ADD / ADHD

Studies

Results of 2 separate studies reveal that hyperactivity, and other behavioral conditions respond well to chiropractic care and even exceed results seen from medication.

          Walton EV. The effects of chiropractic treatment on students with learning and behavior impairments due to neurological dysfunction. Int. Rev Chiro 1975; 29:4-5, 24-6

               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): 353-63 / Medline ID: 90111454

There exists a positive relationship between cranial motion restrictions and learning disabled children, as well as children with a history of an obstetrically complicated delivery.

          Upledger JE, The relationship of craniosacral examination findings in grade school children with developmental problems., J Am Osteopath Assoc 1978; 77(10):760-76 / Medline ID: 78193624

Children with ADHD and coordination problems were more than twice as likely to have a mother who smoked during gestation, compared with children who did not have ADHD. Many subjects with ADHD also experienced language problems (65% compared to 16% of children without the disorder). The study evaluated 113 6-year olds, including 62 who had been diagnosed with ADHD plus deficits in motor control and perception.

          Landgren M, Kjellman B, Gillberg C. Attention deficit disorder with developmental coordination disorders. Arch Dis Child 1998; 79(3):207-12 / Medline ID: 99092173

1971 - Study entitled "Hyperactive Children as Teenagers: A Follow - up Study". 83 Children were followed up on, from 2 to 5 years after being diagnosed as hyperactive or as having attention deficit. 92 % of the children were treated with Ritalin. Results were as follows:
    83 % had trouble with frequent lying
    78 % found it hard to sit still and study
    60 % of the children were still overactive and had poor schoolwork (the original reasons for being put on Ritalin), but in addition were now viewed as rebellious
    59 % had some contact with police
    59 % were viewed as a discipline problem at school
    58 % had failed one or more grades
    57 % had reading difficulties
    52 % were destructive
    44 % had arithmetic difficulties
    34 % threatened to kill their parents
    23 % had been taken to the police station one or more times
    15 % had talked of or attempted suicide.

Mendelson W; Johnson N; Stewart MA; Hyperactive children as teenagers: A follow-up study. J Nerv Ment Dis 1971; 153(4):273-9 / Medline ID: 72027685

1987 - Satterfield study states: "We found juvenile delinquency rates to be 20-25 times greater in our hyperactive drug-treated only group than in the normal control group." In the "Delinquency Outcome for the drug-treated group" the results were: of 61 Boys,
    46% were arrested for one or more felony offenses before age 18
    30% were arrested for 2 or more felony offenses
    25% were institutionalized
The authors go on to state "Studies of the long term effectiveness of drugs have been consistently discouraging." 

          Satterfield JH; Satterfield BT; Schell AM; Therapeutic interventions to prevent delinquency in hyperactive boys. J Am Acad Child Adolesc Psychiatry 1987; 26(1):56-64 / Medline ID: 87222077

1976 - Study by Riddle & Rapoport - it was concluded that among the continuously treated hyperactive children it was found that peer status and academic achievement did not seem to improve.

          Riddle KD; Rapoport JL; A 2-year follow-up of 72 hyperactive boys. Classroom behavior and peer acceptance. J Nerv Ment Dis 1976; 162(2):126-34 / Medline ID: 76121908

1976 - Study by Hechtman &Weiss stated: Thirty-five individuals aged 17 to 24 in whom severe chronic hyperactivity had been diagnosed 10 years before were studied together with 25 matched controls. Cognitive style tests indicated continued difficulty in reflection (resulting in more errors) but less impulsivity (longer reaction time) in the hyperactive individuals. Compared with controls, hyperactive subjects were continuing to have more scholastic difficulty, although this difference seemed to be less pronounced than 5 years before. Restlessness, both reported and observed, continued to be a problem for the hyperactive individuals, and socialization skills and sense of well being continued to be poorer than in the controls. The authors concluded that methylphenidate (Ritalin) did not significantly alter poor long-term academic performance, delinquent behavior or poor emotional adjustment.

          Hechtman L; Weiss G; Finklestein J; Werner A; Benn R; Hyperactives as young adults: Preliminary report. Can Med Assoc J 1976; 115(7):625-30 / Medline ID: 77023552

1978 - Study by Blouin stated the following: "Clinical treatment with Ritalin was found to have no beneficial effect, and there was some evidence to suggest a poor behavior outcome for the drug-treated group."

1980 - Ackerman report entitled "Report on Drug Withdrawal Symptoms"; "The abstinence (withdrawal) syndrome associated with amphetamines, methylphenidate (Ritalin) is marked by lethargy, sleep disturbances and prolonged depression." "Depression is perhaps the most significant symptom."

In the book, "Predicting Dependence Liability of Stimulant and Depressant Drugs" researchers Travis Thompson, Ph.D. and Klaus R. Unna, M.D. describe the "chronic effects of stimulants in man": "Perhaps the best-known effect of chronic stimulant administration is psychosis. Psychosis has been associated with chronic use of several stimulants; e.g., d- and 1- amphetamine methylphenidate (Ritalin-P), phenmetrazine and cocaine." 

          Thompson T; Unna KR; Predicting dependence liability of stimulant and depressant drugs. Published by University Park Press ISBN: 0839111479

1987 - The Diagnostic and Statistical Manual of Mental Disorders III-R, states: That methylphenidate (Ritalin), along with other amphetamine-type drugs and cocaine, can create "persecutory delusions" and may "cause a highly organized, paranoid delusional state indistinguishable from the active phase of schizophrenia." It states "The person may harm himself or herself or others while reacting to delusions." 

This American Psychiatric Association’s Manual goes on to state: "Initially, suspiciousness and curiosity may be experienced with pleasure but may later induce aggressive or violent action against ‘enemies’. Delusions can linger for a week or more, but occasionally last for over a year." This DSM III-R also states "Suicide is the major complication of withdrawal from methylphenidate and other amphetamine or amphetamine-like drugs."

          Diagnostic and Statistical Manual of Mental Disorders, Dsm-III-R. by American Psychiatric Association January 1987. ISBN: 089042019X

1991 - Journal of Behavioral Optometry, "The Efficacy of the Use of Ritalin For Hyperactive Children". This study evaluates 22 previous studies/articles since 1976 concerning Ritalin use for hyperactive children. It states: "The fact that the above studies do not show the efficacy of Ritalin for helping hyperactive children should be apparent to the skeptic and make a skeptic out of the believer. But the argument should not stop at this point. The weak evidence of the value of Ritalin must now be viewed in the light of its reported side effects." And it concludes: "...at this time there is scant evidence for the use of Ritalin in hyperactive children to produce improved learning. This lack of evidence is consequential because of the many side effect produced by Ritalin administration."

1988 - Journal of the American Academy of child and Adolescent Psychiatry, January 1988 Case Study entitled: "Methylphenidate-induced Delusional Disorder in a Child With Attention Deficit Disorder With Hyperactivity" discusses a case study involving a 6 year old child, J. R. who was placed on 20mgs of Ritalin in the morning and 10mgs in the afternoon, but due to measurable weight loss after 1 ½ months the dosage was decreased to 20mgs. After 4 months the child was placed on 20mgs of the sustained released Ritalin, the results were as follows: "Approximately 6 months into therapy, J.R.’s mother reported that the child was becoming physically and verbally aggressive and difficult to manage. He was agitated and verbalized repeatedly that "someone" was " going to kill "him." ...the child was suspicious and delusional, accusing others of thinking homicidal thoughts towards him " "J.R.’s stimulation (Ritalin) therapy was terminated and his behavioral disorganization and psychosis resolved completely over the next several days but only with a full return of his attention problems and hyperactivity." The conclusion: "J.R.’s psychological disturbance certainly seemed to have been associate with his methylphenidate therapy." The final paragraph of this study states: "Young (1981) suggested that psychotic reaction to stimulants in children may be common, as prescribing physicians are generally less alert to possible signs of toxicity when these medications are prescribed within normally accepted dose ranges. J.R.’s reaction was certainly more intense than what has usually been described and it is unlikely that his behavioral changes would have gone unnoticed indefinitely. On the other hand, as most reported instances of psychotic reactions in children have involved less dramatic behavioral changes, such as tactile hallucinosis, there may be considerably potential for such changes to remain unrecognized for prolonged periods of time." 

          Bloom AS; Russell LJ; Weisskopf B; Blackerby JL; Methylphenidate-induced delusional disorder in a child with attention deficit disorder with hyperactivity. J Am Acad Child Adolesc Psychiatry 1988; 27(1):88-89 / Medline ID: 88139122

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The Hyperactive Child and Chiropractic

By: Larry Webster, D.C
Originally printed in: Todays Chiropractic Jan/Feb 1988; 17(1):73-4

Depending on which study you read, there are now 1.5 to 3.5 million children who have been diagnosed as having attention deficit disorder with hyperactivity (ADDH). In some cases, the terms hyperkinetic and attention span deficiency cover the same diagnosis. Recent publicity has focused on the medical approach of using Ritalin (a stimulant medication) in these cases. This particular type of drug has been used for a longer period, and more frequently by far, than any other psychoactive drug administered for childhood psychiatric disorders. Its efficacy and side effects are well documented and are part of the chemical treatment used by most, if not all, child and adolescent psychiatrists.

Characteristics of ADDH
In using medication to "control" child the child's behavior pattern, the results are inconsistent and controversial. One child may become subdued and controllable, while others may become even more "hyper" and uncontrollable. In several case studies, it seemed initially that some improvement was obtained from medication, but later serious side effects developed and the child lapsed back into the original symptoms. Other symptoms developed, as well. The most common of these were nail biting, crying easily, and irritability. Several children bit their fingernails until they bled while manifesting no sign of pain during the biting.

In medical studies of ADDH, there is evidence that diminished activity of the brain DA may exist and that this neurotransmitter abnormality may contribute to the pathophysiology of this syndrome. With this evidence of a neurotransmitter abnormality and the inherent danger of side effects of the medication, a serious look at the chiropractic approach to this disorder must be made.

In our early studies of hyperactivity we observed interconnecting factors in the hyperactive child. One, a diet heavy In sugar-rich foods and/or junk foods was revealed. Two, a chronic subluxation of the upper cervical spine, mainly the atlas vertebra, was presented.

Regarding neurotransmitter abnormality with a chronic upper cervical subluxation, we now have the start of chiropractic management of ADDH. In the early 1950's, a study by Dr. George Malcolm of Canada labeled the spine as a "shock organ". By this, he meant that certain chemicals, food preservatives, dyes, or other pollutants could cause the spine to subluxate. Although this particular observation that chemicals can produce subluxations was not new in chiropractic, perhaps the term "shock organ" was new.

After reading this study, we began our own study on children focusing on the effect of these "chemicals" producing subluxations. The study utilized pre and post examinations in the following manner. The hyperactive was checked via nerve instrument, palpation, and thermographic plates. The adjustment (usually a toggle-type) was made, and after 15 minutes a post examination was made to determine a change.

Some very interesting observations were made while establishing the effect of these "chemicals" producing a subluxation, thereby indicating the possibility of initiating a neurotransmitter abnormality, and the bottom line of ADDH, in the child. In the studies, each child was asked to keep a diet diary, containing records of everything ingested in a two week period. Then, we determined whether one of these foods could be producing a subluxation, discovered in Malcolm's studies.

We could examine the child, record our findings, and then have the child ingest the suspected substance. Our findings did indicate the spine was a "shock organ", and certain preservatives, food dyes, and processed sugars did produce abnormal readings after immediate ingestion of the chemical. In some of the cases, we could have the child change his diet, monitor and adjust it, and then find our readings greatly reduced. We also felt that the subluxation was greatly reduced.

In several of the study groups, we would have the child immediately ingest the suspected chemical irritant after our post-improvement findings. On re-examination, our readings were off the wall again. Our conclusion was that in a chronic subluxation, as in these children, it took less and less chemical irritant each time to maintain the subluxation.

One of the major problems in treating the hyperactive child is dietary control. So many food products can irritate the nervous system that the chiropractor may have a difficult time eliminating or finding the "shock" food. We also found that parents at times chose not to exercise dietary control over their child, even though it may benefit the child's health care. The youngster wakes up to find a sugar laced cereal (such as Apple Jacks, Lucky Charms, or Crunch Berries) on the table for breakfast. In the grocery store, you can find more than 100 brands of cereal which have a sugar content of up to 68 percent. (If you write us, we can send you a list of the sugar content of approximately 80 of these cereals.) In many cases, not only will the child be served cereal with a high sugar content, but he will then place extra sugar on the cereal.

In the case of food dyes, you must be careful of red and yellow colorings. These seem to be major irritants. Forty years ago, the chiropractor did not have to pay much attention to dietary effects on the subluxation. dyes, preservatives, and other chemicals were not found in food products. Now, with studies indicating that the spine can subluxate in reaction to these additives, we must heed these factors and isolate them.

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© 1996-2003 Craig M. Anderson, D.C.