A Patient’s Perspective – April 2005 (ADD/ADHD)

Welcome to my latest newsletter which looks at Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD). As there is an increasing tendency for drugs to be prescribed to our children and lately adults for the treatment of this condition I felt that it is timely to provide some information with regards to the potential treatment of this disorder using an upper cervical chiropractic approach.

I hope you enjoy this edition and as always feel free to provide me with any feedback and suggestions to info@upcspine.com. The purpose of my newsletters is to challenge the mainstream thinking on what may be the cause of some conditions and to encourage researchers to think outside the ‘normal’ boundaries when looking for solutions. I am a patient and not a medical practitioner; however I am entitled to my own opinions. People are free to disagree with me. My newsletters are provided as an informational source only, and are not a medical opinion. Therefore you should do further research for yourself and make your own decisions.

Condition Report

Attention Deficit Hyperactivity Disorder (ADD/ADHD)

I recently watched a TV news show in which a doctor was being interviewed about Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD). Apart from the increasing numbers of children being diagnosed with these disorders the doctor claimed that around 4% of the US adult population was also suffering from the disorder. Ah! I thought here we go, yet another market opportunity opens up for pharmaceutical companies. It made me think about the current drug advertising. Some of the current drug advertisements make you feel like you are missing out on something and that you should run straight to your doctor to get a prescription! Isn’t it amazing to think that a product which is supposed to help sufferers of diseases is peddled as if it was the latest consumer ‘got-to-have’! Such are the dynamics of a global multi-billion dollar drug industry.

Mercola and Droege[1] reported (2004) that “well over 1 million American children are on drugs for ADHD” and “that drugs for attention disorders bring in $2.2 billion a year” despite evidence that “the effect of treatment beyond four weeks has not been demonstrated. In other words, no one knows what the long-term effects will be.” Mercola and Droege further state that “Although it is estimated that more than 8 million adults in the United States have ADHD, the disorder is typically thought of as something that is outgrown during adolescence. Why, then, would adults need these drugs? Perhaps it has something to do with one pharmaceutical executive’s statement in a Reuters interview, “The adult market is three times the size of the children’s market. The market is ripe and is moving in the right direction.”

A newspaper article[2] recently reported a case of a woman who was incorrectly diagnosed with bipolar disorder and ADHD and subsequently prescribed medications. According to the article she “suffered a drug induced psychosis from the range of medications which included Prozac and dexamphetamine.” Additionally she was told that her 7 year old son had ADHD which turned out to be yet another misdiagnosis. The article goes on to say that “doctors are increasingly prescribing drugs to treat an array of conditions including ADHD” and “despite ongoing education campaigns and research into ADHD, debate about the prevalence and treatment of the condition continues.” Further a report in the lower house of the West Australian parliament “estimated 11,500 children in that state – some as young as two were prescribed psychostimulant drugs, mainly dexamphetamine, for ADHD.” Perhaps even more disturbing is that a survey of parents “found 11 per cent thought their child was suffering from the symptoms of ADHD.” The article concludes with figures showing that prescriptions for dexamphetamine (the top-selling ADHD drug) rose from 46,000 in 1994 to 246,000 in 2004 in Australia. Sadly this trend is increasing.

For those of you who read my Parkinson’s disease blog you will note that I covered off on Dr Fernandez-Noda’s[3][4][5][6] assertion and findings that Parkinson’s and other diseases (Alzheimer’s, multiple sclerosis & epilepsy) may well be a consequence of a reduction of oxygenated blood flow to the dopamine producing cells of the brain and compression of the brachial plexus of nerves, the assumption being that the restoration of correct blood flow and nerve impulse amplitude may well have a positive effect on peoples’ health and go some way towards reversing this condition.

Why do I mention Parkinson’s disease in an ADHD newsletter you ask? Well as I started to research various treatments I found that the dopamine link could also be found in pharmaceutical approaches to treating ADHD. Many imaging studies of children with this ADHD have found an imbalance of the neurochemical dopamine. Methylphenidate, (Ritalin) a dopamine reuptake inhibitor, is the most common pharmaceutical treatment for attention-deficit hyperactivity disorder despite there being little evidence of any long-term benefit, nor knowledge of potential chronic side-effects. However, according to Gottlieb[7] reporting on an article in the Journal of Neuroscience, “Methylphenidate works in the treatment of attention deficit hyperactivity disorder by increasing levels of dopamine in children’s brains”. Apparently “the drug seems to raise levels of the hormone by blocking the activity of dopamine transporters, which remove dopamine once it has been released.”

If Parkinson’s, Alzheimer’s, multiple sclerosis, epilepsy and now ADHD drug treatment targets dopamine depletion, could there be a common causal link in all of these diseases? If the end result is dopamine depletion then I assume the causal link could be something which reduces the production of dopamine? Could Fernandez-Noda et al be correct in their conclusions that it is muscular compression of structures (arterial and neurological) which is the causal factor in the lack of dopamine production? Seems quite plausible I would think and certainly worthy of at least some amount of focus from research organizations. Given that all of these conditions reportedly respond positively to upper cervical chiropractic treatment to realign the relationship between the skull and cervical vertebrae could the causal link be upper cervical subluxations causing compression of neurovascular structures at the base of the skull and/or further down at the base of the neck, where it meets the shoulders?

The phenomenon of upper cervical subluxations causing various health issues needs to be researched vigorously now, and I call on all Governments to pour funds into upper cervical chiropractic research. I have found it no use whatsoever approaching various research organizations to get them to put some of their funds towards chiropractic research. They are usually polite but dismissive that chiropractic would produce any positive results. Surely scientists need to keep an open mind when it comes to research and investigate all avenues and claims?

Conservative treatment for ADHD is becoming a viable alternative as my research shows. In particular the application of manual therapy (chiropractic) appears to result in both reversal of the condition and the elimination of the need for administration of pharmaceuticals.

I came across a really wonderful book “Manual Therapy in Children”[8] edited by Heiner Biedermann which communicates the benefit of manual therapy in the treatment of children for various disorders including ADHD. When one reads this book one could be forgiven for thinking one was reading a chiropractic textbook because it discusses and advocates the manipulation of the skeleton including the upper cervical spine using many of the approaches developed by chiropractors over decades. The book is a great reference for any practitioner.

In fact, this book has contributions from various medical doctors (MD) including surgeons! In the ‘Introduction’ (p5) Biedermann says “the problems associated with and labeled ADHD have a close connection with problems originating in functional spinal disorders”. At the end of the book, in the ‘Epilogue’ (p321), as if out of frustration he says “From the inside out it (manual therapy) is a wonderfully all-encompassing variant of the healing professions” and it is “this very ability which turns manual therapy into an unwelcome guest of one’s own field of work.” He cites comments from his peers like “How dare these people claim to solve problems which have been hounding us for many years … branding those intruders as confidence tricksters.” Sound familiar? If you have been following the chiropractic scene you would immediately see the parallels between what Biedermann and his associates are now facing from their own peers and the systematic denigration of chiropractic over the past century. The fact is that Biedermann et al are right on the money and history will eventually show that they and chiropractors have been right all along.

Chapter 12[8], “Attention deficit disorder and the upper cervical spine”, 133-42; Theiler R. DrMed FMH is of particular significance for this newsletter. Theiler discusses findings relating upper cervical spine (sub-occipital) subluxations or what they call KISS (kinematic sub-occipital strain syndrome) to ADD/ADHD. In particular he notices that children with ADHD exhibit postural distortions and associated movement deficits of the upper cervical spine. He finds that following manual therapy applied to the cervical spine not only do postural deficits resolve in the children but so do concentration and cognitive abilities. As such visual concentration span and thus reading difficulties were improved immediately following manual manipulation. “Ten children achieved an oral reading fluency appropriate for their age usually in the days following therapy.” Interestingly there is a discussion about one of the main findings being “reduced capacity for processing information” which is “an expression of deficiencies in executive functions, which are carried out in the dopamine-dependent structures of the frontal lobe and corpus striatum.”

The chapter finishes with the discussion of three case studies of ADHD, the first one (p139) of a female 7.2 years who apart from a “fall from a swing” had no other trauma. She showed “persistent postural asymmetry and insufficient gross motor functions” and “her attention span was short and she was impulsive when assigned tasks.” Examination revealed head tilted to the right and rotated to the left with a C1/C2 blockage. She was treated with manual therapy left C1/C2. Apart from initial giddiness, her posture straightened and motor coordination improved and her verbal capacities and visual component became better than an 8 year old. A later reoccurrence of the subluxation was subsequently corrected following a relapse, and after the correction things returned to normal again.

The second case study (p140) is of 6.5 years female who was born with a fractured clavicle. It was noticed that as she developed, her clumsiness was remarked and drawing and scribbling skills lagged her age group. At age 6 she could not use scissors nor fasten her shoes and jumping on one leg was impossible for her. Fine motor tasks were also below par and her memory capacity and processing capacity were 1.5 years below average. An examination revealed impaired side bending of the head and reduced left sided rotation, as well she had “excessive thoracic kyphosis.” X-rays showed “a lateral displacement of C1/C2 to the right”, in other words upper cervical subluxation. The treatment administered was “a sagittal impulse on C1 and a HIO C1/C2 from the right side (impulse manipulation).” I take the HIO reference to mean “Hole-in-One” as developed by B.J. Palmer http://www.upcspine.com/tech8.htm. Two months post the manipulation and even though the mother reported no change, the doctors found she now had unhindered head movements, could “jump a bit on one leg now”, was more considered and less impulsive when working, was able to concentrate longer and her verbal memory was now +2 years her age. Her mother conceded an improvement when showed comparisons of test results.

The third case study (p141) is of a 11.5 years female with concentration and long term attention span problems, fine motor coordination difficulties with increasing speed, problems with writing and becoming impulsive when tackling difficult tasks. “In copying of dots and in repeating nonsense syllables, her performance was at the level of an 8 – 8 1/2 year old.” Examination revealed scoliosis with associated postural deviations, a blockage at the SI joint, right head tilt, C1/C2 blocked on the right and x-rays revealed “an offset of the atlas to the right”. Hmmm … sounds like upper cervical subluxation to me. The family decided upon Ritalin therapy and the girl improved immediately. After a time manual therapy was finally applied and simultaneously the medication was stopped. She was able to function normally without medication but the parents requested resumption of the Ritalin to see if they could get further improvement. When it was determined there were no more “perceptible gains” the medication was stopped. The improvements have lasted well into the next school year. The authors conclude “we are in favour of examining and treating functional problem of the cervical spine …. even if a pharmacotherapy seemed top have already resolved the problem at hand.”

Erin Elster[9] reports in a case study about a 9 y.o. boy suffering from Tourette syndrome, Attention Deficit Hyperactivity Disorder (ADHD), depression, asthma, insomnia and headaches that he was born via forceps delivery and was taking various medications for his conditions. Chiropractic examination revealed evidence of an upper cervical subluxation and he was treated with an upper cervical chiropractic technique (IUCCA) http://www.upcspine.com/tech12.htm. After 6 weeks of care all six (6) conditions were absent and all medications except a small amount of one were discontinued. Five months post all symptoms remained absent. Elster suggests a link between the patient’s traumatic birth, the upper cervical subluxation, and his neurological condition. Further research is suggested.

In another case Giesen, Center and Leach[10] discuss 4 of 7 children who showed statistically significant improvement in their ADHD condition following specific chiropractic care and although not conclusive the authors suggest that chiropractic manipulation has the potential to become and important non-drug intervention for children with hyperactivity.

Interestingly a newspaper article[11] suggests “Head injuries could be responsible for some behaviour disorders in children and adolescents, a study has found. As many as 20 per cent of children who have suffered mild head injuries through sport or playground falls may develop symptoms years later. These symptoms, according to Uni of New England lecturer Dr James Donnelly, may be misdiagnosed as ADD or attitude or motivational problems. “Blows to the head that cause changes in the child’s ability to think clearly, especially those that cause a loss of consciousness, may have jarred the brain in the skull,” Dr Donnelly said. A well known Sydney neurosurgeon once told me that the results of brain injuries are usually evident immediately and do not become evident years later. I think that this is just another piece of evidence that the contributing event to many conditions is head and/or neck trauma, and I think one could rightfully conclude that this leads to an upper cervical subluxation. I’ve also heard that Daniel G. Amen the author of “Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD” runs a clinic for treating ADD/ADHD in California and apparently when someone goes to his clinic they will be asked no less than 5 times whether or not they have sustained a head injury. I also find many people on discussion forums questioning whether or not a head injury was the initial event in their disease or condition. It seems many people do recall a head injury prior to the onset of symptoms. I know I did!
In a case study Bastecki et al[12] report that a 5 year-old patient diagnosed by a medical practitioner with ADHD and for which Ritalin treatment for 3 years was not effective, and who exhibited cervical kyphosis (reversed neck curve), underwent multiple chiropractic treatments. During chiropractic care the child’s facial tics and behaviour vastly improved and the child’s paediatrician stated that the child no longer exhibited the signs of ADHD. The reduction in symptoms was significant enough to discontinue medication. The authors suggest a possible correlation between cervical kyphosis and ADHD.

In 1995 Lahat et al[13] in a study of 114 children with ADD concluded that they have brainstem dysfunction as measured using BAEP (brainstem auditory evoked potentials) and that BAEP, may contribute to the diagnosis of ADD. Wehrenberg and Mulhall-Wehrenberg[14]in their SIDS book discuss how an upper cervical (atlas) subluxation can affect the brainstem area in SIDS kids.

Hospers[15] presents case studies of 5 children, two with petit mal (absent seizures), two with hyperactivity and attention deficit disorder and one rendered hemiplegic (one-sided paralysis) following a car accident. Following upper cervical  adjustment in the seizure cases a reduction in the frequency of seizures resulted, for the ADHD cases, increased attention span and improvement of social behaviour were reported and in the hemiplegia case the child was able to utilize his arm and leg without assistance.

McPhillips et al as discussed in Kirk Eriksen’s book[16] studied 60 children with “persistent primary reflexes (relating to the balance system) and reading difficulties”. In a number of studies there has seen to be a correlation between movement disorders or problems and reading difficulties. This study also found such a link and the authors suggest a “new approach to the treatment of reading difficulties involving assessment and remediation of the underlying neurological functioning.”

Robert Goodman presents a case history of a 9 y.o. female diagnosed with ADD “with signs of hyperactivity, short attention span and poor impulse control”. Examination revealed postural distortions consistent with upper cervical insult and X-rays revealed atlas subluxation complex and hypolordotic cervical curve. A NUCCA www.nucca.org upper cervical adjustment was delivered and follow-up results indicated a complete remission of the symptoms associated with ADD.

There are two further references in Kirk Eriksen’s book p404[16] one being a Peet[17] case of a 4 y.o. child whose ADHD and asthmatic symptoms improved following upper cervical adjustment and Hospers et al[18] a case of a 15 y.o. with a history of head injury and concussion. His EEG showed “lack of synchronization of alpha and beta frequencies between left and right hemispheres” and he exhibited restlessness and “compulsively handled objects around him”. Following upper cervical adjustment the restlessness and compulsiveness resolved and his social communication improved. A follow-up EEG revealed synchronisation between alpha and beta frequencies.

Summary

To me it seems quite plausible that sub-occipital strain caused by upper cervical subluxations can cause problems for young children. When your head is not on straight you experience all kinds of symptoms. It also makes complete sense that following a well administered precision upper cervical adjustment that these kids’ symptoms improve or disappear. The explanation can only be that these skull base subluxations do occur and do interfere with the body’s normal control mechanisms and blood flow to and from the brain. Let’s get serious and put at least a fairer portion of available research funds toward ‘disease analysis and correction utilising upper cervical chiropractic methodologies and techniques’. We owe it to our kids to open up every avenue and analyse every possible option for the eradication of the symptoms associated with Attention Deficit Hyperactivity Disorder.

Suggested Further Reading

1. International Chiropractic Pediatric Association (I.C.P.A.); http://www.icpa4kids.org/research/chiropractic/adhd.htm

2. Phillips C: “Case study: the effect of using spinal manipulation and craniosacral therapy as the treatment approach for attention deficit-hyperactivity disorder.” Proceedings of the National Conference on Chiropractic and Pediatrics 1991, P. 57.

3. Anderson C, Partridge J: “Seizures plus attention deficit hyperactivity disorder.” International Review of Chiropractic Jun 1993; P. 35.

4. Barnes T: “A multi-faceted approach to attention deficit hyperactivity disorder: a case report.” International Review of Chiropractic Jan/Feb 1995; P. 41.

5. Barnes T: “Attention deficit hyperactivity disorder and the triad of health.” Journal of Clinical Chiropractic Pediatrics 1996;1(2):59.

6. Thomas M, Wood J: “Upper cervical adjustments may improve mental function.” Manual Medicine 1992;6(6):215.

7. Walton EV: “The effects of chiropractic treatment on students with learning and behavioral impairments due to neurological dysfunction.” International Review of Chiropractic 1975;29(4-5):24

8. Jacinda’s Story – Tourette Syndrome and ADHD – http://www.kentuckiana.org/jacinda.html

9. Stephen’s Story – ADHD – http://www.kentuckiana.org/stephen.html

10. Tucker’s Story – ADHD, Autism, Depression – http://www.kentuckiana.org/tucker.html

11. Erin Elster Case Studies – http://www.erinelster.com/Case%20Studies/pediatric_case_studies.html

12. The Chiropractic Resource Organization – http://www.chiro.org/pediatrics/ADD.shtml#Articles

13. Chiropractic First site

References

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[1] Mercola, J and Droege R; Adults With ADHD: Don’t Become the Next Drug Target … Here’s How to Treat it Naturally; 2004, June 26th

[2] Clara Pirani, Unhappy Pills; The Weekend Australian, January 29-30, 2005, 19-20

[3] Fernandez Noda EI, Lopez S; Thoracic outlet syndrome: Diagnosis and management with a new surgical technique. Herz 9 (1984), 52-56 (Nr.1)

[4] Fernandez Noda EI, Lugo A, Berrios E, Rodriguez de Valle J, Alvardo F, Buch MS, Perez Fernandez J; A new concept of Parkinson’s disease as a complication of the Cerebellar Thoracic Outlet Syndrome. Japanese Annals of Thoracic Surgery 1987;7(3):271-5

[5] Fernandez Noda EI, Nunez-Arguelles J, Perez Fernandez J, Castillo J, Perez Izquierdo M, Rivera Luna H; Neck and transitory vascular compression causing neurological complications-Results of surgical treatment on 1,300 patients. J cardiovasc surg 1996;37(Suppl. 1 to No. 6):155-66

[6] Fernandez Noda EI, Rivera Luna H, Perez Fernandez J, Castillo J, Perez Izquierdo M, Estrada C; New concept regarding chest pain due to hypoxia of the internal mammary arteries in more than 1,600 operated patients with cerebral thoracic neurovascular syndrome (CTNVS). Panminerva Med 2002;44:47-59

[7] Gottlieb, S New York ; Methylphenidate works by increasing dopamine levels. BMJ 2001;322:259 (3 February) http://bmj.bmjjournals.com/cgi/content/full/322/7281/259/b

[8] Beidermann, H (MD) edited by; Manual Therapy in Children; Elsevier Limited 2004, Churchill Livingston http://www.elsevier.com/wps/find/bookdescription.cws_home/695526/description#description

[9] Elster, E, D.C.; Upper Cervical Chiropractic Care For A Nine-Year-Old Male with Tourette Syndrome, Attention Deficit Hyperactivity Disorder, Depression, Asthma, Insomnia, and Headaches: A Case Report; Journal of Subluxation Research (JVSR); July 12, 2003 www.jvsr.com

[10] Giesen JM, Center DB, Leach RA; An evaluation of chiropractic manipulation as a treatment of hyperactivity in children; Journal of Manipulative and Physiological Therapeutics (JMPT); 12(5):353-63; (Oct 1989)

[11] The Sunday Telegraph, Sydney, Australia ;Head Injury Warning; Sunday Telegraph (July 1st, 2001) pg 27

[12] Bastecki AV, Harrison DE, Haas JW; Cervical kyphosis is a possible link to attention-deficit/hyperactivity disorder; Journal of Manipulative and Physiological Therapeutics (JMPT); 2004 Oct;27(8):e14

[13] R. Frank Gorman, M.B.B.S., D.O. Monocular Scotomata and Spinal Manipulation: the Step Phenomenon; Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 19, No5, 344-49; (June 1996)

[14] Wehrenberg C, Mulhall-Wehrenberg T; The Best-Kept Secret to Raising a Healthy Child .. and the Possible Prevention of Sudden Infant Death Syndrome (SIDS), Publisher: Specific Chiropractic 2000

[15] Hospers LA: EEG and CEEG studies before and after upper cervical or SOT Category II adjustment and children after head trauma, in epilepsy, and in ‘hyperactivity; Proceedings of the National Conference on Chiropractic and Pediatrics 1992:84

[16] Eriksen, Kirk; Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. , pp150-55. Publisher: Lippincott Williams & Wilkins 2004; www.lww.com

[17] Peet JB; Hyperactivity and Attention Deficit:A Chirpractic Perspective; AM J Clin Chiopr, 1993: 3(3):5

[18] Hospers LA, Zezula L, Sweat M;Life Upper cervical Adjustment in a Hyperactive Teenager; Today’s Chiropractic, 1987, 15(16):73-75