CASE STUDY Improvement in a 6 year-old Child with Autistic Spectrum Disorder and Nocturnal Enuresis under Upper Cervical Chiropractic Care Allison Noriega, DC,1 Jonathan Chung, DC,2 Justin Brown, DC2 ABSTRACT Objectives: To report on the improvement of a pediatric patient with nocturnal enuresis and Autistic Syndrome Disorder (ASD), after undergoing upper cervical specific chiropractic care. Clinical Features: A 6 year-old oy who presented for chiropractic care with a history of nocturnal enuresis and ASD. The child experienced a traumatic irth and at the time of chiropractic care was following the Defeat Autism Now# (DAN#) Protocol. Intervention and Outcomes: An atlas su luxation complex was determined ased on clinical data collected at the first visit. O jective clinical evaluation included: static palpation, motion palpation, radiographs, paraspinal thermography, supine leg length ine(uality, as well as measurements of hip leveling, and ilateral weight distri ution. National )pper Cervical Chiropractic Association (N)CCA) upper cervical specific adjustments were administered over a 1,-wee- period. There was an overall reduction in the patient.s pattern of atlas su luxation, in addition to successful resolution of nocturnal enuresis and mar-ed improvement in oth his social interactions and learning difficulties at school. Conclusions: The case presentation of a 6 year-old oy with nocturnal enuresis and Autistic Spectrum Disorder who underwent upper cervical chiropractic care is descri ed. The reduction of verte ral su luxation was related in time with the resolution of nocturnal enuresis and significant improvements in ehavioral patterns. /urther research in oth su ject areas is advocated. Key Words: nocturnal enuresis, chiropractic, subluxation, upper cervical, children, autism Introduction also faces it.s own psychological challenges and economic Primary nocturnal enuresis, or ed-wetting, affects five to impacts that are involved in caring for the child.3,4 5ard- seven million children over the age of six in the )nited Smith and 6arry1 descri e edwetting as the cause of this States.1, 0 1m arrassment, lac- of control, and low self-esteem psychological distress, rather than the result of psychological are only a few emotional repercussions that the child endures. distress.1, 4 2owever, it is not only the child who is affected, the family The Diagnostic and Statistical 7anual of 7ental Disorders, 4th edition (DS7-I9), defines the criteria for enuresis to e: voiding of urine at least two occurrences per wee- for at least 1. Private Practice of Chiropractic, Southeast, PA 3 months: the child must e at least , years of age 0. Private Practice of Chiropractic, Coral Springs, /L Autistic Spectrum Disorder J. )pper Cervical Chiropractic Research - January 30, 0010 1 (chronologically or developmentally): and the child.s urinary which resulted in the ina ility for the child to progress through incontinence must not e due exclusively to the direct the irth canal. As a result, the child was delivered via physiological effects of a su stance or a medical condition.4-9 cesarean section. The mother noted that the patient.s forehead The three main causes of primary nocturnal enuresis include was lue immediately after eing irthed. The patient was nocturnal polyuria, ladder over-activity at night, and disorder reast fed for the first three months following his irth and of arousal.3, 9, 10 formula fed for the remainder of his first year. A small ody of evidence has lin-ed ed-wetting to ehavioral It was noted y the patient.s mother that her son had endured issues in children, such as Autistic Syndrome Disorder several falls as an infant, as well as had een afflicted with (ASD).11 Such evidence provides a small view into the multiple ear infections. Over the course of the patient.s interference occurring etween the child.s urologenital and lifetime, he had received three to five series of injected neurological systems. A 1996 cross-sectional data analysis anti iotics and had ta-en three to five oral prescriptive conducted y 6yrd et al.11 revealed that extreme scores on the anti iotics for ear infections. In addition, the patient 6ehavior Pro lem Index (6PI) were more common among reportedly suffered from respiratory allergies and allergies younger oys that wet the ed.11 associated with mos(uito and insect ites. Characterizations of ehavioral pro lems included: antisocial Prior to and over the course of care, the patient followed the ehavior patterns, anxious or depressed mood, headstrong, Defeat Autism Now# (DAN#) Protocol, which includes ta-ing hyperactive, peer conflict or social withdrawal, and vitamins C, D, 1, D, 610 (injected), 66, Co-1nzyme E10, immaturity11 5illiams et al. 10 found that the parents of 010 multi-vitamins, pro iotics, multi-minerals, taurine, carnitine, children with autism reported a 44-A3B incidence of poor and detoxification supplements. The patient had also received sleep, which may attri ute to an increase in the child.s Ca-1DTA suppositories from the age of two years old to six aggression and irrita ility, often characteristic of autism: it years old and stopped six months prior to eginning was also noted that 0C.CB of poor sleep was attri uted to ed chiropractic care. wetting.10 Chiropractic Examination It is estimated that an average of 1 in 110 children in the )nited States have ASD and it is found to e more common The initial chiropractic exam entailed o servation, static among males: 1:C0 versus females: 1:31,.13 Autistic Spectrum palpation, motion palpation, postural evaluation of the hips, Disorder includes autism, childhood disintegrative disorder, weight distri ution, supine leg length comparison, paraspinal Rett syndrome, Asperger syndrome, and pervasive thermography instrumentation, and cervical radiographs. The development disorder-not otherwise specified (PDD-NOS).14 radiographs included were nasium, vertex and lateral cervical A great deal of media coverage has een directed towards views. (/igure 1-3) autism and spectrum disorders in the past decade. There has also een a good deal of research y several factions of health 7otion palpation has een shown to e an effective care investigating the etiology, treatment, and prevalence of assessment for normal and a errant spinal range of motion.16,1C these disorders. 1, This assessment tool has helped to identify areas of motion restriction or joint dysfunction and was found to e a This recognition has played a significant role in allowing responsive tool following an adjustment of the cervical parents and clinicians to identify the signs and symptoms at an spine.16,1C earlier age. A diagnostic criterion for autism issued y the 5orld 2ealth Organization in 1993 indicates that at least six Static palpation has een shown to enhance the clinician.s symptoms within the following categories must e included: a ility to recognize the sites of pain or tenderness in order to impaired social interaction: a normalities in communication: determine the correct regions of the spine in which a spinal or restricted, repetitive, and stereotyped patterns of ehavior, misalignment may e present.1C,1A The inter- and interests, and activities.14 intraexaminer relia ility of clinicians to locate painful and tender points along the spine and sacroiliac joints has een Case Report determined to e high.1C,1A Patient History An assessment tool fre(uently used in the National )pper Cervical Chiropractic Association (N)CCA) procedure A six year-old male with chronic episodes of nocturnal involves measuring pelvic distortion in the frontal enuresis as well as signs and symptoms of autism presented (horizontal), transverse (rotatory), and fixed-point (vertical) for upper cervical chiropractic care. The child was first planes using hip calipers.19, 00 This is done in conjunction with diagnosed with Autistic Spectrum Disorder (ASD) at two measuring the ilateral weight differential of the patient. years of age. The patient steps onto two individual weight scales, the right The patient.s mother reported that the pregnancy was foot on one scale and the left on the other and the weight complicated as the expansion of her a dominal region caused differential is calculated.19,00 According to Seemann,19 when her thigh to num . The mother noted that she had ta-en the pelvis measurement returns to zero degrees in all three Levoxyl for hypothyroidism throughout the pregnancy. She planes and the ilateral weight differential decreases towards stated that the child.s hospital delivery and irth were zero, there has een a successful reduction of the atlas 19, 00 traumatic. She noted having pro lems with vaginal dilation su luxation. 0 J. )pper Cervical Chiropractic Res. - January 30, 0010 Autistic Spectrum Disorder In accordance with N)CCA protocol supine leg length The atlas verte ral complex was categorized as a 6asic Type comparison is performed on the patient while lying in a supine II 7isalignment. Specific upper cervical side-lying position with their feet hanging slightly off the end of the ta le adjustments, ased on N)CCA protocol and procedures were and nec- in a slightly flexed position.01 This comparison is administered. done in order to determine the presence of any neurological interference from an upper cervical misalignment.00 The adjustment set-up entailed the clinician to position the pisiform of his superior hand over the patient.s right atlas 6ased on Frostic.s Dentate Ligament G Cord Distortion transverse process, while sta ilizing his contact hand at the theory, a misalignment of the upper cervical verte rae via the wrist with the opposite hand. The contact arm and the top of dentate ligament results in spinal cord tension and irritation, the clinician.s sternum was aligned in a vector directed 1 J thus affecting the muscles of the pelvic girdle and lower inches inferior and 3 inches posterior to his contact.