ADHD is a common condition, and the number of cases has risen in recent years. According to the National Institute for Health and Care Research, in boys aged 10-16, 1.4% were diagnosed with ADHD and 0.6% had been prescribed medication for their condition in 2000. In 2018, this rose to 3.5% being diagnosed and 2.4% being prescribed medication. The cause of this rise is thought to be due to increased recognition of symptoms and overdiagnosis, but more research is needed to confirm this.

“In ADHD there are three key components. We measure for inattentiveness, hyperactivity, and impulsivity. Some people have the combined type where all three are present and some people have either a predominantly hyperactive impulsive type or a predominantly inattentive type. We also assess whether it is moderate, mild or severe. That interplay is going to have an impact.”
- Dr Chetna Kang, Consultant Psychiatrist

ADHD exists on a spectrum, so one person's symptoms can be very different to those experienced by another person. There are theories about different categories of ADHD, and here, we are taking a closer look at ‘Ring of Fire ADHD’; what it is, if it’s real, how it’s different from other types of ADHD, how to know if it’s what you have, and how to get the support you need.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about ADHD, we’re here to help.

What is ADHD?

ADHD stands for attention-deficit/hyperactivity disorder, which is a type of neurodivergence meaning the brain is hard-wired differently to neurotypical individuals. It can affect all ages, but symptoms tend to be different in children than they are in adults.

ADHD can cause children to struggle with playing quietly or taking clear instructions without any distraction. One common symptom of ADHD is hyperactivity, but it is important to remember that the condition often presents in a different way for females than it does for males; females often display less features of hyperactivity and more of inattentiveness.

In adults, ADHD can cause symptoms that affect everyday life, such as trouble focusing, impulsive behaviours, and an inability to pay attention for long periods of time. This can make some things more difficult, like studying for exams, working, organising things, managing time, remembering things, achieving tasks, learning, and more.

What are the different types of ADHD?

Although ADHD looks different for every individual, according to the Centers for Disease Control and Prevention (CDC), there are three types of ADHD which are categorised by the main symptoms present. These are:

1. Predominantly Inattentive: If ADHD presents as mostly inattentive symptoms, such as becoming easily distracted or forgetful, then the person most likely has Predominantly Inattentive presentation. Individuals may find it difficult to stay organised, finish tasks, and pay attention or follow instructions.
2. Predominantly Hyperactive-Impulsive: If ADHD presents as mostly hyperactive or impulsive, such as excessive fidgeting or talking, then the person may have Predominantly Hyperactive-Impulsive presentation. Individuals may find it hard to sit still for long, or not interrupt others before they finish speaking. Younger children may do a lot of running, jumping and climbing, or struggle to wait their turn.
3. Combined: If ADHD presents as both Inattentive and Hyperactive-Impulsive, then both sets of symptoms may be present.

Most people can be categorised as either Predominantly Inattentive, Predominantly Hyperactive-Impulsive, or a combination of both, however treatment should always be bespoke to the individual as no two cases are the same.

If you are wondering where ‘Ring of Fire’ ADHD sits within these categories, this is one of seven other proposed types of ADHD, as identified by the brain imaging work of Dr. Daniel Amen, MD.

What is ‘Ring of Fire’ ADHD, and is it real?

The legitimacy of ‘Ring of Fire’ ADHD as a further subcategory of ADHD is debated, as some believe it may be a method of categorising people’s symptoms in order to sell them products or medications.

It is important to note the history of ‘Ring of Fire ADHD.' American celebrity doctor, psychiatrist and brain disorder specialist, Dr Daniel Amen, came up with the notion of the ‘Ring of Fire’ based upon a visible ring pattern he saw present in his patients’ brain scans. This is therefore a subcategory of ADHD developed by an individual, highly considered psychiatrist, however it is not officially recognised by the medical community as a category of ADHD and we do not have official scientific evidence to back it.

The concept comes from SPECT brain imaging, which can identify issues in brain centres like the Anterior Cingulate Gyrus, the Deep Limbic System, the Basal Ganglia, Temporal Lobes, Cerebellum, and Ventral Tegmental Area. The idea is that understanding the exact area that may be malfunctioning can help professionals to interpret symptoms more effectively and create a bespoke treatment plan.

At Augmentive, we believe that treatment for ADHD should always be individualised and take into account each person’s specific set of symptoms and circumstances, however it would appear that much more research is needed to establish whether or not this research on the potential 7 subcategories of ADHD is medically defensible. To date it remains unsupported by organisations such as the National Institute for Health and Care Excellence.

This is not to say the initial research and brain imaging does not have potential to help people, and therefore exploring the different proposed types of ADHD could be useful in allowing professionals to better understand and treat the symptoms. We're covering it here because a lot of people ask about 'Ring of Fire' ADHD and want to know more about it, even if it is not officially a recognised type of ADHD amongst psychiatric professionals.

The brain imaging research suggests there are seven distinct types of ADHD:

1. Classic ADHD
2. Inattentive ADHD
3. Over-focused ADHD
4. Temporal Lobe ADHD
5. Limbic ADHD
6. Ring of Fire ADHD
7. Anxious ADHD

Looking at ‘Ring’ of Fire ADHD specifically, SPECT scan findings suggest there could be overactivity in some areas of the brain, and these look like a ‘ring’, hence the name. ‘Ring of Fire’ ADHD symptoms seem to be present while the individual is at rest and when concentrating, and the overactivity affects the Cerebral Cortex, with increased activity in the left and right Parietal Lobes, left and right Temporal Lobes, and left and right Prefrontal Cortex.

It is thought this activity could be related to other conditions too, such as allergies, infections, brain inflammation, or bipolar disorder, so more research and information on the person’s symptoms would be required to make a diagnosis.

What are the symptoms of ‘Ring of Fire’ ADHD?

‘Ring Of Fire’ ADHD symptoms may include (but are not limited to) some of the core symptoms of ADHD, along with:

• Feelings of overwhelm regarding thoughts and emotions
• Difficulty relaxing and ‘switching off’
• Sensitivity to noise, light, clothing and/or touch
• Mood changes (highs and lows)
• Inflexible thinking, and racing thoughts
• Periods of mean/insensitive behaviour, such as demanding to have their own way or extreme opposition
• Unpredictable behaviour and periods of increased impulsivity
• Fast talking
• Feeling anxious, irritable or fearful

A limited amount of research mentions that ‘Ring of Fire’ ADHD could lead to irritation and frustrated behaviour, such as temper tantrums, but more studies are needed to confirm these symptoms; in fact the significant overlap of these symptoms with 'regular' ADHD is one of the points commonly used to prevent 'Ring of Fire' from being recognised as its own distinct diagnosis or a new 'type" of ADHD.

How is ‘regular’ ADHD treated?

As above, we believe advice and support for those with ADHD should always be bespoke and tailored to the individual to help with their specific symptoms, and therefore there really is no such thing as ‘regular’ ADHD because everyone experiences the condition differently. It’s best to reach out to a qualified specialist who can recommend the right therapies or medications for you.

ADHD treatment often involves a mix of:

• Psychoeducation – where patients are encouraged to discuss ADHD and its effects on their life.
• Behavioural therapy – where rewards are used to help children control symptoms.
• Cognitive behavioural therapy (CBT) – where people with ADHD learn to manage day-to-day issues they face by changing their thoughts and behaviours.
• Medication – this is usually prescribed in combination with therapy for best results, and there are many different types of medications to help, depending on the symptoms experienced. You can read our guide to ADHD medication in the UK here.

If you are unsure which treatment option is best for you, our free 15 minute consultation can point you in the direction of the most relevant therapist that can help you manage and treat your ADHD symptoms.

What is the treatment for ‘Ring of Fire’ ADHD?

According to his own research published in his book, The End of Mental Illness by Daniel G. Amen, MD, stimulant medications (which are routinely prescribed in many ADHD cases) can actually make the symptoms of ‘Ring of Fire’ ADHD worse in around 80% of cases, which is a perfect example of why bespoke, carefully considered treatment plans are so crucial when it comes to ADHD. A blanket approach will not suit everyone.

In the case of ‘Ring of Fire’ ADHD, due to the suggested disruption in certain areas of the brain, research indicates that individuals with this type of ADHD may respond best to anticonvulsants and/or certain antipsychotic medications.

However, the same research reports an accuracy of less than 80% in predicting treatment outcomes, so as always, working with an experienced professional is the best way to understand your own symptoms better and create a treatment plan that works for your individual needs.

How is ADHD diagnosed in children?

When diagnosing potential ADHD in children that display a pattern of inattention and/or hyperactivity, the criteria set out by the CDC is often used to determine whether or not the symptoms fit.

In the case of inattentive ADHD:

Children up to age 16 years of age display six or more symptoms of inattention, and for those aged 17 years or older, five or more symptoms are displayed. These symptoms of inattention will have been present for at least 6 months, and are not consistent with their developmental level:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
• Often has trouble holding attention on tasks or play activities
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g. loses focus, side-tracked)
• Often has trouble organising tasks and activities
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
• Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
• Is often easily distracted
• Is often forgetful in daily activities

In the case of hyperactive and impulsive ADHD:

Children up to age 16 years of age display six or more symptoms of hyperactivity-impulsivity, and for those aged 17 years or older, five or more symptoms are displayed. These symptoms of inattention will have been present for at least 6 months, and are disruptive to their developmental level:

• Often fidgets with or taps hands or feet, or squirms in seat
• Often leaves seat in situations when remaining seated is expected
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
• Often unable to play or take part in leisure activities quietly
• Is often “on the go” acting as if “driven by a motor”
• Often talks excessively
• Often blurts out an answer before a question has been completed
• Often has trouble waiting their turn
• Often interrupts or intrudes on others (e.g. butts into conversations or games)

In addition, the below conditions must also be true:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years
• Several symptoms are present in two or more settings (such as at home, school or work, with friends or relatives, in other activities)
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder

How is ADHD diagnosed in adults?

Although ADHD is often diagnosed in school-age children, it can also be discovered in adulthood, and a childhood diagnosis can continue on into adulthood too. Making a diagnosis of ADHD in adults is similar to the CDC’s above criteria for diagnosing children, except in adults and adolescents aged 17+ years, the number of symptoms needed to diagnose is 5, instead of the 6 required from younger children.

The symptoms are the same, but tend to manifest differently. For example, while children may struggle to play quietly, adults may show extreme restlessness – both cases could be hyperactive ADHD.

What to do if you think you may have ADHD (or ‘Ring of Fire’ ADHD)

If you have been struggling with any of the above ADHD symptoms, or the characteristics of ‘Ring of Fire’ ADHD seem to fit your experience, then there could always be a chance that this is an accurate diagnosis for you. However, you would need to start a conversation with a professional with experience in recognising and treating ADHD to formally diagnose your condition.

Whether you believe you may have (or a loved one may have) ‘Ring of Fire’ ADHD specifically, or more general ADHD symptoms you would like to explore, you can start the process of learning more about this by making an appointment with your GP to discuss your symptoms, whatever they may be. Or, to avoid waiting lists and meeting queues, you can reach out to a qualified professional through a private consultation, such as what we offer at Augmentive.

If you have a question about mental health, like if brown noise can help ADHD, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private adult ADHD assessment or AuDHD assessment, to help finding an ADHD specialist near you to support you on your journey.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.