ-Aminobutyric acid) or GABA. This neurotransmitter is a calming neurotransmitter. Remember a neurotransmitter is a chemical that nerves endings use to communicate either an excitatory or inhibitory message to the adjoining nerve ending. We can also use magnesium, which is also a calming mineral. Both Gaba and magnesium and other specific nutritional supplements/herbs can be used to calm the nervous system. One way the nervous system can be calmed is to up-regulate the parasympathethic nervous system (PSNS), which is our “rest and digest” nervous system. In addition a protein-rich diet with plenty of healthy fats helps stable blood sugar (glucose). Low amounts of simple carbohydrates are important in stabilizing blood sugar are well. Remember, glucose is an important part of the fuel delivery system to the brain and the rest of the body. A high carbohydrate diet tends to cause more ups and downs in blood sugar and corresponding energy levels. A high carbohydrate diet also tends to create a state of chronic inflammation in the body. Inflammation in the leading theory not only for cancer and heart disease, but also brain dysfunction.
In order to improve blood flow to the areas of the brain affected with Type 4 ADD, so regular exercise is important. Many nutritional supplements can also improve circulation to the brain, including:
- Gingko Biloba
- Buther’ Broom extract
- Huperzine A
- NAC (N-Acetyl Cysteine)
- Nitrate-Rich Foods such as beet juice crystals
Type 4 Temporal Lobe ADD cases typically respond very well to a individualized program of nutritional support and brain-based therapy consisting of neurofeedback (brain wave retraining), heart rate variability (HRV) biofeedback , and Interactive Metronome. If we can help in any way, feel free to contact us at The Clear Mind Institue of Southeast Michigan at our ADHD hotline; 586-930-5148. We are located on the west side of Van Dyke Avenue in Shelby Township, Michigan, across from the Shelby Township Library.