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CST effects on ADHD
Effect of Craniosacral Therapy on students' symptoms of attention deficit hyperactivity
disorder
Sadeghi Amrovabady Z, Pishyareh E, Esteki M, Haghgoo H. Effect of Craniosacral Therapy
on students' symptoms of attention deficit hyperactivity disorder. IRJ. 2013; 11 (0) :41-50
1. Zohreh Sadeghi Amrovabady (MSc) from Islamic Azad University Central
Tehran, Psychology Department, Tehran, Iran e-mail:
z_sadeghi1985@yahoo.com
2. Mahnaz Esteki (PhD), Associated Professor from Islamic Azad University
Central Tehran, Psychology Department, Tehran, Iran e-mail:
m.esteki@znu.ac.ir
3. Hojjatallal Haghgoo (PhD). Assistant Professor, Pediatric Neurorehabilitation
Research Center , University of Social and Welfare Rehabilitation , Tehran,
Iran h.haghgoo@uswr.ac.ir
4. Ebrahim Pishyareh (PhD). Assistant Professor. Occupational Therapy
Department, University of Social and Welfare Rehabilitation , Tehran, Iran .
keyhoj418@yahoo.com
Correspond Author: Ebrahim Pishyareh (PhD). Assistant Professor. Occupational
Therapy Department, University of Social and Welfare Rehabilitation , Tehran, Iran .
Tel: Work +98 21 22180063 Home +98 21 444 79 817 Mobile: +98 919 864 7961
Email: keyhoj418@yahoo.com
Author Disclosures: the article is derived from MSc. Thesis and there is no funding or grants or
equipment provided for the project from any source and there is no any financial benefits to the
authors. This article is not presented previously in any form.
CST effects on ADHD
Effect of Craniosacral Therapy on students' symptoms of attention deficit hyperactivity
Abstract
Objective: Complementary and alternative medicine methods (CAM) are now used for a wide range of disorders.
Craniosacral therapy (CST) is one of CAM methods in which manual maneuvers with light forces are used for
different aspects of health. In the present research, the effects of CST were studied for reducing symptoms of
attention deficit and hyperactivity disorder (ADHD).
Method: Twenty-four children with ADHD were recruited as an available sample from Roshd Occupational
Therapy Center and divided randomly into control and experimental groups. Before and after intervention, the
Conner’s Parents Rating Scale as well as child's symptom inventory-4th were filled out by parents. Both groups
participated in occupational therapy programs as a routine intervention, while the experimental group received an
additional CST for 15 sessions, twice a week. The collected data were analyzed as the covariance method by
SPSS-16.
Results: CST showed significant effects on increasing attention, reducing hyperactivity, oppositional defiant,
conduct disorder, anxiety and embarrassment, social problems and psychosomatic problems of the participants.
Conclusions: CST as a type of biomechanical correction, can facilitate improvement in children with symptoms
of ADHD.
Keywords: Complementary medicine, alternative medicine, Craniosacral therapy, Attention deficit hyperactivity
disorder, cerebro-spinal fluid (CSF).
CST effects on ADHD
Introduction
Attention deficit hyperactivity disorder (ADHD) with a set of hyperactivity
symptoms, impulsive behaviors and attention deficit leads to concentration problems[1].
The disorder consists of three types including hyperactivity-impulsivity, attention and
concentration deficit and mixed type[2]. The prevalence rate of the disorder in students
and is estimated to occur in 3-7% of school aged children [1] and in Tehran have been
reported 3-6% [3]. The disorder is always associated with a wide range of negative
consequences for children [4, 5] and high costs to the family and communities [6],
therefore this disorder is considered as one of collective health problems[7]. Nowadays,
medication is the most common treatment method in children with ADHD. But, due to
the wide range of heterogeneity in children with ADHD, medication is not effective in
all clients. Furthermore, even some drugs such as methylphenidate which has been
approved by the U.S. Food and Drug Administration as a first-line treatment for people
ADHD, has different adverse effects. These side effects strongly deteriorates patients'
ability to manage their cognitive function such as attention and concentration[8].
Therefore, the medication alone cannot meet the therapeutic requirements of children
with ADHD and shall be combined with other intervention methods[9]. Hitherto,
twenty-four alternative treatments are identified in patients with ADHD. Among them
are oligoantigenic diets, Enzyme-potentiated desensitization,
Relaxation/EMG biofeedback, EEG biofeedback, massage, meditation, mirror
feedback, channel-specific
CST effects on ADHD
Perceptual training, and vestibular stimulation. A few have some supports for their
effectiveness in some selected subgroup of patients while, many of them have no
documented and or convincing evidences of efficacy.
National Centre for Complementary and Alternative Medicine (NCCAM) has
introduced a group of hitherto uncommon care and treatment systems in Westerners
conventional medicine as complementary and alternative Medicine. Manipulative and
body-based group is one of these classes which is carried by manual maneuvers on the
body and includes chiropractic, massage therapy, Craniosacral therapy, etc. The
efficiency of some therapeutic groups including massage therapy for children with
ADHD has been studied [10] and positive results thereof have been reported.
Craniosacral therapy is also milder and less risky than manipulative treatments of
cranium bones and vertebrae. It is believed that Craniosacral therapy is one of the most
useful complementary and alternative interventions to improve the symptoms of
children with developmental disabilities [11]. This method has deep effects on the brain
and spine and can influence the endocrine and body immune system positively and
eliminates pressure patterns and enhances fluid flow in body organs [12].
This treatment method leads to improve movement as well as balance in the central
nervous system and enhances the level of performance via biomechanical improvement
of the body. Therefore, CST not only improves body general state, but also removal of
blockages and constraints can reduce disorders in children with ADHD and prevent
breaking out of social and academic problems, and other mental disorders in their
growth stages.
CST effects on ADHD
According to this approach, there are some theories about the etiology of ADHD. For
example, some experts of this approach believe that some patterns of pressure on brain
cause incidence of ADHD symptoms [13, 14]. More than half of children with ADHD
suffer from structural problem in atlas-occipital region [15]. Upledger believes that such
structural problem which has causal relationship with ADHD occurs during parturition;
in a way that the head turns backward excessively and a hyperextension occurs. This is
a very threatening situation for the central nervous system. Tissues’ reaction leads to
reduction in physiological fluid flow of intracellular fluid, interstitial fluid, lymph and
blood, and reduces the efficiency and productivity of fluids, and finally leads to
abnormal accumulation of these fluids which followed by brain irritability.
According to another related theory, there is no balance between sympathetic and
parasympathetic systems in children with ADHD. It is believed that sympathetic system
is more active and dominant in children with ADHD than parasympathetic system [16].
Accordingly, the effects of CST children with ADHD can be discussed in several
perspectives:
- Impact on the structural problem in the atlas occipital region
- Impact on Craniosacral rhythm
- Impact on autonomic nervous system
Upledger has used Craniosacral therapy as a quite successful treatment in solving the
above issues and in reducing symptoms in children with ADHD since 1975. His clinical
experiences indicated that the special outcome is to remove pressure on the membrane
and cranium which leads to the natural motion of each bone, and the suture junction
between these bones which contribute to adaptive activity and natural pumps [12, 15].
CST effects on ADHD
Craniosacral therapy can alter pressure patterns. That is, elimination of pressure pattern
can regulate brain cycle (brain ventricular contraction and dilatation), Craniosacral
rhythm and accelerate the cerebro-spinal fluid circulation. Reduction in pressures of
cranium and cerebral meninges improves brain function and enhances data processing;
therefore, after reducing abnormal pressure of the brain and cortex, the ability to attend
and concentration will improve significantly [14].
According to another theory based on the fact that there is no balance between
sympathetic and parasympathetic systems in children with ADHD; Levine found that
body interventions such as Craniosacral therapy play a key role in helping these
children and believes that Craniosacral therapy strengthens the parasympathetic system
and creates balance between these two systems[16].
Method
Participants: Twenty-four children (6-11 year old) with ADHD who referred to
Roshd Occupational Therapy is setting in Tehran, Iran and participated in a randomized
experimental study (Table 1). Participants’ diagnosis as ADHD has been approved by
psychiatrists. Subjects were recruited by available sampling. The sample was matched
by age and sex, then, randomly divided into equal control and experimental groups.
Statical results (Table 1) show that there are no significant age differences between
groups.
Characteristics of participants are shown in the table 1.
Table 1- here!
This study and research project was approved by “University of Social Welfare and
Rehabilitation ethical committee”. Parents of all participants were provided with the
CST effects on ADHD
information sheet and ensured that their participation in the research is voluntary and
they are able to withdraw from the study in every stage of the process. Following their
consent data were collected in the participant's convenient time and day. All children
with ADHD whose parents provided consent to the study were included in the study.
Subjects were blinded to the purpose of the study and assessors were blinded to group
assignment.
Implement Practice: by collecting the required sample, the, homologation and
randomized classification of subjects into control and experimental groups were
conducted, and the Conners Parents Rating Scale (CPRS-R) and Child Symptoms
Inventory-4th (CSI-4) were filled out by all parents of the two groups and finally
intervention was performed. Both groups received current occupational therapy
treatment as a routine intervention, but experimental group received additional CST.
The intervention was taken place as individual performance of CST techniques which
lasted 30 minutes each session- 15 sessions, twice a week. The SCT method was
implemented by the researcher on the subjects; of course, initial trainings for CST were
presented by relevant specialists to the research in this field. Therapeutic protocols used
in this study were derived (Pishyareh 2001) to adopt appropriate techniques for children
with ADHD among CST techniques. The two mentioned tests were run as post-tests on
the parents, upon completion of the intervention period.
Data collection tool: There were three tools for collecting data. A questionnaire was
used within which data on age and gender were collected and the two groups were
matched accordingly.
CST effects on ADHD
Data collection tools included CPRS (a 48 questions Form) and CSI-4 (parent form)
in this study. They were empirical and standardized questionnaires. Then, Conners
Parents Rating Scale (CPRS) was used to assess participants and evaluate their
problem behavior. And finally, Child Symptoms Inventory-4th (CSI-4) two screens for
emotional and behavioral disorders in subjects. The CSI-4 questionnaire used in this
study includes A, B, C groups of main questionnaire and 41 questions and measures
three types of disorders other than ADHD, and also oppositional defiant disorder
(ODD) and conduct disorder.
Methods of data analysis: Data were analyzed using SPSS-16 and comparison test
between two groups means (covariance analysis) were used to adjust the pretest sub-
scales. Using covariance analysis, groups' performance was compared with pre-test and
post-test and then pretest was entered as a covariate in covariance analysis to control
initial differences. In covariance analysis, one or more covariances are measured in
addition to dependent and independent variables.
Results
In the present study, Craniosacral therapy was considered as independent variable, and
performance of children with attention deficit hyperactivity with subsets of attention
deficit, hyperactivity, oppositional defiant disorder, conduct disorder, anxiety and
embarrassment, social problems and psychosomatic were studied as the dependent
variable.
Statistic analyses of data concerning students’ scores in the two questionnaires are
presented in the tables 2 and 3.
CST effects on ADHD
Table 2-here!
Table 2 shows in all sub-scales of the child symptom inventory-4th (CSI-4), the mean
difference between experimental and control groups is significant. While no difference
was observed in CSI-4 scores between the two groups in pretest, but in post test
significant differences were observed in all five subscales of CSI-4 between the two
groups.
Table 3- here!
Table 3 shows in all subscales of Conners Parents Rating Scale (CPRS), the mean
difference between experimental and control groups is significant. While no difference
was observed in CPRS-R scores between the two groups at pretest, but in post test
significant differences were observed in all five subtests of CPRS-R between the two
groups.
Table 4- here!
Covariance analysis results in Table 4 shows that after controlling pretest the impacts of
Craniosacral therapy for attention deficit, hyperactivity, attention deficit and
hyperactivity disorder, oppositional defiant disorder and conduct disorder (sub-scales of
the child symptom inventory-4th (CSI-4), were significant (p≤0.001).
Table 5- here!
Covariance analysis results in Table 5 shows that after controlling pretest the impacts of
Craniosacral therapy on conduct disorder, social problem, anxiety, psychosomatic, and
total (sub-scales of CPRS were being significant (p≤0.001).
CST effects on ADHD
Conclusion
According to our data, the effectiveness of CST was significant in mentioned
variables. The pretest effect was controlled as a covariance in this analysis. Results
indicated the effectiveness of CST on increasing attention and hyperactivity in children
participating in this study. These findings are aligned with the theory of Gillespie [14]
and Upledger [12, 15].
Upledger theory can justify these effects. Based on his approach, special effects of
CST are to remove pressure on the membrane and cranium in which this restoration
causes natural motion of singly bones and the suture junction between these bones
which are responsible for adapting activity and natural pumps. Increased movement in
physiological fluids is necessary for all central nervous system and its related structures
and systems for optimal performance and health and comforts the person[15]. CST can
alter pressure patterns and regulate the Craniosacral rhythm and accelerate cerebro-
spinal fluid[14].
CST as a kind of massage and physical therapies’ method, it is believed that
influences on the parasympathetic system of children with ADHD [16]. Cognitive
processes are controlled by the automated system, so there is a relationship between
selective attention and levels of cortisol secretion[17]. The biochemical relationship
between cortisol and attention has also been approved [18]. In other word, one of the
massage therapy results and body-based therapy is to adjust cortisol level in people
receiving the intervention [19]. Logical inference from these findings is that these types
of body-based therapies can influence on cognitive processes and among them attention
and concentration processes.
CST effects on ADHD
The improved attention and hyperactivity symptoms can be also used to explain
other hypotheses in addition to direct effects of CST. No research was found about the
effectiveness of CST on reducing oppositional defiant disorder (ODD) and conduct
disorder (CD) in children with ADHD. Massage therapy in children with AHDH
improves the level of mood and increases of peace and happiness feeling, and may
improve classroom behavior [10]. The effect of massage therapy has been studied using
EEG and the results have shown that it caused to create a special pattern of EEG, i.e.
reducing alpha and beta in the intervention group. In fact, tactile stimulation leads to
increase EEG pattern during mathematical computation and consciousness in people to
be treated [20]. This pattern, which reflects the balanced activity of the parasympathetic
and increased level of comfort, accuracy and consciousness caused to improve the
cognitive processes [20] and increase levels of cognition, adaptation and adaptive skills.
The research findings show that CST can have an impact on reducing social
problems of students with ADHD. To explain the finding, the effect of CST on balance
in sympathetic and parasympathetic system can be mentioned. This balance can
increase comfort and facilitate cognitive processes and subsequent adaptation; it plays a
crucial role in reducing social problems of these children. Gilmore proposed that CST
enhance learning by facilitating the cerebro-spinal fluid flow such as blood in the
brain[21]; Thus, increased learning, in turn, can assist to learn behavioral patterns and
better understand mutual relations and interactions. On the other hand, reduced primary
symptoms of ADHD (attention deficit and hyperactivity) can also decrease the social
problems common in children.
CST effects on ADHD
Based on the analysis, CST influenced on and reduced anxiety and stress of
participants in this study. Researchers have shown that serotonin secretion rate in
children with ADHD is lower and this imbalance in the serotonin secretion is one of the
most important factors in anxiety and embarrassment, moreover, increased serotonin
levels can be considered as one of treatment goals in these children [22]. One of the
special effects of CST is to remove existed obstruction and restrictions; in fact,
Serotonin secretion can be increased by releasing of visceral constraints through
improvement in visceral fascial dysfunction in[22].
Our results showed that CST can contribute to reducing psychosomatic problems of
students with ADHD. This variable is dependent on other components including
anxiety, therefore, reducing anxiety is effective in decreasing in psychosomatic
problems. In an interaction with biological and genetic potentials, anxiety and stress are
considered to be fundamental elements in creating and exacerbating psychosomatic
disorders.
According to previous data, CST has led to improve in living standards and sleep
quality in the CST-treated subjects, therefore it is believed that the removal of
obstructions and fascial constraints will improve the sleep level and reduce its related
disorders[22]. Reduction in the cortisol level and increasing serotonin after tactile
stimulation can on decrease psychosomatic problems by reducing anxiety and
stress[18]. Moreover, one of the CST functions is to reduce muscle tone, leading to
increase relaxation and safe mood in people. The effectiveness of CST has also been
approved by reducing muscle spasticity in children with cerebral palsy[23]. So it can be
concluded that one of possible influencing factors of CST on psychosomatic problems
CST effects on ADHD
in children with ADHD is the ability of this method in reducing muscle tone and
increasing relaxation [23].
Thus, CST method should be considered as a useful treatment for children with this
disorder. Although the effectiveness of this mechanism requires further study, tactile
stimulation has been considered as an effective method. Tactile stimulation and
massage therapy are effective in increasing consciousness and facilitating cognitive
processes and play an important role in reducing stress and anxiety and mood by
balancing of neurotransmitters [20]. Upledger also finds this method useful in
improving ADHD symptoms due to remove obstructions and congestion in atlas-
occipital region because removal of pressure patterns and mentioned constraints
facilitate and modify the cerebro-spinal fluid flow[15].
Research on mechanism of effectiveness of CST on children with ADHD and
removal of ambiguities in this regard is one of the most important requirements in the
field study.
Acknowledgments
Hereby the authors want to thank the respected authorities in Roshd Occupational
Therapy Center and children and families participated in this study for serious
cooperation with researchers.
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CST effects on ADHD
Table 1- Statistics of participants in study
P
t(22)
Mean
age
Number
Group
0.510
0.669
99.42
12 (F 2, M 10)
Control
95
12 (F 2, M 10)
Experimental
CST effects on ADHD
Table 2- Descriptive statistics of the pretest-posttest scores of the control and experimental
groups in CSI-4
Post test
Pre test
kurtosis
skewness
std.
deviation
mean
kurtosis
skewness
std.
deviation
mean
Sub-scales of
CSI-4
-1.52
0.17
1.17
7.58
-1.35
0.24
1.17
7.42
control
Attention deficit
-0.77
0.14
0.97
5.25
-0.99
0.13
0.99
7.68
experimental
0.29
-0.82
1.80
6.83
-0.90
-0.49
1.98
6.58
control
Hyperactivity
0.80
-1.25
1.94
5.17
2.40
-1.60
1.99
6.80
experimental
-0.35
0.55
1.88
14.42
-0.86
0.26
1.95
14
control
ADHD
-0.50
-0.58
1.80
10.50
-0.20
-0.80
1.70
14.5
experimental
-0.89
-0.89
1.22
4.75
1.58
-0.77
1.08
4.50
control
Oppositional
defiant disorder
-0.50
-0.58
1.83
2.68
-0.97
0.80
1.68
4.33
experimental
-0.33
0.44
0.91
4.50
-0.60
0.03
1.55
4.25
control
Conduct
disorder
0.42
0.33
2
3
-0.77
0.25
2.29
4.17
experimental
Table 2 shows in all sub-scales of the child symptom inventory-4th (CSI-4), the mean difference
between experimental and control groups is significant. While no difference was observed in
CSI-4 scores between the two groups in pretest, but in post test significant differences were
observed in all five subscales of CSI-4 between the two groups.
CST effects on ADHD
Table 3- Descriptive statistics of the pretest-posttest scores of the control and experimental
groups in CPRS-R
post test
pre test
kurtosis
skewness
std.
deviation
mean
kurtosis
skewness
std.
deviation
mean
Sub-scales of
CPRS-R
-0.82
-0.21
5.16
65.92
-1.04
-0.45
6.14
65.42
control
Conduct
disorder
0.57
-0.97
5.51
57.75
-0.23
-0.23
7.13
64.08
experimental
-0.40
-0.12
7.03
76
-0.38
0.20
6.65
75.58
control
Social problems
3.85
-1.72
6.75
65.33
2.80
1.37
9.08
78.25
experimental
-0.06
0.96
5.88
65.25
0.38
1.07
5.17
63.17
control
Anxiety
-0.97
-0.19
6.13
52.42
0.49
0.53
6.32
61.92
experimental
-0.33
-0.60
6.51
71.08
-0.41
-0.65
6.91
68.58
control
Psychosomatic
-0.76
0.41
7.05
59.67
1.08
-0.60
7.82
72.33
experimental
0.34
-0.37
3.33
72.75
-0.22
0.46
4.55
72.17
control
Total CPRS
1.43
-0.95
4.82
60.17
-090
-0.91
5.02
72.67
experimental
Table 3 shows in all subscales of Conners Parents Rating Scale (CPRS), the mean difference between
experimental and control groups is significant. While no difference was observed in CPRS-R scores between the
two groups at pretest, but in post test significant differences were observed in all five subtests of CPRS-R
between the two groups
CST effects on ADHD
Table 4- Results of covariance analysis of the impact of Craniosacral therapy in CSI-4
scores in experimental group
sig.
F
mean square
df
sum of squares
source
Sub-scales of CSI-
4
0.001
65.575
19.062
1
19.062
pre test
Attention deficit
0.001
132.186
38.425
1
38.425
group
0.001
182.924
69.370
1
69.370
pre test
Hyperactivity
0.001
56.653
21.350
1
21.350
group
0.001
90.773
61.653
1
61.653
pre test
ADHD
0.001
165.391
112.335
1
112.335
group
0.001
67.903
32.779
1
32.779
pre test
Oppositional
defiant disorder
0.001
46.594
22.471
1
22.471
group
0.001
119.380
45.071
1
45.071
pre test
Conduct disorder
0.001
32.888
12.417
1
12.417
group
Covariance analysis results in Table 4 shows that after controlling pretest the impacts of
Craniosacral therapy for attention deficit, hyperactivity, attention deficit and hyperactivity
disorder, oppositional defiant disorder and conduct disorder (sub-scales of the child symptom
inventory-4th (CSI-4), were significant (p≤0.001).
CST effects on ADHD
Table 5- Results of covariance analysis of the impact of Craniosacral therapy on CPRS-R
scores in experimental group
sig.
F
mean square
df
sum of squares
source
Sub-scales of
CPRS
0.001
159.593
554.238
1
554.238
pre test
Conduct disorder
0.001
87.632
304.328
1
304.328
group
0.001
22.121
369.816
1
369.816
pre test
Social problems
0.001
54.993
919.389
1
919.389
group
0.001
24.417
426.420
1
426.420
pre test
Anxiety
0.001
47.873
836.059
1
836.059
group
0.001
40.024
664.780
1
664.780
pre test
Psychosomatic
0.001
68.117
1131.408
1
1131.408
group
0.001
9.333
116.282
1
116.282
pre test
Total CPRS
0.001
78.957
983.715
1
983.715
group
Covariance analysis results in Table 5 shows that after controlling pretest the impacts of
Craniosacral therapy on conduct disorder, social problem, anxiety, psychosomatic, and total
(sub-scales of CPRS werebeing significant (p≤0.001).
