VOLUME 27 - 3 Attention Deficit Hyperactivity Disorder

Health Tips

Chiropractors Offer Hope and Help to Children with Attention Deficit Hyperactivity Disorder (ADHD)

In the past decade, prescriptions for Ritalin, a stimulant medication commonly used for attention deficit hyperactivity disorder (ADHD), increased five-fold, with 90 percent of all prescriptions worldwide consumed in the United States. As many parents grow leery of the traditional medical approach to ADHD, doctors of chiropractic are offering promising results with non-drug treatments that focus on postural muscles, nutrition and lifestyle changes that affect brain activity.

Some children may simply have difficulty learning certain subjects, but the current system-in a sense-prompts school officials to encourage their parents to have the children diagnosed with ADHD. The higher the number of disabled kids in the school, the more funding the school can apply for.

Some teachers might also have difficulty with students who have a different style of learning. If the child is a visual learner-and the teacher is not-perhaps the child is not being taught in a way he or she can learn. Before diagnosing the child with ADHD doctors should talk to the child and the parents: "Is the child too active? Bored? Has dyslexia or a different learning pattern? It can be a behavior problem, problems at home, or frustrations with the teacher's style". "If we went to a conference where the speakers taught in a way we can't learn, we would be frustrated and would misbehave-we'd get up and leave or chat to the person sitting next to us."

The traditional medical model, however, seems to follow the cookie-cutter principle. The diagnosis of ADHD is based on a questionnaire. But this is not enough. "True ADHD patients have other signs - tics, tremors, balance or postural problems, or unusual sensitivity to touch, movement, sights, or sounds." Unfortunately, although medications can keep ADHD under control, they don't cure it. Eighty percent of patients have ADHD features in adolescence, and up to 65 percent maintain them in adulthood.

Doctors of chiropractic and chiropractic neurologists offer a non-drug and non-invasive treatment alternative for ADHD patients that targets the underlying problems, not just symptoms. "Motor activity-especially development of the postural muscles-is the baseline function of brain activity. Anything affecting postural muscles will influence brain development. Musculoskeletal imbalance will create imbalance of brain activity, and one part of the brain will develop faster than the other, and that's what's happening in ADHD patients.

Chiropractic neurologists are trained to identify the underfunctioning part of the brain and find treatments to correct the problem, to help that hemisphere grow. "On every patient, we perform a brain function exam. We test visual and auditory reflexes through, for example, flashing light in the eye, or asking patients to listen to music in one or the other ear."

When the problem is identified, patients are placed on a treatment program-and most of the therapies can be done at home. "Patients are asked to smell certain things several times a day ... or wear special glasses." We also focus on their individual problems. Some children, for example, have difficulty with planning, organization, and coordination-so they benefit from timing therapies. They learn to clap or tap to the metronome, perform spinning and balancing exercises."

Although currently no studies comparing chiropractic neurological and medical treatment for ADHD are available, chiropractic neurologists are compiling the data. "We test children before they start the treatment and then every three months." Within the first three months, the children get a two-grade-level increase on average-which is pretty dramatic. With children on medications, the improvement in academic performance is short term and lasts only as long as they take the medication. Our programs change the brain function and the improvement doesn't go away."

While chiropractic neurologists have found success in treating ADHD and learning disabilities by providing the necessary brain stimulation, they also recommend nutrition and lifestyle changes that may help correct or prevent biochemical imbalances that cause ADHD. Parents are encouraged to:

• Remove as many food dyes, sugar, preservatives, and additives from the diet as possible.
• Focus on natural, mostly organic foods with as few pesticides or herbicides as possible.
• Determine if there is an allergy-usually starting with dairy and gluten and try elimination diets.
• Stop using pesticide sprays in the house.
• Avoid taking medications, nicotine, alcohol, and other drugs in pregnancy that may harm the fetus.
• Find ways to relax during pregnancy. Stress on the job may affect the unborn baby's health, as well.
• Breastfeed. The first months and years of a child's life are critical to physical and psychological development. Breastfeeding mothers' diets are important as well.

Research

Iron Supplementation May Help Children With ADHD

Arch Pediatr Adolesc Med. 2004;158:1113-1115

Iron deficiency may contribute to the physiopathology of attention deficit-hyperactivity disorder (ADHD) in children, according to the results of a controlled group comparison study published in the December 6, 2004 issue of the Archives of Pediatric & Adolescent Medicine. Iron supplementation may benefit this population.

"Iron deficiency has been previously considered a potent cause of poor cognitive impairment, learning disability, and psychomotor instability," writes Eric Konofal, MD, PhD, from Robert Debré Hospital in Paris, France, and colleagues. "Iron deficiency could lead to ADHD symptoms in relationship with central dopaminergic dysfunction."

In the study, the investigators found that serum ferritin levels were significantly lower in children with ADHD (n = 53; mean age, 9.2 ± 2.2 years) compared with age- and sex-matched control subjects (n = 27; mean age, 9.5 ± 2.8 years) with mild reading disabilities (serum ferritin levels, 23 ± 13 ng/mL vs 44 ± 22 ng/mL, respectively; P < .001).

Serum ferritin levels were also abnormally low (< 30 ng/mL) in a significantly greater proportion of children with ADHD compared with control subjects (84% vs 18%; P < .001).

In children with ADHD, low serum ferritin levels were correlated with more severe general symptom scores on the Conners' Parent Rating Scale. A trend toward a correlation with greater hyperactivity was also observed but did not achieve significance.

"Only the cognitive subscore correlated significantly with low ferritin levels," the authors note. "This correlation suggests that the iron-deficient children are mainly inattentive and distractable and suffer from learning disabilities, a finding consistent with the role of iron deficiency in cognitive defects and mental retardation."Iron supplementation could be considered a first-line treatment for children with ADHD and iron deficiency," the authors conclude, adding that such therapy may improve central dopaminergic activity and decrease the need for psychostimulants.

Discussion:

This ferritin research may not seem Olympian, but it really is important. Any non-pharmacologic agent that can be used in the control of attention deficit and/or hyperactivity disorder is very significant, for the medications currently in require very delicate management and health review. I have included a brief overview of ADD/ADHD here in the USA and how it has been traditionally been approached for management. (From the American Journal of Health-System Pharmacy, 12/20/2004)

Attention-deficit/hyperactivity disorder (ADHD) affects an estimated 4-12% of school-aged children in the United States. ADHD is diagnosed by the presence, in two or more settings, of at least 6 of 18 characteristics indicating hyperactivity, impulsivity, and inattention. In addition, these characteristics must be evident by age seven, persist for at least six months, and significantly impair academic, social, or occupational function. Up to 65% of children with ADHD also have co-morbid psychiatric disorders, including mood disorders, depression, anxiety, and oppositional defiant disorder. Functional problems, such as academic underachievement and difficulty with social and family interactions, are also likely in these patients. Persistence of ADHD into adulthood has been reported in 4-60% of patients, and adults with ADHD are more likely to exhibit occupational, financial, and social deficiencies.

ADHD is caused by a deficit in response inhibition, an executive function in the prefrontal cortex. As a result, those with this disorder are unable to control responses to external stimuli. Patients with ADHD also display a dysregulation of arousal wherein they are inappropriately stimulated during exciting activities and inattentive in the completion of more routine tasks. This condition may be attributed to dysregulation of norepinephrine, as noradrenergic activation is associated with the attention span.

Medications that balance the dysregulation of dopamine and norepinephrine improve response inhibition and regulate arousal, leading to improved performance, which supports the hypothesis that modification of monoamine transmission in critical brain areas may be the basis for pharmacotherapy of ADHD. Historically, only stimulants have been approved for use in children to treat ADHD. Noradrenergic agents, such as tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), bupropion, and clonidine, have been used in ADHD therapy. While these agents have shown efficacy, there are potential limitations to their use, including an approximately 30% failure rate, intolerance, adverse effects including potential worsening of comorbid anxiety, dosage regimens typically consisting of multiple doses of short- or long-acting agents throughout the day, and concerns about potential abuse.

A new medication for ADD/ADHD has just emerged on the market, called Strattera (Eli Lilly, Indianapolis, IN). It is Atomoxetine hydrochloride. This is a selective norepinephrine-reuptake inhibitor (SNRI), and is the first nonstimulant indicated for the management of ADHD in children over six years of age, adolescents, and adults.

If you have family diagnosed as either ADD of ADHD, you might want to have serum ferritin levels run to see if there may be low levels. You might also ask about Strattera. Getting away from stimulants would be well worth the inquiry.

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