While I am nominally a general practitioner I am now working full time in a rather specialised practice dealing almost entirely with ADHD and its sequilae in adults (I see a more limited number of children). The most troublesome of these sequilae are the very high incidence of complex chronic pain syndromes that are actually the consequence of their disordered and unstable gait and their chronic postural defects.
I work in close conjunction with a very experienced psychoanalyst, several other psychiatrists and psychologists and a number of physical therapists, including an extraordinary chiropractor who specialises in neurological rehabilitation. The latter man has been responsible for the near resolution of my own ADHD, and huge improvements in both my children.
My approach to ADHD is holistic, and the principal tool I use is body mindfulness, which helps us identify the specific cause of any given episode of inattention or other symptoms. (Few non ADHD people fully grasp that for much of the time our function is perfectly normal- but that the triggers for our symptoms and dysfunctional behaviours are usually very obscure.
When I assess my patients I do very thorough reviews and always find and document a mix of
1) Predictable postural deformities secondary to malalignments in the upper cervical spine.
2) Childhood histories consistent with upper cervical birth trauma ( I always get histories of the pregnancy, the birth, their infancy and childhood).
or 3) A history of a head injury in early childhood
4) Clearly detectable abnormalities in vestibular and cerebellar function which underpin the gait abnormality.
5) Eye tracking defects secondary to 4). These are very important functionally as the make reading very burdensome and tiring, and also cause one to keep losing one’s place when reading. Usually a child will simply say reading is boring and avoid it.
6) Serious problems with orthostatic intolerance.
Most of my patients come in to see me white faced and sweating, with a mild tremor.
When I do serial blood pressure and pulse readings I find either a borderline tachycardia, or a markedly abnormal acceleration of heart rate when they stand and are required to stand still for any period of time.
They have often had repeated blood tests done for anaemia— but their usual doctors have never noticed that they are pleasingly pink faced when they lie down.
Given the evidence of cerebral ischaemia that has been documented in SPECT scan studies in ADHD, it is clear that those white faces reflect relative cerebral ischaemia. (Blood flow to the internal carotid artery and external carotid artery rises and falls in parallel). The only real exceptions to this have been patients with a naturally red complexion- and it is highly probable that most of those have underlying food intolerances. These patients do not have pale faces – but still exhibit symptomatology consistent with cerebral ischaemia.
In short the majority of inattentive symptoms of ADHD can be explained by cerebral hypoxia, and the majority of the hyperactive symptoms can be explained by the chronic sympathetic nervous system activation required to increase cerebral perfusion.
It is clear to me that the upper cervical malalignments are causing issues with a mismatch between the proprioceptive data received by the brain and the actual body position. The problem is worsened by the
tilted head posture— and all of these patients are really struggling to adequately process the mismatching and confusing sensory data input.
I have enough evidence from a group of German physicians and surgeons to prove that the issues of dyspraxia, (including gait disorders) dysarthria, dysgnosia and dyslexia that are found in the overwhelming majority of ADHD patients are directly linked to this functional disruption of sensory input data.
In addition the stress signals due to a poor sense of balance and chronic fear of falling (both subliminal due to their chronicity) add to the sympathetic dominance seen in ADHD, and the scoliotic posture actually makes sitting up straight for any period painful, contributing to more hyperactivity.
Equally this model fits exceedingly well with the model of consciousness proposed by the neurologist Antonio Damasio in his books “Descartes Error” and “Self Comes to Mind”. ( Damasio dwells at great length on the function of the brain in mapping and cross referencing different sensory data).
In addition, it is known in some circles that the biggest single drain on “working memory” is movement. When movement is effortful and requires more conscious attention than usual- that creates a relative deficit of working memory available for complex processing tasks.
Current neuropsychology tests actually measure available working memory, not “total working memory.
The data re orthostatic intolerance is a genuinely new insight, but I now have a large enough case series to start looking for research partners and seeking a research grant.
However, data from other sources suggest that the critical causative behind orthostatic intolerance is an inherited tendency (polygenic) to connective tissue hyperelasticity.
So this model probably accounts for all the major known data about ADHD.
Naturally there is more to it than this and there are a number of side issues that that need to be considered. These include, but are not limited to:
-the physiological consequences of adopting correct meditation posture as our default sitting posture
-the role of emotional trauma in shaping “body armouring”
– the importance of autonomic regulation in establishing a stable platform for prosocial body language, and the role of the freeze response in trauma responses.
the critical need for more exercise in all our lives
the physiological toxic effects of spending one’s time face down in an iPhone or other screen or book.
the issues around electrical grounding, and the regulation of chi
the numerous issues connected to minor metabolic variants in the human genome and the relevant gene environment interactions (methylation being the big one here)
the consequences of intestinal dysbiosis
the danger of toxins in our environment— especially organic toxins from plastics manufacture, and neurotoxins that are given to people in the name of medical treatment _ fluoride and mercury.
However- these are side themes of the primary causative elements in ADHD.
Please note that this material is the output of many years of personal research and is protected under a Creative Commons licence. I am more than happy for this to be taken and used by anyone who wishes to but I request that people link to it and do not alter it without discussing with me.
I am interested in furthering research in this area and would be happy to consider any proposals put to me.
My name is Dr Andrew Kinsella. I am in practice in Melbourne Australia.
I can be contacted through this blog.