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Adhd: A Patient’s Perspective

By Greg Buchanan

This article 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, it is timely to provide some information from an upper cervical chiropractic perspective.

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 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 that 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 reported in 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 recently reported the 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 percent 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.

As addressed in a previous article, Dr. Fernandez-Noda’s assertion and findings that Parkinson’s and other diseases (Alzheimer’s, multiple sclerosis, and 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 individuals’ health and go some way towards reversing this condition.

Why is Parkinson’s disease mentioned in an ADHD article, 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 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, 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 treatments target dopamine depletion, could there be a common causal link? If the end result is dopamine depletion, then the causal link could be something which reduces the production of dopamine? Could Fernandez-Noda et al be correct in their conclusion that it is muscular compression of structures (arterial and neurological) that is the causal factor in the lack of dopamine production? Seems quite plausible 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 adjustments 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 all Governments should 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, believing that chiropractic would not 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 resolution of the symptoms and the elimination of the need for administration of pharmaceuticals.

I came across a really wonderful book Manual Therapy in Children edited by Heiner Biedermann, MD, that communicates the benefit of manual therapy in the treatment of children for various disorders including ADHD. When reading this book, it would be easy to think that it was 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 and has contributions from various medical doctors including surgeons. In the Introduction, Biedermann says “the problems associated with and labeled ADHD have a close connection with problems originating in functional spinal disorders. “

In Chapter 12, “Attention deficit disorder and the upper cervical spine,” Theiler discusses findings relating upper cervical spine (sub-occipital) subluxations or what they call KISS (kinematic sub-occipital strain syndrome) to the symptoms of ADD/ADHD. In particular, he notices that children diagnosed with ADHD exhibit postural distortions and associated movement deficits of the upper cervical spine. He notes that, following manual therapy applied to the cervical spine, not only do postural deficits resolve in the children but, concentration and cognitive abilities improve as well. 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 dopaminedependent structures of the frontal lobe and corpus striatum.”

The chapter finishes with the discussion of three case studies of ADHD, the first one of a 7.2-year-old female 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. Her upper cervical spine was adjusted. 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 return of symptoms, and after the correction function normalized.

The second case study is of 6.5-year-old female who was born with a fractured clavicle. It was noticed that as she developed, her clumsiness was remarked and her drawing and scribbling skills lagged compared to 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 as abnormal mid back curvature. X-rays showed upper cervical subluxation. The doctor administered a specific upper cervical “adjustment.” Two months post the manipulation and even though the mother reported no change, the doctors found the child 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 had a verbal memory +2 years her age. Her mother conceded an improvement when showed comparisons of test results.

The third case study is of an 11.5-year-old 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 – 8.5 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.” The family decided upon Ritalin therapy and the girl’s symptoms 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 to have already resolved the problem at hand.”

Erin Elster reports in a case study about a 9-year-old boy suffering from Tourette’s syndrome, Attention Deficit Hyperactivity Disorder (ADHD), depression, asthma, insomnia, and headaches. He had been born via forceps delivery and was taking various medications for his conditions. Chiropractic examination revealed evidence of an upper cervical subluxation and he began care with an upper cervical chiropractic technique. After 6 weeks of adjustments all 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 dysfunction. Further research is suggested.