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Case Study: Osteopathy to help ADHD Teen

Background................................................................................................ 1

Are there alternatives? Can we remove the need for methylphenidate?.... 1

Case study. .................................................................................................3

Musculoskeletal sign....................................................................................5

Conclusion. .................................................................................................5


Background

ADHD diagnoses are on the increase. According to the U.S. Centers for Disease Control and Prevention, as of 2011, 11 percent of people ages 4–17 have been diagnosed with ADHD[1]. The prevalence of ADHD is three times higher in males than in females[2]… and this number is only rising.

Around me, I see many parents with children who have attention disorders and take methylphenidate drugs (most known are Ritalin® and Concerta®). This drug is similar to amphetamine in that it stimulates the central nervous system and increases the transmission of dopamine to the brain. Unfortunately, methylphenidate has many sides effects, the most common being nervousness, sleeping problems and lack of appetite. If taken abusively, Ritalin® or Concerta® may be addictive. Since succeeding in school is important, we understand that parents want to give their children the full opportunity to learn as best they can, and the best solution the doctors give is usually methylphenidate drugs.

https://www.drugabuse.gov/publications/drugfacts/stimulant-adhd-medications-methylphenidate-amphetamines Cuffe SP, Moore CG, McKeown RE. Prevalence and correlates of ADHD symptoms in the national health interview survey. J Attention Disorders. 2005;9(2):392-401.


Are there alternatives? Can we remove the need for methylphenidate?

As I am an osteopath, I looked for solutions in my area (I have not explored other medicines or natural / herbal alternatives to the drug). One of the primary rule of osteopathy is that the structure governs the function. This implies that if we improve the musculoskeletal system, the physiology will be improved allowing us to reduce or remove the need for drugs.

I searched for articles in the field and found one, written in 1976 by Viola Frymann[1], which showed back then, how osteopathic treatments can significantly help children with Attention Disorders…. if taken early on.

We can see in the picture below (taken from V.M. Frymann article of Sept. 1976) how the harmony of the child’s body improved in conjunction with her Attention Disorders reduction.

(credit: Viola M. Frymann, article JAOA sept. 1976)

“Learning difficulties of children viewed in the light of the osteopathic concept” by Viola M. Frymann DO, FAAO, JAOA vol. 76 September 1976 p.46



(credit: Viola M. Frymann, article JAOA sept. 1976)


Another article presented a new study about the “Effect of Osteopathic Manipulative Therapy in the Attentive Performance of Children With Attention-Deficit/Hyperactivity Disorder”[1] published in The JAOA in May 2014. It concluded that “The participants who received Osteopathic Manual Therapy (OMTh) had greater improvement in Biancardi- Stroppa Test scores than participants who received conventional care only, suggesting that OMTh can potentially increase performances of selective and sustained attention in children with ADHD”.

Lassovetskaia[2] carried out also a study on children with language and learning problems. Among 96 children with delayed academic performance, children who received OMT scored significantly higher in almost all categories of academic performance after 6 to 12 weeks compared with children who did not receive OMT.

Therefore, the answer is YES. It is possible to use OMT to help reduce and sometime solve the problem of Attention Disorders.

Nevertheless, I needed to check by myself and took a pro-bono case: an 11 year old boy-Yair (alias name).

Since most of the bones are ossified by the age of 12-13, it is best if we can do a thorough osteopathic treatment before that, and Yair filled the case perfectly. He happened to be in the risk group being a boy (ADHD prevails in men 3 out of 1), and was born before term at week 35.

Case study

Born in July 2006, Yair was 11 years old at the beginning of the treatment (July 2017).

He is the second child of a three child family, born week 35 via Caesarean section.

His mother first brought him to me with strong pain on his medial left malleolus.

I treated his leg and soon enough he was ready to jump and run. However, his mother told me he has attention disorders and takes Ritalin®.

I decided to take him pro-bono to see for myself that, indeed, what Viola Frymann[3]had said is correct and that osteopathy can improve his condition.

At Yair, the main osteopathic findings showed incorrect arches in the spine (lordosis and kyphosis inversed almost and right scapula significantly lower). In addition, I found:

- FFT right

- Ilium right posterior

- Right scapula is lower

- T4-5 in Extension

- C1 in Sidebending Right.

Unfortunately, I didn’t think of taking a picture of Yair at the very beginning of his treatment.

“Effect of Osteopathic Manipulative Therapy in the Attentive Performance of Children With Attention-Deficit/Hyperactivity Disorder” Published in The Journal of the American Osteopathic Association May 2014 | Vol 114 | No. 5 - From the Accademia Italiana Osteopatia Tradizionale in Pescara, Italy (Drs Accorsi, Lucci, Granchelli, Barlafante, Pizzolorusso, & Cerritelli); private practice in Civitanova Marche, Italy (Dr Di Mattia); the European Institute for Evidence Based Osteopathic Medicine in Chieti, Italy (Drs Accorsi, Barlafante, Pizzolorusso, & Cerritelli); & the Neuropsychiatry Department at The Macerata Public Hospital in Macerata, Italy (Ms Fini & Dr Pincherle). Lassovetskaia L. Applications of the osteopathic approach to school children with delayed psychic development of cerebroorganic origin. In: King HH, ed. Proceedings of International Research Conference: Osteopathy in Pediatrics at the Osteopathic Center for Children in San Diego, CA 2002. Indianapolis, IN: American Academy of Osteopathy; 2005:52-59. “Learning difficulties of children viewed in the light of the osteopathic concept” by Viola M. Frymann DO, FAAO, JAOA vol. 76 September 1976 p.46


  1. A: 24-September 2017 B: 19 November 2017I gave Yair osteopathic treatment on a weekly basis (some weeks were missed due to vacation, colds….) finding, fixing and leaving it alone from foot to head or top to bottom.I made 14 treatments.

  2. 20/7/17 26/7/17 13/8/17 20/8/17 7/9/17 17/9/17 24/9/17 15/10/17 22/10/17 29/10/17 5/11/17 12/11/17 19/11/17 10/12/17

Around treatment 10, I Yair reported he felt more focused.

During treatment 13 of Nov. 19, 2017, the mother reported that Yair’s teacher said that his behavior had improved (she was unaware that I was treating Yair).

As a secondary benefit, he also improved his skills in Capoeira (martial art that combines elements of dance, acrobatics and music).

I am still treating Yair, and I have now moved to one treatment every two weeks. From all the lesions, T5 stays in extension and I cannot manage to fix it. C1 has to be fixed each time as well as the ilium. The Ilium however (always right side), changes from post to anterior.

Musculoskeletal sign

I have seen a few more children with attention disorders for treatments not related to their deficit. I have observed in most of them non-symmetric Scapula and mid thoracic lordosis(T3-T7). At the point, it may be significant to enable early detection. However, this is from my empiric observation and should be backed up by serious studies.

Conclusion

Osteopathy can help reduce (hopefully remove) the need for Ritalin® or like drugs and improve focus and attention in children. It is most effective before the age of 12, 13 before all the bones are ossified

However, (on an osteopathic scale) it is a long treatment which takes a minimum of 3 months of weekly treatments. The more harmonious the skeleton is at the starting point, the more rapid the treatment will be. Observing lack of symmetry in the scapula accompanied by mid-thoracic lordosis might be a musculoskeletal sign for early detection.

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