Chiropractic, Attention Deficient Hyperactvity Disorder (ADHD) and Autism Spectrum Disorders

Background

The label ADHD has been in evolution since 1902 when George Still described 43 children with characteristics of aggression, defiance, emotionality, “disinhibition”, limited sustained inattention, and deficient rule governing behaviour as having a “deficiency of sustained attention”. In the first half of the 20th century this type of behaviour was examined on the basis of insults (i.e. damage through toxins, trauma and infection) and the term “minimal brain damage” was coined. As no brain damage could be found this was changed to “minimal brain dysfunction” and in the 1950s to “hyperkinetic reaction of childhood” and as such hyperactivity became the central focus.

Stimulant medication to reduce the expression of symptoms was first used in the 1930’s but it did not gain widespread use until the 1960’s.

By the 1970’s the focus had gone full circle and the term “Attention Deficient Disorder (ADD)” was the buzzword of choice. The term ADHD acknowledges the element of hyperactivity which presents in many medical diagnoses.

The label ADD/ADHD belong to in a spectrum of neurological diagnoses which go from ADD/ADHD through Learning Disorders, Obsessive Compulsive Disorder (OCD), Tourette’s Syndrome to Pervasive Developmental Disorders to Autism.

The diagnosis of ADHD is based on the history of manifestation of 3 types of behaviour: - Inability to perform everyday tasks/distractibility - Impairment to control impulses/impulsivity - Restlessness/hyperactivity

A child does not have to express all 3 types of behaviour to be labelled ADHD indeed its diagnosis is based on a cluster of behaviours with no biological indicators. This prompted Wender (2) to comment: ”The published diagnostic criteria lend an aura of objectivity to the diagnosis, but the application of these criteria is based on subjective judgements regarding the accuracy of information given by parents and teachers”.

TEST YOURSELF FOR ADHD – Follow this link to the diagnostic criteria and you will realise that WE ALL SUFFER ADHD to one degree or another.

In 2006 it was estimated that in the UK, nearly 1 in 5 children experience some sort of learning disability or behavioural problem – potentially over 2.25 million children(3)

chiropractic and adhd

The Medical Approach

The medical approach is to treat the symptoms of ADHD, predominantly with pharmacology (drugs) such as methylphenidate (Ritalin) or selective serotonin reuptake inhibitors (SSRIs). Ritalin is a central nervous system stimulant class II drug which is categorised by the US FDA in the same category as cocaine, methadone, methamphetamine, opium and others. Cocaine and Ritalin both use the same receptor sites in the brain except Ritalin is a more powerful stimulant as it blocks more dopamine transporters which clean up the synapses of excessive dopamine (dopamine gives a ‘hit’ of pleasure) and therefore Ritalin gives a longer high than cocaine

Studies have shown some short term benefit for stimulant medication but there is little to no long term benefits in ADHD children administered these drugs. . No difference has been found between treated and untreated ADHD patients in terms of failed grades, achievement scores, memory retention or anger control (4). Another study found that after 8 years of stimulant medication and other modification 80% of children continued to have ADHD symptoms. Of the children in the study 20% were not medicated although it was unclear how many untreated children were in the 20% improvement group (5)

Antidepressant drugs have been used to treat children with ADHD; however, children are susceptible to side effects like those that affect adults and researchers from Harvard medical school have expressed concern over the link between these medications and increased risk of suicidal tendencies(6). Since ADHD is generally considered to persist into adulthood many adults are now taking stimulant drugs with amphetamines (e.g. Adderall) This is potentially devastating as a study found that children born to mothers or fathers who took amphetamines, antihistamines and/or mind altering drugs were at an increased risk of developing acute lymphoblastic leukaemia (7) The Physicians’ Desk Reference (PDR) 50th Edition, 1996, notes that methylphenidate (Ritalin) should not be administered to children under the age of 6 since safety and efficacy in this age group have not been established. Indeed, the long term use of this drug, in terms of safety and efficacy, has not been established for children of any age. The know possible side effects include the following:

- Nervousness and insomnia

- Suppression of growth (weight and/or height)

- Exacerbation of behavioural disturbances and thought disorders- Frank psychotic episodes

- Drug dependence

- Visual disturbances

- Dermatological problems

- Fever

- Arthralgia (painful joints)

- Necrotizing vasculitis (inflammation of blood vessels leading to death of surrounding tissue)

- Anorexia

- Nausea

- Dizziness

- Palpitations

- Headaches

- Tardive Dyskinesia (impairment of voluntary motion which may persist after stopping the drugs)

- Drowsiness

- Blood pressure and pulse changes

- Tachycardia (excess heartbeat), angina (starvation of oxygen to the heart muscle) and cardiac arrhythmia (irregular electrical heart activity)

- Abdominal pain

- Loss of appetite

- Tourette’s syndrome

The Chiropractic Approach

Chiropractic and ADHD have a long history together - for decades clinical case studies have reported on the effectiveness of chiropractic care for children with many kinds of neurological conditions including learning disorders, hyperactivity, dyslexia, inability to concentrate and behavioural problems.

Typical among clinical case studies of Chiropractic and ADHD include a non-motivated nonverbal failing high school student on Ritalin ™ who, after chiropractic care was removed from the drug and began talking and expressing herself and showed improvement in reading comprehension and reading speed. Another 8 year old boy with extreme hyperactivity, irritability, severe behavioural problems and failing grades who was also on Ritalin™. After commencing chiropractic care the drug was discontinued and grades and behaviour improved dramatically(8).

Another typical study of Chiropractic and ADHD, by Giesen JM et al showed that with a group of hyperactive children 57% of the children in the group showed improvements in parental ratings of hyperactivity, in chiropractic radiographic analysis and in improved nervous system response. 71% showed a reduction in overt behavioural activity and the results were taken as “ … impressive evidence that the majority of the children in this study did, in fact, improve under specific chiropractic care.”(9)

244 children at a Kentucky reform school, many of whom were undoubtedly suffering from from various emotional and learning disorders were given chiropractic care and teachers wrote,” As the records will show the boys who underwent treatment improved from the first adjustment and in many instances showed improvement beyond belief. Not only did they improve in health, but also in their school work as pupils, showing better results in the shops and other industrial training and above all there has been a marked improvement in their moral life."(10)

Quentin Willson - Celebrity Advocate of Chiropractic

chirorpactic and adhd

But it is not just in the US that there are case studies of Chiropractic and ADHD. In the United Kingdom, the celebrity Quentin Willson, who came to prominence in the testosterone fuelled car programme ‘Top Gear’ extols the virtues and success of chiropractic care for his son stating “I’m startled by the difference in Max before and after chiropractic,” he says. “ He has gone from being labelled autistic and needing a classroom assistant to becoming an active and feisty seven-year-old in mainstream education.” They were at the point of putting Max on Ritalin when a mother suggested they take their son to see her chiropractor. In desperation they did so and the chiropractor explained that of the seven bones in the neck, 4 were severely misaligned, which was putting excess pressure on the neural cord. The Willsons remember the ensuing chiropractic care being painless “It was just flicking bones around his neck and shoulders,” says Quentin but that night Max slept continuously until morning for the first time since his birth.(11)

How Does Chiropractic Effect Brain Function?

What is the link between chiropractic and ADHD? Studies indicate that chiropractic adjustments balance nerve reflexes in the spinal cord (12,13) and improve blood flow to the brain (14) which helps lessen anxiety and improve wellbeing and brain function. Other mechanisms may well be involved.

References and Further Useful Resources on Chiropractic and ADHD:chiropractic and adhd

(1) Dr Joel Alcantara DC, Director of Research, International Chiropractic Paediatric Association. www.icpa4kids.org chiropractic and adhd

(2) Wender et al chiropractic and adhd

(3) Dr Robin Pauc “The Learning Disability Myth” p4, 2006, Virgin Books chiropractic and adhd

(4) Dr Kirk Eriksen DC “Upper Cervical Subluxation Complex” p 291, 2004, Lippincot, Willians & Wilkins chiropractic and adhd

(5) Jacobvitz D, Sroufe A, Stewart M, Leffert N “Treatment of Attentional and Hyperactivity Problems in Children with Sympathomimetic Drugs: A Comprehensive Review” J Am Acad Child Adolesc Psychiatry, 1990: 29(5): p 677-688

(6) Teicher MH, Glod CA, Cole JO. Antidepressant drug and the emergence of suicidal tendencies. Drug Saf, 1993: 8(3): p 186-212

(7) Wen W, et al Parental Medication Use and Risks of Childhood Acute Lymphoblastic Leukaemia. Cancer 2002; 95(8):1786-1794

(8) Walton EV. Chiropractic effectiveness with emotional, learning and behavioural impairments. International review or chiropractic. 1975: 29:2-5:21-22

(9) Giesen JM, Centre DB, Leach RA. An Evaluation of Chiropractic Manipulation as a Treatment of Hyperactivity in Children. J Manipulative Physiol Ther, 1989; 12(5): 353-363.

(10) Chiropractic Success in a Reform School Report of State Supervisor of Chiropractors of Kentucky In Connection With Kentucky Houses of Reform, Greendale, Kentucky, Marshall L.T., Lexington, Kentucky (December 1, 1931).

(11) Christina Hopkinson, Daily Telegraph, 26 May 2005. p22 "Chiropractic treatment has transformed the life of Max Willson and his parents."

(12) Shambaugh P, Pearlman RC, Hauk K. Changes in brain stem evoked response as a result of chiropractic treatment. 1991 Conference of Spinal Manipulation FCER:227-229

(13) Wyke B. Neurology of the cervical spine joints. Physiother. 1979; 65:72

(14) Risley WB. Impaired arterial blood flow to the brain as a result of a cervical subluxation: a clinical report. Journal of the American Chiropractic Association. 1995; 32:63