Attention Deficit Hyper-activity Disorder (ADHD)
ADHD is a medical condition characterised by inattention and/or hyperactivity and impulsi-vity. This is one of the most common mental disorders among children, affecting approximately 5 to 7 % of school-age children and about 2-5% of adults.
Myths about ADHD
- Only affects children and disappears in adolescence
- Consequently it does not work in adult
- Drugs used are dangerous because of possibility of addiction
Prevalence & History
- Begins in childhood and can affect all areas of a patient
- In India – 1-2 million children
- In US – about 2 million children and about 5 million adults
- 3 : 1 ratio for boys : girls
- Nature: Neurobiology/genetics
- Nurture: Environmental factors
Types of ADHD
Predominantly Inattentive Type: Very short attention span, over- frequent changes of activity, extreme distractibility.
Predominantly Hyperactive Impulsive Type: Excessive movements, especially in situations expecting calm such as classroom etc. The affected person will not wait their turn; very often act without thinking, rule-breaking.
Combined Type: It is a combination of both the above types.
- Doesn’t seem to listen
- Fails to finish assigned tasks.
- Often loses things
- Can’t concentrate
- Easily distracted
- Requires frequent redirection
- Can be very quiet and missed
- Can’t sit still
- Talks excessively
- Always on the go
- Easy arousal
- Lots of body movement
6 out of 9 Hyperactive-Impulsive characteristics
- Fidgets with hands or feet or squirms in seat
- Leaves seat in classroom inappropriately
- Runs about or climbs excessively
- Has difficulty playing quietly
- Is ‘on the go’ or ‘driven by a motor’
- Talks excessively
- Blurts out answers before questions are completed
- Has difficulty awaiting turn interrupts or intrudes on
- Abusive and destructive
- Creativity and flexibility
- Enthusiasm and spontaneity
- Energy and drive
Management of ADHD cases involves Education, Medication, Behavior modification and Classroom/work-place accommodations.
Tips for Parents
- Take a disability perspective
- Manage behaviour at the point of performance
- Use rewards and incentives more than punishments
- Work closely with the school
- Know what your child’s responsibilities are in school
- Provide close supervision for homework
- Help your child stay organised
- Monitor the child’s performance and let doctors know
- Find the things your child does well and encourage them
- Get additional help for academic skill problems if needed
- Learn as much about ADHD as you can
- Maintain a good sense of humor
Tips for Teachers
- Preferential seating
- Shorter assignments and Clearer instructions
- Closer supervision
- Help in getting started on assignments
- Closer supervision of homework
- Frequent communication with Parents/doctors
- Daily report card program
- Allow time for movement
- Extra set of books
- Environment with fewer distractions during tests
Homeopathic Approach towards ADHD
Peevish, hasty and hurried, internal hastiness, but slow in execution, hence making mistakes in writing and speaking, confusion of intellect, loss of memory, uses words not intended. Mathematics, calculating inept for. Weak will, the boy weeps constantly against his will, involuntary tears. The child wakes up confused and wonders where he is.
Very easily offended takes everything in bad part. Want of moral feeling, contradictory impulses, laughs at serious things, remaining serious at laughable things. Obstinate, malicious and destructive, under control of two wills, indecisive, timid, shameless, want of self-control. Irresistible desire to curse and swear.
Constant whining in children, great tearfulness, cannot help crying, weeps day and night without any cause. Irritable especially when crossed. Always restless, always want to keep himself busy. Fruitless activity. Very jealous, awkward, drops things readily. Desire to break things and laugh over it.
Hurried and impulsive, very fast, hurried to make mistakes in school. Deceitful and sly, liar. Anxious and timid, timidity in appearing in public. Does strange and foolish things. Loquacity changing quickly from subject to subject.
Restless; capricious, want to be carried; wants to go from father to mother to nurse. Fear of being left alone, insecurity, wants company. Sensitive to reprimands, criticism and reproaches. Clinging-held desire to be, better when carried about. Fastidious, sensitive to disorders.
Very sensitive to criticism, reprimands, indolent to consolation. Restless children with destructive outbursts. Disobedience; refusal of parental control, refusal to accept any authority. Perfect but very untidy in home and clothes. Sleeplessness in children since birth, must be rocked.
Disobedient, stubborn, contempt for everything, rudeness of naughty children. Oversensitive – both mental and physical. Disposition to hurt to her people’s feeling. Fear of dogs and other animals, aversion to be caressed. Theorizing, ideas abundant, plans many. Mistakes in speech and writing, reverses words while talking, artistic attitude.
Restless, tosses about. Uneasy and distressed all the time. Indifference to play, anger when things he wants are refused, contradiction is intolerable. Doesn’t like caresses, whining restless, desire many things but don’t know what.
Piercing shrieks; nervous, uneasy, complaining. Fear of society, shuns everything. Aversion to any change. Maliciousness, joy at misfortune of others. Attacks of rage; wants to bite bystanders; alternating yielding and headstrong; dictatorial.
Rejects things asked for. Domineering, strong minded and possessive especially in family. Cant’ find the right word for anything; cannot concentrate his thoughts, impatient. Quarrelsome, scolding or abusive without being angry. Desire many things but refused when offered.
Irritable, nervous, hysterical; slight noise intolerable. Excited by least contradiction; dominating, always claims to be right. Positiveness, duty bound, strong willed. Haughty looks self-contented; aversion to company.
Stupefaction sensorial depression or blunt sensibility, looks semi-idiotic; picks at lips and clothes. Awkwardness, especially if he takes his mind from what he is doing even to speak; the muscle refuses to obey his will. Deeds as if he could do great. Indifference to loved ones, to pleasure. Child lies upon the back and rolls the head from side to side.
Child cross; doesn’t laugh, doesn’t amuse itself. Sits silent and speechless in corner; sits still. Anger at trifles, throws things into fire. Quarrelsome – hard to get along with; disposition to contradict; discontented, nothing pleases him, dislike persons, places; become cross and violent; impolite.
Behavioral problem in children. Poor control over his impulses; talking, joking, throwing tantrums at the most inappropriate time. Biting everyone who disturbs him; desire to break things; abusive and insulting; foolish behavior like monkey. Shameless child – desire to uncover, remain naked in bed. Talk vivacious; restless and sleepless child; destructive and malicious.
Cross and restless; easily angered or insulted; always intent on revenge. Tear things to pieces; constantly busy but not in organized manner. Sudden impulse to run, to do violent, hurried impulse to kill. Loquacity; horrible things and sad stories affect him profoundly.
Irritable; child cry and screams, fly into passion, can hardly articulate. Aversion to company, to answer question. Destructiveness; tear things, clothing, violent. Startled easily, when touched.
Great loquacity, jumps from one story to another. Doesn’t tolerate restrictions; play dirty things on others and teacher concerned; mischievous. Difficult concentration; overactive mind, quick to act. Jealous without any reason; possessive about his things.
Peevish and cross when waking; ugly kicks and screams; seeks dispute, easily angered; cannot endure contradiction or opposition. Confused speech, weak memory, inability to express oneself correctly. Dominating; serious looking; never smiling child.
Weakness of memory, cannot concentrate, forgetful of names, later of words, cannot finish sentence; mistakes in writing. Aversion to responsibilities; postponing homework to next day. Irritable at trifles. Destructiveness, striking at animals, tears and throws things. Sensitive to reprimands, criticism, reproaches; rudeness.
Great restlessness; internal hurriedness with slowness in action; hurried and rapid speech. Rudeness, impolite; inclination to catch passing strangers by nose. Nervous, timid and shy; impulsive without thinking, without considering. Aversion being touched or looked at. Destructiveness.
Hurried tremulous and awkward; cunning; violent anger, talks excitedly; raves, scolds till mouth become dry, lips blue and eyes staring and she fall unconscious. Abusive, insulting; destructiveness; striking at imaginary objects, attention seeking attitude.
Cross and irritable; strong aversion to certain person. Self-contended; difficult to concentrate, slow compre-hension; forgetful, makes mistakes in writing. Foolish behavior; worse from music.
Cross when spoken to; very irritable, easily offended, angry at trifles and inconsolable. Tendency to make mistakes in writing and speaking. Distracted, puzzled, awkward – drop things from hands. Revengeful, reversed.
Irritable, vindictive, violent anger. Cursing, swearing; using vulgar language; excitement during debate. No disposition to work. Hatred, unmoved by apologies. Selfish, discontented.
Restless child, roving, wandering; very irritable, fastidious, quarrel-some, spiteful. Impatient and impulsive; ill humored, fault-finder. Angered easily, every harmless word offends. Biting people who try to control him; tears things. Oversensitive to all impression
Madness with inclination to bite. Weak mentally; obstinate. Destructiveness; shameless, want to be naked
Cross and cries when spoken to; crawl nervously. Weeping children who cry piteously if taken hold of or carried. Obstinate stubborn head-strong. Oversensitive both mentally and physically. Restless fidgety, starts at least noise. Conscientious about trifles, everything neatly marked but without conveying anything new, no imagination.
Very sensitive to least mental impression, takes offence at every little meant or unmeant insult. Ill-humored and cross; great indignation about things done by others or himself; grieves about consequences. Great aversion to any authority; subdued anger. Rudeness of naughty children; anger throwing things aroun
Excessive loquacity, talks of nothing but one subject. Cannot bear solitude and darkness; want light and company. Child awakes terrified knows no one, screams with fright, clings to those near him; answer with a shrieking look as if afraid of the first thing she sees. Fear of dark, of animals
Spoiled, very selfish, have no regard for others; child jumps starts and screams fearfully. Rags seems beautiful; aversion to amusement. Restlessness and sleeplessness; foolish behavior, too much coquettish. Artistic attitude; bragging; timidity and great tendency to fright.
Abrupt; tremendously hurried, intense, excited and restless. Lack of control; cunning, manipulative and dishonest; selfish; mischievous. Destructiveness of clothe; breaks, tear and throws things. Disobedient and refuses to eat; quarrelsome; sensitive to music. Rolls on ground from side to side, or strikes vehemently; screaming
Dissatisfied and restless, desire for change; desire to travel, doesn’t remain long in one place. Violent and wants to fight. Sensitive and worse from music; indifferent to punish-ments and reprimands. Obstinate, malicious and destructive.
Autism is classified as a neuro-developmental disorder that manifests itself in markedly abnormal social interaction, communication ability, patterns of interests, and patterns of behavior. It is an organic disorder affecting several areas of a child’s development. Autism is present from birth, or very soon after, but the nature of the disorder can mean that diagnosis is delayed for months or years. Early intervention can improve long-term function and help the families. Babies with autism may display characteristic features of gaze, hearing, social development and play. Nurses working with babies and young children are in a prime position to recognise these characteristics and refer the family for specialised assessment.
Learning disabilities may or may not be present in children with autism. They often suspect something is wrong even though they may not be able to be precise.
Myths and Misunderstandings
- Children with autism do not make progress
- Children with autism do not smile at you
- Children with autism are not affectionate
- Autism can be outgrown
- Children with autism are retarded
- Children with autism do not make eye contact
- Children with autism do not relate to peers and adults
- Children with autism cannot be tested by conventional means
- Underneath the autism is a normal child, if you can discover the key.
Types of Autism
Low Functioning Autism: Such children are more likely to display mental retardation, epilepsy, and extremely limited receptive or expressive language skills. They are extremely weak on ‘theory of mind,’ and overload on too much sensory stimulation quite easily. As a rule of thumb, testing will show IQ ratings of 70 or below.
High Functioning Autism: Such children are much more efficient with expressive and receptive speech, less likely to suffer from epilepsy, and have IQ scores of 71 or above. Although too much sensory input can overload them, they have a higher tolerance and learn to desensitise themselves. These children have a stronger grasp on the theory of mind and can empathise with the feelings and reactions of others.
- Childhood Autism
- Asperger’s Syndrome
- Childhood Disintegrative Dis-order
- Rett’s Disease
- Pervasive Developmental Dis-order not otherwise Specified
- 1 in 1,000 individuals are diagnosed with ‘classic’ autism, 1.2 million people are affected in India
- 1 in 500 individuals are within the Autism Spectrum including Per-vasive Developmental Disorders
- 1 in 200 individuals are within the Autism Spectrum including both PDD and Asperger’s Syndrome
- Autism is four times more prevalent in boys than girls
- Research shows that 50% of children diagnosed with autism will remain mute throughout their lives.
- It has no racial, ethnic or social boundaries
- Approximately 10% of autistic individuals have abilities.
Causes of Autism
A specific cause is not known, but current research links autism to biological and neurological differences in the brain Studies of twins in the UK confirm that autism has a heritable compound but suggest that environmental influences play a role as well, Such as infections, alcohol, smoking, drugs, etc. By examining the inheritance of the disorder, researchers have shown that autism does run in families, but not in a clear-cut way: Siblings of people with autism have a 3 to 8 percent chance of being diagnosed with the same disorder
Symptoms of Children with Autism Communication
- Avoid eye contact
- Act as if deaf
- Develop language, then abruptly stop talking
- Fail to use spoken language, without compensating by gesture.
- Act as if unaware of the coming and going of others
- Are inaccessible, as if in a shell
- Fail to seek comfort
- Fail to develop relationships with peers
- Have problems seeing things from another person’s perspective, leaving the child unable to predict or understand other people’s actions
- Physically attack and injure others without provocation.
Exploration of Environment
- Remain fixated on a single item or activity
- Practice strange actions like rocking or hand-flapping
- Sniff or lick toys
- Show no sensitivity to burns or bruises, and engage in self-mutilation
- Are intensely preoccupied with a single subject, activity or gesture
- Show distress over change
- Insist on routine or rituals with no purpose
- Lack fear.
A- Total of 6 (or more) items from 1, 2, and 3. With at least two from 1, and one each from 2 and 3:
(1) Qualitative impairment in social interaction as manifested by at least two of the following:
- Marked impairment in the use of multiple non-verbal behavior such as eye-to-eye contact, gaze, facial expression, body posture, and gestures to regulate social interaction
- Failure to develop peer relationships appropriate to developmental levels
- A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
- Lack of social or emotional reciprocity
- (2) Qualitative impairments in communication as manifested by at least one of the following:
- Delay in , or total lack of, the development of spoken language
- In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
- Stereotyped and repetitive use of language or idiosyncratic language
- Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
(3) Restricted repetitive and stereotyped pattern of behavior, interests, and activities, as manifested by at least one of the following:
- Encompassing preoccu-pation with one or more stereotyped and restricted patterns of interests that is abnormal either in intensity or focus
- Apparently inflexible adherence to specific, nonfunctional routines or rituals
- Stereotyped and repetitive motor mannerism
- Persistent preoccupation with parts of objects
B- Delays or abnormal functioning in at least one of the following areas with onset prior to age three:
- Social interaction
- Language as used in social communication
- Symbolic or imaginative play
The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegration Disorder.
Behavioral Interventions – Research suggests that early, intensive behavioral interventions may improve outcomes for children with autism and help the children achieve their maximum potential.
Sensory integration – Integration and interpretation of sensory stimulation from the environment enhances cognition.
Diet – People with autism are more susceptible to allergies and food sensitivities than the average person. The most common food sensitivity in children with autism is to gluten and casein.
Vitamin therapy – Parents have reported that they have tried B6/magnesium, often with good or even spectacular results
Teaching Tips for Children with Autism
- Use visuals and avoid long strings of verbal instruction
- Encourage development of child’s special talents
- Use child’s fixations to motivate school work
- Use concrete, visual methods to teach number concepts
- Let child use a typewriter instead of writing
- Protect child from sounds that hurt his/her ears
- Place child near a window and avoid using fluorescent lights
- Use weighted vests to calm nervous system
- Interact with child while he/she is swinging or rolled in a mat
- Don’t ask child to look and listen at the same time
- Teach with tactile learning materials (e.g. sandpaper alphabet)
- Use printed words and pictures on a flashcard
- Generalise teaching
Homoeopathic Approach Towards Autism
Remedy for depravities, due to bad inheritance, mentally as well as physically deprived. Great weakness of memory, idiotic, feeble minded, deceitful, propensity to bite, impatient, nervous, extremely sensitive to light and noise, every little noise distresses. Desire to be solitude, music intolerable, fear animals and strangers, talk non-sense, and then angry, if not understood.
Mothers’ history of emotional suppression and deep guilty feeling Desire dancing and music, love as well as fear of thunderstorm Aversion to reprimands or contradiction, fastidious, artistic Fear of crowd Desire for travel
Apprehensive about the shift in consciousness and nervous someone would notice Difficult to concentrate, hide away from the world, aversion to company and conversation, estranged himself from his family and friends Unsociable, desire to be alone in evening Impateint, activity alternating with lethargy Patient repeats the same thing again and again Sensitive to music
Loss of memory, forget how to talk (amnesic aphasia) Slow, hesitate, omits or mixes up words in talking and writing Melancholy, suspicious, fear of people, horrid delusion Profound indifference and disgust for life Fidgety, busy hands, fumbles, moves arms about wildly
Detached feeling, lack of feeling, indifference to everything, indif-ference to suffering, sensation of isolation, irritable Absent minded, difficult to concentrate, irresolution, lack of confidence, anxiety, changeable mood Fastidious, aversion to company, discontented, thoughts are disconnected Cursing, sensitive to everything
Timidity, loss of self-confidence, poor self esteem Anticipation, fear of public speaking, averse to under taking new thing, apprehensive, sensitive, melancholy, afraid to be alone Fear of men, presence of new person, of everything Headstrong and haughty, weeps whole day and sleeps whole night Weak memory, confused thoughts, suspicious
Anxious, fear of being alone at twilight, of ghost, of thunderstorm Timid, irresolute, disinclined to work, loss of memory Want sympathy, restlessness, fidgety, child cannot sit or stand still for a moment especially in dark, twilight Oversensitive to external impression
Child is aggressive, self-stimulating, ritualistic, less communicating Cannot bear solitude or darkness, must have light and company and has a horror of shining objects, fear and anxiety on hearing water run, sight of water run and glittering objects brings spasm Fearful hallucination, delusions about his identity Stupid, imbecile
Anti-social, apathetic, sad, lamenting, cross, irritable, peevish, impulse to wash hands Fear of night and the suffering from exhaustion on awakening Loss of memory, very nervous, weeps and laughs without a cause , doesn’t want to be soothed
Dissatisfied and restless, always want a change, desire to travel, doesn’t want to remain in one place long Melancholy, anxious, changeable mood Fear of dogs, aversion to cats Irritable when awaking, throws things and want to fight even without a cause Sensitive to music, confusion everything in the room, seems strange, aversion to mental work
Weak memory, forgetful, averse to work, to talk Very sensitive to noise, child repeats everything said to it Fretful, peevish, cries if vexed, moved during sleep Melancholy, lethargic, stupid, easily startled, weeps when angry
This is the case of an extremely restless boy of 5 years of age, a known case of Autism. He had a fair complexion, and light hair. He did not pay attention to anything, remained busy in his own world, moving here and there, up and down. He was observed to be rolling on floor, spitting, striking on the table and bed. There was excessive drooling from his mouth, the saliva was dropping on the floor and he was trying to spread it on floor with his hand and trying to lick it back. All the time, he was making noises, that were non-perceptible to the listener. He had indistinct voice and no proper words were spoken. Apart from these symptoms observed, some more information was given by the mother. The boy was extremely sensitive to sudden noise, especially the telephone ring or doorbell. Even during infancy, he used to cling to the mother when she used to try to make him sleep in a couch. He hated coming down through lift though he would come down by stairs reluctantly. His palms were very hot to touch. He had a very strong craving for chicken, especially tandoori chicken. He also liked to eat clay, chalk and pencils. Sweating was there on forehead only. Daily counselling was needed for bowel movement.
Past History: The baby was born at full term, was delivered normally, though forceps was used due to little larger head. Pregnancy period of the mother was quite eventful. In the 7th month of pregnancy, she lost her mother with whom she was very much attached. Also, her husband faced gross financial loss in share market due to which the family economy remained extremely disturbed for a long time. After birth, the baby was seemingly normal for a year but afterwards he started developing autistic picture gradually. The lack of response, no communication, no learning pattern, and occasional seizures also, repetitive behavior all attributed to the diagnosis of Autism.
There was nothing specific noted in the family history of the patient.
Analysis and Evaluation
- History of grief during pregnancy
- History of mental shock during pregnancy due to gross financial loss
- Excessive restlessness
- Unaware of surroundings
- Sensitive to noise
- Aversion to downward movements
- Making noise
- Desire for tandoori chicken
- Desire for indigestible food
- Excessive salivation
- Speech indistinct
- Fair complexion, light hairs
Particulars: Heat of palm
Evaluation of symptoms: Since the pregnancy period was highly eventful and seemed to be the probable cause of illness, the symptoms are evaluated in following manner:
- Ailments during pregnancy
- Ailments from grief
- Ailments from mental shock
- Indifferent to surroundings
- Sensitive to noise
- Fear of downward movement
- Makes noise all the time
- Autistic behavior
- Excessive salivation
- Indistinct speech
- Desire for tandoori chicken
- Desire for indigestible food
- Fair complexion, light hairs
- Heat of palm
High in totality
Sensitivity to external impressions
Bossy attitude at home
Timid at other place
obstinate and irritable
unaware of surroundings
lives in his own world
Grief and mental shock
Cramps and spasms
Comparison of Close Medicines
Though Sulphur seemed to fit in the case, but Ignatia was selected as the remedy to begin with as it was strongly covering the causative factor of case along with abnormal behavior pattern. A single dose of Ignatia 10M was given with a request to second visit after 15 days. There was significant change in his behavior pattern since first dose and regular positive changes observed during the succeeding consultations. Boy is still under treatment but over a period of three months follow up, regular positive changes are observed in the following manner:
- More calm and quite
- Eats food properly
- Regular bowel movement
- Salivation much better
- Attentive, listen to his father
- Follows commands
Effect of Homeopathic remedy was highly encouraging in this case and is still going on.
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