ADD/ADHD Case Study

Because I have 9 kids, I was sure when I started a practice, my focus would be on children and pregnant women–since I’ve obviously had so much experience with each.

We can’t talk about treating kids with acupuncture without discussing the world-renowned, pediatric-acupuncture-specialist, Alex Tiberi.

Have you ever seen or heard of Alex?

I met him in my first semester at Pacific College of Oriental Medicine in San Diego. He arrived on his motorcycle with a leather backpack, straggly curly hair, mega tattoos, and cowboy boots.

When I heard he was one of the founders of our school, and the most popular pediatric acupuncturist in the nation, I was shocked. He just didn’t look like a kid friendly kind of guy.

Once I met him, it didn’t take long for me to realize why kids love him. He’s real.

He talks about snot, diarrhea, vomit, and temper tantrums just like a kid would–facial expressions and all. Eventually, I learned he’s a genius when it comes to kids. Alex taught me that everyone should have his/her own style.

Quote:

“Alex Tiberi practices and encourages his students and fellow practitioners to practice Oriental medicine as an Art, where culture, style, expertise and individual expression come through in treatment. He instills in his patients a confidence that they are in capable hands.”

I never wound up opening a full-on pediatric clinic, but I do treat a lot of kids (and pregnant women) in my family practice. It was my privilege and opportunity to study with the best-of-the-best.

Do you ever treat kids?

In this case study, we are going to talk about ADD/ADHD in terms of TCM pattern diagnosis combined with graph analysis. AcuGraph has been a great resource for pediatric acupuncture in my clinic.

I started out with my basic TCM knowledge. Now that I’ve been able to add graph analysis to my diagnostic skills, I have more insight to the needs of my patients.

Parents appreciate a modern approach to Traditional Chinese Medicine. Kids… Well, they just think I’m cool (because computers are cool)!

This blog will be a two-part series. First, we will discuss ADD/ADHD from a TCM Pattern identification approach.

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.There are four main TCM patterns relating to ADD/ADHD.

Heat – MOST COMMON (according to Alex Tiberi)

Symptoms: HOT, red face, red lips. Anger, tantrums, biting, can’t sit still. Disturbed sleep, wakes up early.

Social: Argumentative, runs around shouting, screaming and disturbing others.

Pathomechanisms: Heat in the body rises up and affects the Heart, which houses the spirit. The Heart is easily affected by heat–leading to irritability and restlessness.

Heat Pathogenesis:

• Food: hot/spicy, flavorings, food colorings
• Lingering pathogens
• Lingering fever
• Womb heat (transferred through the placenta from Mom)

*If antibiotics are used to clear a fever, heat can be lodged in the system. Immunizations can also cause lingering heat pathogens.

Treatment principles: Clear heat from the Liver; calm the spirit.

Heat + Phlegm

Symptoms: Hot symptoms PLUS mania-type symptoms including aggressivity, and violence.

Social: Willfully destructive–tearing things apart, breaking toys; hitting, kicking, and cruelty to other children. Kids do things they know are wrong, but don’t care because their morals are blotted out.

Pathomechanisms: Heat combined with phlegm rise up to affect the Heart and disturb the spirit–leading to anger and willful acts of aggression. Phlegm causes the mind to be clouded, which can lead children to do things they know are wrong–without feeling moral consequences.

Phlegm/Heat Pathogenesis:

• Lingering pathogen from immunizations
• Food: dairy, refined sugar, wheat
• Accumulation disorder: Eating the same damp/heat creating foods over and over

Treatment principles: Clear heat, resolve phlegm.

SPLEEN DEFICIENCY

Symptoms: High energy, poor appetite, bloating, gas, poor memory; anxious, restless, fidgety, can’t sit still. Instead of having heat boiling up inside like the above two patterns, this patient is pale or gray in the face with possible feelings of cold.

Social: Needs attention and acts out when attention is not received; manipulation, hatred.

Pathomechanisms: When the child isn’t getting the energy from the Spleen through good nourishment, he/she reaches out to those around them (typically the parents). If qi is withheld for some reason, the child gets angry, probably because he/she is frightened from loss of energy. The qi becomes deficient and the blood does not circulate properly, withholding nourishment from the Heart. The child then becomes anxious, restless, fidgety, and can’t sit still.

Spleen Deficiency Pathogenesis:

• Immunizations
• Lengthy childbirth
• Anesthetics in childbirth
• Long-term food accumulation disorder
• Drinking too much fruit juice
• Not having boundaries

*These children seem to be good at manipulating parents. They manage to get their way in most things. They draw on their parents’ energy, which in turn becomes more and more exhausted–thus parents are not able to stand up to the child.

Treatment principles: Tonify the Spleen

Kidney Deficiency

Symptoms: Frail and weak, tends towards hyperactivity when they are tired or excited. Don’t like to go to bed even though they are tired. Even though they are hyper, they don’t generally become violent. During the day they might be weak and lethargic.

Social: Easily startled, slow development.

Pathomechanisms: The Kidney energy is weak–thus can’t hold the energy down, and it rises up to the Heart and mind resulting in hyperactive behavior. Symptoms are worse when the child is tired.

Kidney Deficiency Pathogenesis:

• Constitutional Kidney weakness–weakness from the parents, genetic disorders, severe illness during pregnancy
• Long-term illness
• Severe illness

Treatment principles: Tonify kidney yin, regulate the nervous system, bring energy up.

 

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You’ll notice each of the TCM patterns listed above affect the Heart and mind. We can’t talk about a modern-day diagnosis without considering the effect of modern lifestyle choices. I found this quote in a pediatric TCM textbook:

“Hyperactivity is almost unknown in China, whereas it is now well-recognized in the West as a major problem.”

Isn’t that sad? The lifestyle we have created in the West is obviously hurting our children.

Here’s a list of common Western lifestyle choices leading to hyperactivity and Attention Deficit Disorder.

• Spicy Foods                         • Greasy Foods
• Antibiotics                           • Immunization
• No Parental Boundaries   • No Exercise
• Over-stimulation                • TV, Computers, and Digital Devices
• Disruptive Home Life

Too many children are stuck in cyclical lifestyle that promotes ADD/ADHD. What help are these kids getting from their Western medical doctors? Drugs. That’s it. We, as responsible, well-educated, medical providers, need to educate our communities regarding the benefits of a Traditional Chinese Medicine approach to ADD/ADHD–involving not only acupuncture and herbology, but lifestyle changes.

Alex Tiberi taught me that kids don’t really want to misbehave.

“They do not want to be like this; they are often desperate to stop their behavior and are miserable because of it. With your treatment, you can actually ‘bring them back’ to their parents and family. They turn from aggressive, difficult children into happy, lively, and contented kids who are a joy to be with. “

It doesn’t take much to make an energetic shift in a kid’s body–yet the changes that occur are literally life changing for these kids.

The following section shows a graph report from a child with ADD, and discusses how meridian imbalances were affecting his ADD and other symptoms in his body.

 

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Case Study:

11-year-old-male

• Emotions: Frustration, worse in the morning; parents have to constantly push, which leads to yelling. Occasional panic attacks. Holds emotions in and then screams into his pillow as an outlet. Better if he can run or ride his horse.
• Diet: Grilled cheese and pizza kind of kid. Would choose these always IF mom would let him.
• Digestion: Gas and stomach ache.
• Sleep: Trouble falling asleep and staying asleep; bad dreams 50% of the time; nighttime incontinence.
• School: Dyslexia, likes to read, self-confidence issues.
• Pain: Headache between the eyes (at Yin Tang), radiating up to the top of his head, caused by yelling or dehydration, sharp and throbbing in nature; neck and shoulder  tension.
• Other: No palpitations, but feels heartbeat in the tip of his forefinger and his neck; eye twitching.

Chief complaint: ADD

I’m going to walk you through my own thinking process when I’m looking at a graph for a new patient. I’ll also alert you to things I’m seeing in the graph, which lead me to ask further questions.

STEP 1:

Baseline Graph

In the baseline graph, I’m looking at the differences between the hand and foot channels. What is happening in the upper body (hand) channels versus the lower body (foot) channels.

For this patient, you’ll notice there seems to be more excess in the lower body channels than the upper body channels. An easy way to confirm my thoughts is to look at the Ratio Graph….

Notice how the red plus sign is lower. When the upper body and lower body channels are well balanced, the cross will be find right in the center of the screen.

Thought: I may consider treating the Dai Mai for this patient…. TE 5, GB 41

 

STEP 2:

Yin/Yang Graph

The significant thing I see here is excess in the Small Intestine and Bladder channels in the Tai Yang channel pairing. I’ve typically found that when there is excess in these channels it relates to tendinomuscular problems.

Question: Are you having any neck, back or shoulder pain?

I also notice that the Triple Energizer is deficient in comparison to the Gallbladder in the Shao Yang channel pairing.

Thought: More confirmation for treating the Dai Mai… TE 5, GB 41

 

STEP 3:

Element Graph

He has several elements out of balance, but the first one that jumps out at me is Wood. Both the Liver and GB are high.

Questions:

• Do you get headaches?
• Do you get angry easily?
• Have you had a hernia? (If he were an adult I’d ask about prostate issues.)
• Do you have any eye twitches?

Some interesting information came up when I clicked on the LV channel and showed it to mom. When I explained how the Liver channel goes up the inside of the leg and encircles the genetalia, she was quickly reminded about a surgery he had for undescended testicles.

Thought: Wondering if child has scar tissue build up from the undescended testicle. 

 

STEP 4:

Treatment

• Dai Mai: Because he was a child, and it was his FIRST experience with acupuncture, I decided to use as few needles as possible. I knew I could make a big difference by balancing energy between the upper and lower body. TE 5, GB 41
• Move Liver Qi: LR 3
• Ear treatment: I looked up the ADD/ADHD program in Auriculo 3D and treated the electrically active points with my StimPlus Pro. (He thought that was the coolest thing ever.) I then put ear seeds on the active points and asked him to self-treat from home by pressing on the seeds several times per day. (We talked about how he could tell his friends that a Chinese Ninja gave him the ear seeds for special power.)

 

AcuGraph’s Contribution 

Before AcuGraph, I would have come up with a standard pattern approach to treatment. AcuGraph allows me to watch the pattern diagnosis along with channel blockages. I’ve found that channel blockages can actually cover the real underlying pattern diagnostics and if channel excesses and deficiencies are dealt with first, the underlying pattern begins to shine through.

This patient, for instance, became more of a Spleen deficiency patient within a few visits. Once we took care of his channel imbalances, his Liver heat symptoms resolved and he presented more with a Spleen deficiency constitution. At this point, we discussed dietary recommendations and herbal formulas to strengthen his Spleen.

I appreciate having multiple diagnostic skills while treating a patient. Most patients who walk into my practice have an array of problems involving layers of imbalances. AcuGraph helps me to sift through the layers week by week. It’s nice to have a series of graph analyses to show the patient where they began and how far they have progressed.

Using AcuGraph as a resource for diagnosing and treating children has really paid off in my clinic. Parents appreciate having a report of findings.

Kids aren’t always great at explaining what is happening in their bodies, but that’s okay because AcuGraph is!

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Becoming a Pediatric Expert

Are you ready to expand your pediatric practice, but you need more training?  Many acupuncturists know they can help kids with acupuncture but are unsure how to actually treat kids.  Our friend and fellow AcuGraph user, Robin Green L.Ac., has distilled her years of pediatric experience into a new online course called Pediatric Essentials.

Robin’s course will give  you the practical tips you need to get the job done – without fuss. Robin will cover all the best ways to work with both parents and children to make both acupuncture and non-needle treatments fast, easy and effective.

You’ll learn how to get kids comfortable with needles, and to take pediatric herbal formulas. She’ll give you strategies for treating the most common conditions in kids–with real-world tips that get results.

Even Better: If you register for Pediatric Essentials by November 8th  you’ll get my Special Pediatric AcuGraph Training Bonus!

Click here for more details!

 

 

 

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Related Reading

• Acupuncture and Treating Children
• The Stubborn Graph: A Case Study
• Case Study: The Kidney Return Protocol