ADHD Acupuncture Clinic
Welcome!
The ADHD acupuncture consultation clinic in the community clinic *Praxis im Gaengeviertel* will offer a contact point for people with ADHD diagnosis and their reference persons who would like to inform themselves about acupuncture and Chinese medicinal therapy, or who are considering such a therapeutic support for themselves.
Children, teenagers, adolescents/young adults, and adults/'older' people with 'ADHD personality' are equally addressed!
ADHD - construct, 'disorder' or personality trait?
By now, numerous genetic aspects and neurobiological peculiarities are known that lead to the main manifestations of what can be subsumed under the term 'ADHD' (i.e. hyperactivity/impulsiveness, attention deficit related issues or the combination of both, and most likely a more or less constant increase in stress levels).
Voices which postulate that ADHD was 'only a construct', must be clearly disqualified here, and taken offstage. Nevertheless, one may question if individuals with an 'ADHD-personality' per se should be labelled 'disordered', or even 'suffering from a disease' (and thus, still being stigmatised). From what extent on, a peculiarity that may differ from 'the norm' might be considered to be pathogenic, depends on various variables.
Thus, psychological/medical classification schemes like the icd-10/11, or the DSM-IV/V, also can be considered to be mirroring the particular societal/political paradigms of the respective time at which they were published.
The conceptual distinction between ADHD and ADS, which can still be found in German-speaking countries, internationally is no longer used. They have been replaced by the 'subtypes' type hyperactivity/impulsiveness, attention-deficit associated type, and combined type respectively.
'Experts' are currently still in disagreement as to whether, in addition to the genetic predisposition, the 'becoming symptomatic' of the affected person is also, or to what extent, 'genetically predisposed' or whether, despite the existing 'genetic predisposition', this is primarily dependent on individual psychological/socialisation-related/systemic factors (see Faraone and Larsson, 2019).
Whether one wants to understand ADHD as a specialty deviating from the neurotypical norm, as a disorder or even as a disease, there should be agreement on one point: If a diagnosis of ADHD is accompanied by symptoms that imply a considerable degree of suffering for the person affected, the people affected must be helped.
Neurodiversität
Originally originating from Asperger self-help, the term 'neurodiversity' has been extended to ADHD. The underlying idea is that just as there is a natural 'diversity' in biology in general (e.g. sexual preferences), there is also a diversity of neurobiological constitutions (see Eapen, 2012). In turn, there is no need to accredit the dominance of the normativity of the 'average brain'. Thus, neurobiological manifestations deviating from 'average neurobiology' do not per se need to be classified as disorder or disease (cf. White et al., 2011).
In the meantime, several therapists and scientists from various disciplines have adopted this approach.
The ADHD acupuncture consultation clinic in the *Praxis im Gaengeviertel* also is dedicated to this approach.
Therapeitical methods
Whichever therapeutic methods are ultimately used in an individual case: A combination of different approaches often seems to be most meaningful ('multimodal approach').
The current standard of care is pharmacotherapy with either the central stimulants methylphenidate (MPH; e.g. Ritalin or Medikinet, each in different forms (direct, partially retarded, delayed) or lisdexamfetamine (e.g. Elvanse), which have a dopaminergic effect, or the norepinephrine reuptake inhibitor atomoxetine hydrochloride (ATX; Strattera), which is not a central stimulant.
The most common psychotherapeutic approach is currently provided by Cognitive Behavioral Therapy (CBT). Systemic and psychoeducative approaches are applied as well.
When pharmaceutical therapy might be indicated needs to be assessed on a case-by-case basis.
It is important that any pharmaceutical therapy is considered as one component within an individually composed therapeutic concept.
In contrast, the daily reality of many affected persons may present a different picture: Often the administration of e.g. Ritalin/ MPH is the only received treatment, no further therapeutic measures seem to be scheduled.
Nevertheless, at this point the general 'demonisation' of pharmacotherapeutic approaches which partially reaches conspiracy theory-related dimensions, must be clearly rejected.
In addition to the therapy methods mentioned above there are several complementary and alternative medicine (CAM) approaches.
What help can acupuncture provide for people with symptomatic ADHD?
According to the practical experience of many CM practitioners (in Germany this is naturopathic practitioners according to the 'Heilpraktker law', as well as MDs) and, meanwhile, several research papers, acupuncture can have a positive impact on ADHD core symptomatology (hyperactivity/impulsiveness; reduced attention).
In addition, there is a certain evidence that acupuncture can have a positive influence on the perception of/dealing with stress. Since many people with 'ADHD peculiarities' have to deal with permanently elevated stress levels, a potentially significant potential opens up here.
Furthermore, acupuncture that is provided lege artis is a therapy with few or no side effects.
This is relevant since there is still a lack of available data regarding the assessment of the possible risk of long-term use of psychostimulants such as MPH/Ritalin (see Frederiksen and Peleikis, 2015).
What is the current state of research on the use of acupuncture in ADHD?
Several research studies show a positive effect of acupuncture on ADHD core symptomatology.
At the same time, methodological limitations can unfortunately be detected in many studies.
The currently highest level of scientific knowledge in medicine is the Systematic Review with accompanying meta-analysis (a statistical procedure). Here, scientific studies with a high number of particiants and of high scientific quality are filtered out of the large number of scientific publications on a topic and become compared with each other in regards of content and statistics (keywords: evidence-based practice/ evidence-based medicine EBM).
This presupposes that the measurement parameters used in the various studies are comparable. Furthermore, there must be at least one control group and in each group (here: group receiving acupuncture; control group receiving e.g. MPH or ATX; possibly an additional control group receiving 'fake' acupuncture (similar to the administration of a placebo)) are sufficiently required to generate statistical power and in order to allow generalisations. Furthermore, the allocation of study participants among the groups must be undertaken in a randomized way.
Two such systematic reviews (see Li et al., 2011 and Lee et al., 2011) and a meta-analysis (see Li et al., 2011) are currently available regrding the effects of acupuncture on ADHD.
However, only three studies (out of hundreds originally reviewed) were included in one Systematic Review. Due to the differences in the measurement methods, only two of these studies could be compared in a meta-analysis. Even these studies had certain methodological limitations. The authors found that there is a certain amount of evidence (burden of proof) for the positive effect of acupuncture on ADHD core symptomatology, but that no final recommendations can yet be made due to the still somewhat thin data coverage (Li et al., 2011).
Some data show that acupuncture and MPH (e.g. Ritalin) provide equivalent results, but that the combined treatment is superior to pharmacological therapy alone (see Li et al., 2011).
To sum up: The scientific 'ice sheet' is already load-bearing to a certain extent, but still needs to harden in order to ensure that all skaters can safely be hold.
The author of this page conducted a study on this topic as part of his MSc dissertation. This study also showed a positive impact of acupuncture on ADHD core symptomatology, as well as on the perception of/dealing with stress (see May, 2019).
May, N. (2019) The Impact of Acupuncture on self-perceived Stress and ADHD Core Symptomatology in an adult, Atomoxetine-taking ADHD Participant.
An in-depth Single Case Study. MSc Dissertation Advanced Oriental Medicine (Research and Practice), Northern College of Acupuncture, York, UK.
What help can Chinese herbal medicine (CHM) provide for patients with symptomatic ADHD?
Chinese herbal medicine (CHM) is another approach to alleviate ADHD-related symptomatology. It follows the same basic Chinese medical models as acupuncture (see above).
The pharmaceutical formulations, which are mainly composed of herbal drugs, may have (among others) a balancing effect on the autonomic nervous system.
Classically taken as decoction or powders, granulates or capsules and tablets are available today as well.
From a repertoire of possible compounds, differential diagnostics is applied to select and, if necessary, modify (i.e. individual herbs may be removed and/or others added) the particular compound that specifically addresses the patient`s complaints.
What is the current state of research on the application of Chinese herbal medicine in the treatment of ADHD?
Some research studies show a positive effect of Chinese herbal medicine (CHM) on the core symptoms of ADHD.
Unfortunately, the studies are very heterogeneous in the choice of the respective herbal formulas. This needs to be considered in the context of Chinese herbal medicine according to which, despite the same 'diagnosis of disorder' (in the present context ADHD), the particularly applied herbal formula is always associated to the individual symptoms of a patient.
Particularly worth mentioning is a high-quality study by the colleagues around M. Katz (cf. Katz et al., 2010), who carried out an elaborate study on the topic and developed a placebo that smells and tastes synonymous with the Chinese herbal formulation.
This study met high methodological criteria and found an equivalent effect of the Chinese herbal formulation compared to Ritalin, with better long term results of CHM after discontinuation of therapy, compared to Ritalin/methylphenidate.
Similar to above-mentioned explanations regarding the effectiveness of acupuncture, the 'ice sheet'-analogy also applies here: The scientific 'ice sheet' is partially sustainable, but must harden further.
Although more studies applying a robust design are needed, prediction can be considered positively confident and promising.
How does Chinese medicine describe the special traits that are subsumed under the term ADHD?
First of all, the special nature of the Chinese medical terminology must be pointed out. Without further explanation, these may raise questions rather than provide explanations. Therefore, a small digression is inevitable at this point.
Chinese medicine considers the specificities subsumed under the term ADHD as an imbalance of different biofunctional and organ systems.
Chinese medicine-related (differential) diagnoses such as 'liver-qi stagnation', possibly an underlying 'liver-blood' or 'liver-yang deficiency', often accompanied by 'ascending liver-yang' or even 'liver-fire', or a (constiutionally) weakened qi of the functional circuit 'spleen/pancreas/stomach' or a constitutionally weakened 'jing' of the functional system of the 'kidneys/adrenal glands' come into consideration (cf. e.g. Ni et al.., 2014).
What's this all about?
In Chinese philosophies, there was, and is no strict separation into the 'exclusively physical' and the 'exclusively mental/spiritual' per se.
In Chinese medicine, certain processes concerning the spirit and the 'soul' - in Chinese, most closely corresponding to the concepts of shen and ling - are associated with the respective zang fu, the internal organs or organ systems/functional circuits.
The term organ system is apllied because each yin or yang organ describes a concept consisting of the actual organ, its local and systemic tasks, including its influences on certain tissues or structures, a respective sensory organ, the 'meridians' emanating from it or leading to it, as well as its associated psycho-emotional correspondences.
Extensive associations such as times of day and seasons, cardinal points etc. form the basis of the Wu Xing or 5 phases of change theory, an important school of thought within TCM, which is based on macrocosmic (i.e. occurring in the natural environment) and microcosmic correspondences (i.e. in this case the human being and their organ systems) derived from observations of nature.
Also important and indispensable for the understanding of Chinese medicine is the postulated idea that all living organisms are flowed through by a kind of vital energy, the qi. Qi is composed of endogenous qi and the qing qi of the air we breathe, and is furtherly divided into many different forms with specific functionalities, similar to the understanding of blood in biomedicine with its division into the erythrocytes, the 'red blood cells', the thrombocytes ('coagulation platelets'), and the different proportions of leukocytes, the 'white blood cells' including their many subgroups and their manifold functions.
With regard to the descriptions of ADHD at the beginning of this paragraph, the 'organ systems'/functional circuits of the liver, spleen/pancreas and kidney/adrenal glands are of particular interest:
The functional circuit 'liver' has the physiological task of ensuring the flow of qi, blood and emotions throughout the organism. The 'liver-yin' and the 'liver-blood' have a structuring, rather 'balancing', and parasympathetic quality. If the latter-mentioned is in a weakened state (e.g. constitutionally), the 'liver-yang', or in more severe cases even 'liver fire' or the 'liver wind' can 'rise' and cause complaints like tension or migrainic headaches, high blood pressure, neurological tics, dizziness, outbursts of anger or rage.
'Stagnant Liver Qi' is associated with pain (in different areas of the body, depending on where the stagnation occurs), e.g. dysmenorrhea or gastric mucosal events, or with depression and frustration.
The organ system of the 'spleen/pancreas' is in turn associated with the ability to focus thoughts in a mental and psycho-emotional context. A weakened 'spleen-qi' or 'spleen-yang' due to constitutional or lifestyle factors may lead to attention and concentration difficulties, to a feeling of 'lack of rootedness' or circling thoughts/chains of thoughts, which are often associated with sleep disorders. On a physical level, for example, some gastrointestinal complaints, metabolic diseases, connective tissue issues, menstrual disorders or particular immunological or respiratory complaints are associated with the functional circuit 'spleen/pancreas'.
The functional circuit 'kidney/adrenal gland' is closely associated with the constitution of a human being, their urogenital and reproductive systems.
In the biomedical context of ADHD, the axis of the hypothalamus, pituitary and adrenal gland (HPA axis) that is immensely relevant in terms of corticoids (i.e. cortisol, colloquially known as 'stress hormone'), as well as dopaminergic, adrenergic and noradrenergic (i.e. dopamine, adrenaline and noradrenaline) processes are closely associated with the Chinese medicine concepts of the functional circuits of 'liver' and 'kidneys'.
Chinese medicine attempts to regulate both the respective zang fu (organ systems) and the shen (mind), as well as the yi (cognitive capacity). Therefore, acupucture, Chinese herbal medicine, and Qi Gong may be applied.
Might a treatment with acupuncture and/or Chinese herbal medicine be worthwhile for me/my son/my daughter?
This question needs to be addressed individually. Empirical experience shows that both acupuncture and Chinese herbal medicine (CHM) can have a positive impact on ADHD-symptomatology and the quality of life of those affected.
Although the burden of proof from studies that methodologically satisfy the criteria of evidence-based medicine is still somewhat small at present, the scientific data nevertheless is promising (see above).
Mr. May (MSc AOM) will be happy to advise you on this.
References/nteresting links/DOIs and PDFs
Eapen V. (2012). Neurodevelopmental Genes Have Not Read The DSM Criteria: Or, Have They? Frontiers in psychiatry, [e-journal] 3(75), 1-3. doi: 10.3389/fpsyt.2012.00075.
Evidence-based Acupuncture: https://www.evidencebasedacupuncture.org
Faraone, S.V. and Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry, [e-journal] 24(4), 562-575. doi: 10.1038/s41380-018-0070-0.
Fredriksen, M. and Peleikis, D. (2015) Long-Term Pharmacotherapy of Adults With! Attention Deficit Hyperactivity Disorder: A Literature Review and Clinical Study. Basic & Clinical Pharmacology & Toxicology, 118(1), 3-31.
Lee, M., Choi, T., Kim, J. et al. (2011) Acupuncture for Treating Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Chinese Journal of Integrative Medicine, 17(4), 257-260.
Li, S., Yu, B., Zhou, D. et al. (2011) Acupuncture for Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents (Review) [online] Cochrane Database of Systematic Reviews. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007839.pub2/abstract.
May, N. (2019) The Impact of Acupuncture on self-perceived Stress and ADHD Core Symptomatologyin an adult, Atomoxetine-taking ADHD Participant. An in-depth Single Case Study. MSc-Dissertation, [PDF] Northern College of Acupuncture, York, UK.
Ni, X., Zhang-James, Y., Han, X. et al. (2014) Traditional Chinese Medicine in the Treatment of ADHD. Child and Adolescent Psychiatric Clinics of North America, 23(4), 853-881.
White, H. and Shah, P. (2011) Creative style and achievement in adults with attention-deficit/hyperactivity disorder. Personality and Individual Differences, 5(11), 673-677.