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Home Chiropractic Research ADD/ADHD Prospective Cohort of ADHD Patients Under Chiropractic Care

Prospective Cohort of ADHD Patients Under Chiropractic Care

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a common behavioral disorder of childhood. Prevalence estimates indicate that between 3-11 percent of children are affected by this disorder 1. The diagnosis of ADHD is based on a subjective evaluation of the core symptoms of impulsivity, inattention, and motor overactivity 2. The most well-studied and effective medical treatments have been psychostimulants such as methylphenidate and dextroamphetamine 3. Given the controversy with respect to the dubious diagnosis of ADHD and the questionable effectiveness and safety of psychotropic medication in this pediatric population; parents are spurred to consider “alternative” forms of treatment for their child with a diagnosis of ADHD. Parallel to the increase use of complementary and alternative medicine (CAM) in adults, CAM use in children has also become more prevalent 4.

Chiropractic, with its holistic and conservative approach to patient care has become the most popular choice of all the alternative therapies. Anecdotes and testimonials abound on the success chiropractic care in patients with ADHD but the scientific literature is virtually non-existent in the documentation of such successes. To the best of our knowledge, we are only aware of the following. In a single subject research design (N=7), Giesen et.al. 5 found five of the seven children showed improvement in mean behavioral scores from placebo care to chiropractic treatment, four of the seven demonstrated improvement in arousal levels, and the improvement in the group as a whole was highly significant. Agreement between tests was also high in this study. For all seven children, three of the four principal tests used to detect improvement (i.e., parent ratings of activity, motion recorder scores, electrodermal measures, and X-rays of spinal distortions) were in agreement either positively or negatively.

Recently, Bastecki et.al. 6 described the successful chiropractic care (i.e., symptom improvement with medical withdrawal of medication) of a 5-yr-old male with ADHD and facial ticks. Pre-treatment and comparative cervical spine radiographs reveal changes from a 12° kyphosis (C2-C7) to a 32° lordosis. Bastecki et.al. concluded that an improvement in cervical lordosis in patients with ADHD may be a desirable outcome.

To further contribute to the knowledgebase on the conservative care of patients with ADHD, we present the successful chiropractic care of patients with a diagnosis of ADHD.

Methods: A prospective cohort of pediatric patients comprised the study population. Inclusion criteria required a medical diagnosis of ADHD and that spinal adjustments were not contraindicated. The patient population underwent chiropractic care that may be characterized as a combination Gonstead Technique 7 and a nutritional supplementation program 8. Main outcome measure was a survey instrument for parents and teachers of ADHD patients to score a patient’s behavior/ performance at home and at school 8. Additionally, the types of medication prior to, during and following a period of chiropractic care were noted.

Results: Nine patients (8 males and 1 female) comprised the study population. The average age of the patients was 9.2 years (range: 2–15 years). A parent for each patient agreed to perform the questionnaire. Although the patients have variable lengths of care, ADHD symptoms based on parent survey for each patient demonstrate a steady improvement. Comparison of the initial and latest parent scoring for ADHD symptoms as a group demonstrated a 53% reduction. Teacher ratings were available for 4 of the 9 patients. Similarly to the parent survey, teacher ratings of these 4 patients demonstrated improvement in ADHD symptoms over time. Comparison of the initial and latest teacher ADHD symptom scoring demonstrated a 45% reduction. Of 5 patients under ADHD medication prior to chiropractic care; 3 patients were no longer on medication due to symptom improvement while the 2 remaining on medication were at decreased dosages.

Conclusions: The results of this study suggest that patients with ADHD may benefit from chiropractic care utilizing a combination of fullspine spinal manipulative therapy and nutritional supplementation. Additionally, this study provides information vital for higher- level research designs investigating the effectiveness and safety of chiropractic care in patients with ADHD.

Joel Alcantara, DC, MPH
Research Director, International Chiropractic Association, Media, PA, USA
and Private Practice of Chiropractic, San Jose, CA, USA

Jim Davis, DC
Private Practice of Chiropractic
St. Paul, MN, USA


References:

  1. Szatmari P: The epidemiology of attention deficit hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 1992;1:361-372.
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC). American Psychiatric Association; 2000. p. 86-102.
  3. Bennett FC, Brown RT, Craver J, et al: Stimulant medication for the child with attention-deficit/hyperactivity disorder. Pediatr Clin N Am 1999; 46:929–944.
  4. Pitetti R. Singh S, Hornyak D, Garcia SE, Herr S. Complementary and alternative medicine use in children. Pediatric Emergency Care. 2001;17:165-169.
  5. Giesen JM, Center DB, Leach RA. An evaluation of chiropractic manipulation as a treatment of hyperactivity in children. J Manipulative Physiol Ther 1989;12(5):353-363.
  6. Bastecki AV, Harrison DE, Haas JW. Cervical kyphosis is a possible link to attention-deficit/hyperactivity disorder. J Manipul Physiol Ther 2004;27:525e1-e5.
  7. Plaugher G, ed. Textbook of clinical chiropractic: a specific biomechanical approach. Baltimore: Williams & Wilkins, 1993
  8. www.nordicnaturals.com/professional/proefa.asp


Pathways Issue 4 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #04.

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