Chiropractic Management of ADHD

A Structural and Nutritional Approach

Attention Deficit Hyperactivity Disorder is the most common neuropsychiatric condition diagnosed today, affecting anywhere between 5-11% of children1. It is characterized by inattention, impulsivity and hyperactivity, and usually occurring together, although they can occur separately2. Although the underlying cause or causes of the disorder are still unknown3, it is thought to be due to a variety of complex biochemical and neuro-electrical interactions within the brain and spinal cord.

The mainstay of treatment for attention-deficit disorders is stimulant medication4, including methylphenidate (Ritalin), dextroamphetamine (Adderall). Newer medications including atomoxetine have been developed that work when stimulant medications fail to achieve the desired result or have intolerable side effects4. Still others respond to anti-depressant medication, or medications that depress the sympathetic nervous system, which is responsible for the fight-or-flight response4.

It is useful to examine why these medications work, and how they affect the brain. From a structural perspective, the body consists of approximately 640 muscles (some people actually have more and some have less!). Each of these muscles is connected to a nerve that comes from the brain, brainstem or spinal cord, and is wired directly into the brain5. Each of the muscles also has special sensors embedded inside that communicate information back to the brain, telling the brain6 the state of the muscle, contracted or relaxed. The brain makes use of this information, in order to coordinate the complex movements of the body such as walking, jumping, swimming, speaking, or eating.

A Structural Approach
Chiropractors believe, and research backs up that when the bones of the spine, called vertebrae are not able to move properly, or are misaligned, that the information from the brain going to the muscles, telling the muscle to move, and the information from the muscles going to brain, telling the brain where the muscle is in space, does not flow properly, and the brain gets a distorted or decreased signal. The brain thrives on sensory input and does not like having a diminished or decreased signal.

One hypothesis of ADHD is that due to decreased signal from the muscles, the brain increases the motor output, creating an irresistible urge to move, in order to increase the signal coming back to the brain. It is thought that by taking stimulant medication, the brain is made more sensitive to the otherwise decreased signal coming from the muscles and joints, and does not need to increase muscle movement. The evidence for this is that children who engage in rigorous physical activity and have better muscle tone and strength, tend to do better in tests of attention, planning and decision making7.

Although there has not been a great deal of high quality scientific inquiry on the effects of chiropractic spinal manipulation (CSM) on ADHD, numerous case studies8,9 and clinical studies10, support the principle that CSM increases the communication between the brain and the muscles, decreasing inattention and hyperactivity through improved signal entering the brain. Children with ADHD, in general, score more poorly on test of muscle strength, dexterity, balance and coordination than children without this diagnosis11. Exercise, in addition, by increasing the activation and thereby strength and endurance of muscles12, results in a greater signal being sent to the brain, even at rest. This increase in incoming signal results in more stimulation of the brain, which leads to lower expression of symptoms of inattention, impulsivity and hyperactivity.

Manipulating Nutrition To Improve Functioning

There are a number of nutritional protocols that purport to help with the symptoms of ADHD. Many sources cite nutritional deficiencies of certain minerals such as magnesium13,14, iron15, and zinc16, or essential omega-3 fatty acids17. The research is mixed on these minerals and supplements as to whether they actually work. To date, there have been few well-designed, large scale studies evaluating the effects of these supplements on ADHD.

On the basis of the mechanism of action of stimulant medication, supplementation that increases neurotransmitter levels can be used. Supplements such as 5-Hydroxytryptophan (5-HTP), L-Tyrosine and the herbal M. pruriens are easily available without a prescription, are well tolerated, and serve as the direct chemical precursors to neurotransmitters. A clinical study18 involving 85 patients evaluated the effect of a protocol involving these three nutrients on symptoms of ADHD. They found that their protocol appeared to work better than some prescription ADHD medications, with no adverse reactions noted. It is thought that the action of stimulant medications, and by extension, medications that control and manipulate the neurotransmitter serotonin, exert a calming effect on the brains of those with ADHD through the modulation of the neurotransmitter dopamine. Dopamine utilization by the ADHD brain has been shown to be lower than that of neurotypical individuals19.

5-HTP and L-Tyrosine taken together can increase the utilization of dopamine through a similar mechanism as the stimulant medications. The effect of 5-HTP administration on hyperactivity has been demonstrated in a mouse model20, which helps to isolate the mechanism of action somewhat, although the neurophysiology cannot be directly extrapolated to humans.

Conclusions

The chiropractor, with several viable treatment options for children and adolescents with ADHD, working in concert with a trained mental health provider, should be able to manage many cases of ADHD without the use of harsh stimulant medication and its attendant adverse effects. Although many consider chiropractors to be only spinal specialists, through the judicious use of nutrition, and nutritional supplements, there are many viable options for reducing the effect or severity of ADHD, and improving the quality of life of the patient.

Dr. Robert Press, a chiropractor with Chiropractor On Wheels, LLC, based in Franklin Lakes, NJ, has significant experience managing the structural and nutritional aspects of ADHD therapy in concert with the patient’s medical and/or mental health provider. Call (551) 486-6143 to set up a consultation for management of ADHD.

  1. Holland K., Riley E. (2014, September 4). ADHD by the Numbers: Facts, Statistics, and You. Retrieved December 23, 2015, from http://www.healthline.com/health/adhd/facts-statistics-infographic

  2. Johns Hopkins College of Medicine. Attention-Deficit / Hyperactivity Disorder (ADHD) in Children. Retrieved December 23, 2015, from http://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/attention-deficit_hyperactivity_disorder_adhd_in_children_90,P02552/

  3. Sharma, A., & Couture, J. (2014). A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Annals of Pharmacotherapy, 48(2), 209-225.

  4. De Sousa, A., & Kalra, G. (2012). Drug Therapy of Attention Deficit Hyperactivity Disorder: Current Trends. Mens Sana Monographs, 10(1), 45–69. http://doi.org/10.4103/0973-1229.87261

  5. Levitan I., Kaczmarek L. (2015). Intercellular communication. The Neuron: Cell and Molecular Biology (4th ed.). New York, NY: Oxford Univerty Press. pp. 153–328. ISBN 0199773890.

  6. Hulliger M. (1984). The mammalian muscle spindle and its central control. Rev. Physiol. Biochem. Pharmacol., 101, 1–110. doi:10.1007/bfb0027694. PMID 6240757.

  7. Davis, C. L., Tomporowski, P. D., Boyle, C. A., Waller, J. L., Miller, P. H., Naglieri, J. A., & Gregoski, M. (2007). Effects of Aerobic Exercise on Overweight Children’s Cognitive Functioning: A Randomized Controlled Trial. Research Quarterly for Exercise and Sport, 78(5), 510–519.

  8. Bastecki AV., Harrison DE., Haas JW. (2004). Cervical kyphosis is a possible link to attention-deficit/hyperactivity disorder. Journal of Manipulative and Physiological Therapeutics, 27(8), e14.

  9. Cassista G. (2009). Improvement in a child with attention deficit hyperactivity disorder, kyphotic cervical curve and vertebral subluxation undergoing chiropractic care. Journal of Vertebral Subluxation Research, 5, 1-11.

  10. Alcantara J, Davis J. (2010). The chiropractic care of children with attention-deficit/hyperactivity disorder: a retrospective case series. Explore (NY), 6(3),173-182.

  11. Cho H., Ji S., Chung S., Kim M, Joung YS. (2014). Motor function in school-aged children with attention-deficit/hyperactivity disorder in Korea. Psychiatry Investigation, 11(3), 223-227.

  12. Jeoung, B. J. (2014). The relationship between attention deficit hyperactivity disorder and health-related physical fitness in university students. Journal of Exercise Rehabilitation, 10(6), 367–371. http://doi.org/10.12965/jer.140175

  13. Black LJ. et al. (2015). Low dietary intake of magnesium is associated with increased externalizing behaviors in adolescents. Public Health Nutrition, 18(10), 1824-1830.

  14. Starobrat-Hermelin B, Kozielec T. (1997). The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes. Res., 10(2), 149–156.

  15. Bener, A., Kamal, M., Bener, H., & Bhugra, D. (2014). Higher Prevalence of Iron Deficiency as Strong Predictor of Attention Deficit Hyperactivity Disorder in Children. Annals of Medical and Health Sciences Research, 4(Suppl 3), S291–S297. http://doi.org/10.4103/2141-9248.141974

  16. Arnold LE, Bozzolo H, Hollway J et al. (2005). Serum zinc correlates with parent- and teacher-rated inattention in children with attention-deficit/hyperactivity disorder. J. Child Adolesc. Psychopharmacol. 15(4), 628–636.

  17. Colquhoun I, Bunday S. (1981). A lack of essential fatty acids as a possible cause of hyperactivity in children. Med. Hypotheses 7, 673–679.

  18. Hinz, M., Stein, A., Neff, R., Weinberg, R., & Uncini, T. (2011). Treatment of attention deficit hyperactivity disorder with monoamine amino acid precursors and organic cation transporter assay interpretation. Neuropsychiatric Disease and Treatment, 7, 31–38. http://doi.org/10.2147/NDT.S16270

  19. Forssberg, H., Fernell, E., Waters, S., Waters, N., & Tedroff, J. (2006). Altered pattern of brain dopamine synthesis in male adolescents with attention deficit hyperactivity disorder. Behavioral and Brain Functions, 2, 40. http://doi.org/10.1186/1744-9081-2-40

  20. Gainetdinov R., Wetsel W., Jones S., Levin E., Jaber M., Caron M. (1999). Role of Serotonin in the Paradoxical Calming Effect of Psychostimulants on Hyperactivity. Science, 283(5400), 397-401.