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Case Report: Effectiveness of a complementary and alternative approach on a 8 years old children diagnosed with ADHD opposition and provocation disorder.

Dr Geneviève Gagné DC

Abstract:

introduction:

The purpose of this case report is to demonstrate the effectiveness of using a complementary and alternative approach using corrections toward retained primitive reflexes and nutrition on an 8 year old child diagnosed with ADHD, opposition and provocation disorder.

Assessment:

Case history and physical evaluation of an 8 years old Caucasian female diagnosed with ADHD, opposition and provocation disorder.

Treatments and Results:

Data were collected on an 18 week period. The patient had receive nutritional support with pyridoxal-5-phosphate vitamin supplementation and manual corrections made with RNR technique (Retained Neonatal Reflexes™) and chiropractic spinal adjustments. During that period, the patient showed general improvement in her general behaviour and also in her school reports.

Discussion:

An important improvement on the patient’s condition in a short period of time shows the benefits of introducing RNR™ techniques for this type of condition.

Conclusion:

The results show that the RNR™ complementary and alternative approach helped a patient diagnosed with ADHD, opposition and provocation disorder.

 

Introduction:

In the past decade, the worldwide leading new paediatric epidemic is ADHD. Every year, the number of prescription for methylphenidate (Ritalin®) is exploding. Between 1990 and 1998, its use has increased by 800 percent even though it has severe side effects and its long-term consequences on the developing brain are still unknown. Unfortunately, its ratio of success on the young population diagnosed with ADHD is no more than 30%.[1]

Toward this evidence, pharmaceuticals and medical doctors are focusing their approach on finding new medications and psychotics to try to help those children such as methylphenidate (Concerta®, Ritalin®, Biphentin®), lisdexafetamine (Vyvanse®) and other neuro-stimulants.

Alternative medicine though is placing its efforts into understanding why the incidence and prevalence is increasing in recent years. According to the Institute of Neuro-physiologic Psychology research, the major cause of learning difficulties is an immature central nervous system with the presence of retained primitive reflexes. The gene theory has been rejected in Sweden following the study of Dr Gillberg in which the results were more suggestive of social and environmental circumstances as causal factors for ADHD[2]. An interesting study made in a classroom in 2004 showed that a higher number of children diagnosed with ADHD were demonstrating non-integrated reflex such as Moro, Tonic Labyrinthine reflex (TLR), Asymetrical Tonic Neck Reflex (ATNR) and Symetrical Tonic Labyrinthine Reflex (STNR) compared to those who were not having that diagnosis. The retention of these reflex patters also correlated with lower maths achievement than the students that were not diagnosed with ADHD.[3]

The purpose of this case report is to demonstrate the effectiveness of treating retained primitive reflexes on a young child of 8 years of age diagnosed with ADHD, opposition and provocation disorder.

Assessment:

An 8 year and 4 month old Caucasian female, consulted at a Chiropractic outpatient clinic complaining of sleeping disorders, anxiety, tamper tantrums, aggression, opposition disorder and fecal retention. She had been diagnosed with ADHD, opposition trouble and provocation disorder. She had been medicated with Vyvanse® 20mg for 2 years with no success. For 3 months, she had been taking Intuniv® XR 2 mg and Biphentin® 30mg. The parents had not seen any clear results at the commencement of this study.

The case history showed a difficult delivery assisted by forceps. Between the age of 18 months and 3 years of age, the mother reported a recurring of otitis media. The mother subjectively monitored that her daughter had overcome some difficulties to determine the dominant hand and had experienced having trouble sitting still for long periods. She had also been diagnosed with dyslexia and reported to be a messy writer by her teachers. She performed well in most sports. She has no friends and had a hard time entering into friendships because of her aggressive reactions towards others. She had received all the vaccines considered normal for her age with no specific reactions reported by her parents. At the commencement of this study she was in 2nd grade in a specific school for children with learning difficulties. Her school reports are below average in mathematics and also in French.

The patient was examined using Applied Kinesiology protocols. Retained Neonatal Reflexes (RNR™) is an advanced applied kinesiology tool that was developed to help the integration of retained primitive reflexes by Australian Chiropractor Dr Keith Keen DC DO.

Physical examination subjectively demonstrated frowning of the eyebrows, crossed arms and avoidance of the questions. No postural abnormalities and Adam test was negative. Rib expansion was suboptimal at 1 inch at T10 level ( N: ≥3 inches) Abnormal hypertonicity in the mandible muscles was noticed such as the masseter and the temporalis bilaterally. Palpation of the skull demonstrated tenderness on the temporo-parietal suture bilaterally. The patient subjectively referred to the sensation as pain but didn’t want to collaborate in using a pain scale. Functional evaluation detected a retained Fear paralysis reflex (FPR), a retained Moro Reflex, and a retained bilateral Asymmetrical Tonic Neck Reflex (ATNR). She also demonstrated a hard time crossing the midline in cross-pattern exercises. Chiropractic evaluation showed subluxations at T12 and C1 level.

Treatments and Results:

At the first visit, chiropractic adjustments were performed on the young patient using diversified High Velocity Low Amplitude (HVLA) manipulations and correction on the FPR and Moro reflex using the RNR™ technique which consist in cranial and structural corrections.

The next visit, two weeks later, the mother reported more disorganisation than what they were used to: more yelling, highly aggressive and she also attacked one of her classmates. The exam showed a persistent Moro reflex which is related to an hyperadrenic state[4]. Pyridoxal-5-Phosphate was suggested to the patient on a dose of 100mg a day to help assist the breakdown of noradrenalin[5]. The RNR™ correction for Moro was performed again on the patient as well as the correction for ATNR.

On the 3rd visit, two weeks later, the mother reported a general improvement. She was more calm, polite and did not constantly confront authority. At school, her teachers reported a better attitude toward other students and a better participation in class. The evaluation showed no positive challenge on the FPR, Moro and ATNR reflex. The patient was more compliant to her treatment and she also demonstrated signs of good humour like smiling and being playful. She was kept on P5P vitamin.

Six weeks later, the patient came to her follow up appointment. Rib expansion went back to normal. Tenderness on the skull suture was 0 on a subjective pain scale. Her school reports revealed an increasing of 7% in French, 16 % in mathematics and 5% in ethics. The teachers and the resident psychologist at her school highly recommend that she integrate into a normal school next year. She also made a new friend and had been invited to a birthday party.

2 months later, the psychiatrist did not consider the need for further follow up appointments in psychiatry.

Discussion:

The results of this case report suggest that there is a possible efficiency in using a complementary and alternative approach protocol on children diagnose with ADHD. However, there were a certain number of parameters to consider in the treatment. It is not possible to conclude that soley the manipulations themselves were effective in bringing on these changes or the introduction of pyridoxal-5-phosphate to support the biochemistry of the body. Regardless, evidence suggests in this case that there were better results using non-medical therapies than the medication taken alone. School reports indicate significant improvements in only a few months. The history of this important progression in such a short period of time demonstrates that the introduction of the treatments for the patient was beneficial. However, it is hard to exclude the time as a considerable parameter. Further studies should be considered for reproducibility on the results. It is also important to mention the interlinking of the different approaches used as a major weakness in determining the efficacy of each individual therapeutic component applied. A doubled-blinded study could be useful to determine if the supplementation itself could be more efficient than manual therapies using RNR™ techniques and chiropractic adjustments.

Conclusion:

The results show that a complementary and alternative approach can help a patient diagnosed with ADHD. These results probably correlate with the fact that children diagnosed with ADHD have retained primitive reflex. As mentioned above, further investigation with a double-blinded research study should be appropriate to determine more specifically which therapy has a major impact on the symptoms of ADHD. This case shows a positive hope for developing more investigations in understanding the neurology underneath ADHD disorder.

References:

[1] Desorbay,T. (2013) A neuro-developmental approach to specific learning difficulties. International Journal Of Nutrition, Pharmacology, Neurological Diseases,3 (1), 1-2.

2 Movement that Heal, Harald Bloomberg MD and Moira Dempsey, BookPal, Éd 1, 2011, Australia, p.29

3 Primitive Reflexes and Attention-Deficit\Hyperactivity Disorder: Developmental
Origins of Classroom Dysfunction, InternationalJjournal of Special Education, 2004, Vol.19, N0.1.

4 Alcantara J, Davis J(2010). The Chiropractic Care of Children With Attention-Deficit/Hyperactivity Disorder: A Retrospective Case Series. The Journal Of Science and Heakling. Vol ?, Isuue 3, May-June 2010, P.173-182

5 Blumenthal J (2008). Retained Primitive Reflexes: Their relation to Pervasive Developmental Disorders, Autistic Spectrum Disorders, Attention Deficits, and Learning Difficulties. Journal of Vertebral Subluxation Research, May 7, 2008. P14

6 Principles of Neural Science, Eric R. Kandel, Mc Graw Hill, 4th Edition, 2000, USA, p 281-283

[1] Desorbay,T. (2013) A neuro-developmental approach to specific learning difficulties. International Journal Of Nutrition, Pharmacology, Neurological Diseases,3 (1), 1-2.

2 Movement that Heal, Harald Bloomberg MD and Moira Dempsey, BookPal, Éd 1, 2011, Australia, p.29

3 Primitive Reflexes and Attention-Deficit\Hyperactivity Disorder: Developmental Origins of Classroom Dysfunction, InternationalJjournal of Special Education, 2004, Vol.19, N0.1.

[4] Movement that Heal, Harald Bloomberg MD and Moira Dempsey, BookPal, 1st Ed, 2011, Australia, p.105

[5] Principles of Neural Science, Eric R. Kandel, Mc Graw Hill, 4th Edition, 2000, USA, p 281-283