Our team has been seeing something called “ring of fire” ADHD spreading across the internet. It’s a supposed subtype of ADHD promoted by Daniel Amen, a celebrity psychiatrist with clinics in multiple states and a huge online following.
But in reporting this episode, we found that “ring of fire” ADHD isn’t recognized by mainstream science. Nor are brain scans approved by the FDA as a diagnostic tool for ADHD.
Our guest today, clinical psychologist Roberto Olivardia, PhD, explains why he believes Dr. Amen’s approach is unethical — and how it may lead to real harm for patients seeking answers.
For more on this topic
Episode transcript
Roberto Olivardia: She said, "So is this Ring of Fire ADHD? Do I have that and bipolar?" And I said, "No, there is no such thing as Ring of Fire ADHD. That is not a diagnostic category. That is not in the DSM." And she was shocked by that.
Rae Jacobson: Lately I have been really curious about this thing I have been seeing all over the internet and social media: Ring of Fire ADHD. Light Googling showed me that it is a purported type of ADHD suggested by Dr. Daniel Amen, a celebrity psychiatrist with clinics all across the country and a big internet presence.
Roberto: In my opinion, absolutely, I think it is unethical.
Rae: The thing is, though, as you just heard our guest, Roberto Olivardia, a clinical psychologist, say, Ring of Fire ADHD does not exist. And the technology used to diagnose it — it is not approved by the FDA. And that is where the problem lies. I wanted to know more, and Roberto, as you will hear, had a lot to say.
I am Rae Jacobson and this is "Hyperfocus." Today on the show: the Amen Clinic, brain scans, and the harmful myth of Ring of Fire ADHD.
Roberto: I remember the first time many years ago I did a consultation of a woman in her 40s who had done these SPECT scans, and she had been diagnosed — put it in quotes — with Ring of Fire ADHD. She was sold supplements that happened to come from the same clinic that did the SPECT scan, that she thinks were maybe fish oil, different vitamins. She said she honestly does not even remember what they were.
She had a handout of an exercise plan for her to do and a diet — dietary recommendations. And she had had that done, I think, in her late 20s. So for about 12, 13 years between that time and the time she ended up in my office, her life was like in ruins, she said. And these were her words.
She had suffered tremendous and deep, dark depressive episodes, suicidal ideation, self — harm behaviors, very impulsive behaviors that were very dangerous, and assumed this is what ADHD is. And was "treated" for ADHD. And when doctors that she had been seeing were telling her, "This is something else that is going on here," she rejected it because she was like, "Look, I had my brain scan."
And I said to her — it is not that there was any judgment against her — I understand why she would reject some of those future recommendations because she is like, "I have seen a picture of my brain, and I saw these top experts, and this is what they said."
Rae: "I have seen a picture of my brain." The scan the woman told Roberto about is called a SPECT scan. It is an acronym that stands for single photon emission computed tomography. And basically what it does is create a 3D map of the blood flow in the brain. But these scans, as you will hear later, cannot diagnose ADHD or bipolar disorder.
Roberto: And so when she came to me, she had just had a suicide attempt and had been hospitalized at a hospital nearby here in Boston. And this is, by the way, years ago. This woman gave me full permission to share these stories — obviously I am leaving out confidential information — because she felt very, very strongly about this.
I had diagnosed her — she had bipolar disorder. Now, she did also have ADHD. She had a long-term history of ADHD and she had bipolar disorder. And so now when you look at these recommendations: Exercise, of course, is good for everybody. Exercise, though, is not a treatment. It is not something that is going to be in replacement of medication, of a lot of cognitive behavioral therapy, dialectical behavior therapy.
Of course, it is health — we should be sleeping and eating well and exercising well. Fish oil has been shown to be helpful with ADHD. That does not even touch, though, what this woman had been going through: psychosis, self-harm, suicidal ideation.
Rae: The place where Roberto's client had been scanned, diagnosed, and given her treatment plan was the Amen Clinic. The concept of Ring of Fire ADHD was coined by Dr. Daniel Amen, the founder of the Amen Clinic. The name comes from the so — called ring of hyperactivity that the Amen Clinic says is visible on those SPECT scans we talked about earlier.
In addition to Ring of Fire, the clinic's website lists six other types of ADHD. This, again, diverges from the DSM, which only lists three: inattentive, hyperactive, and combined. The site also outlines specific symptoms for Ring of Fire ADHD, and you will see me read a list here.
This includes the core symptoms of ADHD, but also things like cyclic mood changes, highs and lows, inflexible or rigid thinking, periods of mean, nasty, or insensitive behavior, periods of increased talkativeness, unpredictable behavior, periods of increased impulsivity and grandiose or larger — than — life thinking, rapid speech, racing thoughts, and more.
These symptoms are not listed as core symptoms of ADHD in established scientific literature. However, they are very similar to symptoms associated with bipolar disorder, a serious mental health condition that requires serious and specific treatment.
Roberto: So she is like, "Why was I not told that I have bipolar disorder?" And it turns out she had a family history of bipolar disorder. That was not considered. She said, "So is this Ring of Fire ADHD? Do I have that and bipolar?" And I said, "No, there is no such thing as Ring of Fire ADHD. That is not a diagnostic category. That is not in the DSM."
And she was shocked by that. And this is an educated woman who, of course, is hearing from doctors and a team of experts who she just would believe them. And she goes, "So what is that?" And I am like, "No, you have ADHD, and that has been established." Through, again, we did a long, very thorough clinical evaluation.
"And you have bipolar disorder. And the things that you have been experiencing are certainly worsened — I mean, we know that ADHD can fuel these things if it is not treated." But she got treatment for the bipolar disorder, she started to understand it, and her life dramatically changed.
And there was a lot of anger and a lot of grief that she had around that. But this is what got me really upset because people — we know already this is a population — ADHD, learning differences — that get misdiagnosed, that clinically are underappreciated.
06:58: The Amen Clinic's specific diagnostic methods and lack of scientific approval.
Roberto: And we know ADHD, that having a comorbid or associated condition is the rule rather than the exception with ADHD. We are more likely to have depression, anxiety, substance abuse, eating disorders, PTSD, histories of trauma, personality disorders — it is just — so we need to understand those comorbidities and not see it as, "Oh, this is just a type of ADHD." Because then that means this comorbid disorder is never really being adequately treated.
But what really upsets — I mean, there are so many things that upset me, Rae, about this. But one, as you can tell, I am sort of namaste, but...
Rae: It is true, you are a very calm person.
Roberto: Yeah, is — I feel so much for, obviously, I do this work because I care so much about people suffering. And not only did this woman feel like she had years lost in terms of getting adequate treatment, but she spent a ton of money on these SPECT scans.
She spent a lot of money on these supplements that were meant to be in treatment of this. And that money could have been toward actual, adequate treatment.
Rae: I should say here that our "Hyperfocus" team reached out to the Amen Clinic with a detailed list of questions and asked for comment. They did not respond with comments. Like we said before, Dr. Daniel Amen is very famous for a psychiatrist, at least. His clinic's catchphrase: "Taking the guesswork out of psychiatry."
He has had PBS specials, numerous TV appearances, and several of his books have been "The New York Times" bestsellers. He has been on a ton of top podcasts like the "Huberman Lab" and "Diary of a CEO." He has been praised by celebrities like Miley Cyrus and Mel Gibson.
He personally scanned Kim Kardashian's brain on a 2025 episode of "The Kardashians." And that notoriety translates into visibility and credibility, something that worries Roberto.
Roberto: I saw something recently where Kim Kardashian went to him and looked at a picture of her brain. And I think where we live right now, especially where there is so much misinformation and just a lot of information in general, I want — and I know you and Understood.org — like, we want the public to have the most accurate information, especially where we know having ADHD, having learning differences, can place people in very vulnerable positions.
And the clinic would purport that it has done hundreds of thousands, apparently, scans of people's brains. And according to them, will and can make certain diagnostic assumptions based upon these pictures and then will make treatment recommendations. The controversy is how accurate are those diagnoses that are made, how useful and effective are those treatment interventions, and that is where the problem lies.
Rae: To be 110 percent clear, Ring of Fire is not a type of ADHD listed in the DSM. A reminder: the DSM, the "Diagnostic and Statistical Manual of Mental Disorders," is published by the American Psychiatric Association, or the APA. It is the authority for diagnosing ADHD and all other mental disorders.
The Amen Clinic says that brain imaging can help reveal patterns in brain functioning and help guide personal treatment decisions. But SPECT scans, or any brain scans, are not approved as diagnostic tools for ADHD, bipolar disorders, or any other psychiatric disorder.
None of this has stopped Dr. Amen from continuing to purport that Ring of Fire is a type of ADHD or from using the scans, something that really troubles Roberto.
Roberto: And I want people directed toward what we know are empirically sound, methodologically strong studies that inform the right treatment interventions. Because I certainly have come across many patients over the years who have spent a lot of valuable time and money and emotional energy on things that are not actually useful, that have been sold to them as a way of diagnosing, treating, curing ADHD that is not accurate, or has really delayed their process of really getting effectively treated.
And something like Ring of Fire ADHD, which we can talk about, is one of those examples of something that is not a diagnosis and is not particularly helpful and may actually prevent somebody from truly seeing the full diagnostic picture of a potential comorbid disorder like bipolar disorder, borderline personality disorder, or PTSD — a lot of other things that this Ring of Fire ADHD might be referring to.
Rae: So it sounds like you have some pretty serious reservations about what the Amen Clinic is putting forward.
Roberto: As a clinical psychologist, I look to, well, what does the science show? What do we know in the research? And the truth is, Rae, first of all, SPECT scans are not FDA approved for diagnosis. The American Psychiatric Association does not say that this is an empirically derived way of making any sort of diagnosis. That SPECT scans on an individual basis are not going to be helpful — that they may show group differences.
Now, what does that mean? So for example, if I said to you that if we did a study of a thousand people with ADHD, a thousand people who did not have ADHD, you may find a higher incarceration rate — people who are in prison — within the ADHD group.
So those are group differences. So nowhere in any scientific literature, and especially when we are looking at treatment that can involve psychopharmacology and medication, should we be relying on something that has literally no data to it? It would be laughable if it were not and did not have serious consequences.
And I have seen those serious consequences with patients over the years. And I do not take people's financial situations lightly. That we know that even just mental health care is — I mean, not accessible to everybody. It is not always economical to everybody.
So now when you have something in which people have spent three to four thousand dollars — and it could be that much — for some of these workups that really do not generate anything that is going to be helpful for them except like, "Oh, that is cool."
When someone is going to get an answer to something that is going to help direct their lives in a way and they want treatment in a certain way, it is not like they have thousands of dollars to just — they are not looking at this just as a novelty to be like, "Cool." They need help. They need serious help. So it offends me, honestly.
13:55: Empirical evidence and the ethics of "curing" ADHD.
Rae: Roberto is a clinician who depends on empirical evidence for making diagnoses and treating patients. And in the case of using SPECT scans to diagnose ADHD, there is just not enough scientific evidence to prove that they can make that diagnosis accurately. And as we mentioned earlier, the American Psychiatric Association agrees.
Still, Dr. Amen keeps getting tons of celebrity cosigns and heaps of attention. He continues to offer SPECT scans through his clinics as well as selling so — called brain health supplements. And of course we should say that the Amen Clinic says that their supplements are designed to support overall brain health and offered as part of a broader treatment program. So with all of this adulation, with all of this attention, is anyone pushing back?
Roberto found at least one case on a podcast called "The Checkup with Dr. Mike." In their exchange, Dr. Mike asks Dr. Daniel Amen why there are no randomized controlled data to back up their use of SPECT scans.
Roberto: Dr. Mike pushed and — I mean, he is so nice and then there is a part of the interview that he really took him to task about like where are the studies? And Amen was very, very defensive.
Dr. Mike: How can we generalize what you are doing so that I can do it too? But in order for me to do it, I need to know it works from a randomized controlled study. Why do we not have that?
Dr. Daniel Amen: So design it for me. Because you are going to randomize — you got imaging, you did not. So automatically it is not blinded because you know...
Dr. Mike: Well, you can get sham imaging.
Dr. Amen: Okay.
Roberto: It is like the first time someone finally, I felt like, made him a little bit more accountable and of course it never — he basically said, "I do not need to do that." So if Roberto's thinking is right, that Ring of Fire is actually ADHD plus something else, how does a responsible clinician handle that?
Rae: We have talked to a lot of clinicians on the show and throughout my career I have interviewed a lot of people. And one thing is very consistent when you talk about the comorbidities with ADHD, if there is a — I hesitate to say dangerous, but a more severe comorbidity, like bipolar disorder, you would never just treat the ADHD and then see if the other comorbidity needed treatment.
You would either treat simultaneously or focus on treating the thing that seemed like it put the patient at greater risk. Does that bear out with what you have seen or what you do in your practice?
Roberto: 100 percent. Absolutely. That you know, I always say with ADHD it is always there. So we are at least treating — definitely have to make sure we keep our eye on it because in a lot of ways ADHD is often clinically underappreciated and the impact of untreated ADHD really can undermine the treatment of anything else.
Because we are talking about Ring of Fire which, one of the disorders that could speak to that constellation — and there are others, but one would be bipolar disorder — is a very serious condition. I mean, one of which, up to 10 to 15, some studies show up to 20 percent of people with bipolar disorder end their lives, at least 40 percent attempt suicide. It has serious morbidity if left untreated.
So we definitely want to make sure that we have our eye on that, but always making sure that the ADHD is also controlled so that if at the very least it is not undermining the treatment of the comorbid condition.
Rae: Roberto says that in his view, the practice raises ethical concerns.
Roberto: In my opinion, absolutely, I think it is unethical. It is unethical if it is under this guise that we are going to do this as a way of uncovering something that is not able to be uncovered in any other way. It is unethical if people are led to believe that this is something that is grounded and based in independent scientific data, recognized by the medical community.
And a lot of people are not aware of that, Rae. I mean, that is the thing — it is like and I do not you know, people say like, "Buyer beware." No. Like, when you are dealing with health care, people are suffering. And I — this gets me really riled up. Like, people are suffering and I am a parent, I have two kids with ADHD and dyslexia — you do whatever you can to try to — what is the best way, the most effective way?
So in ways, there is a lot of emotion in this, in a way that is a lapse of ethics if there is something that is sold to people that is not really grounded in science. Now, are the let us say people who do this, do they think they are doing something that is helpful? Perhaps. I do not know them. I am not going to say they are all sort of fraudulent — like being deceptive and actively manipulative.
But the ethical part comes to, well, what is our duty? My duty as a psychologist is making sure that what recommendations I am giving my patients is based upon scientific evidence.
Rae: Obviously this field of thinking, the things that are being put forth by the Amen Clinic, did not just pop into existence. He is very popular. People are very interested in what he has to offer. And one of the things that he posits is that there are seven types of ADHD, which again, I think could feel novel to a lot of people. How did this happen, I guess is what I am trying to ask?
Roberto: Well, I remember when one of his books had come out. At that time it was six different types of ADHD. I guess one got added to the list. And I certainly, it captured my interest because it was different. It was different than all the other stuff that was written and I thought, "Huh, okay." You know, there was something catchy of that.
And I remember back then — I mean, this was years ago — reading that and thinking, "Well, this sounds like what we are talking about is ADHD plus OCD, ADHD plus bipolar disorder, ADHD plus maybe even personality disorder." I am like, "This just does not hold."
But I remember when you become popularized in kind of media — and this is especially true now with social media. This is even adults that I work with, but particularly with young people, I ask them who they follow on social media as part of my intake. Because as you know, I also specialize in eating disorders. I specialize in other things, and I want to know what information and advice are people being siloed into, basically.
Because the reality is if you see somebody that is being interviewed by top podcasters, who Kim Kardashian went to, there is just an instant credibility. Again —
Rae: Andrew Huberman talked to him for two hours!
Roberto: Yeah! But I think for a lot of people with ADHD because it is so vastly misunderstood and often this kind of invisible condition in a lot of ways that we just are looking for hope for something that is novel and new that is going to push something forward in terms of better treatment and better recognition.
Rae: This legitimizing of questionable information creates a big question for people who are just looking to get good care. How can you tell if what is being offered is actually helpful? With all of this taken into consideration, the fact that there is a lot of information out there and a lot of it can feel very legitimate while still being from what I can tell from everything that you have said, pretty much not legitimate at all — and people are in this situation where they are pretty desperate for good care and that care is not always available. And this kind of stuff that feels so legitimate on its face, how can people spot that?
Roberto: These brain scans have what is called a face validity, and that is a research term to refer to something that at face value looks like it should have validity. We are looking at our brain. Like, that has to be real! You showed me a picture of my brain! One of the things that I have a personal and professional reaction to is anytime you hear someone talk about curing ADHD, healing ADHD.
Rae: I did notice that language on the website. It gave me some pause, I have to say. "Healing your ADHD."
Roberto: Recovering from ADHD. And I want to be very clear because I am very precise with language that there is no question that there are wounds that come along with the experience of having untreated ADHD, or ADHD in which people sometimes grow up where it is not validated, that their executive function issues are characterized as character flaws.
But any of this "cure your ADHD" or any other red flag is this idea where people really sow the seeds of doubting whether ADHD is even a real thing, is a real condition. That is a big red flag. Because I think that what that does is sort of pray upon people who, again, have a lot of those wounds, which I understand and are just hoping like, "Okay, maybe I am not damaged or I am not broken."
But what I say is that, "No, ADHD — you are not damaged and you are not broken. And you have ADHD. This is just part of who I am." And let us take the stigmatization out of it. But you cannot cure this thing. And a lot of times when that language is used, what really is underneath that are people saying this is not a real thing.
Like, "You just need to sleep better." And "Kids just need to get out and play more." Well, yes, we need to sleep better. Yes, kids need to get out and play more and not be on video games all the time. And yes, we need to eat more healthy — all those things are true. And we still have ADHD.
As a psychologist, when I give presentations, I have to disclose any financial interest that I might have. So for example, if I was part owner or owned stock in a supplement company, I have to disclose that when I give a talk. Because if I am giving a talk, let us say on ADHD, and I say, "Hey, you know what can help ADHD? These supplements," and I am an owner or benefit financially from that company and you do not know that, that is deceptive.
That is not ethical. Now, I can disclose it and then you as the public can decide, "Okay, well, this person is benefiting from it. It does not mean that they are necessarily deceptive, but we have to be aware of that." Anytime, you know, when someone is tied to those kind of things, you have to sort of take it now with a grain of salt.
And it is not to automatically say that they have to be negated, but let us put it through that rigorous lens.
Rae: Thank you for listening. If you are interested in learning more about ADHD and brain scans and where we are with the science, check out our last episode with Dr. Jessica Rosenfeld and Dr. Reneh Karamians. They are two researchers who are trying to develop a better test for ADHD. We will put a link in the show notes. See you in two weeks.
"Hyperfocus" is made by me, Rae Jacobson, and Cody Nelson. Calvin Knie is our video producer and video is edited by Alyssa Shea. Additional editing by Julie Subrin. Our research correspondent is Dr. KJ Wynne. Briana Berry is our production director and Neal Drumming is our editorial director.
If you have any questions for us or ideas for future episodes, write me an email or send a voice memo to hyperfocus@understood.org. This show is brought to you by Understood.org. Our executive directors are Laura Key, Scott Koschier, and Jordan Davis.
Understood is a nonprofit dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. If you want to help us continue this work, you can donate at understood.org/give.
Host
Rae Jacobson, MS
is the lead of insight at Understood and host of the podcast “Hyperfocus with Rae Jacobson.”
