The Role of Osteopathic Cranial Manipulation in a 7-Year Old Male with Attention Deficit Hyperactivity Disorder

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a disease process that involves mismanagement of the executive functions of the brain. Typical symptoms of ADHD may include aggression, attention loss with hyperactivity, anger, impulsivity, anxiety and even depression. ADHD is known to affect children with a prevalence of up to 9%, with symptoms being manifested in males more often than females. ADHD diminishes the quality of the lives of children and their families due to poor schoolwork and unacceptable social behavior. Osteopathic Cranial Manipulation (OCM) is a technique that can be used as a supplemental therapy for patients with ADHD. It has shown to provide significantly sustained improvements in attention and intellectual performance in pediatric patients. Case Presentation: A 7-year-old Caucasian male patient with a past medical history of strabismus and nocturia was presented to the Osteopathic Manipulative Medicine (OMM) clinic at the University of North Texas Health Science Center (UNTHSC) by his mother with the chief complaint of attention problems at home and school. The mother complained that the patient lacked attention at school, inappropriately touched his teachers at school, as well as friends and family members at home. The patient had trouble reading, writing and speech difficulties. For the academic term of 2020-2021, the patient had complaints of disruptive behavior from teachers every day. During late 2021, he also was officially diagnosed with ADHD. Over a period of 3 visits, osteopathic examination revealed restrictions in the right ethmoid bone, dural strain, sacroiliac joint restrictions, occipitomastoid suture restriction, right temporal bone external rotation and bladder restrictions in the pelvic area. The mother preferred medications to be a last resort of treatment. So, osteopathic cranial manipulative medicine (OCMM) was used with the intention of addressing underlying structural dysfunction. The treatments led to subjective relief of symptoms which led to increased attention span, better grades, acceptable social behavior and an overall increase in quality of life in the patient. In order to assess treatment outcomes objectively, the Vanderbilt Assessment Scale was used over a period of three months. The post treatment symptom score from the mother decreased by 8 points in comparison to pre-treatment symptom score and the cognitive performance score decreased by 1.28 points. However, post treatment symptom score from the teacher increased by 1 point compared to pre-treatment and the cognitive performance score stayed the same. Conclusion: This case sheds light to the potential use of OCMM as a stand-alone therapy for patients who refuse to use stimulant medications and may be of use for osteopathic physicians in an outpatient setting. Due to conflicted scoring on the assessment scale from the mother and the teacher, it is difficult to conclude whether OCMM was of significant benefit to this patient. Therefore, a better solution would be to conduct clinical trials with stand-alone OCMM and a bigger sample size and then calculating the assessment scale results over a longer period of time.