Use of Acupressure Magnetic Pellets
in the Treatment of ADHD

 Michael O. Smith, MD ............... Lincoln Hospital (Bronx NY)

I have described the current Lincoln Hospital protocol for treating Attention Deficit Hyperactivity Disorder (ADHD) in the first issue of Clinical Acupuncture and Oriental Medicine (Vol. 1, No. 1).

We have used a type of acupressure magnetic pellet (called "ear magnet seeds" in Chinese), which is easily applicable to the surface of the ear by adhesive tape. The magnetic pellet is a round metallic object, which is coated with gold. It is somewhat larger than most acupressure devices. There is often a clear sensation of Qi when this bead is applied. We use a treatment location on the posterior surface of the external ear, which is just opposite the "shemmen" location on the anterior surface. This location is above the superior end of the "depression groove". One can frequently observe distended veins, moderate erythemia, and poor skin tone at this location suggesting a need for tonification treatment. These magnetic pellets merely rest in place; they do not need to be pressed or manipulated. The magnetic pellets must be replaced whenever the adhesiveness of the tape becomes inadequate. Treatment is more or less continuous for the duration of the patient's problem.

We have trained colleagues in several clinics to use this technique on a pilot basis. Most of the ADHD patients come to us when they are taking medication but yet continue to have very significant symptoms. We never suggest that medication should be changed when the magnetic pellets are applied: Medication should only be changed by the primary prescribing physician on the basis of clear changes in the clinical picture.

The Child Psychiatry clinics at Lincoln Hospital and nearby Morrisania NFCC have conducted a 6 weeks clinical trial of this method in 2000. Staff responsible for this project were Sandra Runes, PhD, director; Cecily Dell, PhD; Rene Valentin, MSW; Michael Smith, MD; and Lauren Kittel, MS, a psychology intern, who is coordinating the analysis.

Sixty subjects, between the ages of 6 and 12 (from 2 psychiatric outpatient clinics in the South Bronx) were recruited to receive 2 consecutive treatment conditions of auricular acupressure, each lasting 3 weeks in length. These subjects were selected because their symptoms of ADHD were more severe than average. Some subjects were on medication, but none of them had be experienced a successful response to medication. All subjects received both conditions, had been diagnosed with ADHD, and were referred by a treating professional. Subjects were matched for age. Medication. and gender. They were then randomly assigned to 1 of 2 treatment groups. The groups differed only in the order of delivery of treatment conditions. Group 1 received the experimental condition first and the placebo condition second. Group 2 received the same treatment in reverse order. Both conditions involved the placement of a small adhesive patch, at approximately the shen men point, on the back of each ear. The experimental condition patches were loaded with a magnetized acupressure pellet, approximately the size of a sesame seed; the placebo condition involved the placement of a plain adhesive patch with no pellet attached. Parents were trained by an expert in acupressure to administer the treatment and given replacement patches to apply as needed. Patch placement was checked after one week to ensure proper application. Parents completed the Connors' Parent Rating Scale (CPRS) and teachers completed the Connors' Teach Rating Scale (CTRS) pre treatment and post treatment 1 and 2. All subjects completed a symptom self-report questionnaire at the conclusion of both treatments. Parents completed a brief questionnaire about treatment compliance and behavior at the conclusion of both treatments.

Preliminary analysis of the results indicates that there are significant limitations to the parent Connors evaluations. The parents could not be adequately blinded and the rating questionnaire was difficult to complete appropriately. The teachers Connors evaluations can be used for outcome evaluations. 32 of the 48 participants had teacher Connors completed both as a baseline and subsequent to the first half of the crossover design. Very few teachers completed the third Connors, which was to follow the last phase of the crossover design.
Therefore we can evaluate the study only as a comparison between 17 patients in the initial pellet group and 15 patients in the initial plain patch group. The magnetic pellets were covered by a patch so that teachers were fully blinded to the nature of each treatment. During the first 3 weeks of the study the parents had not been able to observe the alternative treatment condition so that the parents were more nearly blinded during the first phase of the study.
Using an outcome measure of seven or more points (10%) drop in the teachers Connors score plus a similar drop in the parents Connors score to indicate a beneficial effect, the following preliminary results are obtained:

6 of 17 patients had a beneficial effect with the pellet.
1 of 15 patients had a beneficial effect with the plain patch.

The average difference in teachers Connors score was 12 in the effective bead group. The average difference in the parent Connors score in the same group was 16. The single patient responding well to the placebo patch had 17 points difference in the teachers Conners and 20 points difference in the parents Conners. These findings show a significant treatment effect. Our evaluation of this study and subsequent studies will be ongoing. Let me conclude by describing several anecdotal reports that suggest future directions for this area of work.

Jim Dolan, who is an occupational therapist at a special public school in Manhattan, reports using the Lincoln protocol on a 16 years old Down's Syndrome girl with nystagmus. The patient had great trouble sitting still and focusing because of her rapid eye movement. The patient was asked to draw a self-portrait (Fig. 1) several months before the magnetic pellets were placed on her ears. Prior to treatment the patient was observed to be "mopey, not focusing, and keeping her head down on the desk." Five days after the bead treatment the patient seemed to be focusing more clearly. She was asked to draw another self-portrait (Fig. 2).
The contrast of these two drawings is quite striking. It may be an accurate indication of a treatment-related effect on this girl's nystagmus.

Future studies are required to assess the usefulness of serial self-portraits as an evaluation tool, as well as the effectiveness of acupressure magnetic pellets on children's neurological disorders.
We have been also exploring possible differences between magnetized gold acupressure pellets and smaller silver acupressure pellets in the Lincoln Child Psychiatry population.

1. A seven-year-old boy had a long history of oppositional defiant behavior with escalating tantrums. The gold pellets seemed to make the patient more "hyper". Using the silver pellet correlated with more calm, focused behavior without escalating tantrums. The patient was then able to do his homework.

2. One eight year-old boy who had failed every prior treatment for ADHD improved his behavior and focus using the gold pellet. However, the patient remained anxious. Substituting a silver pellet eliminated the anxiety while his behavior continued to be improved.

3. An eight-year-old girl was known for extreme tantrums and a propensity to turn on the gas stove in the middle of the night. The silver acupressure pellets had no effect. Use of the gold pellets calmed the patient's behavior and helped her sleep through the night consistently and safely one week after application.

In traditional acupuncture texts gold is described as "tonifying" and silver is described as "sedating". Our premise in using gold pellets was that severely hyperactive, inattentive children had an underlying deficiency with "empty fire" symptoms. Some of the children may respond better to silver pellets. Future studies of a crossover design may actually document claims made about gold and silver needles in the ancient texts.