Attention Deficit Disorder and Hyperactivity

Studies in Peer Reviewed Journals

Chiropractic for Children in the News

The following television interview on Health Watch shows the benefits of chiropractic care in children with ADHD symptoms. Dr. Marty Rosen, ICPA Certification instructor for SOT. View the news clip here: http://wbztv.com/video/?id=30936@wbz.dayport.com

Manual Therapy in Children: Proposals for an Etiologic Model
J Manipulative Physiol Ther 2005 (Mar);   28 (3):   e1–e15 ~ FULL TEXT
Heiner Biedermann, M.D.

The effects of uppercervical adjustments on the child with learnign disorders is explored and shown clinically.
Article Excerpt: KISS-Induced Dyspraxy and Dysgnosy

Developmental Delay Syndromes and Chiropractic: A Case Report

Blum CL, Cuthbert S, Williams S, Developmental Delay Syndromes and Chiropractic: A Case Report. International Conference on Chiropractic Research. Vilamoura, Portugal - May 17-19, 2007: CM53.

Chiropractic treatment for developmental delay syndromes (DDS), while controversial to some, has growing support in the research literature. Yet at this time there is no conclusive information on the causation of DDS. This ultimately leads to some lack of clarity about treatment options, particularly for children sensitive to medication or who do not choose medication as an option.

Patients are actively seeking alternative care, and particularly care that offers low risk and measurable benefits should be brought to their attention. Since for many patients and their families the option of no treatment for DDS is not an "option," we need to explore which patients might best respond to conservative therapies such as chiropractic.

The current evidence supports the premise that some DDS may be secondary to trauma and related to the sensory-motor impairment syndrome known as dyspraxia. While the studies are inconclusive, there is an emerging evidence base that does show chiropractic care may be successfully employed in the treatment of patients with DDS such as dyslexia, dyspraxia, learning disabilities, and ADHD.


ADHD Helped With Chiropractic, A Case Study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15510091

  • In the October 2004 issue of the peer-reviewed research publication, the Journal of Manipulative and Physiological Therapeutics (JMPT), comes a case study of a child with ADHD (Attention-Deficit/Hyperactivity Disorder), who was helped with chiropractic.
  • The case was of a 5 year old boy who had been diagnosed with ADHD at age 2. The child’s pediatrician prescribed methylphenidate (Ritalin), Adderall, and Haldol for the next 3 years. The combination of drugs was unsuccessful in helping the child.
  • At age 5 the child was brought to a chiropractor to see if chiropractic care would help. The history taken at that time noted that during the child’s birth, there were complications during his delivery process. The results of this trauma and complications resulted in a 4-day stay in the neonatal intensive care unit. The child’s mother reported no other incidence of trauma.
  • The chiropractic examination and x-rays showed noticeable spinal distortion including a reversal of the normal neck curve indicative of subluxations. Chiropractic care was begun and the child ’s progress was monitored.
  • According to his mother, positive changes in her son`s general behavior were noticed around the twelfth visit. By the 27th visit the patient had experienced considerable improvement.
  • The child was brought by the mother to the medical doctor for a follow up visit and questioned the usage of the Ritalin. The medical doctor reviewed and examined the child and based on that assessment and his clinical experience, the MD felt that the young boy was no longer exhibiting symptoms associated with ADHD. He then took the boy off the medications that he had been taking for 3 years.
  • The conclusion of the author of the JMPT case study noted, “The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication.”



An evaluation of chiropractic manipulation as a treatment of hyperactivity in children.   Giesen JM, Center DB, Leach RA   J Manipulative Physiol Ther 1989 (Oct);12 (5):353-363

  • The principle aim of this study was to determine the effectiveness of chiropractic manipulative therapy in the treatment of children with hyperactivity. Using blinds between investigators and a single subject research design, the investigators evaluated the effectiveness of the treatment for reducing activity levels of hyperactive children.

    Data collection included independent evaluations of behavior using a unique wrist-watch type device to mechanically measure activity while the children completed tasks simulating school-work. Further evaluations included electrodermal tests to measure autonomic nervous system activity. Chiropractic clinical evaluations to measure improvement in spinal biomechanics were also completed. Placebo care was given prior to chiropractic intervention.

    Data were analyzed visually and using nonparametric statistical methods. Five of seven children showed improvement in mean behavioral scores from placebo care to treatment. Four of seven showed improvement in arousal levels, and the improvement in the group as a whole was highly significant (p = 0.009). Agreement between tests was also high in this study.

    For all seven children, three of the four principal tests used to detect improvement were in agreement either positively or negatively (parent ratings of activity, motion recorder scores, electrodermal measures, and X-rays of spinal distortions). While the behavioral improvement taken alone can only be considered suggestive, the strong interest agreement can be taken as more impressive evidence that the majority of the children in this study did, in fact, improve under specific chiropractic care.

    The results of this study, then, are not conclusive, however, they do suggest that chiropractic manipulation has the potential to become an important nondrug intervention for children with hyperactivity. Further investigation in this area is certainly warranted.

Behavioral and Learning Changes Secondary to Chiropractic Care to Reduce Subluxations in a Child with Attention Deficit Hyperactivity Disorder: A Case Study

Lovett L,  Blum CL Behavioral and Learning Changes Secondary to Chiropractic Care to Reduce Subluxations in a Child with Attention Deficit Hyperactivity Disorder: A Case Study  Journal of Vertebral Subluxation Research,  Oct 2006:1-6.

Objective: Attention Deficit Hyperactivity Disorder (ADHD) is extremely subjective in both diagnosis and treatment. No single cause has yet been determined for this disorder nor has there been a single treatment plan that is effective in a majority of cases. This paper proposes a possible etiology for some cases of ADHD with respect to concentration and hyperactivity along with a possible positive association with chiropractic adjustments.

Conclusion: There are many causes to ADHD as well as other learning and behavioral disorders; therefore conclusions cannot be conclusively drawn by a single case study. A possible conclusion that can be drawn in this case is that adjusting spinal lesions (e.g., subluxations) appeared to reduce the child’s pain and discomfort, which allowed him the ability to concentrate, learn and “sit still.” Further studies with controls need to be conducted in this area to determine the effectiveness of chiropractic care in aiding the symptoms of children who are classified as ADHD.

The relationship of craniosacral examination findings in grade school children with developmental problems   Upledger JE   J Am Osteopath Assoc. 1978 Jun;77(10):760-776

  • This study examined grade school children and came up with a positive relationship between cranial motion restrictions and learning disabled children, as well as children with a history of an obstetrically complicated delivery.


Additional Chiropractic Case Studies:


1)   Larry Webster, D.C. International Chiropractic Pediatric Association Newsletter. January 1996.

  • "After examining several diagnosed ADHD children, we find an upper cervical subluxation that can lead to neurotransmitter involvement."


2)   A Mother's Testimonial. ICPA Newsletter. July/August 1998   (Dr. Angiolillo is in private practice in North Brunswick, NJ).

  • "When Kevin was 3 he was diagnosed as having ADHD. After trying diet changes, allergy testing and behavior modification techniques, we reluctantly agreed to put Kevin on Ritalin. The medication did its job as far as slowing him down a bit, but he suffered many side effects. In 2 years he grew only 2 inches and did not gain any weight at all. He cried easily, had trouble sleeping, no appetite, and would "zone out" quite often.

    Finally at age 6 we made the decision to stop giving him Ritalin. He grew 6 inches in less than 1 year and gained nearly 15 pounds. His sleeping and eating patterns were still erratic, and the schoolwork was horrible…his writing was illegible and math made no sense to him.

    We brought him to Dr. D'Angiolillo for chiropractic care, twice a week for 6 weeks. This past week when I went to his parent-teacher conference, the first thing the teacher asked me was had we put Kevin back on Ritalin. I said no, and she showed me samples of Kevin's work and showed me the sudden improvement…for the first time his writing is in the lines, it is easy to read and much more age appropriate.

    Although he still tends to move around more than the average child does, he is able to concentrate, answer questions correctly and is reading better than most of his class!"



3)   International Chiropractic Pediatric Association Newsletter May/June 1997.

  • A six year old boy with nightly nocturnal enuresis, attention deficit disorder and toe walking (walked with his heels 4 inches above the ground). Medical specialist recommended both. Achilles tendons cut and both ankles broken to achieve normal posture and gait. Chiropractic findings included: C1, Occiput, sacrum and pelvis. After 4 weeks of care both heels dropped 2 inches and bedwetting decreased to 2-3 times/week.


4)   ADHD - A multiple case study.   Wendel P,   International Chiropractic Pediatric Association. March/April 1998.

  • This is a 12-month study began on October 4, 1997 of twenty-one children: 17 male and 4 female, ages from six to sixteen years. Eight of the children in the study are on Ritalin. As of March 18, 1998, thirteen of the initial twenty-one children are still participating in the study. Five of the remaining children are on Ritalin.

Four Case Reviews from this study:

  • Female, age 10. The child had poor grades due to lack of focus on homework and parental supervision was needed to complete homework. After three months of care, she received "Most Improved Student" award for bringing grades from an F and a D to an A and B respectively.

  • Male, age 13. History included traumatic birth (cord wrapped around neck) and did not crawl as a young child. After four weeks of care (including learning to cross crawl) he improved his grades from four F's to a B, D and notable improvement in the remaining 2 classes.

  • Male, age 12. Run over by a car while riding a skateboard at age 5. He exhibited severe discipline problems at school with school suspension several times. Failing all classes. There has been little behavior improvement but grades have improved to a B, 3Cs and two Ds.

  • Male, age 15. Tested positive for allergies and had severe hand tremors. After one week of care hand tremors diminished. After 5 months grades improved to 3 As, 2Bs and 1C.


5)   Epileptic seizures, Nocturnal enuresis, ADD   Langley C.   Chiropractic Pediatrics Vol 1 No. 1, April, 1994

  • This is an eight year old female with a history of epilepsy, heart murmur, hypoglycemia, nocturnal enuresis and attention deficit disorder. The child had been to five pediatricians, three neurologists, six psychiatrists and ten hospitalizations. Child had been on Depakote, Depakene, Tofranil and Tegretol. She had been a difficult birth, a cesarean had to be performed under general anesthesia. The mother was told the baby was allergic to breast milk and formulas and was stayed on prescription feeding.

    The doctors told the mother the girl would never ride a bike nor do things like normal children do. The child was wetting the bed every night and experiencing 10-12 seizures/day, with frequent mood swings, stomach pains, diarrhea and special education classes for learning disabilities.

    Chiropractic adjustments were given C1 andC2 for approximately three times per week. Two weeks after beginning care the bed-wetting began to resolve and was completely resolved after six months. She was also going to leave special education classes to enter regular fifth grade classes. After one year of chiropractic, the seizures were much milder and diminished to 8-10 per week. Patient was also released from psychiatric care as "self managing." Her resistance to disease increased and she can now ride a bike, roller skate and ice skate like a normal child. After medical examinations, she is expected to be off all medication within a month.


6)   First report on ADD study.   Webster L.   International Chiropractic Pediatric Association Newsletter. Jan. 1994

Two cases from the ADD study are mentioned:

  • Case #1: Ten-year-old girl on 60 mg. Ritalin/day, severe scoliosis of 48 degrees Cobb angle. First seen 11/15/93. After ten adjustments mother reported a happier child, immune system doing much better and endurance much higher. Re-exam revealed scoliosis reduced to 12 degrees. By 1/10/94 off medication

  • Case #2: 12-year-old boy diagnosed as ADD, asthma and seizures. First entered clinic 12/9/93 and after 8 adjustments, parent has withdrawn all medication with the cooperation of their doctor. Positive personality change has been noted.

8)   The effect of chiropractic treatment on students with learning and behavioral impairments resulting from neurological dysfunction (part 1). Brzozowske WT, Walton EV. J. Aust Chiro Assoc 1980;11(7):13-18. and Part II:   J. Aust Chiro Assoc 1980;11(8):11-17.

  • A group of 12 ADHD students reviing stimuland medication were compared to a group of 12 ADHD students receiving chiropractic care. The group receiving chiropractic care both hyperactivity and attentiveness improved along with gross and fine motor coordination. In the medicated group, hyperactivity and attentiveness improved initially (not gross and fine motor coordination) and the medication effectiveness decreased requiring higher dos-ages. Over half the medical group had personality changes, loss of appetite and insomnia relating to their treatment. The study concluded that chiropractic care was 20-40% more effective than medication.


9)   Webster, L. Chiropractic Showcase Magazine, Vol. 2, Issue 5, Summer 1994.

  • Case Study. Male - age 7 years. The child was placed under care on February 14, 1994 with the following clinical picture:

    Hyperactivity, stuttering, slow learner, retarded growth, left leg approximately 1" shorter than right with a limp while walking. Medical plans were to break the left leg, insert metal rods in an attempt to stimulate growth and equalize leg lengths. Our examination consisted of Metrecom evaluation, full spine X-rays, and chiropractic examination of the spine.
    Areas of subluxation were as follows:
    Sacrum anterior, inferior on left, 5th lumbar body left, atlas, anterior superior left.

    Patient was placed on an intensive correction program of 3 times weekly for a period of two months. During the first seven visits the legs were never balanced, however, each time a reduction of the short leg occurred. On the 8th, visit the legs balanced for the first time. Also noticed by 8th visit:
    1. The stuttering had stopped.
    2. The grades in school had risen from non-satisfactory to satisfactory.
    3. The hyperactivity had abated.
    4. The limp was no longer constant.

10)   Case study: the effect of utilizing spinal manipulation and craniosacral therapy as the treatment approach for attention deficit-hyperactivity disorder.   Phillips CJ.   Proceedings on the National Conference on Chiropractic and Pediatrics (ICA), 1991:57-74.

  • A 10-year-old boy with a three year history of hyperactivity, also suffering from ear infections, headache and allergic symptoms. Chiropractic analysis revealed multiple cervical, thoracic and pelvic dysfunctions. The boy also had multiple cranial faults. By the 11th chiropractic adjustment hyperactivity symptoms had abated (his other health problems had cleared up from earlier spinal adjustments). After 5 1/2 months relatively symptom free he had two falls and hyperactivity, headache and allergy symptoms returned. A single session of spinal and cranial adjusting revolved this exacerbation. A strong link between spinal "dysfunctions" and hyperactivity is suggested.


11)   A multi-faceted chiropractic approach to attention deficit hyperactivity disorder: a case report.   Barnes, T.A.   ICA Int'l Review of Chiropractic. Jan/Feb 1995 pp.41-43

  • From the author's abstract: an 11-year-old boy with medically diagnosed Attention Deficit Hyperactivity Disorder has been a patient and student at the Kentuckiana Children's Center for three years...His case shows a history of early disruptive experience, repeated ear infections, consistent temporomandibular joint dysfunction, heavy metal intoxication, food allergy, environmental sensitivity and multiple levels of biomechanical alteration. This report emphasizes the need for care in all aspects of the structural, chemical and mental triangle of health in children with attention deficit hyperactivity disorder. "He has improved academically and has advanced to the next grade level...he recognizes that he has control over his behavior and there is hope that he will be mainstreamed back into a regular public school setting soon...his mother says she notices improvement in his attention span and temper."


12)   Effects of biomechanical insult correction on attention deficit disorder.   Arme J.   J of Chiropractic Case Reports, Vol. 1 No. 1 Jan. 1993

  • Seven-year-old male was referred by his mother because of radical behavioral changes (uncharacteristic memory loss, inability to concentrate and general agitation) following a motor vehicle accident (other symptoms included loss of appetite, headache, difficulty in chewing, ear pain, hearing loss, difficulty in breathing through the nose, neck pain, and bilateral leg pain). An M.D. diagnosed "attention deficit disorder" and Ritalin was diag-nosed with partial improvement. After four months, the mother sought chiropractic care.

    Spinal analysis revealed anterolisthesis of C2 on C3, reversal of cervical lordosis from C1- C4. Correction was accomplished using the Thompson technique with the terminal point table, three times a week for 16 weeks and twice per week for one week....12 week follow up revealed restoration of cervical curve, with residual C2 anterolisthesis. At 17 weeks Ritalin was stopped by M.D., the patient's medically diagnosed attention deficit syndrome seems to have been solved as were the other symptoms. The mother discontinued chiropractic care after settlement and the patient's behavior symptoms gradually returned and is back on Ritalin.


13)   EEG and CEEG studies before and after upper cervical or SOT category 11 adjustment in children after head trauma, in epilepsy, and in "hyperactivity."   Hospers LA, V Proc of the National Conference on Chiropractic and Pediatrics (ICA) 1992;84-139.

  • Five cases were presented. Conventional EEG studies demonstrate responses of two chil-dren with petite mal (absent seizure) with potential for generating into grand mal. Upper cervical adjustment reduced negative brainwave activity and reduced the frequency of seizures over a four month period. In two cases of "hyperactivity" and attention deficit disorder, upper cervical adjustment reduced non-coherence between right and left hemi-spheres in one child and in another, CEEG demonstrated restoration of normal incidence of the alpha frequency spectrum. Increased attention span and improvement of social behavior were reported in both cases. A child rendered hemiplegic after an auto accident displayed abnormal brainwave readings. After adjustment, the CEEG demonstrated more normalized brainwave readings. Child was able to utilize his left arm and leg contralaterally to the injured side of the brain without assistance after upper cervical adjustments.

Review more research on ADD/ADHD at Chiro.Org


References:

From Koren Publications' brochure: Learning Disorders and Chiropractic

Palmer, D.D., The Art, Science and Philosophy of Chiropractic. Portland Printing House, 1910. Reprinted 1966, Davenport IA; Palmer College of Chiropractic.

Walton, E.V. Chiropractic Effectiveness with Emotional, Learning and Behavioral Impairments. International Review of Chiropractic, 29: 2-5, 21-22, September 1975.

Giesen J. M., Center D. B., Leach R. A. An Evaluation of Chiropractic Manipulation as a Treatment of Hyperactivity in Children. JMPT, October 1989; 12:353-363.

Feldenkrais, M., Body and Mature Behavior. Independence, MO: International University Press, 1949.

Lowen, A., Physical Dynamics of Character Structure. Grune and Stratton, 1958.