Chiropractic care for managing ADHD symptoms in kids
By Dr. Kira BaileyFeatures Clinical Patient Care
Attention deficit hyperactivity disorder (ADHD) is now considered the most prevalent psychiatric disorder of childhood, affecting between five and 12 per cent of school-aged children in North America. In addition, 80 per cent of those children will still be manifesting symptoms of ADHD, or attention deficit disorder (ADD), as adolescents, and 60 per cent will carry them into adulthood.
Treatment of ADHD has long been considered to be limited to the use of medication such as Ritalin, with only minor references to the successful application of alternative medicine practices such as chiropractic care. I contend that chiropractors are ideally suited to manage the symptoms of ADHD – using their unique tools, techniques and holistic philosophy to offer effective alternative and complementary management strategies.
A brief traditional definition of ADD/ADHD looks like this, “a disorder characterized by inattention, hype-activity and impulsivity to the point that it significantly affects social, economic functioning.”
The holistic definition of ADHD is a very different animal and reflects a deep-seated belief in humanism, vitalism, compassion and an inclusive perspective on health and healing. To quote Ned Hallowell, MD (one of the world’s foremost experts on ADHD), “ADD is a misleading name for an intriguing kind of mind. ADD is not so much a disorder but rather a collection of traits and tendencies – some positive, some negative – that define a way of being in the world.”
Dr. Hallowell has also coined one of the great phrases in ADHD culture. He says, “people with ADHD have a Ferrari for a brain, but they only have bicycle brakes,” meaning those with ADHD are intelligent, creative, intuitive and have a high level of energy, but they also possess an underdeveloped ability to inhibit their impulses, curb their behaviour or limit their energies to those realms society finds acceptable.
Regardless of how you define ADD/ADHD it is crucial to understand the devastating impact of living with unmanaged ADHD. Those with ADD have a much higher probability of being diagnosed with learning disorders and with multiple other mental illnesses. They have a higher likelihood of repeating a grade in school, being suspended and failing to graduate. They also have a much greater likelihood of being arrested, incarcerated and being involved in serious car accidents. They are more likely to suffer serious injuries, head trauma, accidental poisoning, alcohol and drug abuse, self-harming behaviours and are at higher risk for suicide.
Family dynamics are also disrupted with increased parental alcohol consumption, marital conflict, maternal depression and rate of divorce. Siblings of those with ADD are at increased risk of suffering from emotional and conduct disorders. When someone in the family has ADHD, everyone suffers. However, when a practitioner improves the life of a person with ADD, they are improving the life of everyone in that person’s family, friend and social networks.
Chiropractors are perfectly placed to work with children and adults with ADHD using the wide variety of tools in their professional toolbox. One of the biggest skills that chiropractors possess is their wide-ranging and extensive education. This gives them the ability to assess a complex and multisystem symptom picture and to delve further into a person’s history and symptomatology to weed out the truly important facts from the noise.
They are extremely well trained in history taking and examination techniques, and this helps with one of the largest challenges in ADHD: determining whether or not a person truly has it.
There are a wide variety of conditions that mimic the symptoms of ADHD, but are actually just ADHD “look-alikes.” These include thyroid disorders, convergence insufficiency, poor oculomotor function, sensory processing disorders (visual or auditory), learning disorders, developmental delays, problems with executive functioning, dis-autonomia, environmental or food sensitivities or allergies, to name a few. Very few professionals have the education required to take a clinically significant look at all of the systems required to separate the look-a-likes from a true manifestation of the disorder – but chiropractors are well equipped to do so.
Understanding functional neurology is a key principle in the management of ADHD. Chiropractors have a deep understanding of the relationship between neurology and its effect on human experience. They also have the perfect tool to affect change in the nervous system – the chiropractic adjustment. When a neurologically balancing chiropractic adjustment is used in the care of someone with ADHD, good things have been shown to happen. There is wonderful preliminary research available demonstrating that children with ADHD under chiropractic care show improvements in behaviour, hyperactivity and executive functioning.
There is a vital relationship between the neurosensory receptor networks found in the spine, spinal cord, dura, joints and muscles and cerebellar function. Spinal mechanoreceptors, and muscle spindle fibres ascending through the spinocerebellar tracts provide the largest source of ascending information to the brain via the cerebellum. When the function of this receptor array is enhanced, improvements in the quality/quantity of information travelling into the cerebellum are noted. This stimulates the mid-brain, limbic system and prefrontal cortex and results in improvements in executive functioning (attention span, ability to concentrate, decision making, memory), improved mood stability, decreased kinetic activity, better emotional control and improved impulse control.
There are other excellent tools a practitioner can use to improve cerebellar function and the co-ordination/integration of neurosensory information. A strong education in biomechanics and neuroscience gives the chiropractor a solid foundation from which to work when using what are called “functional movements.”
The concept of functional movements to improve academic performance and behaviour came into popular culture through “Brain Gym,” created by Paul and Gail Dennison. The relationship between physical development, neurological function and cognitive performance has been expanded upon through the years, and today, research pioneers such as Dr. Ted Carrick continue to explore these complex relationships.
Occupational therapists, educators, speech and language pathologists have long been using functional movements and educational kinesiology to facilitate improvements in children with ADHD and the same tools are available to the chiropractor. Functional movements, exercises and games focus on improving balance, proprioception, primitive reflex integration, core strength, timing and co-ordination, crossing the midline and oculomotor function. They are used to activate core neurological pathways and facilitate improvements in academic scoring, behaviour, hyperactivity and emotional control.
Practitioners may design their own routines or systems. Brain Gym, the Learning Breakthrough System and the Interactive Metronome are easy to use and integrate easily into the chiropractic practice.
Metabolic balance is another key concept in the holistic management of ADHD. Although most of the most obvious symptoms of ADHD focus on the behavioural aspects of the disorder, there are a host of secondary symptoms, including a characteristic pattern of poor digestive function and food sensitivities.
A whole article could be dedicated to the metabolic status of those with ADHD; however, for the purpose of this article it will be outlined in broad strokes only.
The presence of digestive dysbiosis and a “leaky gut” is associated with the ADHD population. Gluten and casein sensitivities are also a part of this picture for many people, creating a doom-loop of digestive inflammation and production of morphine-like derivatives triggering a slowing of digestive function that in turn perpetuates more inflammation. Inflammation in the gut stimulates the sympathetic nervous system, exciting the autonomic nervous system and brain toward a fight or flight state. A sympathetic/ adrenergic response in the brain down-regulates executive functioning and as outlined above, this manifests in a poor ability to plan, problem-solve, pay attention and regulate behaviour. Maldigestion and incomplete digestion of food results in vitamin, mineral and other nutrient deficiencies, which can also contribute to the symptom picture of ADHD.
In order to balance metabolism and heal the gut, a process of omission and supplementation of food, vitamins and minerals must be instituted. The most common food allergens must be removed from the diet; hence, a gluten-free, casein (dairy) free, food additive/dye-free, aspartame-free diet filled with low-glycemic index whole foods containing adequate protein is recommended for a minimum of 90 days.
In addition, a regimen of supplements should be considered, including high-quality, soil-based probiotics, pure and high potency EFAs, vitamin B6, vitamin D, and magnesium. There are many other supplements, nutraceuticals and homeopathic remedies that can be added to the diet on a case-by-case basis, and in accordance with the doctor’s level of expertise. However, the above represents the basics in supplementation and outlines those items that will have a positive effect on the majority of your patients with ADHD.
Lastly, environment and lifestyle factors play an enormous role in not only achieving positive results but in maintaining the gains that have been achieved through the use of other modalities. Who is better suited to coaching people on how to incorporate healthy lifestyle choices than the chiropractor?
DCs are unmatched in their ability to educate, empower and support a patient’s desire to live a healthy and vital life. As seen above, those living with ADHD and their families need that guidance and support more than most. Frustration, anger, depression, anxiety and sleeplessness are all a part of daily life and must be given an outlet in order to bring calm and healing to the whole family dynamic.
The person with ADHD should be kept completely away from tobacco smoke. They should also be very limited in their screen time from all sources: TV, video games, cellphone and tablet. Even so-called “educational” games that are electronically based should be factored into the total screen time a child experiences.
Of far greater value is unstructured, outdoor playtime – a minimum of 60 minutes a day is recommended. Enrolment in structured activities such as martial arts, gymnastics, yoga or dance are also wonderful outlets for energy, creativity and, at the same time, they help with strength, timing and co-ordination. Mindfulness training through meditation, yoga or biofeedback can also be very helpful.
Sleep hygiene is of crucial importance as sleeping is typically problematic. The use of sleep inducing music, the presence of “white noise” in the child’s room, complete darkness, no exposure to blue light (such as that found in TV and computers) one hour prior to bed, and the use of melatonin can all help establish a good sleep routine. In fact, the use of structure in all aspects of life is most beneficial.
Creating and maintaining consistent routines around getting ready for school, homework, grooming and bed can reduce the amount of friction in the home and facilitate increased success. Checklists and labels are also helpful in supporting these routines, and should be used for any area in which the child is struggling, or for activities that require multiple steps to complete.
One cannot understate the importance of creating an environment of unconditional love and support. Those with ADHD struggle with self-esteem and anxiety; unfortunately, they are typically exposed to multiple negative messages throughout their day. They grow up being told that they are “bad,” “naughty” or “stupid,” and expressions of exasperation from parents, teachers and siblings are often directed towards them.
It is crucial to be always coming from a position of compassion and acceptance while working with children with ADHD. Practitioners and families must set small goals, and celebrate each tiny achievement. Embracing the role of both trusted advisor and head cheerleader is crucial for success.
ADHD in North America is growing rapidly and many parents are seeking drugless solutions for the management of their child’s ADHD. Chiropractors are perfectly poised to provide a variety of holistic, effective management strategies that can have a powerful effect on improving the lives of those with ADHD.
Gains in academic performance, social functioning, behaviour and family dynamics are all possible using the strategies outlined above. Working with children and adults with ADHD is a fun and fulfilling way to augment your existing practice, to generate new patients and to become “known” in your community as a doctor who does something unique. This increases practice prestige, provides a point of difference to separate you from your competitors, and increases revenue while allowing you to fill your practice with laughter and make your community a happier, healthier place to live.
Dr. Kira Bailey holds a diploma with the International Chiropractic Pediatrics Association and has a very special interest in helping children and adults with ADD/ADHD and neuro-sensory processing disorders. She was the chiropractic clinical advisor for Shine for Doctors, a program that trains chiropractors in the holistic management of ADHD. She can be reached at email@example.com.
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