You’ve most likely read the line before: “We can’t generalize based on these findings, but…” It’s a common limitation of case reports. They are valid and valuable contributions to the evidence bank, but always carry a disclaimer that further research is necessary. A recent case report and literature review listed 18 separate cases in which an improvement in behavior was reported in a patient with ADHD under chiropractic care. We aren’t claiming that chiropractic is a cure – that would be far too simplistic for a complicated condition. But perhaps there is something to see here; something that may occur when subluxations are removed and optimal neural function is enabled – something that is worth another look.

The latest addition to the evidence bank surrounding ADHD and chiropractic care emerges from the office of a private practice chiropractor in Auckland, NZ. The case report was published in the journal Clinical Chiropractic Paediatrics in June 2019 and followed the care of a 7-year old female who presented with “anxiety, sleep disturbances, learning difficulties and behavioral issues.” She had been medically diagnosed with ADHD and prescribed standard medication, but the child’s parents were “interested in seeking alternative solutions [1].”

This search for other solutions had involved cognitive behavioral therapy (CBT), psychotherapy and dietary changes, all of which were found to be ineffective. Then came chiropractic care. Upon first assessment, the chiropractor noted, “the child presented with an unsettled demeanor and short attention span, was distracted, hyperactive and had difficulty following instructions [1].” Her gait and coordination were normal, but the examination revealed a few other things of note:

• High left mastoid and shoulder with left scapular winging
• Anterior pelvic tilt
• Retained bilateral asymmetrical tonic neck reflex
• Inability to track on H-test
• Subluxations noted at C1, T2, T4, T9, and sacrum (assessed via a range of standard tests)
• Resolution of asymmetrical tonic neck reflex

Over the course of care, the patient’s ocular tracking (H-test) normalized, as did her leg length inequality, levator scapular hypertonicity, joint play, intersegmental motion (T3/4) and right C5/6 edema. These “indicated a reduction of direct objective indicators of vertebral subluxation when compared to the initial presentation [1].” Also noted alongside these improvements were:

• Improvement in behavior
• A reduction in symptoms associated with ADHD
• A reduction in anxiety
• Improved sleep
• Improvement in concentration

Her care took place over 11 weeks, during which she had the last 2 of 5 visits for CBT. As her improvement in behavior was rapid once chiropractic care commenced, the mother “did not believe CBT had been as effective.” Full details of care, including subluxation listings and progress details by visit, can be found in the original paper (referenced below).

Not an isolated case

This case report alone is significant if we look simply to the impact this might have on the course of her life in terms of sleep, anxiety, academic performance, and other factors. However, the literature review shows us this is far from being an isolated case. It revealed “three systematic reviews, one clinical trial, one qualitative study, four case series and 18 case reports relevant to chiropractic management of people presenting with ADHD. All but one study described the care of pediatric patients [1].”

Make no mistake: there are issues with the existing evidence. The clinical trial only described the proposed protocol for a study and the systematic reviews all reported a limited range of low level of evidence regarding ADHD. However, the most recent one does suggest chiropractic “may be beneficial for this population” whilst simultaneously recognizing further investigation is necessary. The literature review goes into detail on each of the pieces of evidence (check it out via the original source) and it should be noted that many of the studies look at specific techniques or multimodal management plans.  Still, many of the studies do indeed report on the assessment and correction of vertebral subluxations.

All in all, the evidence suggests that chiropractic care “can improve symptoms related to ADHD” and that “the current case study is congruent with previously reported studies investigating the effects of chiropractic care on the symptoms associated with ADHD [1].” 

While it is certainly a beautiful thing to be able to make a difference in the life of one child, it is also encouraging to see continued indications that chiropractic care and the management of ADHD make a good pair.

REFERENCES:

1. Fairest C, Russell D (2019), “Improvement in behavior and attention in a 7-year-old girl with ADHD receiving chiropractic care: a case report and review of the literature,” Journal Clinical Chiropractic Pediatrics, Volume 18, No 1. http://jccponline.com/ADHD.pdfretrieved 1 June 2019