Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological disorder. Common symptoms are inattention, hyperactivity, impulsivity, and executive functions deficit, often with comorbidities. Main treatment involves pharmacological and non-pharmacological therapies (cognitive-behavioral therapy, psycho-pedagogical programs). Emerging non-pharmacological treatments include manual therapies (MTs) in mental health. Several MT techniques have shown effectiveness in ADHD. The objectives of this study are as follows: (a) to assess short-term effects and persistence of an MT program on neuropsychological (hyperactivity index through the Conners’ Global Index [CGI]) and neurophysiological (time–frequency domain parameters of heart rate variability [HRV]) variables in ADHD children, and (b) to test the feasibility of the design. This study was approved by the Parc Tauli Corporation Clinical Research Ethics Board (#2017311). Pilot, controlled, multidisciplinary study of eight children with ADHD randomly assigned to control group (CG; n = 4) and intervention group (IG; n = 4). Both followed multimodal treatment, and IG also received an MT program per week for 4 weeks. A physiotherapist and a psychologist analyzed short-term effects (1-week post-program) and persistence (36 weeks). Eight children (boys, 62.5%; girls, 37.5%) with an average age of 10.375 ± 0.74 years were included. Baseline HRV parameters showed basal sympathetic predominance. The MT program increased the parasympathetic activity, which was significantly maintained at 1 to 36 weeks; there were no changes in CG. One-week post-program IG showed significant CGI reduction (–7 points, p = .016*), CG without changes ( p = .41), with significant differences CG – IG ( p = .0097*), and very large effect size ( d = 2.235); 36 weeks post-program showed no effects (IG, p = .293; CG, p = .247), without differences CG – IG ( p = .369). The MT program reduced the hyperactivity index with a 1-week persistence and increased the parasympathetic activity with a 36-week persistence. More investigations are needed to generalize the outcomes. Additional research is planned to further explore the possibilities of MT in psychiatric disorders with autonomic imbalances.
Highlights
IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a neurobiological disorder (global prevalence: 5%–7%, boys: 2.5%– 5.6%, girls: 1%) with a genetic substrate, and symptoms occur early in pediatric age
Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological disorder with a genetic substrate, and symptoms occur early in pediatric age
The hyperactivity index (CGI) and Heart rate variability (HRV) parameters were collected at 1 and 36 weeks after the last intervention in both groups; they were compared within each group and between groups to study the persistence of the effects of each program and to determine differences between both programs
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological disorder (global prevalence: 5%–7%, boys: 2.5%– 5.6%, girls: 1%) with a genetic substrate, and symptoms occur early in pediatric age. ADHD shows three main presentations: predominantly inattentive, hyperactive–impulsive, and combined inattentive and hyperactive–impulsive. Main treatment involves pharmacological (methylphenidate/atomoxetine/ dexamfetamine) and non-pharmacological therapies (cognitive-behavioral, comorbidities treatment, and tailor-made educational psycho-pedagogical school programs; Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]; American Psychiatric Association [APA], 2013)
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