Saturday, January 16, 2010

Does Chiropractic Treatment Help ADHD?


This morning I scanned the articles on one of my usual webpages for something interesting. What caught my eye was a headline about chiropractic treatment for ADHD. As a psychologist who frequently deals with ADHD and educating the public about treatments I was skeptical about the optimistic sound headline and knew that this treatment has been one of many that are not supported by research as effective.

I clicked on the link and watched a compelling human interest video about a family where the daughter had a bad response to the more common treatment for ADHD, medication. In fact, it is not just more common, but is actually supported by a mountain of research as helpful for many people suffering from ADHD. Behavioral interventions are also well supported, but not mentioned at all in this video. The video did not bother to mention these comparative supports in the various treatments. They just made it seem as if the use of pills was "popular".

In this compelling case study, the child was eventually given chiropractic treatment which led to a reduction of symptoms. Then the chiropractor talked about the theory behind why chiropractic treatment should help with ADHD. An author who wrote a book about ADHD talked about how he endorses anything that is safe and legal and if it works, wonderful.

This entire piece would probably lead many parents to want to try the "safe" and non-medication approach. Why? Many parents want to avoid medication due to the impression that medication can be unsafe while there is no impression given that chiropractic treatments can ever be unsafe, in this video. However, all treatments have some possibility of harm. Manipulation of bones can be harmful. Not getting more effective treatment can also be harmful. I have often seen parents who have delayed treatment for years while their child is falling further behind in school, having discipline problems, and often suffering emotionally due to the difficult disorder of ADHD. This video did not show any case examples of that, but showed the most positive case example of success with ADHD.

This is not how research is done. We do not cherry-pick the most positive case and ignore the ones where there is no positive effect and there are negative effects. However, the use of anecdotes is more compelling for people, despite the fact that it is a poor way to make informed decisions about treatment. The fact that there are coincidental changes that may or may not be resulting from an intervention and the fact that there are powerful placebo effects that are not controlled for in anecdotes are two reasons to be skeptical of such evidence.

I searched for some more objective evidence of the efficacy of chiropractic treatment as opposed to the mountain of evidence supporting medication and behavioral treatments for treating ADHD. On a website called healthcentral.com, I found some information about the use of chiropractic treatment with ADHD. The author of the article, Bailey (2010) wrote:

"Chiropractic care is sometimes used to treat symptoms of ADHD. This is based on the belief that trauma to the spine occurs throughout our lives, beginning at birth and causes a misalignment of the spine. This impacts our body’s ability to function properly. Another theory is that when the skull is misaligned, there is uneven pressure on certain parts of the brain. Chiropractors work to correct misalignments and proponents of this treatment claim that the realignment will help to alleviate symptoms of ADHD (para. 1)."

"Modern knowledge of human anatomy does not agree with this assessment. Medical science has shown that the bones in the skull do not move. (para. 3)"

Furthermore, Bailey pointed out that the research supporting ADHD treatment with this procedure is minimal.

"To date, there has been only one study that evaluated the results of using chiropractic care to treat hyperactivity. Dr. Joel Alcantara, a chiropractor, noted in an article, Attention Deficit Disorder, “The results of this study ... are not conclusive.” Other than this study, no additional scientific information is available to substantiate the claim that this type of treatment helps, improves or cures symptoms of ADHD (Bailey, 2010, para. 2)."

Reference

Bailey, E. (2010). Chiropractic care. Healthcentral, Retrieved from http://www.healthcentral.com/adhd/alternative-treatments-200135-5.html

Image Attribution

7 comments:

Zachary Ward, DC said...

Dr. Weisz, thank you for your openness to the possibility that chiropractic care may indeed have a therapeutic benefit for children with ADHD. Please keep in mind that the data that exists on pharmaceutical interventions exists because of the powerful market command that these companies can bring to medical research. To put it simply, there is no money in researching manual therapeutics, not to mention the problems in developing proper sham procedures that are "good enough" to fool the participant, but weak enough to not have any therapeutic effect.

A lack of evidence is simply a lack of evidence, and doesn't say anything about the effectiveness of a procedure.

I'd like to direct you to an interesting read on the relationship between the spine and child development, by the German Medical Doctor Biedermann. The full title of the book is "Manual Therapy in Children," but a summary of that work can be found in the journal JMPT.

The work is also summarized here.

Dr. Dave said...

I find that it is great that you have looked into conservative approaches to ADD/ ADHD. I think it is also important that you point out the difference between a Randomized Control Study, and a Case Study.
Another scenario that Chiropractic considers is Neurological inefficiencies due to neuro toxins during development (ie. mercury/thermerisol) from the over 24 vaccinations given to developing children. (Not to mention the flu shot given to pregnant women).
Chiropractic is not suggesting that a bone out of place is the cause of anything, but rather a normal reaction of the nervous system as a short term reaction to Chemical, Physical, or Emotional Stress. A University of Colorado study, done by Seth Sharpless, found that 8-10 mm of hg pressure on a nerve, (the weight of a dime) is enough to cause decreased nerve function. 6% stretch on a nerve can cause up to 70% of reduction of nerve function.
Chiropractic is not a "treatment" for ADHD, Headaches, or even low back pain. Chiropractic is the detection of nervous system inefficiencies (we use emg, thermography, even hear rate variability, in our office), and removing the physical interference from the nerve via, Chiropractic Adjustment. When you remove the pressure from a nerve, it functions with less interference.
Without getting too technical, from my expereriance, and many of my colleagues who compassionately serve our patients, I can tell you that amazing, seemingly unrelated health issues just go away.
Chiropractic puts things back to were they are supposed to be, and the body does what it’s supposed to do (heal and regulate). Does it happen all the time, the way we would want it to? No, just like another form of health/medical care, its a "practice".
I love the fact that you are interested in helping your patients and readers find the best way to serve them.. In that sense we are "kindred spirits". I hope that this has given you a "Chiropractors Perspective". I would love to give you more insight from our perspective. I am very involved nationally in Chiropractic and can offer a different insight into its Philosophy. You can check me out directly at www.doctordavidmoore.com.

Dr. Gaston Weisz said...

There are some interesting comments from people who have a different viewpoint from me. I appreciate the comments.

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Liz Ditz said...

Dear Dr. Weisz,

After you published your piece, Chiropractic & Osteopathy published a systematic review by Karpouzis et al.

Chiropractic care for paediatric and adolescent Attention-Deficit/Hyperactivity Disorder: A systematic review

Chiropractic & Osteopathy 2010, 18:13doi:10.1186/1746-1340-18-13

Avaialable on online http://www.chiroandosteo.com/content/18/1/13

From the abstract's conclusion section:

To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD.


You may also be interested in a recent post on another chiropractic treatment for ADHD (and autism and everything else, apparently): The Brain Balance Centers, which is a franchise operation developed by Robert Mellillo, DC.

Brain Balance Centers: A Critique.

seattle chiropractor said...

Many diseases improve with chiropractic care, but chiropractic doesn’t “cure” anything.
Health is normal. If you're not healthy, something is interfering with this normal state. The only thing that doctors of any type can do is to remove interferences that may be preventing your body from expressing your normal health or mask symptoms (pain) with drugs.