A clinical investigation of chiropractic neuro emotional technique (NET) for attention-deficit/hyperactivity disorder (AD/HD) in children

This thesis is an investigation of chiropractic management for paediatric Attention-Deficit/Hyperactivity Disorder (AD/HD). The aim of this thesis was to answer two questions: Q1: Does chiropractic care have a role to play in the management of paediatric AD/HD? and Q2: Does the emotional component of the Neuro Emotional Technique (NET) [a technique used by some chiropractors] have a role to play in the management of paediatric AD/HD? Traditionally AD/HD is managed by paediatricians, developmental and behavourial health specialists, clinical psychologists and allied health professionals. However, as complementary and alternative medicine gains popularity, more parents seek alternative care for their children diagnosed with AD/HD. -- A review of the AD/HD literature was conducted in order to update current understanding on the subject matter. Furthermore, a systematic review of the chiropractic literature was undertaken in order to construct a thorough profile of chiropractic care for paediatric AD/HD to answer the first research question. This systematic review found a paucity of published articles in the area and conclusions drawn that there was insufficient evidence to support the efficacy of chiropractic care for paediatric AD/HD. As a result of these findings, a unique pilot study in the form of a randomised controlled trial (RCT) was conducted on the biopsychosocial principles of NET, following the Consolidated Standards of Reporting Trials (CONSORT) checklist. This RCT was designed and undertaken in order to answer the second research question of whether the emotional component of NET can affect outcomes in paediatric AD/HD by decreasing the symptoms of inattention, hyperactivity and impulsivity. -- This study was a multi-centre study with four chiropractors (certified in NET) providing interventions for sixty-nine children. The children underwent an intense one-month management program of two sessions per week followed by another six sessions administered monthly. The parents of the participants and their teachers were the informants used throughout the study reporting on the children's behaviours, in two different contexts. The Conners' Parent and Teacher Rating Scales (CPRS-R:L and CTRS-R:L) were used as the outcome measures for this study. The results were interesting but not unusual, according to the literature. Conflicting results between the parent and teacher observations were found at months one and seven (i.e. at the conclusion of the study). The complete case analysis for the CPRS-R:L revealed statistically significant results and clinically meaningful changes in some outcome variables. Participants who were unmedicated and did not have comorbid disorders demonstrated greater improvements than the other participants. Furthermore, the intention-to-treat (ITT) analysis revealed significant results for all outcomes by the end of the study. The reliability of the teachers' observations were raised by the author and as a result, the validity of the CTRS-R:L remains uncertain. Accordingly, conclusions were drawn from the parent observations. Findings suggest that the tested aspect of NET therapy may have some role to play in the management of paediatric AD/HD. -- It is important to note that only one aspect of the NET protocol (i.e. emotional components) was examined. A study involving all aspects of the NET protocol (i.e. emotional, chemical, and physical/structural) would be needed in order to test the effectiveness of NET therapy in a clinical setting for paediatric AD/HD. Despite the limitations of this study (i.e. CRS-R low inter-rater reliability, uneven randomisation between groups and high attrition rates), the results suggest that (the emotional component of) NET therapy has some promising outcomes that may be effective in reducing some of the symptoms for some of the children with AD/HD. Definitive recommendations cannot be made about the intervention studied at this time. Despite the difficulties associated with carrying out clinical research in multiple sites and with challenging children over a long period of time, the study has provided a foundation for continuing research in the area of NET therapy for paediatric AD/HD.