Excerpted form Journal of Clinical Chiropractic Pediatrics Volume 1, No. 2, 1996, Barnes, Tracy A., D.C.
Objective: To examine alternative, non-pharmacological treatment options for children with Attention Deficit Hyperactivity Disorder?. Method: ADHD has been estimated to affect approximately 3.5 million American children. The primary medical treatment involves the prescription of the psychostimulant drug methylphenidate (Ritalin). It has been shown that the number of children being treated with Ritalin for ADHD has doubled every two years since 1994.
Conclusion: ADHD refers to a combination of symptoms encompassing inattention, impulsiveness, and hyperactivity.
The behavior exhibited by the child with ADHD is usually seen as being disruptive and unacceptable by parents and teachers, and the child may be socially handicapped as a result. Traditionally, the treatment of ADHD had relied on behavioral techniques and Ritalin. In planning an appropriate treatment program for the child with ADHD, it is important to consider learning disability and hyperactivity separately. Since ADHD is strongly associated with learning disabilities, its treatment should be based on educational intervention, not drug therapy. The doctor of Chiropractic can play a significant role in the care of children with ADHD by assessing all aspects of a child’s problem and working to restore balance to the physical, chemical and mental aspects of the child’s life.
D.D. Palmer, founder of Chiropractic, wrote in 1910 that, “The determining causes of disease are traumatism, poison and autosuggestion.” Today’s concept of the triad of health parallels these early writings but changes Dr. Palmer’s terms to structural, chemical and mental factors. This triad can best be visualized as a balanced triangle with equal sides. The base of the triangle represents a person’s structural nature including physical aspects of spine, nervous system, organs, musculature, etc. Chemical factors such as nutrition, medication, and environmental toxins are represented by another side of the triangle. The third side illustrates mental and emotional aspects. Individuals with ADHD often have an imbalance in one or more of these interrelated factors. True health may come from restoring balance to the entire triad.
The Chiropractic approach to the child with suspected ADHD will naturally include an examination of the musculoskeletal system for possible structural causes (Table 1).
STRUCTURAL CAUSES ASSOCIATED WITH ADHD
- Subluxation
- Genetics
- Birth Trauma
- Head Injury
- Neurologic Disorganization
- Craniosacral Dysfunction
Two studies2,3 reveal clues as to the anecdotal success of upper cervical adjusting in children with ADHD.
Pregnancy, delivery and infancy complications were found relevant to the expression of attention problems in a 1993
study.4 In another study, attention deficit problems were related to mild, closed head injury in a group of 1,345 high school and 2,321 university students. The reported head injuries resulted in loss of consciousness in from 12 to 15 percent of these sub-jects.5 In addition, another study of 26 adults with history of head injury and 23 adults with attention disorders were matched with controls. Both groups showed similar symptoms in motor response, speed and attention. This study found that “whereas the group with head injury was characterized by generalized slowness in their response times, the group with ADD was characterized by impulsiveness or an inability to regulate their attention and responses.”6
CHEMICAL CAUSES ASSOCIATED WITH ADHD
- Maternal Cigarette Smoking
- Fetal Alcohol Syndrome / Effect
- Heavy Metal Toxicity
- Food Coloring
- Food Sensitivity
- Nutritional Deficiency
- Antibiotic Overuse
- Vaccination
- Aspartame (Nutrasweet®/Equal®) Toxicity
The question of diet has long been debated in the case of ADHD. Multiple studies indicate certain ties in some children with synthetic food coloring, sensitivities to wheat, dairy and corn,7 aspartame (Nutrasweet/Equal) toxicity,8 and nutritional deficiencies. Inadequate supplies of magnesium, zinc, copper, iron and calcium have been shown to affect behavior.9 One study analyzed urine and hair samples for these trace elements in 50 children with hyperactivity. Their results stressed the necessity of supplementing trace elements in children with ADHD symptoms.10 The role of foods, preservatives and artificial coloring in ADHD was evaluated in one study of 26 children who met the criteria for ADHD, by treatment with a multiple item elimination diet. The results of this study showed that 19 children (73%) responded favorably.11 On open challenge, all 19 children reacted to many foods, dyes, and /or preservatives. This study demonstrated a beneficial effect of eliminating reactive foods and artificial colors in children with ADHD.
PSYCHOLOGICAL CAUSES ASSOCIATED WITH ADHD
- Child Abuse
- Adverse Family Environment
CHIROPRACTIC LITERATURE REVIEW
An article, published in the Journal of Manipulative and Physiological Therapeutics in 1989, reported on seven cases in which Chiropractic adjustment was used as a treatment for hyperactivity in children.12 The seven children in the study were not receiving any medication for their ADHD but did receive Chiropractic manipulative therapy (CMT) for a period of one month. The authors of this study reported that group improvement was statistically significant during the period and concluded that CMT showed promise as a non-pharmacological treatment option for children with ADHD.
CHIROPRACTIC MANAGEMENT STRATEGIES FOR ADHD
Patience and persistence are the key elements in working with any child affected by ADHD. Spinal adjusting techniques often have to be modified and adapted to a child who cannot sit still and follow instructions. Maintaining a flexible approach toward the physical examination and treatment process is essential. Allowing the child to explore the examination room while history-taking is in progress may help them relax during the later physical examination.
These children should also be rewarded with lots of verbal praise, as many of these children experience criticism all day long for their inappropriate behavior and consequently are never allowed to feel successful.
Children with ADHD can be challenging to work with for families, schoolteachers, peers and especially for their doctors. However, taking the time to determine the cause(s) of their condition and attempting to restore balance to all three sides of the triad of health may help to improve their behavior and their life.
REFERENCES:
- Palmer DD. The science, art and philosophy of Chiropractic. Portland: Portland Printing House, 1910:364-5.
- LaHat E, et al. BAEP studies in children with attention deficit disorder. Developmental Medicine & Child Neurology 1995; 37:119-23.
- Heilman KM, Voeller KK, Nadeau SE. A possible pathophysiologic substrate of attention deficit hyperactivity disorder. J Child Neurol 1991; 6:76-81.
- Sprich-Buckminister S, et al. Are perinatal complications relevant to the manifestation of ADD? J Am Acad Child & Adole Psych 1993; 32:1032-7.
- Segalowitz S, Lawson S. Subtle symptoms associated with self-reported mild head injury. J Learn Dis 1995; 28:309-19.
- Arcia E, Gualtieri C. Neurobehavioral performance of adults with closedhead injury, adults with attention deficit and controls. Brain Injury 1994; 8:395-404.
- Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediater 1994; 125:691-8.
- Stoddard MN. The deadly deception, Aspartame Consumer Safety Network 1991:1-6.
- Tu JB, Shafey H, Van Dewetering C. Iron deficiency in two adolescents with conduct, dysthymic and movement disorders. Can J Psych 1994; 39:371-5.