Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition affecting millions of children worldwide. While traditionally only outward behaviour was looked at, recent advancements in neuroscience offer a deeper understanding of ADHD and its impact on school-aged children. Looking through a holistic healthcare lens, we want to explore how chiropractic care and other allied health treatments can support children with ADHD alongside traditional psychology and medical approaches.
Understanding ADHD
ADHD is characterised by challenges with focus, attention, impulsivity, and hyperactivity. However, it's crucial to remember that ADHD manifests differently in each child. Some children may exhibit primarily inattentive symptoms, easily daydreaming or losing track of instructions. Others may present with hyperactive-impulsive symptoms, struggling to stay seated or blurting out answers. It's common for children to have a combined presentation of both types. It is also important to note that these symptoms may present differently in boys and girls, with boys more commonly exhibiting impulsive behaviours and girls more often exhibiting inattentive/daydreaming-type behaviours.
ADHD and Brain Function
The Prefrontal Cortex: The Control Centre
Recent research delves into the role of the prefrontal cortex (PFC) in ADHD. This critical brain region governs complex functions like planning, organization, impulse control, and attention. Studies suggest that children with ADHD may have a less developed, under-active, or less efficient PFC function [1]. This can explain difficulties with focus, task initiation, and emotional regulation commonly observed in ADHD.
The PFC plays a crucial role in various aspects of learning that can be impacted by ADHD.
- Focus and Eye Tracking: The PFC is involved in directing our gaze and sustaining attention. Deficits in this area can lead to difficulties focusing on a specific task or activity, with children with ADHD appearing easily distracted [2]. Dysfunction in eye tracking can also lead to difficulties with reading in children with ADHD.
- Vestibular Function and Balance: The vestibular system, located in the inner ear, works closely with the PFC to maintain balance and spatial awareness. Research suggests potential links between vestibular dysfunction and ADHD symptoms like inattention and impulsivity [15].
- Emotional Regulation: The PFC is central to managing emotions. Children with ADHD often struggle with emotional regulation, which may lead to frustration, outbursts, or social difficulties.
Diagnosis and a Holistic Approach
Diagnosing ADHD typically involves a comprehensive evaluation by a paediatrician and/or mental health professional. This may include psychological testing, parent and teacher reports/observations, standardised behavioural assessments, and ruling out other potential explanations for behavioural or emotional difficulties.
While there are many ways to help support your child, a multidisciplinary approach often shows the best results [10]. A holistic approach to supporting children with ADHD emphasises addressing the underlying issues, as well as managing the symptoms. This may include:
- Traditional Approaches: Medication, behavioural therapy, and occupational therapy remain important components of managing ADHD.
- Nutritional Support: Diet plays a crucial role in brain health and can significantly impact children with ADHD. Deficiencies in certain nutrients have been linked to ADHD symptoms.
- Vitamin D deficiency has been linked to cognitive difficulties. Ensuring adequate vitamin D levels through diet or supplementation may benefit children with ADHD [11].
- Omega-3 fatty acids, found in fatty fish like salmon and tuna, walnuts, and flax seed, are essential for brain development and function. Studies suggest they may improve focus and reduce impulsivity in children with ADHD [12].
- Some studies have shown that iron deficiency is more common in children with ADHD and can contribute to fatigue and difficulty concentrating. A healthcare professional can check iron levels and recommend dietary changes or supplements if needed [13].
- Sleep Regulation: Good sleep hygiene is crucial for overall brain health and can positively impact focus and behaviour in children with ADHD.
- Exercise: Physical activity has been shown to improve focus, executive function, and emotional regulation in children with ADHD.
- Reducing Screen Time: Excessive screen time can be particularly challenging for children with ADHD. The fast-paced, stimulating nature of many digital games and apps can further hinder focus and impulse control. Additionally, the blue light emitted from screens may further disrupt sleep patterns, leading to increased difficulty concentrating and managing emotions the following day. It's important to establish healthy screen time limits. The Australian Institute of Family Studies recommends no screen time for children under 2 years old, 1 hour or less for children aged 2-5, and no more than 2 hours for children 5-17 years old [14].
Chiropractic Care and the Nervous System
Chiropractic care focuses on the musculoskeletal system and its connection to the nervous system. Research by Dr. Heidi Haavik and colleagues suggests that specific chiropractic adjustments may improve nervous system function and potentially support children with ADHD [3,4,5].
The proposed mechanisms include:
- Improved Proprioception: Chiropractic adjustments may enhance the body's awareness of its position in space (proprioception), which can benefit children with potential vestibular dysfunction.
- Reduced Sensory Overload: Some research suggests that chiropractic care may help regulate sensory processing and increase sensorimotor integration in the PFC [3,4], potentially reducing the overwhelming sensory experiences that can exacerbate ADHD symptoms.
- Enhanced Nervous System Communication: Chiropractic adjustments aim to improve communication between the nervous system and the brain, which may indirectly support the functioning of the PFC.
- Improved Eye Movement: A recent pilot study looked at eye tracking in children with ADHD before and after chiropractic adjustments and showed improved reading times after adjustments [7]. Another case study showed improved saccadic eye movements after chiropractic adjustments [6].
While more research is needed in this area, there is some promising research looking at the overall effects of chiropractic care for children with ADHD. One case study showed improvement in hyperactivity, impulsivity, and inattentiveness, as well as behavioural, social, or emotional difficulties in children with ADHD after receiving chiropractic care [9]. Another pilot study, due to be published this year, showed the feasibility of further research into the effects of chiropractic care on ADHD symptoms [8]. Pilot studies such as this lay the framework for ongoing research in the future.
Working Together for Success
It is crucial to understand that chiropractic care is not a replacement for traditional ADHD treatment plans. It can, however, be a valuable complementary approach to support nervous system function and regulation, potentially improving overall well-being in children.
It can be challenging to find the right support when navigating ADHD. A holistic approach that combines traditional therapies, chiropractic care, and a healthy lifestyle, children with ADHD can thrive in school and beyond.
Talk to one of our Chiropractic Team today about how Chiropractic Care may be able to support your family!
Resources:
[1] Shaw, P., Eckert, M., & Lennon, P. (2000). Attention-deficit/hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America, 9(1), 209-231.
[2] Durston, S., Tottenham, N., Thomas, K. M., Davidson, M. C., Eigsδόttir, M., & Raaen, T. (2003). Differential prefrontal cortical activation in adolescent attention-
[3] Altered sensorimotor integration with cervical spine manipulation- https://pubmed.ncbi.nlm.nih.gov/18328937/
[4] The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control https://pubmed.ncbi.nlm.nih.gov/22483612/
[5] Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study https://pubmed.ncbi.nlm.nih.gov/27047694/
[6] Effects of Cervical Spinal Manipulation on Saccadic Eye Movements https://pubmed.ncbi.nlm.nih.gov/38539679/
[7] The Effects of Spinal Manipulation on Oculomotor Control in Children with Attention Deficit Hyperactivity Disorder: A Pilot and Feasibility Study https://pubmed.ncbi.nlm.nih.gov/34439666/
[8] The effects of chiropractic adjustment on inattention, hyperactivity, and impulsivity in children with attention deficit hyperactivity disorder: A pilot RCT https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1323397/abstract
[9] The chiropractic care of children with attention-deficit/hyperactivity disorder: a retrospective case series https://pubmed.ncbi.nlm.nih.gov/20451152/
[10] Multimodal integrated intervention for children with attention-deficit/hyperactivity disorder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10336987/#:~:text=These%20results%20indicate%20that%20a,ADHD%2C%20improving%20their%20memory%20and
[11] Thapar, A., & Cooper, A. (2016). Vitamin D and ADHD. Developmental Neuropsychiatry, 8(1), 86-95.
[12] Chang, J. Y., Lin, H. Y., Huang, Y. C., Lin, P. Y., & Yeh, H. L. (2015). Omega-3 fatty acid supplementation for attention-deficit/hyperactivity disorder in children and adolescents: a meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 7-15.
[13] Szymura, M., Szewczyk, K., & Chmurzyńska, T. (2016). Iron deficiency and attention deficit/hyperactivity disorder in children and adolescents. Neuropsychiatric Disease and Treatment, 12, 2297-2303.
[14] Too much time on screens? Screen time effects and guidelines for children and young people https://aifs.gov.au/resources/short-articles/too-much-time-screens
[15] Relationships between sensory integration and the core symptoms of attention-deficit/hyperactivity disorder: the mediating effect of executive function https://pubmed.ncbi.nlm.nih.gov/35999304/#:~:text=In%20detail%2C%20the%20vestibular%2Dbalance,correlated%20with%20only%20inattention%20symptoms.
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