Issue link: https://www.massageandbodyworkdigital.com/i/1174218
CLINICAL RELEVANCE AND OTHER IMPORTANT TAKEAWAYS To the massage clinician, it makes sense that massage therapy can positively affect children and adolescents with ADHD. While the supportive evidence from this systematic review was graded somewhat low overall, this is more of an indication that research in the topical area is still early and that a need exists for better designed, larger research studies. As I have pointed out in various columns, the building of a research evidence base takes time. The oldest study in this review was from 1998, which indicates the topic has only even been on the research "radar" for approximately 20 years. Twenty years isn't terribly long, relatively speaking, considering the massage therapy research funding support context during this time; what used to be only relatively small foundation support has expanded to larger federal mechanisms with the growth of complementary, alternative, and/or integrative medicine. It is also notable that the last Western- originating study was published over 15 years ago on this topic. This is unfortunate considering the vast improvements to research design and reporting for the massage field, the steady increase in diagnosis and understanding of ADHD in children and youth, and the strengthening research literacy in the massage field. Given that a large proportion of massage clinicians practice from a Western approach, updated research in this area would be welcomed and is warranted. In the meantime, all massage clinicians can look to the studies included in this systematic review for potential starting points in their practice when working with children and adolescents with ADHD. If you don't already incorporate Eastern approaches, perhaps familiarizing yourself with the acupoints most included in the TCM-related studies would be a beneficial addition to your technique tools for working with those with ADHD. From a clinical standpoint, the overarching message from this review SOMATIC RESE ARCH is that the relatively small amount of evidence on massage for ADHD does point to massage therapy being beneficial for children and adolescents with ADHD. A final item massage clinicians might consider is the reminder that ADHD symptomology and impact is not exclusive to children and adolescents. While, to my knowledge, no massage-related research has focused specifically on adults with ADHD, the potentially effective treatment principles highlighted in this review would likely translate to adults. I have known many people who were diagnosed with ADHD as adults. These same adults have anecdotally told me the diagnosis explained their behavior and challenges in youth and that massage has always been beneficial for them to ground down and focus. Surely there is grounds here for a case report or series coming from massage clinicians within this readership. While single case reports were excluded from this systematic review, rigorous case series were included. Perhaps work inspired by this column will be included in an updated systematic review and meta-analysis in the future. Notes 1. Centers for Disease Control and Prevention, "What Is ADHD?" (2018), www.cdc. gov/ncbddd/adhd/facts.html. 2. National Institute of Mental Health, "Attention- Deficit/Hyperactivity Disorder (ADHD): The Basics" (2016), www.nimh.nih.gov/health/publications/ attention-deficit-hyperactivity-disorder-adhd- the-basics/qf-16-3572_153275.pdf. 3. Mai Uchida et al., "Adult Outcome of ADHD: An Overview of Results from the MGH Longitudinal Family Studies of Pediatrically and Psychiatrically Referred Youth With and Without ADHD of Both Sexes," Journal of Attention Disorders 22, no. 6 (2018): 523–534. 4. Centers for Disease Control and Prevention, "What Is ADHD?" (2018), www.cdc. gov/ncbddd/adhd/facts.html. 5. Melissa L. Danielson et al., "Prevalence of Parent- Reported ADHD Diagnosis and Associated Treatment Among US Children and Adolescents," Journal of Clinical Child and Adolescent Psychology 47, no. 2 (2018): 199–212. Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 49 6. Cathy Southammakosane and Kristine Schmitz, "Pediatric Psychopharmacology for Treatment of ADHD, Depression, and Anxiety," Pediatrics 136, no. 2 (2015): 351–359. 7. David Moher et al., "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement." Annals of Internal Medicine 151, no. 4 (2009): 264–269. 8. Douglas G. Altman and Iveta Simera, "A History of the Evolution of Guidelines for Reporting Medical Research: The Long Road to the EQUATOR Network," Journal of the Royal Society of Medicine 109, no. 2 (2016): 67–77. 9. Shu-Cheng Chen et al., "Massage Therapy for the Treatment of Attention Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents: A Systematic Review and Meta-Analysis," Complementary Therapies in Medicine 42 (2019): 389–399. 10. Shay Beider and Christopher A. Moyer, "Randomized Controlled Trials of Pediatric Massage: A Review," Evidence-Based Complementary and Alternative Medicine 4, no. 1 (2007): 23–34. 11. Tiffany M. Field et al., "Adolescents with Attention Deficit Hyperactivity Disorder Benefit from Massage Therapy," Adolescence 33, no. 129 (1998): 103. 12. Barbara Maddigan et al., "The Effects of Massage Therapy and Exercise Therapy on Children/ Adolescents with Attention Deficit Hyperactivity Disorder," The Canadian Child and Adolescent Psychiatry Review 12, no. 2 (2003): 40. 13. Sonya Khilnani et al., "Massage Therapy Improves Mood and Behavior of Students with Attention- Deficit/Hyperactivity Disorder," Adolescence- San Diego (2003): 623–638. 14. Shiying Chen and Ling Huang, "Clinical Research of Treatment for Hyperkinetic Syndrome of Children with Pressing Acupuncture Points According to the Channel," Modern Journal of Integrated Traditional Chinese Western Medicine 21 no. 20 (2012): 2167–2172. Niki Munk, PhD, LMT, is an associate professor of health sciences at Indiana University, a Kentucky-licensed massage therapist, a visiting fellow with the Australian Research Centre in Complementary and Integrative Medicine, and a mother of two young daughter- scientists. Munk's research explores real-world massage therapy for chronic pain, trigger point self- care, massage for amputation-related sequelae, and the reporting and impact of massage-related case reports. Contact her at nmunk@iu.edu.