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Parents who have children that suffer from ADHD as well as doctors and therapists who treat these families are well aware that there is a higher rate of difficulty with regard to bladder control for these children. This most times is at night but may also be a problem throughout the day as well. In addition to an obvious sign of delayed development, this also has considerable social stigma attached to it. A recent study in the Journal of Urology confirms and brings into objective evidence what those of us in the field already know. Yes, children who have ADHD are far more likely to have issues with bladder urgency and eneuresis ( bed wetting.) In fact, the higher the child scored on the Connors Parent Rating Scale a psychometric tests for ADHD, the more likely he or she was to have urgency.
In the functional neurology model, this association between ADHD and bladder control makes perfect sense. An under developed cortex or higher brain is going to give one less ability to resist a socially inappropriate urges as well as a lower reflexes such as relating to your bladder. Let’s combine the two situations to make an example. When your bladder fills, you will have the urge two empty your bladder. This is what you do as an infant. It is a reflex. As your higher brain develops you become aware that it is socially inappropriate to empty your bladder whenever it feels full. It is your higher brain which is able to inhibit the bladder reflex to empty your bladder. Thus, if you’re higher brain is not developed sufficiently you will not be able to inhibit the lower bladder reflex and you will have urgency and daytime as well as night time accidents. Now, let’s look a situation in which the child is able to control his bladder during the day but has issues with bed wetting at night. In this situation, your cortex or higher brain is less active at night when you are sleeping. Therefore, you have less ability to inhibit the lower bladder reflex and thus your bladder empties. In the second case, the child’s cortex is sufficiently developed to inhibit the bladder reflex during the day however with decreased cortical activity at night, his ability to inhibit the bladder reflex falls below threshold and he loses his ability to inhibit.
The trick of course is to find the appropriate exercise to stimulate the under functioning area of the brain (the area of dysfunction must be localized) in order to accelerate its development and address both the issue with ADHD and bladder control. This of course is the job of the functional neurology practitioner.
J Urol. 2011 Feb;185(2):663-8. Epub 2010 Dec 18.
Lower urinary tract conditions in children with attention deficit hyperactivity disorder: correlation of symptoms based on validated scoring systems.
Burgu B, Aydogdu O, Gurkan K, Uslu R, Soygur T.
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Abstract
PURPOSE: We investigated whether certain voiding problems have a higher incidence in patients with attention deficit disorder with hyperactivity compared to age matched controls.
MATERIALS AND METHODS: We used the Conners Parent Rating Scale-revised for attention deficit disorder with hyperactivity and lower urinary tract symptom score to evaluate voiding problems. A total of 62 children with attention deficit disorder and 124 healthy controls were enrolled. We evaluated uroflowmetry patterns in both groups. Residual urine volumes and Bristol stool scale were noted. We examined the correlation between total Conners Parent Rating Scale-revised and lower urinary tract symptom score in patients with attention deficit disorder. Additionally we analyzed each index of the Conners Parent Rating Scale-revised separately in terms of correlation with symptom subgroups for lower urinary tract symptom scores.
RESULTS: Mean ± SD total lower urinary tract symptom score was 11.1 ± 2.9 in patients with attention deficit disorder with hyperactivity and 3.2 ± 1.3 in controls, a difference that was statistically significantly (p <0.001). With the exception of constipation, mean scores of all lower urinary tract symptom subindices were significantly higher in patients with attention deficit disorder compared to controls. Symptoms evaluated in lower urinary tract symptom score were mostly correlated with attention deficit disorder index of the Conners Parent Rating Scale-revised. If a child with attention deficit disorder has a high index in the Conners Parent Rating Scale-revised, he or she is more likely to have urgency. Also, if a child with attention deficit disorder has a high hyperactivity subscale score, he or she is more likely to have enuresis.
CONCLUSIONS: Voiding problems are more common in children with attention deficit disorder with hyperactivity than in age matched controls. Urgency and enuresis are the outstanding problems in children with attention deficit disorder. Simultaneous use of the Conners Parent Rating Scale-revised and lower urinary tract symptom score questionnaire should be encouraged in patients with attention deficit disorder to allow a structured and quantitative evaluation of these overlapping problems.
Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
PMID: 21172714 [PubMed - in process]
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Parents are always looking for things they can do to help their children suffering from ADHD and/or learning disabilities. Among the risk factors, there are some we can control and some that we can not. We can not control whether or not we have a family history of ADHD, whether our child was born premature or whether our child is a boy or a girl. It may be too late to change the fact that we smoked during pregnancy, drank alcohol during pregnancy or were exposed to toxins such as lead. But, we can look forward and help our child by not exposing him or her to second hand smoke. This is completely within our control.
And now a new study out of the Sleep Disorders Center at the JFK Medical Center finds that electronic media such as texting and video games at bed time can also influence our children’s risk for ADHD and learning issues. Girls seem to text more and boys play video games. Most parents were unaware of these behaviors. These activities can disrupt sleep cycles which can lead to learning difficulties as well as anxiety and depression. Parents must be aware of their children’s activities. And yes, you may need to take their phone away or at lest confiscate it at bed time.
Also, remember that you can help your child by keeping a regular routine and helping him with organization, getting regular sleep and planning for circumstances that you anticipate will be difficult such as those that will require prolonged waiting.
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September is literacy month in Florida and I thought I would briefly discuss the connection between functional neurology with regard to reading difficulties. This article will deal more with getting the information into the brain rather than what areas of the brain process different types of information. In order to read properly, there must be coordinated eye movement at a near distance. This means that the right eye must be talking to the left eye with regard to movement. The pupils must also be active, responsive and working together. In addition, there are different areas of the brain that initiate and stop eye movement. This relates to moving from one word to another as well as moving down to the next sentence. For proper reading to take place all these activities must function in synchrony. For example, if one eye does not move in conjunction with the other, the reader will experience double vision or one eye will shut down in order not to confuse the brain. This is all important from a reading standpoint, but realize that the functional neurologist is using this information as a way to assess brain function. It is by addressing deficient or desynchronized brain function that we make the difference to the reader. This means that, not only will the reader be given specific eye exercises in order to facilitate proper eye function and coordination but that other parts of the body may be brought into the treatment in order to smooth and coordinate brain function and thereby help with eye movements when reading. In my office, we have a simple 15 minute test which evaluates eye movements during reading which provides us with considerable information regarding brain function. This is a painless task which requires no preparation and is very much appropriate for children.
The ability to read is important in order for children to succeed in school as well as in life. In school a child who is frustrated with an inability to read may begin to have behavioral issues as his peers start to label him as “dumb.” In addition, if he cannot read and do the work then he may become bored and inattentive. This may lead to a miss diagnosis of ADHD and even perhaps a child being placed on medication that is unnecessary. As these children become older and progress through life their rates of juvenile delinquency may increase. One study revealed that 90% of the juvenile delinquents participating could not read. Thus, simple but many times undetected functional reading problems may come at great cost to you and your child but also a greater cost to society. Thus, before you place your child on ADHD medication please be sure to discuss the issue of near point coordinated eye movement with your doctor.
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Tampa, Aug 23,2010
Improvements as much as 2 to 4 grade levels upon pre-and post-WIAT (Wechsler Individual Acheivement Test) with regard to reading, comprehension, written and oral expression and math reasoning were observed after a 12 week program of Hemispheric Integration Therapy. The program consisted of procedures such as aerobic and strength conditioning exercises, motor training including rhythm and timing exercises, sensory stimulation as well as academic training. A WIAT is a common test used by psychologist and the school systems to assess children with ADD and ADHD as well as other learning disorders. The WIAT includes subtest such as word reading, reading comprehension, math reasoning, spelling, written expression, listening comprehension and oral expression. The Brown Scale an ADHD assessment tool also showed improvements. The study was conducted by the F.R. Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience, University of Haifa, DeMontfort University, and the Carrick Institute for Graduate Studies.
Tampa Dr. Nelson Mane D.C., is a pioneer in the use of functional neurology and Hemispheric Integration Therapy for the treatment of ADHD, learning disabilities and autism spectrum disorders said “ This is definitely a great day for functional neurologist applying the concepts of hemispheric integration to neurobehavioral disorders!” This type of treatment is growing in popularity due to the improvements that parents are seeing their children make. There is a great amount of research behind the concepts of Hemispheric Integration Therapy, last year the concept of functional disconnection syndrome was presented in the scientific literature and now the first outcome study was published in the “International Journal of Adolescent Medicine and Health.” I have personally seen many children go from worst to first in their class and have standardized testing scores improved. Parents are most impressed with how quickly their children can make gains. In the world of ADHD and learning disabilities to see such significant improvement in a 12 week period amazes many parents and teachers alike. I am a clinician and am grateful to the researchers providing outcome studies which will advance these procedures into the mainstream for the one in ten children with ADHD and the one in six children with a learning disability. As this is a drug-free approach, funding from the large pharmaceutical companies is not available and so it will probably take many years for Hemispheric Integration Therapy to become a standard practice. This is a great first step.
Dr Nelson Mane a Board Certified Chiropractic Neurologist has been interviewed by Spectrum Magazine, and the Tampa ABC, CBS, NBC affiliates as well as Bay News 9 for his work applying Hemispheric Integration Therapy and functional neurology for children and adults with ADHD, learning disabilities and autism spectrum disorders. He was featured in the Autism documentary “Walking in the Dark: Finding the Light in Autism.”
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Just a reminder that our conference is tomorrow at the Hillsborough County Children’s Board. The Conference is free as everyone including the speakers are volunteering their time. In addition to myself, Dr. Sutton,Suzi Azizi and June Paulsen CLTC. Attorney Mary Greenwood who specializes in special needs planning will also be participating. We have a full house if all the reservations show up but you can call the office , ask for Marilyn and see what the latest head count is. It will be good information for those newly diagnosed as well as more experienced parents.
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Monica Wharton of Disability Radio was recently kind enough to interviewed me regarding Hemispheric Integration Therapy and our upcoming free ADHD, Autism Spectrum Disorder and learning disability conference coming up this Saturday on May 8th at the Hillsborough County Children’s Board. She also asked me about our support group for parents which is sponsoring the seminar. The support group provides monthly meetings for the parents, families(the kids) as well as the outings and informational conferences like the one this Saturday. Here is the link to the interview http://www.disabilitynewsradio.com/
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I had the opportunity to be a guest on Studio 10 this past Monday, April 26th. Studio 10 is on WTSP the local CBS affiliate. The show is hosted by Holley Sinn and Jerome Ritchey who were extremely nice and welcoming. I was thrilled as always to have an opportunity to speak about Hemispheric Integration Therapy especially as it relates to ADHD, the Autism Spectrum and learning disabilities. Sharon Baron a parent whose child has had success with Hemispheric Integrationwas also on the show to give her perspective as a parent. We also were able to get the word out about the upcoming HIT conference at the Hillsborough County Children’s Board on May 8th http://www.hitautism.com/events Here is a link to the Studio 10 interview http://www.youtube.com/watch?v=3hPtqT0eK4M
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Hemispheric Integration Therapy is becoming increasingly popular due to its success with treating children with Autism Spectrum Disorders. Autism spectrum disorders include A.D.D.,A.D.H.D., Sensory Integration Disorder, Processing Disorders, Asperger’s Syndrome, O.C.D., Tourette’s Syndrome and Autism. Business dictionary.com defines integration as the process of attaining close and seamless coordination between several groups, departments, organizations or systems. Hemispheres relates to the right and left halves of the cerebral cortex, the highest part of the brain that makes us most human and is different from other animals. Thus, Hemispheric Integration Therapy aims to coordinate different areas and systems within the brain both in the cortical hemispheres and between them in order to get the most efficient function possible.
Integrating the cerebral hemispheres in order to optimize communication between the right and left sides of the brain to improve neurological function is part of Functional Neurology. Functional Neurology deals with not just evaluating the nervous system for disease states such as tumors, infections, strokes, etc. but evaluating the function of the nervous system as a continuum that starts with optimal function and ends in a disease state. Thus, the Functional Neurological examination will not only evaluate if a task can be performed but how well that task can be performed. The quality of that performance will give the Functional Neurologist clues as to how close that system or pathway is to optimal functionality. As an example, a Functional Neurologist will evaluate not only if the eyes can move in different planes, as a yes or no, but the quality of those movements. Are the movements synchronized and smooth? Is there any breakdown in these movements? This will give clues as to how well the systems involved in the different eye movements are working.
Based on the findings of the examination, the Functional Neurology practitioner will look to localize a functional lesion. In a functional lesion, “the wires are there but they are not transmitting signals properly or efficiently.” Another example may relate to a nerve center not integrating the information it receives well and thereby passing on the appropriate information. A Functional Neurologist will try to find one area of the brain or pathway that explains all or most of the symptoms that the patient is complaining of.
Similar to looking at a map, the Functional Neurologist is familiar with the neurological pathways/roadways and will find the roadblock that would disrupt function downstream from that roadblock. He will then develop a specific treatment program to stimulate that particular area or pathway of the brain that is under functioning and/or conversely inhibit a pathway or area that may be over functioning.
These types of lesions are termed functional lesions as opposed to ablative lesions. An ablative lesion can be seen on standard imaging such as MRIs. Only with the advent of the SPECT scan and functional MRIs was neuroscience able to localize what areas of the brain are activated while certain functions are being performed. That is, we can ask the patient to do math or sing a song and see what areas of the brain are activated when these tasks are performed on these newer imaging techniques. This type of research, which blossomed more so in the 90s, termed “the decade of the brain,” led to great advances in neuroscience and the clinical application of these findings and techniques to remedy these functional lesions “Functional Neurology.” at present SPECT scans and functional MRIs are typically only available at the research level. In clinical practice, a Functional Neurological examination performed by qualified practitioner should determine where the functional lesion is without the need for the research type imaging studies.
Functional Neurology has its roots in Chiropractic Neurology. Dr. Frederick Robert Carrick created the Chiropractic Neurology program in the late 1980s. Dr. Carrick is considered the father of Chiropractic Neurology and Functional Neurology. Classes in Functional Neurology are taught through the Carrick Institute and can lead to a Diplomate of the American Chiropractic Neurology Board. These classes also qualify you toward the newer multidisciplinary American College of Functional Neurology.
With that background and history here are the questions I would suggest you ask a doctor if you are interested in “Hemispheric Integration Therapy” and/or “Functional Neurology.”
1. Is he/she a Diplomate of the American Chiropractic Neurology Board? The Diplomate program and Chiropractic Neurology takes approximately 3 years to complete and therefore one of the most important factors for your consideration.
2. How long have they been board-certified?
3. How much of their practice is devoted to Functional Neurology and/or Hemispheric Integration Therapy?
4. Are they a fellow of the American College of Functional Neurology, a newer multidisciplinary group?
5. If you’re looking for a doctor to treat a child on the autism spectrum, ask how long they have been treating children with Hemispheric Integration Therapy?
6. Especially with regard to a child on the autism spectrum, ask if you can speak to a current or past parent whose child has been treated.
I wrote this article because there are very few experienced doctors with this specialized training and therefore, our office gets a lot of calls and e-mails asking if I know of a doctor using Hemispheric Integration Therapy to treat children from places like Iowa and France. I do treat patients that travel from a distance but many times that is not a practical option. With that in mind, these are questions I recommend you consider when doing your research.
