ADHD used to be known as attention-deficit disorder, but was renamed ADHD in 1994 and broken down into three subtypes, each distinctive with their own pattern of behaviors: an inattentive type, a hyperactive-impulsive type and a combined type.

While every child diagnosed with ADHD will not act the same, there seems to be a pattern of behavior that is being seen more frequently.

In the 1990s there were about 900,000 children being treated for ADHD with Ritalin. Today that number is more than 5 million. It’s time to find out what is causing such a dramatic rise in the number of diagnosed cases of ADHD.

Contributing Factors

While no one has, of yet, been able to determine the exact cause of ADHD, there has been much speculation as to the contributing factors. These factors include: genetic and environmental links, smoking during pregnancy, premature delivery, low birth weight, birth injuries, excessive television watching, diet, nutrition and allergies. Much of this has to be considered as pure speculation, but recent studies are proving that one particular area is adding up to be more than just conjecture.

Diet, Nutrition and the Busy Family

Unfortunately, in today’s busy families, it’s not unusual to see that healthy meals prepared at home are the exception and not the rule. In some nutritional circles, the “fast” or “box” food has led to a “toxic food environment.” Fresh fruits, vegetables, poultry, fish and whole-grain products are no longer a part of the standard diet. With this processed-food approach, parents might not realize the excessive amounts of preservatives, artificial flavors and colors their children are consuming.

The Trouble With Food Coloring

In a recent article published in The Lancet medical journal, researchers at Southampton University in England reportedly have found a link between food dyes and hyperactive behavior in children. Professor Jim Stevenson and his colleagues published their results based upon the examined effects of additives on 153 children age 3, and 144 children ages 8 and 9.

The children were divided into three groups, two of which were given one of two drinks that contained a different combination of food colorings and sodium benzoate. The third group was given a placebo that contained no food coloring or preservatives.

This double-blind, placebo-controlled study determined that those artificial colors and the preservative sodium benzoate (or both) in a child’s diet result in increased hyperactivity.

In response, Susan Jebb, nutrition scientist at Britain’s Medical Research Council added, “Such additives are most likely to be found in foods that we would like to see children eating less of (i.e., soft drinks, confectionery, and so on) and so it reiterates the general healthy eating messages of encouraging healthier food choices.”

A Natural Approach

A study done at Harvard Medical School, in their neuropsychology post-graduate program, tested 20 children who had been diagnosed with ADHD. Ten were treated with Ritalin, the most commonly prescribed drug. The other 10 were treated with dietary supplements. The results were compared using the most popular neurological tests, including IVA/CPT and the WINKS analysis. The tests revealed that the subjects in both groups showed significant and essentially identical improvements.

These studies suggest that the majority of neurological symptoms ascribed to ADHD can be attributed to food and additive allergies, heavy-metal toxicity and other environmental toxins, low-protein/high-carb diets, thyroid disorders, mineral imbalances, essential fatty-acid deficiencies, amino acid deficiencies and B-vitamin deficiencies.

The dietary supplements used were a mix of vitamins, minerals, phytonutrients, amino acids, essential fatty acids, phospholipids and probiotics that attempted to address the ADHD biochemical risk factors. These findings support the effectiveness of food-supplement treatment in improving attention and self-control in children with ADHD, and suggest that food-supplement treatment of ADHD may be equally effective to Ritalin treatment.

Dietary Recommendations

Chiropractors and other health care professionals agree that diet plays a vital role in a child’s health and well-being. In your family wellness practice, consider providing the following recommendations:

• Do not allow children to drink soft drinks. These chemical concoctions contain artificial food coloring, additives and preservatives.
• Eliminate baked products. These items contain high quantities of bleached flour and sugar, both of which wear down a child’s immune system and overtax their digestive system.
• Limit fast food. The only healthy option is to avoid it all together, but if this isn’t possible, then limit it to once a month.
• Encourage eating at least four servings of vegetables and one serving of fruit every day. Fruit is an important part of your child’s diet, but fresh vegetables contain more of the vitamins and minerals children need.
• Eat whole grains and protein-rich foods. A diet that is high in protein and healthy carbohydrates will give children the energy they need without over-working and over-loading their bodies.
• Don’t forget the omegas. This is vital for supporting the child’s concentration.
• Promote all-natural as much as possible. Avoid foods that have been treated, processed, packaged, colored, flavored or pasteurized.

The Chiropractic Factor

Although there are no studies to support the role of chiropractic care in the life of the ADHD child, many parents report a vast improvement in their child’s ADHD symptoms in conjunction with regular chiropractic care. My experience from a clinical perspective is that I have definitely seen the positive role that chiropractic care can play in the life of the child with ADHD.

Resources

1. McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet, Nov 3, 2007;370(9598):1560-7. Available at www.thelancet.com.
2. Alternative Medicine Review, Aug. 2003;8(3):319-30.
3. Agency: Food Coloring May Stimulate Kids. Available at www.food.gov.uk.

Parents tend to make decisions based on what they’re told by their health care providers. So, what should parents do when science starts proving that what they’ve been told for more than 50 years could be wrong?

What Is Fluoride?

Fluoride is defined as a salt of hydrofluoric acid consisting of two elements. The first element is fluorine, which, in its elemental form, is part of the Earth’s crust. This doesn’t mean much to a parent unless they understand that Dr. Robert Carton, a former EPA toxicologist, considers fluoride “somewhat less toxic than arsenic and more toxic than lead.” Now that they understand!

What doesn’t make sense about this is that fluoridated water contains an average of 1 mg/liter of fluoride, but the EPA considers any water containing more than .015 mg/liter of either lead or arsenic to be in excess of what is considered “its maximum contaminant level.” In other words, fluoridated water would be considered poisonous if it weren’t for all the hype around “fluoride.” Dr. Carton believes, “Fluoridation is the greatest case of scientific fraud of this century, if not of all time.”

Fluoride Sources

Many city and county governments have added fluoride to their water because it’s supposed to be good for us; but this isn’t the only source. Several items you purchase for your home contain fluoride including toothpaste, grape juice (pesticides), chicken (bone dust released during the separation process), bottled spring water, tea and wine (natural byproducts from the earth).

The Problem With Fluoride

We’ve all heard that the American Dental Association says fluoride is good for our teeth; the problem is this is a fallacy. Fluoride is not good for our teeth. In fact, it’s quite the opposite.

In order for fluoride to bond to teeth, it must remove calcium. That process is called fluorosis. Fluorosis is defined as an abnormal condition caused by excessive intake of fluorides, characterized in children by discoloration and pitting of the teeth, and in adults by pathological bone changes. Not only is fluoride not good for our teeth, but some authorities also believe it’s possible many adults suffering from “arthritis” are, in reality, battling fluorosis.

Fluoride Research

In 1988, the National Institute of Dental Research and the United States Public Health Service completed a massive $3.6 million nationwide survey to determine the efficacy of fluoridation. The data, which was released only after a Freedom of Information Act filing, revealed there was no difference in the amount of tooth decay between fluoridated and nonfluoridated communities. Public health officials in New Zealand and Canada have made similar findings.

In 1999, the New York State Department of Health completed an unprecedented 45-year study comparing children in Newburgh, N.Y., which had fluoridated water for 45 years, with Kingston, N.Y., which never had fluoridated water. It was determined there were no significant differences in the amount of cavities between the two cities. Unfortunately, there was more dental fluorosis in Newburgh.

In 2000, a systematic review of more than 200 water-fluoridation safety and efficacy studies found they were lacking in any real scientific data. One researcher was quoted as saying, “The most serious defect of the studies of possible beneficial effects of water fluoridation was the lack of appropriate design and analysis.”

A similar study taken on by the University of California, Davis Department of Mathematics said, “The announced opinions and published papers favoring mechanical fluoridation of public drinking water are especially rich in fallacies, improper design, invalid use of statistical methods, omissions of contrary data, and just plain muddle-headedness and hebetude.” In other words, they basically were making it up as they went along.

Finally, according to a 1998 U.S. patent by the pharmaceutical company Sepracor, fluoride activates the very oral “G proteins” that have been determined to lead to chronic gingivitis, periodontal disease and, ultimately, tooth loss.

Fluoride Dangers

The first obvious danger is that fluoride is a poison, but it also is a proven carcinogen. Studies performed by the National Cancer Institute’s former Chief Chemist Emeritus, Dr. Dean Burke, show fluoride is responsible for about 10,000 deaths annually. “In point of fact, fluoride causes more human cancer deaths, and causes it faster, than any other chemical.”

Similar studies from St. Louis University, Japan’s Nippon Dental College and the University of Texas showed fluoride actually increases tumor growth rate, and the New Jersey Department of Health found the risk of osteosarcoma among males under 20 was up to seven times higher in fluoridated areas.

Equally surprising is the fact fluoride has been shown to cause brain damage. In 1999, 1,500 EPA scientists, lawyers and engineers signed a joint resolution to oppose fluoridation because they found fluoride causes “gene mutations, cancer, reproductive effects, neurotoxicity, bone pathology, and … decreases (of) about 5 to 10 I.Q. points in children aged 8 to 13 years.”

What Can Parents Do?

There are several things that can be done to lessen the amount of fluoride children and parents ingest besides simply switching to a nonfluoride toothpaste. The first is to quit drinking from the tap if your community is one of the many with fluoridated water. In addition, be careful when purchasing bottled water, since water-bottling companies are not required to list the amount of fluoride in their water. It’s best to purchase only water that says it’s purified, distilled, deionized, demineralized or produced through reverse osmosis, as this always will be low in fluoride. It goes without saying to avoid any water that says, “Fortified with fluoride.”

It’s also important to note the American Dental Association and the Centers for Disease Control and Prevention finally have admitted fluoridated water should never be mixed into concentrated formula or foods intended for babies.

As family wellness chiropractors, we are here to provide wellness lifestyle information to parents so they can make the best decisions for their families. When given the opportunity, provide them with resources – Web sites, research papers and books – to come to their own conclusion as to what is best for their children.

Resources

1. www.icpa4kids.org/research/children/flouride.htm.
2. www.nofish.org/new_page_17.htm.
3. www.icpa4kids.org/research/articles/childhood/Fluoride_More_to_Swallow.htm.
4. www.mercola.com/article/links/fluoride_links.htm.
5. www.fluoridealert.org.

The journal Chiropractic & Osteopathy recently published a thematic series on the chiropractic care of children. While I’m glad that many academics in our profession are interested in the growing arena of chiropractic pediatrics, I found the thematic series limited in the number of participant authors and feel it would have been better served with more differing views.

Dr. Joel Alcantara is the director of research for the International Chiropractic Pediatric Association (ICPA). In this capacity, he directs all research activities and oversees the largest and most successful practice-based research networks in chiropractic. Recently, Dr. Alcantara and colleagues published a landmark study in the Journal of Alternative and Complementary Medicine on chiropractic care for children. In addition to characterizing pediatric chiropractic, they estimated that approximately 80 million pediatric visits are made to chiropractors each year. The authors acknowledge that this may be an overestimation, but it does support the study by Barnes and colleagues from the National Institutes of Health that chiropractic is the most popular CAM-based therapy for children. In this interview with Dr. Alcantara, I asked him to share his thoughts on the thematic series in Chiropractic & Osteopathy.

Before I ask your opinion regarding the articles published in Chiropractic & Osteopathy, can you give us a synopsis of the thematic series? Chiropractic & Osteopathy commissioned a thematic series on the chiropractic care of children and invited their key people in the field of pediatric chiropractic to provide an up-to-date review on the chiropractic care of children. You have Sharon Vallone and her colleagues providing their opinion on the chiropractic approach to the management of children; Ferrance and Miller addressing the diagnosis and chiropractic management of musculoskeletal conditions in children and adolescents; Kim Humphreys discussing the safety of pediatric chiropractic; Fay Karpousiz and her colleagues exploring care of the child with ADHD; and finally, Leboeuf-Yde and Hestbaek addressing the question: “Is research enough?”

Overall, the articles addressed aspects of pediatric chiropractic we should all be aware of. I didn’t necessarily agree with all the opinions made, but the editorial commentary by Simon French, Bruce Walker and Stephen Perle was especially disturbing from my point of view as a researcher and a practitioner.

In their article, they posed the question: “Should we be treating children at all?” and based this on the limited amount of research currently available. Please explain why you disagree with the position they took in their editorial commentary? Everyone would agree that the chiropractic profession needs more research. In terms of pediatric chiropractic, this is painfully true. French and colleagues questioned, given the sparse research evidence available on the chiropractic care of children, whether we should be treating children at all. They caution clinicians who accept without question the suggestion that a trial of chiropractic care is warranted, particularly with children presenting with non-musculoskeletal conditions.

I don’t disagree with this cautionary statement. I think it prudent for every clinician to critically appraise the literature in the context of their clinical experience and expertise and the request of the patient or parent. This is essentially evidence-based practice. However, they go a bit further and, using the chiropractic care of children with colic as an example, quote the Bronfort Report by stating, “There is no evidence that chiropractic care for infant colic is more effective than sham therapy.” They then propose: “It may also be reasonable to suggest that a short trial of ‘placebo treatment’ is warranted.” Their comment was not only unjustified, but irresponsible. French and colleagues acknowledge the principles of evidence-based medicine, but they throw it out the window if it doesn’t support their point of view.

The decision to pursue or recommend a trial of chiropractic care is based on many factors, with safety and effectiveness at the core of this decision and the principles of evidence-based medicine providing the overall guiding principle. So, what is a clinician to do when the research is not available? Evidence-based medicine allows you to rely on your clinical expertise and the needs and wants of the patient or the parent (in the case of pediatric chiropractic).

Sackett and colleagues, in defining evidence-based medicine, stated: “Evidence-based medicine is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.” When RCTs are not available, they recommend to “follow the trail to the next best external evidence and work from there.” Sackett and colleagues said it best: “External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision.” This is true not only in chiropractic, but also for orthodox medicine.

Going back to the colic issue, French and colleagues based their comment on the recent review by Bronfort, et al., on the effectiveness of manual therapies for various conditions. First of all, I believe Bronfort and colleagues are wrong in their conclusion regarding the evidence for colic. If one closely examines the clinical trials on chiropractic SMT and infantile colic, you will find that no study exists comparing chiropractic SMT versus sham therapy.

Now, sham therapy has been defined as a procedure that closely mimics the active procedure, but remains inert with respect to the specific effects of the active treatment. Wiberg and colleagues compared the effects of chiropractic SMT versus simethicone, a common medication for infantile colic. Browning and colleagues compared the effects of chiropractic SMT and occipito-decompression in infantile colic. Finally, Olafsdottir and colleagues compared an unproven chiropractic technique versus “no treatment.”

Wiberg and colleagues found chiropractic superior to simethicone; Browning and colleagues found both techniques decreased the hours of crying compared to baseline; and Olafsdottir and colleagues found their chiropractic technique as ineffective. So, the bottom line is, there is some evidence in support of chiropractic care for infantile colic.

If you look at safety, the two major studies examining the safety of pediatric SMT are the systematic review of the literature by Vohra and colleagues and our publication on the safety and effectiveness of pediatric chiropractic, the latter of which is based on our findings from the ICPA practice-based research network. Vohra essentially found (in more than 100 years of literature) only a handful of cases documenting adverse events with chiropractic SMT in children. When you closely examine the literature, these involve mostly minor adverse events like soreness and stiffness at the site of the adjustment. It was difficult to find fault with the chiropractor since the patients described had a pre-existing condition and/or suffered from trauma with symptoms corresponding to their supposed adverse event.

Our ICPA study surveyed chiropractors and parents of children receiving chiropractic care. The chiropractors indicated three adverse events in 5,438 office visits involving the care of 577 children. The parents indicated two adverse events in 1,735 office visits involving the care of 239 children.

Compare this to the medical care of children with infantile colic. The literature essentially indicates that medications like simethicone are no more effective than placebo and are associated with severe adverse events. Add to this the research that indicates parents may have thoughts of infanticide due to their crying baby. As a researcher and clinician, I think a trial of chiropractic care is warranted, in line with the principles of evidence-based medicine and the principles of biomedical ethics. That is, respecting a patient’s autonomy, avoiding harm, placing their interests and well-being first and allowing them access to essential care like chiropractic.

As a clinician, you’ve essentially explained the principles of evidence-based medicine and affirmed what thousands of chiropractors are doing in practice. What about the other articles in the thematic series? Do you have any comments about them? When it comes to safety, we need to keep doing the research. As Dr. Humphreys pointed out in his article, severe adverse events are rare in pediatric chiropractic, but that may also be underreported. We need to find out what these adverse events are, what’s causing them and develop a means of preventing them. We need to continue our research on the safety of pediatric chiropractic. The ICPA PBRN has been established to continue the research on pediatric safety. It’s our ethical and professional responsibility.

Of course, as a researcher, I agree with Drs. Leboeuf-Yde and Hestbaek that we need more research, not only in quantity but also in quality. We differ in our direction and focus for research, but this is understandable given our different interests and methodologies.

What about the article on the management approach to children? Dr. Vallone and colleagues are respected members of the chiropractic community and key in education, research and clinical practice in the field of pediatric chiropractic. Given their expertise, I was quite surprised that they would recommend “hypermobility” as an absolute contraindication for manual therapy for children. They are essentially recommending that chiropractic SMT should not be performed on children. If you look at the unique biomechanical features of the pediatric spine, hypermobility is one, in addition to malleability, changing spinal contours, an immature neuromusculoskeletal system, etc. Essentially, this would eliminate the practice of pediatric chiropractic as we know it, since the chiropractic adjustment is the primary approach to the care of children.

On another point: Vallone, et al., recommend that the inversion maneuver for infants and young children is a relative contraindication. My question is: On what basis do these authors make this recommendation? The scientific literature does not support them in terms of adverse events due to the procedure. Furthermore, their stated reasons for not performing the procedure (possible undiagnosed clinical entities) just does not make clinical sense. It takes clinical uncertainty to a different level and how it affects one’s decision to perform a diagnostic test or treatment procedure.

Finally, they qualified that, based on their experience, mechanical lesions are “expected to respond within approximately three to six treatments, depending on the duration of the problem.” We need to look at this and accept that this is based on their clinical experience and not necessarily the experience of all chiropractors. Additionally, comments like this are unfounded given the heterogeneity of the clinical presentations that chiropractors address in the care of children. If there’s one thing certain about clinical practice, it is clinical uncertainty.

Not only is it safe to visit a chiropractor during your pregnancy, it’s also highly beneficial. All chiropractors are specially trained to treat pregnant women, but you may want to do a little research and find one who specializes in prenatal or perinatal care. Getting regularly adjusted while pregnant is a great way to relieve the added stress on your spine that comes along with the weight gain. It can also prevent sciatica, the inflammation of the sciatic nerve that runs from your lower back down through your legs and to your feet. It’s also important to maintain pelvic balance, which is oftentimes thrown off as your belly grows and your posture changes.

Besides making you feel better during pregnancy, getting regular chiropractic adjustments can also help control nausea, prevent a potential C-section, and has even been linked to reducing the amount of time some women spend in labor.

How do I know if my horse needs Chiropractic Care?

• Loss or decrease in level of performance.
• Problems or difficulty executing desired movements.
• Behavioral changes (i.e. refusals, cinchy, bucking).
• Short striding.
• Diagnosed conditions, such as degenerative arthritis.
• Muscle imbalance, spasms, or atrophy.
• Gait problems, such as cross-canter, loss of collection, refusal to pick-up lead.
• Injuries resulting from falls, training, or other activities.

Stressful situations, such as conformation of the horse, various riding and training equipment, performance level and ability of the rider, shoeing.

There are numerous, common stressful or traumatic situations, such as the birth process, conformation of the horse, training and riding equipment, ability of the rider, shoeing trailers, or direct trauma, that can cause abnormal or restricted movement to occur in the spine. This change in proper movement of the spine is what chiropractors call a “subluxation”. When a subluxation occurs, the horse’s spine loses it’s normal flexibility. This results in stiffness which further leads to resistance and decreased performance. The most common symptom associated with spinal subluxations is pain, which can manifest changes itself in a variety of ways. Horses in pain will show compensatory changes in posture and gait. These changes can cause stress in other joints and muscles.

Symptoms such as lameness, stiffness, lack of impulsion or power, difficulty in obtaining or maintaining collection, poor attitude, gait abnormalities, being cold-backed or cinchy, or the presence of muscle atrophy are commonly associated with spinal misalignments.

Subluxations may also cause changes in muscle coordination and flexibility that affects the performance ability of the horse. These symptoms may be lack of coordination in gaits, unusual, perhaps indefinable gait abnormalities which vary from limb to limb and change depending on gait, stiffness in lateral movements of neck or back, rope walking, shortened stride in one or two limbs, inability to engage rear quarters, difficulty flexing at the poll, or on line or pulling on one rein.

Common complaints from horse owners include resistance or stiffness when moving to one direction, irritability, decreased performance, and sensitivity to touch, such as when being groomed.

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