ADHD and Chiropractic

The Role of Chiropractic in the Treatment of ADHD

by Rebecca McClay, DC, LC, and Michael E. Mileski, DC, LNFA

Author's note: This paper is based on empirical data derived from our pediatric practice. Many of the conclusions are based not only on our practice, but on other scientific data.

Attention deficit hyperactivity disorder (ADHD) is a syndrome that allegedly affects millions of children and adults in the United States alone. In our practice, we have found that many children (and adults) diagnosed with this malady are classic examples of medical misdiagnosis. This is not to single out any one of the medical professions; we have seen this misdiagnosed by medical doctors, osteopaths, chiropractors, school counselors, and parents. 

Does ADHD Exist?

We believe this disorder does exist. However, we also believe the diagnosis is wholly overused on otherwise healthy children. Research in all healing professions shows this to be a viable diagnosis for a very specific number of symptoms:

Signs of Inattention

• becoming easily distracted by irrelevant sights and sounds;
• failing to pay attention to details and making seemingly careless mistakes;
• rarely following instructions carefully or completely;
• losing or forgetting things like toys, pencils, books or tools needed for a task; and
• avoiding tasks that require sustained mental effort.

 Signs of Hyperactivity and Impulsivity

• acting restless, often fidgeting with hands or feet, or squirming;
• running, climbing or leaving a seat in situations where sitting or quiet behavior is expected;
• acting as if driven by a motor;
• blurting out answers before hearing the whole question; and
• having difficulty waiting in line or for a turn.

These behaviors must appear early in life, before age 7, and continue for at least six months. In children, they must be more frequent or severe than in others the same age. Above all, the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work, or social settings. (Adapted from Attention Deficit Hyperactivity Disorder, National Institute of Mental Health, 1994.)

We have seen many children with these specific symptoms, along with a variety of others, diagnosed as having ADHD. We have found that children with the above symptoms only may actually be afflicted with the disorder. This only amounts to two children between the two of us in our combined years of practice. Nothing we did for these unfortunate two children helped. The only option for these children was drug therapy, which worked remarkably well for them.

Drug Therapy: Does it Work?

It is our opinion that in almost all cases, drug therapy only provides a bandage approach to rectify a deeper problem. Many doctors (of all professions) only look to treat the symptoms. Few look to see what the actual cause of the problem is.

We have seen many children utilizing drug therapy that ostensibly progressed toward wellness. We have also seen many of these same children plateau, then revert to previous behaviors. It is usually at this point that we become involved.

Unfortunately, many still view chiropractic as a last resort to be used only after everything else has failed. Where the fault lies in this view has long been a question for the chiropractic profession. In our opinion, all fingers eventually point to strife within our profession between those who are willing to treat the whole patient and those who limit themselves and refuse to think beyond the spine.

How Can We Help?

We have found that simplistic changes to the diets of those who are afflicted have gained the most spectacular and significant changes. Rarely have we ever had to go further than these dietary changes. Essentially, we have critiqued the diets of people diagnosed with ADHD or similar symptoms and shown them how to heal themselves. We have taken away key preservatives; all artificial colors and flavors; and all milk. Within 30 days, we have seen remarkable changes.

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Case Studies

We have seen so many children come to us that have seen other chiropractors already. Unfortunately, the chiropractors confined their aid to do what they felt they do best: adjust vertebrae. Therefore, we have included these case studies to help those who do not believe in dietary changes.

Case #1: AB, 9-year-old male. Diagnosis: ADHD

Our first example of how simple nutritional interventions can help is AB, a 9-year-old boy diagnosed by both a psychiatrist and psychologist as having ADHD. AB was on drug therapy at the time of his first visit.

AB's mother was referred to us by another patient with an unrelated disorder. The mother had never been to a chiropractor before, and told us she had some "severe misgivings about bringing my child to you, (because) chiropractors cause strokes you know." We then tried to discuss pertinent research with her, but she stopped us and said that this was her last resort before she sent her son off to a military school where they would "fix him right." We met with her son for about five minutes. During this period the young man could not keep his eyes fixed on us during conversation; he kept writhing on the table as if he were in pain; and he could not keep his leg from tapping the floor (even when asked if he could refrain). After witnessing this somewhat classical case, we asked about his diet. His mother interrupted that he ate "fine." We then asked her to define the term "fine" for us. She told us that she did not spend lots of time at home and the boy often fended for himself, but that she bought quality foods such as his favorite red gelatin in a cup for snacks; lots of whole milk; and those cereals with cartoon characters (all top sinners on our list).

We then had this young man sit in the waiting room while we spoke with his mother privately. We asked if her child was important in her life. She stated, "My child comes first." We then discussed a diet that eliminated processed foods with artificial flavors and colors, food additives and preservatives, and dairy. She stated that it was "preposterous to torture my child like that." We then asked what was more important, her opinion of what her child should eat, or her child's health. Her attitude changed; she stated that it would be too hard for her to do this (there was no mention of the impact of the changes on AB). We then asked her to try it for a month. Our proposed treatment plan did not include an office visit for a month, but we would give her a courtesy call every week to check up on her and her son. She agreed to this and stated that she "would see to it that her son ate right."

We brought her son back into the room and told him together what we had discussed and how his life would change for a month if he would be willing to make the effort (always make it the child's idea to change, not yours). He said that he would try it because he did not want to go off to school. This was possibly the easiest time either of us ever had convincing a child that they should not eat what they want and are used to.

We spoke to the mother five times afterward: four times on the telephone and once at the last office visit. The telephone calls were distant, and she would not tell us much about her sons' progress; she said he was "all right" and was doing what he could. She would only state that he was a "little" better. The office visit was exactly 34 days after we first met this young man. We walked into the examination room and heard his mother say, "Go ahead." He stood up, shook both of our hands, and said "thank you" as he looked straight into our eyes. There was no writhing, no tapping, and only his undivided attention. He also told us that he stopped taking his drugs, as they made him "sick." We know you are probably skeptical, as this seems rather unbelievable. Never did we lay a chiropractic hand on this child. However, following are two other cases with similar results.

Case #2: CD, 13-year-old male. Diagnosis: ADHD, schizophrenia

This case involved CD, a 13-year-old male who was also brought to us as a last resort by his mother. CD was diagnosed not only with ADHD, but also schizophrenia, by a medical doctor (he was medicated for each diagnosis). He had much of the same symptomatology as the 9-year-old in the previous case; as such, we offered him the same nutritional interventions and timeline.

On the second week of his treatment plan, his mother called and said CD was worse. He was becoming violent and striking out at other children at school. We asked that he be brought in immediately. When he arrived, he was "pure evil" to us. We decided that some massage might calm him a bit. As such, we proceeded with the massage, during which time we discovered a huge prominence on the right side of his neck that was tender upon palpation. We also did some range of motion exercises and discovered that he had limited mobility in his neck. We discussed it with him and his mother, and decided to adjust his neck. A shotgun blast would be a light description of the sound his neck made; in fact, it was heard in the next room. For those of you who are core believers, yes, it was C1. After he was done being scared, he calmed down and was rather pleasant when he and his mother left the office.

Three weeks passed after this visit, and we heard nothing from this family. The next case explains the lapse in follow-up with this young man.

Case #3: EF, 17-year-old female. Diagnosis: Grand mal seizures, history of ADHD

EF, a 17-year-old girl, presented four weeks after the last visit of our previous case. We found out why we had never heard from CD's family; his sister EF was in a motor vehicle accident and was in the hospital with seizures and lapses of consciousness. Her lapses in consciousness had ceased in two weeks; however, she was now on medications to prevent more seizures. CD, EF and the children's mother showed up at the office one afternoon, and the mother filled us in as to what happened. The accident had caused the daughter to put her head through the driver's-side window. She arrived at the hospital in a comatose state having seizures; she also had a severe concussion. She finally woke up about three days into her stay at the hospital. However, she was still experiencing seizures. The doctors were able to finally control the seizures with a course of medications. She left the hospital three weeks after she entered. EF was very concerned about the procedure the doctors recommended, which she described as "surgery to cut my brain in two if the seizures do not stop." We discussed what that meant, and she asked us if we could help her like we did her brother (who had not yet come up in conversation). She told us she was afraid of chiropractors, but was more afraid of surgery. She also asked if we could do anything without "making popcorn" in her neck.

We decided to utilize craniosacral therapy to help her. At the end of the first session, she stated that she felt as if she were "high" (she also stated to her mother that she assumed that was how it would feel, as she had never smoked anything). We saw her one more time about six months later before she left for college. She stated that she never had another seizure after her last visit, and she had to go back to the medical doctor to get off the drugs because they made her "woozy." She also told us that the dietary changes she had to "suffer through" because of her brother also helped her (she now has a 3.9 GPA at college). By the way, her brother is now 16; asymptomatic; utilizes no drugs; and is on the honor roll.

Impossible? No. The process of allowing these children to heal themselves was quite easy. The issue in the big picture is having both the parents and the children believe in the changes. The parents are the easy part (once they get past how their lives will also have to change). The children will eventually buy into the idea once they see the positive changes in themselves. There are often short-term lapses in diet, especially with older children, but they tend to turn back to the diet as they see the negative changes their deviance causes. We have found little to be more satisfying than seeing the positive changes in the children when they realize the transformation that has occurred.

The solutions we utilized are quite simple. These cases are only three of the many we have seen with the same issues. Did we cure anything? No, we just provided the right thing at the right time to the right body, and allowed miracles to happen.

Rebecca McClay, DC, LC
Michael E. Mileski, DC, LNFA
Houston, Texas

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(The following information taken from website: http://addhelpsite.com/
SIDE EFFECTS OF RITALIN

The recognized side effects for Ritalin have been taken from an article titled "Medication for ADHD, Hyperactivity and Attention Deficit Disorder" by Thomas W. Phelan, PhD. What Dr. Phelan talks about in this article are the "positive effects" of Ritalin and the "side effects". He also discusses dosages and the times release formulas.

The side effects are as follows:

INSOMNIA: usually only a problem if medication is taken late.

APPETITE SUPPRESSION: very frequent; research shows, however, that this is usually a temporary phenomenon and after about 6 months the child will rebound and resume more normal eating patterns.

HEADACHES & STOMACHACHES: sometimes occur in the beginning of using a medication and many times will disappear in a very short period of time; If not, another medication may have to be tried. Stomachaches can usually be reduced by taking the medication with food.

SADNESS OR IRRITABILITY: not common, but if it continues, the stimulant medication would have to be stopped.

TICS: rare, but medication would be discontinued.

Dr. Phelan continues that sometimes doctors need to use Tricyclic anti-depressants for other problems that can develop such as: bed wetting, chronic pain, panic disorders, and sleep disorders. (Note that these side effects were not listed before.) Essentially, they will treat the effects of the drug with another drug.

SIDE EFFECTS OF ADDERALL aka aderal, adderal, aderall Article: Out Of Control: A Controversial Drug

Summary

1. Dawn Branson and her son Nathaniel, in a picture taken before his death (CBS)

Branson had no idea at the time, but she believes today her psychosis was a reaction to the drug Adderall, which had been prescribed for her attention deficit disorder.

Why should this drug not be prescribed: Do not use Adderall if you have any of the following conditions:

 - Heart disease
 - Hardening of the arteries
 - High blood pressure
 - High pressure in the eye (glaucoma)
 - Overactive thyroid gland

Never take Adderall within 14 days of taking an antidepressant classified as an MAO inhibitor, including Nardil and Parnate. A potentially life-threatening spike in blood pressure could result.

Your doctor will not prescribe Adderall if you have ever had a reaction to similar stimulant drugs. The doctor will also avoid prescribing Adderall if you appear agitated or are prone to substance abuse.

Most important fact about this drug:
Adderall, like all amphetamines, has a high potential for abuse. If used in large doses over long periods of time, it can cause dependence and addiction. Be careful to take Adderall only as prescribed.

Side effects may include:
Changes in sex drive, constipation, depression, diarrhea, dizziness, dry mouth, exaggerated feelings of well-being, headache, high blood pressure, hives, impotence, insomnia, loss of appetite, mental disturbances, overstimulation, rapid or pounding heartbeat, restlessness, stomach and intestinal disturbances, tremor, twitches, unpleasant taste, weakened heart, weight loss, worsening of tics (including Tourette's syndrome)

Special warnings about this medication:
If you have even a mild case of high blood pressure, take Adderall with caution. Be careful, too, about driving or operating machinery until you know how this drug affects you. It may impair judgment and coordination.

Adderall can make tics and twitches worse. If you or a family member has this problem (or the condition called Tourette's syndrome), make sure the doctor is aware of it.

If the problem is attention-deficit disorder, the doctor will do a complete history and evaluation before prescribing Adderall, taking particular account of the severity of the symptoms and the age of your child. If the problem is a temporary reaction to a stressful situation, Adderall is probably not called for.

At present, there has been no experience with long-term Adderall therapy in children. However, other amphetamine-based medications have been known to stunt growth, so your doctor will need to watch the child carefully.

Summary:

1. ADD/ADHD is only a label: there is no valid, consistent test available to diagnose it
2. Ritalin is an amphetamine-like drug, a controlled substance with similar pharmacological properties to cocaine.
3. Nutrients are vital: In 1979, a double-blind, crossover study in Biological Psychiatry reported that vitamin B-6 was more effective than Ritalin in treating a group of hyperactive children
4. Magnesium can calm hyperactivity: Deficiency in magnesium is characterized by excessive fidgeting, anxious restlessness, psycho-motor instability and learning difficulties.

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Essential Fatty Acids Shown To Improve Performance in Children With ADHD and Dyslexia

by James Meschino, DC, MS

In the February issue of Progress in Neuro-Psychopharmacology & Biological Psychiatry, researchers A. Richardson and B. Puri reported the results of their pilot study on the effects of essential fatty-acid supplementation on 41 learning-disabled boys and girls (aged 8-12) with symptoms of dyslexia and attention-deficit/hyperactivity disorder (ADHD). The three-month study tested an essential fatty-acid supplement containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) derived from fish oil, and gamma linolenic acid (GLA) and linoleic acid, derived from evening primrose oil.

This study showed that a variety of symptoms characteristic of ADHD improved in children who received the fatty-acid mixture, compared to those who received an olive oil placebo, without any apparent side-effects. To assess changes in behavior and mental performance, a questionnaire widely used to assess responses to drugs such as Ritalin and Adderall was given to each child's parents. The questionnaire assessed measures of inattention, restlessness-impulsiveness, anxiousness-shyness, and cognitive problems.

After three months of daily use, notable improvements were observed in most of the scores among the children receiving the special fatty-acid mixture. The study was sponsored by the Dyslexia Research Trust (www.dyslexia.org.uk), an Oxford-based charity dedicated to uncovering the biological basis of dyslexia and related conditions, as a means to developing better methods of identification and management.

Abundant evidence suggests that specific fatty acids are important to brain function and development. According to the researchers of this study, and other sources, these fatty acids are often underconsumed or underproduced in children with behavioral and learning challenges.(1-4) This appears to be especially true for DHA, a member of the omega-3 group of fatty acids, mainly derived from cold-water fish such as salmon, mackerel, herring, sardines and other marine animals. DHA is also produced in the body from EPA, which can be produced from the elongation and desaturation of alpha-linolenic acid (the most prevalent fatty acid in flaxseed oil).

DHA is present in breast milk, but not cow's milk. Due to its importance in brain development and function, and the development of the nervous system and the retina, many physicians recommend breastfeeding or the use of infant formula that contains DHA.(5,6) One study showed that infants receiving supplemental DHA in their formulas scored significantly higher in mental development, as gauged by memory, problem-solving, and related skills.(7) It is also stressed that preterm infants be supplemented with DHA, since they are incubated and not breastfed.(8)

This pilot study provides further evidence that essential fatty-acid supplementation can be an important aspect of the complementary management of ADHD and dyslexia, and possibly in other learning disabilities cases.1

References

1. Dietary Supplement Information Bureau. Jan. 30, 2002. New hope for children with learning disabilities.
2. Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr 1987;26:406-11.
3. Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995;62:761-8.
4. Aman MG, Mitchell EA, Turbott SH. The effects of essential fatty acid supplementation by Efamol in hyperactive children. J Abnorm Child Psychol 1987;15:75-90.
5. Birch EE, et al. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Dev Med Child Neur 2000;(42):174-181.
6. Jorgensen MH, Hernell O, Hughes E, Michaelsen KF. Is there a relation between docosahexaenoic acid concentration in mothers' milk and visual development in term infants? J Pediatr Gastroenterol Nutr Mar 2001;32(3):293-6. 
7. Willatts P, Forsyth JS, DiModugno MK, et al. Effect of long-chain polyunsaturated fatty acids in infant formula on problem-solving at 10 months of age. Lancet Aug 1998;352(9129):688-91.
8. Uauy R, Mena P. Requirements for long-chain polyunsaturated fatty acids in the preterm infant. Curr Opin Pediatr Apr

Maternal Drinking Might Influence Attention Deficit Disorder

Children with attention deficit hyperactivity disorder (ADHD) can have problems completing tasks, staying organized and keeping track of things. Problems with hyperactivity and/or impulsivity may also surface, including fidgeting, squirming, excessive talking and frequent interrupting. Because most children display these behaviors from time to time, its not easy to determine whether a child has ADHD or is just going through the normal adjustments of "growing up."

The problems associated with ADHD can be persistent and severe, and while it's not clear exactly what causes this condition, a recent study suggests that maternal drinking may play a role. Twenty-eight children were selected from three subject groups: children with fetal alcohol syndrome (FAS), a condition characterized by facial deformities due to maternal drinking; children with prenatal exposure to alcohol; and children with no prenatal exposure to alcohol. Researchers evaluated all 28 children in terms of "executive functioning" (EF)  sequencing and self-monitoring, planning, ability to engage in goal-directed behaviors, critical thinking, etc.  and found that those children exposed to alcohol (children with FAS or prenatal exposure) performed worse on tests of EF than children without prenatal exposure to alcohol.

These findings add to the considerable evidence that drinking alcohol during pregnancy can have profound negative consequences. Consult with your doctor before, during and after pregnancy to ensure the health of your child.

Reference:

Mattson SN, Goodman AM, Caine C, et al. Executive functioning in children with heavy prenatal alcohol exposure. Alcoholism: Clinical and Experimental Research, Nov. 1999: Vol. 23, No. 11, pp1808-1815.

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Not a Cookie Cutter Problem: Attention Deficit Hyperactivity Disorder

by Tracy Barnes, DC, Kentuckiana Children's Center

Observe any of the classrooms at Kentuckiana and at first glance all the children might appear to be "normal" school kids. But look a little closer into classroom one: there in the back at a table all his own is Chris. Chris' legs are constantly moving, his hands are always busy and his teachers have a difficult time keeping him focused on his work. He continually blurts out answers and pesters his classmates.

Chris is a 10-year-old student who was referred to the Center after being unable to perform in a mainstream public school. He tripped fellow students, played pranks on them and started a number of fights. Yet through all of his problem behavior, he seemed unwilling to take any personal responsibility for his actions. Chris is far from a dull boy. He has an IQ in the superior range relative to his peers.

Chris is a classic example of Attention Deficit Hyperactivity Disorder (ADHD). However, unlike many of the other children diagnosed with ADHD, Chris is not medicated. In his three years as a student in the Kentuckiana Special School, and as a patient in the Kentuckiana Clinic, his progress has been characteristically, "four steps up, two steps back; three steps up, two steps back," says Roberta Davis, M.Ed, director of Special Education at Kentuckiana. He is a prime example of the need for multidisciplinary care in cases of ADHD.

ADHD's main components are "developmentally inappropriate degrees of inattention, impulsiveness and hyperactivity."(1) It has been estimated that some 5-10 percent of school-aged children are affected.(2) They are commonly diagnosed before four years of age with males being six to nine times more likely than females to have the disorder. Approximately one-third of all ADHD cases have manifestations that progress into adulthood, although the numbers may be much higher.(3)

Work at Kentuckiana, as well as three known studies,(4,5,6) show the benefits of chiropractic adjustments on these children. The importance of the nervous system is certainly not to be overlooked. However, it has been our experience that the stability of chiropractic care is greatly enhanced when combined with other factors affecting the structural, chemical, and mental aspects of this complex disorder.

Among the many possible causes for ADHD, there are those that cannot generally be changed by the time these children enter our offices. The possible causes are fetal alcohol syndrome and fetal alcohol effect (FAS/FAE),(7) maternal prenatal smoking,(8) genetics,(9) and vaccination.(10)

There are, however, other predisposing factors to ADHD that must be acknowledged and investigated to ensure maximal success in treatment. These causes include candida albicans (yeast) proliferation, temporomandibular joint (TMJ aka jaw) dysfunction, heavy metal toxicity, food sensitivities, environmental allergies, neurologic disorganization, hearing problems, visual perceptual disorders, and multiple aspects of psychological disorders.

As William Crook, MD, describes in the vicious cycle of treating childhood infections with broad-spectrum antibiotics.(11,12) yeasts, which are not affected by antibiotics, are allowed to multiply and release harmful toxins into the child's body. These toxins weaken the immune system, lower the body's natural resistance, and in turn set up the child to develop more infections.

Our student Chris had a history of repeated ear infections during his infancy. Even though this was some years ago, it is likely that he is still affected by the disruption of his normal flora caused by the antibiotics. In addition, Chris has a history of allergies to pollen, dust, ragweed, Johnson grass, eggs, wheat, milk, corn, and chocolate. His mother attributes Chris' recurring headaches and sinus infections to these allergies.

The role of allergies and the hyperactive child involves both food intolerance and environmental sensitivities. A recent study looked at 40 children with food-induced hyperkinetic syndrome. They found some 15 foods that provoked an increase in hyperkinetic behavior including chocolate, colorings, cow's milk, eggs, citrus, wheat, nuts, cheese, banana, tomato, apple, pears, beef, pork, and beans.(13)

Current literature is in debate as to the role of dietary sugar in hyperactivity. One recent study claims that sugar and Nutrasweet have absolutely no adverse effects on children's behavior.(14) However, other reports show sugar consumption to correlate significantly with restlessness and destructive-aggressive behavior.(15) Glucose metabolism has been shown to be hampered in hyperkinetic adults and children.(16) Other studies show that sugar leads to an increase in deviant behavior primarily when sugar is in combination with a high carbohydrate meal. The negative effects are sometimes negated when sugar is eaten with a high protein meal.(17)

Having a complete recording of what each child eats for at least one week is the first step toward assessing the importance of dietary change. Questions concerning artificial sweetener consumption should also be included in the history-taking process since these have been linked to many symptoms common to ADHD.

Heavy metal toxicity is another important piece in the puzzle of hyperactivity. A complete history will also include information concerning where the child lives and plays, paying particular attention to areas of highly industrial nature. Toxic chemicals such as lead, copper, and aluminum can be found in high levels in many ADHD children.(18) Locating the source of the chemical toxicity is essential in effectively eliminating its harmful barrage on the nervous system. Possible avenues for heavy metal ingestion include drinking water, beverages served in aluminum cans, and food prepared in aluminum cookware. In addition, children who are regularly exposed to second-hand smoke are at risk for increased cadmium intake. It is important to find out who takes care of the hyperactive child on a regular basis and whether or not tobacco smoke is part of the environment.

Other trace mineral imbalances to look for include mercury, calcium, magnesium, zinc, and chromium. Hair analysis is one method of screening for toxic metals and deficiencies of essential minerals. This analysis provides a way to functionally understand the body chemistry.

Chris's beginning trace mineral hair analysis showed a lead level of four parts per million (ppm). Levels as low as 1ppm have been shown to correlate with high attentional deficit ratings.(19) He also had increased levels of aluminum and cadmium. Chris comes from a home where his father smokes a pipe. On a retest analysis done approximately 19 months later, his aluminum went from 24ppm to 9ppm and his cadmium went from 0.80ppm to 0.26ppm. Nutritional supplements such as chelated proteinates can help to detoxify and stabilize these nutrient mineral imbalances.

A consistent temporomandibular joint problem is also a part of Chris's history. His head pain was so intense at times that he would bang his head against the wall. We have found with some children that addressing TMJ dysfunction has made marked improvement in their behavior. Upon examination of the ADHD child, the TMJ area should be evaluated as well as thorough inspection of the oral cavity. A high raised palate may be found in many of them.

Another element for Chris is that he was adopted at 21 months. This kind of early disruptive experience can have lasting emotional effects on children.(20) For this reason, psychological evaluation can be helpful in determining the need for individual and family counseling. Support of the parents in all aspects of treatment can be the determining factor in any success with ADHD children. Mothers and fathers need to understand the full spectrum of ADHD care and realize the role that they play in its outcome. Parents may often be pushed by school administrators and others into thinking that they have somehow failed or that they lack proper parenting skills. While appropriate discipline is not to be underestimated, they need to know that ADHD children have a problem. It is our job to unravel the problem and theirs is to accept it. Together we can do something about it.

Getting good results with calming down an ADHD child takes time. This is evident in young Chris's story. In recent months, Chris has been improving academically, but his behavior continues to fluctuate. When accepting a case such as this, one must be prepared for extended care, frequent re-evaluations and perseverance. The need for research on this subject is evident.

Additionally, it has been our experience that those children who begin their course of treatment before the onset of puberty benefit the most. With the rush of hormones and the change in body chemistry, it becomes very difficult to affect positive changes after puberty sets in.

There is no cookie cutter approach to dealing with ADHD. No protocol can universally be applied to its treatment. As in all thorough care, each child must be individually assessed and evaluated to determine where the imbalances lie. In subsequent articles, we will be examining in detail some of the etiological factors of ADHD and suggest ways of helping the children and their families cope with this disorder.

References:

1. Diagnostic and Statistical Manual of Mental Disorders -- III. American Psychiatric Association, Washington, D.C. 1987.
2. Berkow R, et al: The Merck Manual of Diagnosis and Therapy. Merck Sharp & Dohme Research Laboratories, Rahway, NJ, 1987.
3. Weiss L: Attention Deficit Disorder in Adults. Taylor Publishing, Dallas, Texas, 1992.
4. Webster L: The hyperactive child and chiropractic. Health Naturally, February 1994.
5. Pigg N: Chiropractic effectiveness with emotional, learning, and behavioral impairments. International Review of Chiropractic, September 1975.
6. Giesen J, Center D, Leach R: An evaluation of chiropractic manipulation as a treatment of hyperactivity in children. JMPT vol. 12, num. 5, October 1989.
7. Caruso K, ten Bensel R: Fetal alcohol syndrome and fetal alcohol effects. Minnesota Medicine, vol. 76, April 1993.
8. Fried P, Watkinson B, Gray R: A follow-up study of attentional behavior in 6-year-old children exposed prenatally to marijuana, cigarettes, and alcohol. Neurotoxicology and Teratology, vol. 14, 1992.
9. Berkow R et al: The Merck Manual of Diagnosis and Therapy. Merck Sharp & Dohme Research Laboratories. Rahway, NJ, 1987.
10. Coulter H: Vaccination, Social Violence, and Criminality. North Atlantic Books, Berkeley, California, 1990.
11. Crook W: The Yeast Connection. Professional Books Inc. Jackson, TN, 1991.
12. Crook W: Help for the Hyperactive Child. Professional Books Inc., Jackson, TN, 1991.
13. Schaub J: Hyposensitisation in children with food-induced hyperkinetic syndrome. European Journal of Pediatrics, vol. 151, November 1992.
14. Mahan K, et al: Sugar allergy and children's behavior. Immunology and Allergy Practice, July 1985.
15. Prinz R, et al: Journal of Behavioral Ecology, vol. 2, num. 1, 1981.
16. Zametkin A, et al: Cerebral glucose metabolism in adults with hyperactivity of childhood onset. New England Journal of Medicine, vol. 323, Nov. 15, 1990.
17. Conners C: Medical Tribune. January 9, 1985.
18. Barnes B, Colquhoun I: The Hyperactive Child. Thorsons Publishers Limited, Wellingborough, Northhamptonshire, 1984.
19. Tuthill R: Low Hair Lead Concentrations in Children. Doctors' Data, West Chicago, Illinois, 1982.
20. Haddad P, Garralda M: Hyperkinetic syndrome and disruptive early experiences. British Journal Psychiatry, vol. 161, Nov. 1992.

Tracy Barnes, DC Kentuckiana resident staff doctor

Editor's note: Lorraine Golden, DC, founder and executive administrator of Kentuckiana, notes that ADHD is only one of the many conditions treated at the Center: cerebral palsy, migraine headaches, autism, neurofibromatosis, sleeping disorders, and seizures are also treated. Kentuckiana has provided services free of charge for 37 years ago and employs a multidisciplinary treatment program with chiropractors as gatekeepers. If you would like to support Kentuckiana write or call:

Kentuckiana 3700 Georgetown Place P.O. Box 16039 Louisville, KY 40256-0039 Tele: (502) 366-5658

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Chiropractic and ADHD

by George Burroughs, D.C.

Attention Deficit Hyperactivity Disorder (ADHD) affects millions of Americans -- adults as well as children. By definition, ADHD is a neurologically based disorder and should, therefore, be treated by the experts in functional neurological disorders: doctors of chiropractic.

The drug Ritalin has not been tested for long-term side-effects or for any withdrawal-related complications, yet it is routinely given to individuals diagnosed with ADHD. At best, Ritalin is simply masking the underlying neurological dysfunction associated with ADHD without doing anything to help ascertain a cure. Unfortunately, at its worst, the drug may be destroying the lives of millions of children. I find neither extreme appealing.

How can chiropractic help? Probably the best way to begin helping an individual with ADHD, or their parents, is by educating them -- not about ADHD, but about chiropractic. A good starting point is to make sure they understand that chiropractic doesn't treat ADHD. Instead, inform them that chiropractic's goal is to treat the underlying cause of ADHD.

Once the involved individuals understand the value of a treatment that addresses the cause of ADHD, the doctor should further educate them regarding chiropractic. Quite simply, it is important to teach people that "subluxations" are structural misalignment that cause neurological dysfunctions, and that the specific purpose of chiropractic is to identify and eliminate such subluxations.

Symptoms give clues. Of course, there is no one specific subluxation that leads to the neurological manifestation of ADHD. However, the symptoms related to ADHD (hyperactivity, inability to pay attention, impulsivity) seem to indicate a disturbance with brain stem function. This idea of brain stem dysfunction is actually supported by the manufacturer of Ritalin who admits that although "how" Ritalin works is not completely understood, it does appear to affect the brain stem.

I find this correlation between brain stem dysfunction and ADHD extremely interesting for chiropractic because a subluxation to the upper cervical (C1-C3) area can be the cause of brain stem dysfunction. Therefore, although every segment of the spine should always be assessed, chiropractors must pay special attention to the upper cervical region when treating individuals with ADHD.

One manner in which upper cervical subluxations can affect brain stem function is through direct pressure. Many upper cervical techniques are aware of the potential of this occurring and teach this along with their technique procedures. A second, and in my opinion more common, manner in which upper cervical subluxations can affect brain stem function is through altered proprioceptive input to the brain stem from the C1-C3 vertebrae and the related soft-tissue structures.

Proprioceptive "input" from the upper cervical area is required by the brain stem before a variety of neurological "outputs" or functions can be performed. Like a computer, the quality of the upper cervical "input" will determine the quality of the "output". Therefore, if the input to the brain stem is altered (as is the case with an upper cervical subluxation), the output from the brain stem will also be altered.

In my opinion, ADHD is simply one example of altered brain stem "output". The key to correction, therefore, lies not in treating the ADHD, but in treating the altered sensory input that caused the ADHD. Although somewhat confusing, I believe that understanding this is paramount to understanding how chiropractic "works" in cases involving ADHD.

It is only fair to state that, although proprioceptive information from the upper cervical area is the most important spinal-related source of sensory input to the brain stem, it is not the only source of such input. Proprioceptive, or more accurately, "position sense" information is also sent directly to the brain stem from the vestibular and visual areas. Once in the brain stem, the sensory input from all three areas (upper cervical, vestibular, and visual) is utilized to determine many brain stem functions, including activity (or hyperactivity) levels.

Although the subject of craniopathy is often controversial in our profession, cranial misalignments do exist and they are capable of producing nervous system interference. For this reason, cranial misalignments that alter the "position sense" of the vestibular or visual areas will also contribute to the manifestation of functional neurological disorders such as ADHD. Therefore, it is not unusual to find sphenoid, maxilla, and/or temporal bone subluxations (as well as upper cervical subluxations) in children with ADHD.

Correcting subluxations, regardless of their location, is a vital contribution that only chiropractors can offer to children with ADHD. These children, along their parents and teachers, need to be educated regarding the dangers of Ritalin and also about the power of chiropractic. Ultimately, all children should be able to experience the joy of a well-adjusted body.

(Dr. George Burroughs is a Magna Cum Laude graduate of Life College, with a B.S. degree from the State University of New York at Albany. He assisted in the development of neuro-synergy, a chiropractic technique originated by Guy Schenker, D.C., that focuses on functional neurological disorders such as learning disabilities, ADHD, and scoliosis. Dr. Burroughs has a private practice in Mobile, Ala.)

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If we don't help our children, who will?

Here is a true story of a child named Justin from Dallas.

Justin was not behaving properly in school. His mother was advised by the school to take him to a child psychiatrist who was an "expert" in child hyperactivity. The doctor labeled Justin as having Attention Deficit Hyperactivity Disorder (ADHD). Debra (his mother) and Justin left his office with a prescription for Ritalin and an understanding that ADHD was a central nervous disorder, and there was no one simple treatment.

Only 20% of those who have this disorder, they were informed, would outgrow it, therefore, Justin could be on Ritalin -- and possibly antidepressants, anti-seizure drugs, and tranquilizers -- for the rest of his life. The psychiatrist also said he would need to be schooled in a special learning environment for the learning disabled.

Justin's mother was so upset she decided to quit her job and home-school Justin. But after two months on Ritalin, Justin's behavior had not changed. The doctor increased the dose, but there still was no improvement.

Debra became so concerned she got every book she could find on the subject. She learned that Ritalin is not recommended for a child under six years of age. Justin was four. She did more research and finally took Justin to someone who could modify his diet and adjust his spine and brought about a total change in this child. That person may have saved Justin from becoming a drug addict.

As I write this column, hundreds of children are being diagnosed by psychiatrists and M.D.s as having ADHD.

Ritalin, the primary drug prescribed for ADHD, has been reclassified (as reported in the June 1995 issue of General Psychiatry Vol. 52) as a "Schedule 2 Drug" of the Controlled Substances Act -- in the same category as cocaine and methadone.

Should you and I sit back and just watch the drugging of our children? Approximately five years ago, the U.S. Government (through medical grants) gave out close to one hundred million dollars of taxpayer money to help learning disabilities in our children. During the exact same period the incidence of learning disabilities increased by 500-fold nationwide.

The manufacturer of Ritalin is now making 400 million dollars annually. That is more than double what the drug company made in 1990. One reason the drug is spreading so quickly is because it's the easiest "solution" for teachers or parents. It is a lot easier for a teacher, who is under pressure from the school system, to label a child not acting properly as having ADHD and drug him or her, than to spend the required time to actually find out what is going on with the child.

There are literally thousands of children in your community who will be labeled as having ADHD. The most common "symptoms" are: fidgeting, squirming, running and climbing (instead of sitting,) talking incessantly, blurting out statements, being easily distracted or forgetful, losing things, not listening and failing to pay attention. These are symptoms of central nervous system disorder. This is a neurological problem. This is a chiropractic problem.

The medical community believes ADHD is due to a lack of norepinephrine, a chemical messenger needed by the brain to inhibit muscle activity and impulsive behavior. Ritalin is a chemical that tries to do what the body itself can do naturally. Unfortunately, it can have enormous harmful affects such as anxiety, tension, insomnia, dizziness, headaches and Tourette's syndrome.

Many experts agree the common causes of ADHD are poor diet, nutritional deficiencies, food allergies, spinal subluxation, or environmental factors such as air pollutants and chemicals. Clients of mine from around the country are reporting that when they give a lecture about ADHD in their community, people show up in droves, compared to lectures on stress or nutrition and other health subjects.

There are many books, studies and documents on the causes and natural treatments for hyperactivity in children.

There is an entire public out there needing our help. If you and I don't help them, who will?

This column was adapted from a taped lecture by Dr. David Singer from his monthly audio tape newsletter, "The Singer Report." To receive a free sample of the Singer Report call 800-326-1797 and ask for Jane.

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Natural treatments for kids with ADD/ADHD

"Just say no" to drugging our children. Saying no is much easier for parents today than ever before. There are many existing natural alternatives that can reverse the symptoms of Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) instead of prescribing drugs. The problem is, some parents don't know about these alternatives. They do know about Ritalin.

In "Arch General Psychiatry," Vol. 52, June 1995, it is stated that: "Cocaine, which is one of the most reinforcing and addictive of the abused drugs has pharmacological actions that are very similar to methylphenidate hydrochloride (Ritalin), which is the most commonly prescribed psychotropic medication for children in the U.S."

Some parents don't know that today they have a choice. Our job isn't limited to educating parents about the potential risks associated with Ritalin, but also about the choices available to them, choices they can control. Research and clinical observations stand back from medical treatment and provide favorable evidence for natural alternative treatments.

Food allergies have often been linked to behavioral disorders, which means, changes in diet alone can prove beneficial. Parents need to be informed so they can help their children naturally.

Dr. Benjamin Feingold was the first to popularize a special diet for children with hyperactivity and aggressive behavior. The diet prohibits the intake of salicylates (found in artificial colors and flavors, aspirin, grapes, tomatoes, red and green peppers) and replaces them with mineral soups, whole grains, raw vegetables and fresh fruit. These changes have been shown to have significant effects on behavior.

A study published in the May 9, 1992 issue of "The Lancet," by J. Eggar, M.D., reported that 76 children with behavioral disorders were placed on elimination diets removing wheat, milk, chocolate, eggs, oranges and sugars from their diets. Behavior improvements (reduced hyperactivity) were noted in 62 children. The study noted that vitamins A, B, C, D, E, as well as calcium, magnesium, chromium and zinc are recommended in order to increase levels of behavioral improvement.

Chiropractic has also been a proven treatment for ADD/ADHD. Twenty-four children were tested in an independent research project conducted by the Psychoeducational & Guidance Service of Texas A&M University. Twelve children received chiropractic care and twelve received medical care. The outcome proved children receiving chiropractic care improved more than children treated with drugs in areas such as verbal output, reading and comprehension, attitude and self-esteem, coordination and emotional maturity.

Providing parents with the information they need will point them in the right direction to help their children naturally:

1. Inform parents about their choices, that they don't have to put their children on Ritalin.
2. Suggest the problem may be a food allergy and tell them about problem-causing foods to eliminate from their children's diets.
3. Show them how chiropractic can potentially improve learning disorders.
4. Remind them about the importance of positive reinforcement -- essential to any child's well-being -- including encouragement and praise for accomplishments.