ADHD and  Chiropractic
Upcoming SlideShare
Loading in...5
×
 

ADHD and Chiropractic

on

  • 1,428 views

 

Statistics

Views

Total Views
1,428
Views on SlideShare
1,408
Embed Views
20

Actions

Likes
0
Downloads
45
Comments
0

2 Embeds 20

http://www.linkedin.com 11
https://www.linkedin.com 9

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • MAKE CHANGES TO THIS SLIDE

ADHD and  Chiropractic ADHD and Chiropractic Presentation Transcript

  • ADHD A CHIROPRACTIC PERSPECTIVE Martin Rosen, DC, CSPP 471 Washington St. Wellesley, MA. 02482 781.237.6673 . [email_address]
  • SOCIOLOGICAL EFFECTS
  • There is a disturbing statistical trend concerning autism, mental retardation, speech and language disability, and learning disabilities (including ADHD) in the state of California. Specifically, between 2000 and 2007 autism incidences increased 229%, mental retardation increased 6%, and speech and language disability increased 7%. In 2007 the number of children with autism was officially recorded as 46,196; the number of children with mental retardation was 43,113; the number with speech and language disability was 176,265; and the number with learning disabilities was 297,933.
  • According to the February 2002 issue of CNS Drugs, the diagnosis of ADHD grew 250% between 1990 and 1998. The number of children in special education programs classified with learning disabilities increased 191% between 1977 and 1994, according to an article in Advances in Learning and Behavioral Disabilities, Volume 12, published in 1998.
  • According to the FDA, ADHD affects about 3 to 7 percent of all school-aged children and about 4 percent of adults. It causes difficulty in maintaining concentration, hyperactivity and impulsiveness leading to difficulty in school, at work and in social interactions. In 2006 approximately 4.5 million children were diagnosed with ADHD that number is now estimated to by around 8 million. (19,20) In 2006 approximately 2.5 million children and 1.5 million adults in the United States take medication to treat ADHD that number has now doubled. The number of adults between the ages of 20 and 44 taking ADHD medications increased more than 139 percent between 2000 and 2005.
    • These disorders have an enormous impact on families and society. According to the 1996 book Learning Disabilities: Lifelong Issues, children with these disorders have higher rates of mental illness and suicide, and are more likely to engage in substance abuse and to commit crimes as adults.
    • A classroom with 30 students will have between 1 and 3 children with ADHD.
    • Boys are diagnosed with ADHD 3 times more often than girls.
    • Emotional development in children with ADHD is 30% slower than in their non-ADHD peers.
    • One fourth of children with ADHD have serious learning disabilities such as: oral expression, listening skills, reading comprehension and/or math.
    • 65% of children with ADHD exhibit problems in defiance or problems with authority figures. This can include verbal hostility and temper tantrums.
    • 75% of boys diagnosed with ADD/ADHD have hyperactivity.
    • 60% of girls diagnosed with ADD/ADHD have hyperactivity.
    • 50% of children with ADHD experience sleep problems.
    • Teenagers with ADHD have almost four times as many traffic citations as non-ADD/ADHD drivers. They have four times as many car accidents and are seven times more likely to have a second accident.
    • 21% of teens with ADHD skip school on a regular basis, and 35% drop out of school before finishing high school.
    • 45% of children with ADHD have been suspended from school at least once.
    • 30% of children with ADHD have either repeated a year in school
    Diagnosis of ADHD increased an average of 3% per year from 1997 to 2006.
  • ADHD and LD are among the most prevalent and widely researched diagnoses of U.S. children. The economic effect of these conditions on families, schools, and the health care system is substantial. A recent review, using conservative prevalence estimates, calculated the annual societal ‘‘cost of illness’’ for ADHD to be between $36 and $52 billion in 2005 dollars (12). Additionally, a recent national survey of special education students showed that children with ADHD are a rapidly growing group of students within special education programs (13).
  • About 17% of school-age children in the United States suffer from a disability that affects their behavior, memory, or ability to learn, according to a study published in the March 1994 issue of Pediatrics by a team from the Centers for Disease Control and Prevention (CDC). The list of maladies includes attention deficit/hyperactivity disorder (ADHD), autistic spectrum disorders, epilepsy, Tourette syndrome, and less specific conditions such as mental retardation and cerebral palsy. All are believed to be the outcome of some abnormal process that unfolded as the brain was developing in utero or in the young child.
  • DIAGNOSIS OF ADHD
  • ADHD is a “persistent and frequent pattern of developmentally inappropriate inattention and impulsivity, with or without hyperacvity.” (8) While organic factors may play a role in the diagnosis of ADHD, there is little evidence that children with ADHD have any real organic clinical findings since evaluations usually focus on brain function. The major factors in diagnosis are behavioral and visual-motor tasks. (11)
  • Childhood ADHD is diagnosed after a child has shown six or more specific symptoms of inactivity and/or hyperactivity on a regular basis for more than six months in more than two settings. There is no single test for ADHD. QEEG’s have shown that children with ADHD have an increased number of lower range theta waves in a conscious state than found in the normal population. “ Persons with ADHD, learning disabilities, and head injuries tend to have excess slow brain waves (usually delta, slow theta, and sometimes excess alpha).”
  • “ When excess slow wave activity is present in the executive (frontal) part of the brain, it is difficult to control attention, behavior, and emotions. Such persons may have serious problems with concentration, memory, controlling impulses and moods, or with hyperactivity. They can’t focus well and exhibit diminished intellectual efficiency.” (17)
  • Another prevalent theory states that when the two sides of the brain do not mature at the same rate, the electrical impulses between the two sides get out of balance and interfere with communication. Proof now exists that this communication problem is responsible for a myriad of behavioral, social and learning difficulties. Most notably Autism, ADHD, Asperger’s syndrome and dyslexia. (18)
    • Physical diagnosis occurs when these children exhibit:
      • Constant motion
      • Squirm and fidget.
      • Do not seem to listen.
      • Have difficulty playing quietly.
      • Often talk excessively.
      • Interrupt or intrude on others
      • Are easily distracted.
      • Do not finish tasks.
    • Some causes of ADHD like behavior or triggers for ADHD are:
        • A sudden life change (divorce, death in family, moving)
        • Undetected seizures
        • Medical disorders affecting brain function
        • Anxiety
        • Depression
        • Inappropriate, lack of, or overabundance of neurotransmitter chemicals.
          • These are susceptible to such things as fatigue, essential fatty acid and micronutrient deficits, oxygen deprivation, toxic chemicals and drugs
        • Genetic predisposition (it is important to note that this is usually triggered by an external source)
  • CHIROPRACTIC PARADIGM
  • The late past president of the American Public Health Association Helen Rodriquez-Trias was among the first to recognize the importance of chiropractic care of infants and children. As a Fellow in the American Academy of Pediatrics and former Director of Pediatrics at Lincoln Hospital in New York, she indicated in her Forward to a new textbook on chiropractic from children she accepted her invitation to write this treatise with both gladness and trepidation. Gladness because she firmly believed that chiropractic fundamentally promotes health for children; trepidation because as a pediatrician she has been indoctrinated to totally reject chiropractic and chiropractors, and who overcame prejudice and fear only two decades ago through my own direct experience. (16)
    • Chiropractic’s main concern is the evaluation of the spine and central nervous system to detect structural or biophysical aberrations (subluxations) that cause one or more of the following abnormal neurophysiological consequences: (1)
      • Abnormal joint mobility (either hypo or hyper)
        • Affects proprioceptive and nociceptive input
        • Creates compensatory reactions (muscles)
        • Lowers adaptive threshold due to biomechanical stress (Dr. Ron Sperry, Nobel Laurate)
      • There is evidence that spinal dysfunction of various kinds has an effect on central neural processing.
        • Altered afferent input from joints can lead to both inhibition and facilitation of neural input to related muscles.
          • Even painless induced joint dysfunction has been shown to inhibit surrounding muscles.
        • Rapid central plastic changes after injuries and altered sensory input from the body have been observed.
        • Adaptive neural plastic changes can occur over time in the CNS due to the altered sensory input. (3)
      • Piezoelectricity - Mechanical energy applied to crystalline structures results in electrical responses.
        • Connective tissue and bones are crystalline in nature therefore biomechanical changes, such as those that occur in subluxations, may elicit electrical responses in bone and other connective tissues.
        • Such electrical changes may effect, “control of cell nutrition, local pH control and enzyme activation or suppression, orientation of intracellular macromolecules, migratory an proliferative activity of cells, synthetic capability and specialized function of cells, contractility and permeability of cell membranes and energy transfer.” (1)
      • Muscle Facilitation (either too tense or too loose)
        • Discomfort
        • Pain
        • Compensation patterns
        • Decreased threshold and tolerance
      • Neurological Irritation and Dysfunction
        • Stretching or compression of spinal nerves causing increased or decreased tone
          • Abnormal nerve conductivity
          • Distorted input and output
            • Too much or too little
          • Systemic fatigue
      • Abnormal Brain and CNS Function
        • Change in blood supply
        • Change in quality and quantity of nerve impulse
          • Neurotransmitter dysfunction
      • Change in CSF (cerebrospinal fluid) flow
          • Dural membrane compression or stretching
            • Brain temperature changes
            • Nutrient deficiencies
            • Waste and toxic residue buildup
  • These biomechanical abnormalities and their accompanying sequela are what is known in the chiropractic field as “Subluxations.” “ The only true subluxation you ever see must be in a child prior to the age of seven years. That subluxation is an actual vertebral misalignment with muscle protectors. If this subluxation goes uncorrected it becomes a primary source of stimulus through life.” (7)   Major Bertrand DeJarnette
  • In children, especially, we are looking for what we call the primary subluxation. This is the initial subluxation that has affected the primary respiratory mechanism between the sacrum and the occiput. Many times this primary subluxation occurs at the occipital-atlanto region, the atlanto-axial region or the sacral boot mechanism at its relationship to the anterior aspect of the ilium. (7)
  • Subluxations of the atlas-occipital region or atlas-axis area can cause the primary respiratory mechanism to distort causing abnormal stress of the meningeal system and damage to the preprogrammed proprioceptive feedback mechanisms located at the base of the spinal cord and brainstem.
  • Damage to these structures at any stage prior to the preliminary development of “normal” neurological functions can cause compensatory patterns to either be learned or occur naturally to allow the individual to interact with their environment to the best of their ability. These compensations can cause a decrease in functional capability, adaptive response, and decreased stress thresholds.
    • It is important to detect and correct these interferences to the function of the nervous system as soon as possible to prevent long term permanent damage or compensatory pattern development.
    • Myelination of most of the axons of the major spinal tracks and the cerebrum are largely completed by the end of the second year of postnatal life, while full myelination is completed after the tenth year.
    • At birth the cerebellum grows so rapidly that by the onset of puberty its surface area has increased fourfold.
    • Structures such as the reticular formation, commisssural neurons, and intercortical association areas mature after the tenth year of life.
    • The dendrites of the cortical neurons are rudimentary at birth but during the first year of life, each cortical neuron develops 1,000 to 100,000 connections with other neurons.
    • Neurological facilitation at any point in the development of the CNS will have permanent and far reaching effects on the functional outcome of the nervous system.
  • MOTOR FUNCTIONS Developmental (normal) Function AGE MOBILITY LANGUAGE MANUAL COMPETENCE Birth Move arms and legs Without bodily movement Birth cry & crying Grasp reflex 2.5-6 mos. Crawling in prone position/ cross pattern Vital crying in response to threat Vital release 7-11 mos. Creeping on hands & Knees / cross pattern Meaningful sounds Prehensile grasp 12-17 mos. Walking with arms in primary balance role 2 words used spontaneously/meaningfully Cortical opposition in either hand 18-35 mos. Walking with arms free from primary balance role 10-25 words & 2 word couplets Cortical opposition bilaterally & spontaneously 36-71 mos. Walking, running in complete cross pattern 2000 words and short sentences Bimanual function with one hand dominant 72 + mos. Using leg in skilled role with dominance Full vocabulary and sentence structure Using hand to write consistent with dominant side
  • SENSORY FUNCTIONS Cognitive Capabilities AGE VISUAL ABILITY AUDITORY ABILITY TACTILE ABILITY Birth   Light reflex Startle reflex Babinski reflex 2.5-6 mos. Outline perception Vital response to threatening sounds Perception of vital sensations 7-11 mos. Appreciation of detail within a configuration Appreciation of meaningful sounds Appreciation of gnostic sensations 12-17 mos. Convergence at simple depth Understanding 2 words of speech Tactile understanding of 3 rd dimension in objects that appear flat 18-35 mos. Differentiation of similar but unlike symbols Understanding 10-25 words & 2 word couplets Differentiation of similar but unlike objects 36-71 mos. Identification of symbols & letters within experience Understanding 2000 words and simple sentences Description of objects by tactile means 72 + mos . Reading using dominant eye consistent with dominant hemisphere Understanding complete vocabulary & proper sentences with dominant ear Tactile identification of objects using hand consistent with dominant hemisphere
  • Since by age six all of the motor and sensory functions we use as adults have been fully developed it is after this time that we can enhance these functional abilities and perfect their use. Damage at any stage prior to the preliminary development of these functions will cause compensatory patterns to either be learned or occur naturally to allow us to interact with our environment to the best of our ability.
  • “ Traumatization of the suboccipital structures inhibits functioning of the proprioceptive feedback loops. The motor development, though preprogrammed, cannot develop normally. These systems are fault tolerant and able to overcome considerable difficulties and restricted working conditions. But the price for this is a reduced capacity to absorb additional stress later. These children may show only minor symptoms in the first months of their life but later on at the age of 5 or 6 they suffer form headaches, postural problems or diffuse symptoms like sleep disorders, being unable to concentrate etc.” Journal of Manual Medicine, Springer-Velag 1992
  •  
  • RATIONALE FOR CHIROPRACTIC CARE How do Subluxations Occur?
  • “ Birth related spinal cord injuries appear to be under diagnosed. Severe injuries cause death immediately; incomplete injuries can either cause death within the neonatal period or permit survival. In birth injuries, the upper cervical spine or the cervicothoracic junction is usually affected. However, any level of the spinal cord can be involved, and the involvement of multiple levels is not uncommon.” Dickman, Reate, Sonnntag, Zabramski Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ.
  • “ The primary mechanism of injury to the spinal cord appears to be excessive traction applied to the spinal canal and cord during the birth process.” Symposium on Operative Obstetrics, Donn, MD: Vol. 10, NO. 2, June 1983 “ Nerve tissue reacts adversely to stretching and the hypermobility of the spine causes nerves to stretch abnormally, causing immediate pathophysiological changes as well as long-term neuropathological changes.” Alf Brieg, MD. Adverse Mechanical Tension in the Central Nervous System
    • Besides these aforementioned spinal cord insults there are a myriad of childhood traumas and injury that can cause damage and dysfunction to the spinal cord and CNS.
      • Sports injuries
      • Auto accidents recurrent micro-traumas
      • Falls
      • Traumatic emotional events
      • Food sensitivity and reactivity (viscerosomatic response)
      • Toxic environments
      • Drugs
      • Etc.
  • Recent scientific evidence is discovering that even genetic predispositions to diseases, including ADHD are triggered not by the genetic makeup alone but by outside influences that damage the protective protein coat of the involved gene therefore allowing it to express itself “ Genes and DNA do not control our biology; that instead DNA is controlled by signals from outside the cell, including the energetic messages emanating from our positive and negative thoughts.” (6)
  • Chiropractic care for children requires a very specific skill set. There are several pediatric certification programs available to the profession. There are specific techniques designed for the pediatric patient. These techniques are extremely low risk an minimally invasive. “ A recent ICPA study, Adverse Effects Associated with Chiropractic Care for Children accepted for publication by a major biomedical journal reports minimal and minor adverse effects associated with care.
  • CHIROPRACTIC EVIDENCE
  • Reversal of symptoms associated with attention-deficit hyperactivity have been reported from children undergoing chiropractic adjustments, with or without nutritional supplements.(14, 15)
    • Studies have shown chiropractic adjustments to be effective in:(1,2,3)
      • Reducing subluxations
      • Normalizing brain wave patterns (through QEEG studies)
      • Increasing circulation and blood supply to the brain.
      • Improving neurological function through autonomic nervous system rebalancing
      • Reducing impaired motor balance which affects reaction time
      • Reducing excessive signaling from the involved intervertebral muscles and therefore changing the way the CNS responds to subsequent input. This alters how the nervous system responds to the environment.
    • Studies have shown chiropractic adjustments to be effective in:
      • Activating and coordinating specific neurological pathways.
      • Increasing reduced nerve response
      • Reducing nerve facilitation and hyperirritability
      • Increasing the quality and quantity neural inputs to the CNS
      • Increasing and balancing the movement of CSF throughout the CNS
      • Improving immune system function.
      • Increasing the threshold at which genetic predispositions are activated. (18)
    • Studies have shown chiropractic adjustments to be effective in:
      • Improving neurological function through autonomic nervous system rebalancing
      • Reducing impaired motor balance which affects reaction time
      • Restoring normal Basal Metabolic Rates (BMR)
      • Increasing individual threshold levels and adaptive responses.
      • Adjustments may “reboot the nervous system resetting abnormal neurological patterns and restoring healthier more normal neurological patterns (neuroplasticity)
  • Case Studies
  • Six Year Old Boy Diagnosed with ADHD and Impulsivity
    • Pre-treatment
    • Ritalin and Adderal stopped due to negative side effects
    • Hyperactivity
    • Impulsive behavior patterns and violent tendencies
    • Post-treatment (3-4 wks)
    • Improved behavior noted by teachers and family
    • Less jumpy and “kept his hands to himself.”
    • Improvement in attention and focus.
  • Four Year Old Diagnosis Developmental Delays and ADHD
    • Pre-treatment
    • Developmental delay
    • Hyperactivity
    • Early speech intervention.
    • Occupational therapy no results
    • Post-treatment
    • “ Remarkable progress very quickly.”
    • Improved speech,
    • Increased functional ability
    • Calmer behavior patterns (could go to the mall)
    • Pre-treatment
    • Asthma, allergies.
    • Asperger’s –rocking, jumping, flapping his hands,
    • Medication for allergies and asthma made Asperger’s worse.
    • Post-treatment
    • Behavior (Asperger’s) settled down within first week of care.
    • Asperger type behavior occurred only under extreme stress but resolved through adjustment. Age 14 no longer present
    • Asthma and allergies resolved no meds needed in over 5 years.
    Seven Year Old Diagnosis Asperger’s Syndrome, Allergies and Asthma
  • Medical Treatment "Medicines approved for the treatment of ADHD have real benefits for many patients but they may have serious risks as well," said Dr. Steven Galson, director of the Center for Drug Evaluation and Research (CDER), in a press release.
  • The most common allopathic treatment for ADHD is Ritalin. (9) However, Ritalin carries with it many side effects such as growth suppression, rashes, headache, stomachache, sudden cardiac death, psychosis, insomnia and anorexia.
  • An FDA pediatric advisory panel recommended that all ADHD drugs carry a “black box” warning on their packages alerting patients to the potential side effects of the drugs, which can include cardiac and psychiatric problems. Strattera already has a black-box warning that it may induce suicidal thoughts in children. 330,000 sudden cardiac deaths occur per year (this includes adults) These guides would be a simpler, more informative form of a warning that would be included in all packages for many ADHD treatments, including Adderall, Concerta, Daytrana, Desoxyn, Dexedrine, Focalin, Metadate, Methylin, Ritalin and Strattera.
  • The new booklets will include information about the heart risks associated with these drugs. The drugs are associated with adverse affects in patients with underlying heart defects, but they also seem to raise the risk of stroke and heart attacks in some adults. Additionally, the guides will include information about the psychiatric risks associated with these drugs, including hallucinations, paranoia and some symptoms of mania. These symptoms seem to occur without any history of psychiatric illness in 1 out of 1,000 people treated for ADHD. (6) New Warnings Highlight Risks of ADHD Drugs Author: Karen Barrow , Medically Reviewed On: March 15, 2007
    • Effects of ADHD Medications
      • Increased heart rate
      • Increased blood pressure
      • Helps with focus/attention
      • Can be a drug of abuse
      • Small increased risk of sudden death
    Source: CBS Healthwatch, cbsnews.com
      • Alternatives or complimentary therapies like chiropractic and diet change have been shown to be beneficial for these children in place of or in conjunction with the drugs.
  • RESEARCH
  • Preliminary research was completed by Chiropractic Equity Offices Inc. showing that chiropractic adjustment affects the nervous system beyond the dorsal nerve root and affects the function of the brain itself. The study utilized EEG equipment that showed a definite change in brain wave frequencies following a chiropractic adjustment. Four criterion were looked at: First –the right/left balance; second – the amount of total activity; third – primary regions ofactivity; fourth – the effect of the adjustment on each of the areas listed above. All criterion were satisfied. (17)
  • It is important to realize that while chiropractic care may be helpful in a myriad of diagnosed conditions (diseases) including ADHD it is not a treatment for disease. Chiropractic focuses on finding the underlying CNS dysfunction that is affecting the patient and then removing or reducing it thereby restoring proper function to the nervous system.
  • Bibliography
    • Blum CL: “Non-synaptic messaging: piezoelectricity, bioelectric fields,, neuromelanin and dentocranial implications.” J. Vertebral Subluxation Res. – JVSR.com, Jan. 30, 2007
    • Kent C: “Vertebral Subluxation and the Nervous System.” The Chiropractic Journal , Vol. 21, No. 7, April 2007
    • Haavik-Taylor H, Murphy B: “Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study.” Clinical Neurophysiology 118 (2007) 391-402
    • Archer J. Bad medicine: Is the health care system letting you down. NSW: Simon & Schuster; 1995: 79.
    • Lipton B. The Biology of Belief. Mountain of Love Productions, 2004
  • 6. New Warnings Highlight Risks of ADHD Drugs Author: Karen Barrow, Medically Reviewed On: March 15, 2007 7. DeJarnette Major Bertrand: “The Art, Science and Philosophy of SOT.” 1965 8. MIMS annual 23rd ed. NSW: C.R. Wills; 1999. 311. 9. Inselman P S. Is There Any Other Way Besides Ritalin? Am Chiro May-Jun 1998; 3(20): 24-25. 10. Blessing SJ. What You Should Know About Ritalin. Chiro Peds Apr 1994;1(1): 16-17. 11. Merck manual of diagnosis and therapy. 17th Ed. Merck Research Laboratories; N.J 1999. 2255-6. 12. Hyperactivity and Learning Disorder: United States, 2004-2006. Vital Health Statistics, Series 10, Number 237, July 2008
    • 13 .Rodriquez- Trias H. In Anrig C, Plaugher G [eds], Chiropractic Pediatric. Baltimore,MD: Williams and Wilkens, 1998, p, vii.
    • 14. Giesen JM, Center DB, Leach RA. An evaluation of chiropractic manipulation as a treatment of hyperactivity in children. Journal of Manipulative and Physiological Therapeutics 1989; 12(5): 353-363.
    • 15. Tanaka ST, Martin CJ, Thibodeau P. Clinical neurology. In Anrig C, Plauger G [eds], Pediatric Chiropractic. Baltimore, MD: Williams & Wilkins, 1998, pp. 479-611.
    • Rosner L. Infant and Child Chiropractic Care. An assessment of research. Foundation for Chiropractic Education and Research 2003.
    • Barwell R., Long A., Byers A., Schisler C. The Effect of the Chiropractic Adjustment on Brain Wave Pattern as Measured by QEEG. Summarizing an Additional 100 Cases Over a Three Year Period. Chiropractic Equity Offices Inc., Cocoa Beach, Fl.
    • 18. Melillo R. Disconnected Kids. A Perigee Book, published by Penquin Group, New York, NY, 2009
    • Schetchikova NV. Children with ADHD: Medical vs Chiropractic Perspective and Theory (part I). J Am Chiro Assoc. July 2002; 28–38.
    •  
    • Schetchikova NV. Children with ADHD: Medical vs Chiropractic Perspective and Theory (part II). J Am Chiro Assoc. Aug 2002; 34–44.