ADHD: ADHD: HOMOEOPATHIC HOMOEOPATHIC

PERSPECTIVEPERSPECTIVE

PRESENTED BY:PRESENTED BY:Dr. BIPIN JETHANIDr. BIPIN JETHANIASSISTANT PROF.,ASSISTANT PROF.,

DEPT. OF ORGANON OF MEDICINEDEPT. OF ORGANON OF MEDICINENEHRU HOMOEOPATHIC MEDICAL COLLEGE & NEHRU HOMOEOPATHIC MEDICAL COLLEGE &

HOSPITALHOSPITALEMAIL: drbipin.jethani@gmail.comEMAIL: drbipin.jethani@gmail.com

It is thought that many great people such a Winston It is thought that many great people such a Winston Churchill, Leonardo De Vinci, Einstein, and Benjamin Churchill, Leonardo De Vinci, Einstein, and Benjamin Franklin had the classic characteristics of ADHD. This Franklin had the classic characteristics of ADHD. This

suggests ADHD people have some exceptional suggests ADHD people have some exceptional qualities with exhausting side effects.qualities with exhausting side effects.

Attention deficit hyperactivity disorder (ADHD) and Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) refer to a range attention deficit disorder (ADD) refer to a range

of problem behaviours associated with poor of problem behaviours associated with poor attention span. attention span.

These may include impulsiveness, restlessness These may include impulsiveness, restlessness and hyperactivity, as well as inattentiveness, and hyperactivity, as well as inattentiveness, and often prevent children from learning and and often prevent children from learning and

socialising well. socialising well.

What is important for our understanding is that What is important for our understanding is that for these problems to be diagnosed as ADHD, for these problems to be diagnosed as ADHD, they must be out of the normal range for the they must be out of the normal range for the

child's age and development.child's age and development.

Attention Deficit Disorder Attention Deficit Disorder (ADD) is the most (ADD) is the most

commonly diagnosed commonly diagnosed behavioral disorder of behavioral disorder of childhood, affecting an childhood, affecting an

estimated estimated 2 - 4%2 - 4% of of school aged childrenschool aged children. .

BoysBoys are more likely to are more likely to be affected than girls.be affected than girls.

Clinical features and Clinical features and criteria for diagnosiscriteria for diagnosis

The Diagnostic and The Diagnostic and Statistical Manual Statistical Manual

(DSM-IV) divides the (DSM-IV) divides the symptoms of ADHD symptoms of ADHD

into those of into those of INATTENTIVENESSINATTENTIVENESS

and those of and those of HYPERACTIVITY HYPERACTIVITY

AND IMPULSIVITYAND IMPULSIVITY..

SUBTYPES OF A.D.D. SPECTRUM OF SUBTYPES OF A.D.D. SPECTRUM OF DISORDERDISORDER

Some children with ADHD Some children with ADHD primarily have the Inattentive primarily have the Inattentive Type, some the Hyperactive-Type, some the Hyperactive-Impulsive Type, and some the Impulsive Type, and some the

Combined Type. Those with the Combined Type. Those with the Inattentive type are less Inattentive type are less

disruptive and are easier to miss disruptive and are easier to miss being diagnosed with ADHDbeing diagnosed with ADHD

ADHD often occurs alongside other ADHD often occurs alongside other difficulties and is not the sole cause of difficulties and is not the sole cause of

problem behaviour. Children may exhibit problem behaviour. Children may exhibit temper tantrums, sleep disorders, and temper tantrums, sleep disorders, and

be clumsy. be clumsy.

ETIOPATHOGENESIS OF ADHDETIOPATHOGENESIS OF ADHD

The wholistic perception of ADHD The wholistic perception of ADHD demands proper understanding demands proper understanding

of the multifactorial nature of this of the multifactorial nature of this disorderdisorder

HOST FACTORSHOST FACTORS

ORGANIC BASIS ORGANIC BASIS

FAMILIAL FAMILIAL INHERITANCEINHERITANCE

PERSONALITY PERSONALITY TYPETYPE

ENVIRONMENTAL ENVIRONMENTAL FACTORSFACTORS

PRENATAL & POST PRENATAL & POST NATAL NATAL

INFLUENCESINFLUENCES

ETIOLOGICAL BASIS OF ADHD: ETIOLOGICAL BASIS OF ADHD: HOST ENVIRONMENT AXISHOST ENVIRONMENT AXIS

ODE TO HAHNEMANN: ODE TO HAHNEMANN: UNDERSTANDINGUNDERSTANDING

HOST ENVIRONMENT AXISHOST ENVIRONMENT AXIS…………For as two things are required for the For as two things are required for the

production of these as well as all other morbid production of these as well as all other morbid alterations in the health of man - to wit., alterations in the health of man - to wit., the the inherent power of the influencing inherent power of the influencing substancesubstance, and , and the capability of the vital the capability of the vital force that animates the organism to be force that animates the organism to be influenced by itinfluenced by it - the obvious derangements of - the obvious derangements of health in the so-called idiosyncrasies cannot be health in the so-called idiosyncrasies cannot be laid to the account of these peculiar constitutions laid to the account of these peculiar constitutions alone, but they must also be ascribed to these alone, but they must also be ascribed to these things that produce them, in which must lie the things that produce them, in which must lie the power of making the same impressions on all power of making the same impressions on all human bodieshuman bodies.…......... .…......... (§ 117 of Organon of Medicine, 6(§ 117 of Organon of Medicine, 6thth edition) edition)

ORGANIC BASIS ORGANIC BASIS OF ADHDOF ADHD

Neuroimaging studies Neuroimaging studies suggest that the suggest that the brains of children brains of children

with ADHD are with ADHD are different from those different from those

of other children.of other children.

In ADHD children, theIn ADHD children, the

frontal lobes are frontal lobes are immature or immature or

sluggish, so theysluggish, so they

appear to act without appear to act without thinking. thinking.

The judgementThe judgement

and control of their and control of their action is seen as action is seen as

limited, much like a limited, much like a child half their age.child half their age.

FUNCTION OF FUNCTION OF FRONTAL FRONTAL LOBE LOBE

This is the executive management partThis is the executive management partof the brain that forms a judgement from all ofof the brain that forms a judgement from all of

the information that has been sent from aroundthe information that has been sent from aroundthe brain.the brain.

FAMILIAL FAMILIAL INHERITANCEINHERITANCE

Studies of twins suggest a Studies of twins suggest a genetic genetic link to ADHDlink to ADHD. In 80-90 per cent of . In 80-90 per cent of identical twins where one has ADHD identical twins where one has ADHD so does the other. Recent research so does the other. Recent research

also suggests there is a greater also suggests there is a greater chance of inheriting the condition chance of inheriting the condition

from from male relatives such as male relatives such as grandfathers.grandfathers.

IN UTERO INFLUENCES IN UTERO INFLUENCES PREDISPOSE TO PREDISPOSE TO

DEVELOPMENT OF ADHDDEVELOPMENT OF ADHD

Intra-uterine lifeIntra-uterine life is the earliest is the earliest phase of life spent by an infant in phase of life spent by an infant in the quiet, dark atmosphere of the quiet, dark atmosphere of mother’s womb (from the moment mother’s womb (from the moment of conception uptil its exposure to of conception uptil its exposure to the outside world) the outside world)

‘‘within the womb’within the womb’ development is a development is a

phenomenon of rapid phenomenon of rapid proliferation and proliferation and differentiationdifferentiation

It is the stage at which the enormous It is the stage at which the enormous potential of an individual to grow and potential of an individual to grow and evolve is realized and therefore is evolve is realized and therefore is extremely susceptible to varied extremely susceptible to varied environmental influences especially environmental influences especially mother’s feelings, attitudes and intra-mother’s feelings, attitudes and intra-natal exposures.natal exposures.

INSIGHT OF HAHNEMANNINSIGHT OF HAHNEMANN

Much ahead of his time, he epitomized Much ahead of his time, he epitomized the importance of intra-uterine life the importance of intra-uterine life in ontogenesis as well as utilized it in ontogenesis as well as utilized it

as basis of prescribing. A as basis of prescribing. A philanthropist, a man of truth and philanthropist, a man of truth and

courage …..courage …..Samuel Christian Friedrich Samuel Christian Friedrich

Hahnemann.Hahnemann.

PRESCRIBING IN PRESCRIBING IN PREGNANCYPREGNANCY

Hahnemann has lucidly explained this Hahnemann has lucidly explained this in in 'The Chronic Diseases - Their 'The Chronic Diseases - Their Peculiar Nature and Their Peculiar Nature and Their Homoeopathic Cure' Homoeopathic Cure' where he states where he states that: 'Pregnancy in all its stages that: 'Pregnancy in all its stages offers so little obstruction to an anti-offers so little obstruction to an anti-psoric treatment that this treatment psoric treatment that this treatment is often most necessary and useful in is often most necessary and useful in that condition'that condition'

He emphasises upon this fact in footnote of He emphasises upon this fact in footnote of §284 of 6th edition of ‘§284 of 6th edition of ‘Organon of Medicine’ Organon of Medicine’

asas ‘…………‘…………But the case of mothers in their But the case of mothers in their

(first) pregnancy, by means of a mild (first) pregnancy, by means of a mild antipsoric treatment,……..is indispensable antipsoric treatment,……..is indispensable in order to destroy the psora – that in order to destroy the psora – that producer of most chronic diseases – which producer of most chronic diseases – which is given to them hereditarily; destroy it is given to them hereditarily; destroy it both within themselves and in the foetus, both within themselves and in the foetus, thereby protecting posterity in thereby protecting posterity in advance………..’ advance………..’

EMBRYOLOGICAL EMBRYOLOGICAL ONTOGENESISONTOGENESIS

DOCUMENTED INTRA-UTERINE INFLUENCES DOCUMENTED INTRA-UTERINE INFLUENCES PREDISPOSING TO ADHDPREDISPOSING TO ADHD

SMOKINGSMOKING

ALCOHOLALCOHOL

MENTAL STRESSMENTAL STRESS

ULTRASOUND ULTRASOUND EXPOSURESEXPOSURES

MOBILE PHONESMOBILE PHONES

EFFECT OF SMOKINGEFFECT OF SMOKING

Smoking during pregnancy is an Smoking during pregnancy is an independent risk factor in the independent risk factor in the

etiopathogenesis of ADHDetiopathogenesis of ADHD

The University of California have found that using mobile The University of California have found that using mobile phone while pregnant could cause behavioural and phone while pregnant could cause behavioural and

emotional problems in childrenemotional problems in children

The study of more than The study of more than 13,000 children found that 13,000 children found that pregnant women using the pregnant women using the handsets just two or three handsets just two or three times a day was enough to times a day was enough to raise the risk of their raise the risk of their babies developing babies developing hyperactivity and difficulties hyperactivity and difficulties with conduct, emotions and with conduct, emotions and relationships by the time relationships by the time they reached school age. they reached school age.

A new study warns that exposure A new study warns that exposure to repeated ultrasound can to repeated ultrasound can affect fetal brain development. affect fetal brain development. The study, funded by the The study, funded by the National Institute of National Institute of Neurological Disorders and Neurological Disorders and Stroke revealed that when Stroke revealed that when pregnant mice were exposed pregnant mice were exposed to ultrasound, a small number to ultrasound, a small number of nerve cells in the developing of nerve cells in the developing brains of their fetuses failed to brains of their fetuses failed to extend correctly in the cerebral extend correctly in the cerebral cortex and led to development cortex and led to development of hypersensitive mice. of hypersensitive mice. Effect of ultrasonic Effect of ultrasonic

waveswaves

Most importantly, it was assessed that Most importantly, it was assessed that damage was analogous to the damage was analogous to the

neurophysiological changes in children with neurophysiological changes in children with ADHD.ADHD.

Research shows that the Research shows that the ultrasounded population ultrasounded population have a quadrupled have a quadrupled perinatal death rate, perinatal death rate, increased rates of brain increased rates of brain damage, dyslexia, damage, dyslexia, speech delays, epilepsy, speech delays, epilepsy, learning difficulties, and learning difficulties, and a 32% increase in left a 32% increase in left handedness (which is handedness (which is thought to be caused by thought to be caused by brain damage).brain damage).

Stott, D.H. “Evidence for a congenital factor in Stott, D.H. “Evidence for a congenital factor in maladjustment and delinquency”, American Journal of maladjustment and delinquency”, American Journal of

PsychiatryPsychiatry

MENTAL STRESS DURING PREGNANCYMENTAL STRESS DURING PREGNANCY

D.H. StottD.H. Stott in a series of papers has in a series of papers has showed that psychological stress during showed that psychological stress during pregnancy may predispose the child to pregnancy may predispose the child to react in an undesirable way to react in an undesirable way to subsequent adverse environment and so subsequent adverse environment and so predispose to behavioral problems and in predispose to behavioral problems and in particular to juvenile delinquency. particular to juvenile delinquency.

BIRTH PROCESS: BIRTH PROCESS: natural transition of a natural transition of a

neonate from the darkness neonate from the darkness of the in-utero environment of the in-utero environment

to the illumination of the to the illumination of the external worldexternal world

History Of Birth TraumaHistory Of Birth Trauma, as due to , as due to forceps delivery or prolonged labour, is forceps delivery or prolonged labour, is a major factor that requires exploration a major factor that requires exploration

in cases with ADHD. The brain in cases with ADHD. The brain structures believed to be linked to the structures believed to be linked to the

development of ADHD are vulnerable to development of ADHD are vulnerable to hypoxic damage during birth.hypoxic damage during birth.

The brain structures believed to be The brain structures believed to be linked to the development of ADHD linked to the development of ADHD are vulnerable to hypoxic damage are vulnerable to hypoxic damage during birth. The damage is caused by during birth. The damage is caused by inadequate oxygen reaching parts of inadequate oxygen reaching parts of the brain while blood flow is reduced. the brain while blood flow is reduced.

A good number of behavioural A good number of behavioural problems in children can be problems in children can be linked to linked to birth trauma, birth trauma, emotional distress of the emotional distress of the mother during pregnancymother during pregnancy

‘‘Attention DeficitAttention DeficitDisorder – A Different Perspective’Disorder – A Different Perspective’

Hartmann (1999) in his book ‘Attention Hartmann (1999) in his book ‘Attention Deficit Disorder – A Different Perspective’ Deficit Disorder – A Different Perspective’ argued that ADHD is the original hunter’s argued that ADHD is the original hunter’s genes. genes.

He reframes the characteristics of ADHD asHe reframes the characteristics of ADHD as

positive qualities for huntingpositive qualities for hunting..

The symptoms of Attention Deficit The symptoms of Attention Deficit Hyperactivity Disorder principally Hyperactivity Disorder principally evolved as adaptive behaviors. evolved as adaptive behaviors.

It has been suggested that the It has been suggested that the behaviors of ADHD evolved to serve a behaviors of ADHD evolved to serve a functional purpose in the distant past functional purpose in the distant past but may not fit well within current but may not fit well within current culture and expectation (Hartmann, culture and expectation (Hartmann, 1993; Shelley-Tremblay & Rosen, 1993; Shelley-Tremblay & Rosen, 1996). 1996).

ADHD: ANTHROPOLOGICAL ADHD: ANTHROPOLOGICAL PERSPECTIVEPERSPECTIVE

‘‘Attention deficit’ he redefines as Attention deficit’ he redefines as ‘noticing everything’. As a hunter ‘noticing everything’. As a hunter heads off across the savannah, he is heads off across the savannah, he is constantly looking out for what might constantly looking out for what might eat him and what he could catch and eat him and what he could catch and eat. In the classroom ADHD child is eat. In the classroom ADHD child is seen as being distracted by noises seen as being distracted by noises and activities instead of focusing on and activities instead of focusing on the student’s own workthe student’s own work

When the hunter sees prey, they When the hunter sees prey, they become single minded, focussed on become single minded, focussed on pursuit and capture. This pursuit and capture. This characteristic in ADHD people shows characteristic in ADHD people shows up in their mono-focus on those up in their mono-focus on those things that interest them. Hunters things that interest them. Hunters will take some personal risks to catch will take some personal risks to catch their prey, while those with peasant their prey, while those with peasant farmer genes would prefer to stop for farmer genes would prefer to stop for a strategic plan. This behaviour is a strategic plan. This behaviour is seen as impulsiveness and risk seen as impulsiveness and risk takingtaking. .

ADHD: MALADATIVE DISEASE ADHD: MALADATIVE DISEASE OF CIVILISATIONOF CIVILISATION

The ADHD needs to be considered as The ADHD needs to be considered as maladaptative disorder in children rather maladaptative disorder in children rather than as an isolated psychiatric illness. In than as an isolated psychiatric illness. In the background of the fact that ADHD is the background of the fact that ADHD is ontogenically malprogrammed disorder; ontogenically malprogrammed disorder; the evolutionary history of each and the evolutionary history of each and every child with ADHD assumes utmost every child with ADHD assumes utmost importance, especially from the most importance, especially from the most initial stage of development i.e. INTRA-initial stage of development i.e. INTRA-UTERINE LIFE.UTERINE LIFE.

ADHD should instead be calledADHD should instead be calledLatent Entrepreneur Personality Latent Entrepreneur Personality

Type Type (LEPT)(LEPT)

The name LEPT conveys the idea that The name LEPT conveys the idea that this is a personality type at one end this is a personality type at one end of a spectrum rather than a brain of a spectrum rather than a brain

disorder.disorder.

PERSONALITY PROFILE OF ADHDPERSONALITY PROFILE OF ADHD

CHARACTERISTICSCHARACTERISTICS that that drives entrepreneurs to drives entrepreneurs to

pursue their business when pursue their business when others would have given upothers would have given up

INSATIABLE CURIOSITYINSATIABLE CURIOSITY, bored by mundane tasks , bored by mundane tasks but enthusiastic to explore new ideas.but enthusiastic to explore new ideas.

MODERATE RISK TAKINGMODERATE RISK TAKING, disregarding the , disregarding the obstacles that prevent others from Starting.obstacles that prevent others from Starting.

ADAPTABILITY AND RESILIENCE TO SETBACKS,ADAPTABILITY AND RESILIENCE TO SETBACKS, learning as they go to overcome difficulties.learning as they go to overcome difficulties.

INTENSE BURSTS OF ENERGYINTENSE BURSTS OF ENERGY INDEPENDENTINDEPENDENT - needing autonomy and often - needing autonomy and often

preferring to be a leader or a loner than a cog in a preferring to be a leader or a loner than a cog in a large wheel.large wheel.

ACTION ORIENTATIONACTION ORIENTATION

CLINICAL CLINICAL EXPERIENCESEXPERIENCES

A 6 year old male child with fair complexion A 6 year old male child with fair complexion and red lips presented with combined type and red lips presented with combined type of ADHD. of ADHD.

Features s/o ADHD were noticed around 2-3 Features s/o ADHD were noticed around 2-3 years of age with marked restlessness, years of age with marked restlessness, very easy distractibility and striking lack of very easy distractibility and striking lack of perceptions of impending dangers.perceptions of impending dangers.

INTRA-UTERINE HISTORYINTRA-UTERINE HISTORY

The INTRA-UTERINE history revealed The INTRA-UTERINE history revealed marked hyperemesis during entire 9 marked hyperemesis during entire 9 months. Had developed severe cough for months. Had developed severe cough for which she took only home remedies. which she took only home remedies. Cough subsided immediately after Cough subsided immediately after delivery.delivery.

It also revealed H/o constant stress of It also revealed H/o constant stress of mother which started during early months mother which started during early months of pregnancy – feeling of anger due lack of of pregnancy – feeling of anger due lack of moral support and unco-operative attitude moral support and unco-operative attitude of inlaws.of inlaws.

The child was born full term LSCS with The child was born full term LSCS with mild IUGR. mild IUGR.

H/o chicken pox (well erupted) at age of 2 H/o chicken pox (well erupted) at age of 2 years.years.

Developmental milestones normal Developmental milestones normal Desire salty foods and paneerDesire salty foods and paneer DESIRE SLEEP ON ABDOMENDESIRE SLEEP ON ABDOMEN Family history of CAD, DM and Family history of CAD, DM and

HypertensionHypertension

CASE ANALYSISCASE ANALYSISThe case analysis underlined the fact The case analysis underlined the fact

that that mental stress during early that that mental stress during early months of pregnancy would have had months of pregnancy would have had enormous dynamic influence on the enormous dynamic influence on the organ-system which begins developing organ-system which begins developing in the most initial period of in the most initial period of organogenesis – the Central Nervous organogenesis – the Central Nervous System, as can be deciphered from System, as can be deciphered from the presenting complaints (ADHD) of the presenting complaints (ADHD) of the patient. Hence the mental trauma the patient. Hence the mental trauma during pregnancy needed to be during pregnancy needed to be especially taken into consideration.especially taken into consideration.

CASE ANALYSIS CASE ANALYSIS

Besides this, her intra-uterine tendency Besides this, her intra-uterine tendency to ‘to ‘THROW UP’THROW UP’ in form of hyperemesis in form of hyperemesis and cough was interpreted as somatic and cough was interpreted as somatic manifestation of her deep subtle desire manifestation of her deep subtle desire to ‘to ‘THROW UP’THROW UP’ the foetus. The the foetus. The emotional drain on the system with lack emotional drain on the system with lack of catharsis and resultant suppressed of catharsis and resultant suppressed anger was manifested by the child in anger was manifested by the child in his misdirected bursts of energy.his misdirected bursts of energy.

CASE ANALYSIS CASE ANALYSIS The understanding of case in terms of The understanding of case in terms of

intra-uterine effect of deep seated intra-uterine effect of deep seated emotional trauma resulting in affection emotional trauma resulting in affection

of Central Nervous system with of Central Nervous system with concomitance of red lips and desire to concomitance of red lips and desire to

sleep on abdomen pointed to the sleep on abdomen pointed to the

remedy remedy THYROIDINUM THYROIDINUM as mentioned by Clarke, Boericke, as mentioned by Clarke, Boericke,

S.K.Ghosh and L.M. Khan in their S.K.Ghosh and L.M. Khan in their respective works on Materia Medica.respective works on Materia Medica.

In In Boger’s ‘Synoptic Key of Materia Boger’s ‘Synoptic Key of Materia Medica’Medica’, Central Nervous System is one , Central Nervous System is one of the principal areas of affection in the of the principal areas of affection in the pathogenesis of drug Thyroidinum.pathogenesis of drug Thyroidinum.

Thyroidinum was prescribed in LM potency Thyroidinum was prescribed in LM potency and patient has become more settled and and patient has become more settled and most importantly now involves himself in most importantly now involves himself in more constructive daily activities. more constructive daily activities.

CASE STUDYCASE STUDY

Case of 8 year old male child, lean Case of 8 year old male child, lean thin, sharp nose presented with thin, sharp nose presented with

Inattentive predominance ADHD.Inattentive predominance ADHD.

PRENATAL & POST NATAL HISTORYPRENATAL & POST NATAL HISTORY

Patient had h/o grief during pregnancy due Patient had h/o grief during pregnancy due to detection of cancer of mother some to detection of cancer of mother some time after her conception and her death time after her conception and her death 1 month just 2 weeks before delivery of 1 month just 2 weeks before delivery of child. Intra-uterine history revealed child. Intra-uterine history revealed gestational hypertension with gestational hypertension with development of pedal edema in the last development of pedal edema in the last trimester. trimester.

Forceps delivery due to obstruction of Forceps delivery due to obstruction of head. Birth cry delayedhead. Birth cry delayed

Tendency to cough and cold with every Tendency to cough and cold with every change of weather with hyperpyrexia but change of weather with hyperpyrexia but

playful even in this stateplayful even in this state

NON COMPLAINING ATTITUDENON COMPLAINING ATTITUDE

PRESCRIBING CLUE {PRESCRIBING CLUE {§ 153} – § 153} – ‘PECULIAR’‘PECULIAR’

A very practical tip by Dr. L.M. Khan is A very practical tip by Dr. L.M. Khan is that in case of a child born of a that in case of a child born of a prolonged labour where he/she had to prolonged labour where he/she had to bear the undue stresses and trauma of bear the undue stresses and trauma of the birth passage, think of Arnica the birth passage, think of Arnica montana as constitutional remedy montana as constitutional remedy especially if there be history of especially if there be history of delayed crying. Absence of cry delayed crying. Absence of cry immediately after birth can be immediately after birth can be analogically considered as NON-analogically considered as NON-COMPLAINING ATTITUDE OF CHILD, COMPLAINING ATTITUDE OF CHILD, a hallmark feature of Arnica Montana.a hallmark feature of Arnica Montana.

Arnica Montana 200 {9 doses} were Arnica Montana 200 {9 doses} were prescribed. prescribed.

As narrated by mother, patient has become As narrated by mother, patient has become more receptive to command following. The more receptive to command following. The

tendency to cough and cold showed tendency to cough and cold showed significant improvement significant improvement

TRAUMA OF PREGNANCY IN FORM OF TRAUMA OF PREGNANCY IN FORM OF GRIEF AND ITS EFFECT ON GRIEF AND ITS EFFECT ON

CARDIOVASCULAR SYSTEM WITH CARDIOVASCULAR SYSTEM WITH ATTITUDE OF ‘NO COMPLAIN’ATTITUDE OF ‘NO COMPLAIN’

ARNICA MONTANAARNICA MONTANA

CASE STUDYCASE STUDY

A stout looking 9 year old child presented A stout looking 9 year old child presented with ADHD with marked destructiveness with ADHD with marked destructiveness and hyperactivity. Intra-uterine history did and hyperactivity. Intra-uterine history did not provide any significant clue. FTND with not provide any significant clue. FTND with no immediate post natal complications. no immediate post natal complications.

Precocious developmental milestones. Precocious developmental milestones.

SIGNIFICANT POINTSSIGNIFICANT POINTS H/o typhoid at 4 years of age.H/o typhoid at 4 years of age.

Family history of alcoholism and Ulcerative colitis. Family history of alcoholism and Ulcerative colitis. Recurrent tendency to coryza Recurrent tendency to coryza

Appetite decreased.Appetite decreased.

Desire for cold drink even in attacks of acute cold Desire for cold drink even in attacks of acute cold which made it worse. which made it worse.

Chilly patient with dry deep cracked tongue.Chilly patient with dry deep cracked tongue.

Started with Phosphorous in LM potency on Started with Phosphorous in LM potency on the basis of:the basis of:

Tubercular diathesisTubercular diathesis Desire cold drinksDesire cold drinks

Chilly patientChilly patient

However there was not much improvement However there was not much improvement even in 30th potency.even in 30th potency.

CASE ANALYSISCASE ANALYSIS

Keeping in mind lack of further guiding Keeping in mind lack of further guiding symptoms and strong SYPHILITIC TAINT symptoms and strong SYPHILITIC TAINT (Family history of alcoholism, (Family history of alcoholism, DESTRUCTIVENESS in form of cold drink DESTRUCTIVENESS in form of cold drink even when it aggravated complaint and even when it aggravated complaint and deep cracked tongue); I prescribed deep cracked tongue); I prescribed Syphilinum LM1/ ODSyphilinum LM1/ OD

CASE STILL UNDER CASE STILL UNDER PROGRESS but according PROGRESS but according to mother, appetite has to mother, appetite has increased and patient is increased and patient is

slightly better with regards slightly better with regards to his degree of to his degree of hyperactivity.hyperactivity.

GENERAL GENERAL MANAGEMENTMANAGEMENT

Create a daily routine for the Create a daily routine for the child, eg homework schedules, child, eg homework schedules, bedtime and mealtime routines. bedtime and mealtime routines. Plan structured programmes Plan structured programmes aimed at gradually lengthening aimed at gradually lengthening the child's concentration span the child's concentration span and ability to focus on tasks.and ability to focus on tasks.

IMPORTANCE OF ACCESSORY IMPORTANCE OF ACCESSORY CIRCUMSTANCES (CIRCUMSTANCES (§5)§5)

Remove disturbing or disruptive elements Remove disturbing or disruptive elements from their daily routine. For example, from their daily routine. For example, remove siblings from the room when they remove siblings from the room when they are doing homework or turn off the TV. are doing homework or turn off the TV. Ensure environment is friendly and Ensure environment is friendly and conducive to better concentration. conducive to better concentration. Communicate with the child on a one-to-Communicate with the child on a one-to-one basis and avoid addressing other one basis and avoid addressing other children at the same time. children at the same time.

BEHAVIOUR THERAPYBEHAVIOUR THERAPY

POSITIVE RE-INFORCEMENTPOSITIVE RE-INFORCEMENT

Use rewards consistently and frequently to Use rewards consistently and frequently to reinforce appropriate behaviour such as reinforce appropriate behaviour such as

listening to adults and concentrating so as listening to adults and concentrating so as to ensure reinforcement of positive traits.to ensure reinforcement of positive traits.

HOLISTIC PRESCRIBING WITH GOOD HOLISTIC PRESCRIBING WITH GOOD GENERAL MANAGEMENT CAN MAKE THE GENERAL MANAGEMENT CAN MAKE THE

BEHAVIOURAL DISORDER BEHAVE.BEHAVIOURAL DISORDER BEHAVE.

THANKS FOR YOUR PATIENT THANKS FOR YOUR PATIENT LISTENINGLISTENING

Attention Deficit Hyperactivity Disorder, more commonly known as ADHD, is a medical condition that has observable symptoms such as Attention Deficit Hyperactivity Disorder, more commonly known as ADHD, is a medical condition that has observable symptoms such as uncontrollable hyperactivity or inattention and impulsivity that causes disruption to the daily functioning of a person in a number of settings uncontrollable hyperactivity or inattention and impulsivity that causes disruption to the daily functioning of a person in a number of settings such as home, school, work or in the community .such as home, school, work or in the community .

    There are three types of ADHD, each with their own distinctive behaviours.There are three types of ADHD, each with their own distinctive behaviours. Inattentative type, Inattentative type, with signs that include:with signs that include: unable to focus on details or a tendency to make thoughtless errors in schoolwork and other activities unable to focus on details or a tendency to make thoughtless errors in schoolwork and other activities trouble with continuous attention in play activities or tasks trouble with continuous attention in play activities or tasks obvious listening difficulties obvious listening difficulties difficulty following instructions difficulty following instructions trouble with organization trouble with organization avoidance or dislike of tasks that requires thinking or focus avoidance or dislike of tasks that requires thinking or focus tendency to misplace belongings such as toys, notebooks, or homework tendency to misplace belongings such as toys, notebooks, or homework easily distracted and distracting easily distracted and distracting forgetfulness in daily activities forgetfulness in daily activities Hyperactive and impulsive type, Hyperactive and impulsive type, with signs that include:with signs that include: squirming or fidgeting squirming or fidgeting trouble remaining still and seated trouble remaining still and seated constant running and climbing constant running and climbing find it hard to play quietly find it hard to play quietly seem to be constantly "on the go" seem to be constantly "on the go" continuous talking continuous talking blurting answers out blurting answers out find it hard to wait in turn find it hard to wait in turn tendency to interrupt or intrude tendency to interrupt or intrude Combined type, Combined type, which is made up of a combination of the other types and is the most common form . which is made up of a combination of the other types and is the most common form . back to topback to top   

How is it diagnosed? How is it diagnosed? Diagnosis is dependent on a full evaluation as there isn't a test that Diagnosis is dependent on a full evaluation as there isn't a test that

detects the presence of ADHD. Diagnosis can be a difficult process, detects the presence of ADHD. Diagnosis can be a difficult process, as factors such as Tourette syndrome, depression or a learning as factors such as Tourette syndrome, depression or a learning difficulty may influence the results. Referral to a specialist such as a difficulty may influence the results. Referral to a specialist such as a psychologist, neurologist or psychiatrist can help dismiss alternative psychologist, neurologist or psychiatrist can help dismiss alternative diagnosis .diagnosis .

To be considered for a diagnosis of ADHD there are four boxes that To be considered for a diagnosis of ADHD there are four boxes that need to be ticked: need to be ticked:

a child must display behaviours from one of the three types of ADHD before age a child must display behaviours from one of the three types of ADHD before age 7 7

behaviours must be more severe than in other children of the same age behaviours must be more severe than in other children of the same age behaviours must be evident for at least 6 months behaviours must be evident for at least 6 months behaviours must take place in and have negative affects on at least two areas of behaviours must take place in and have negative affects on at least two areas of

the child's life (such as school, home, day-care settings, or friendships)the child's life (such as school, home, day-care settings, or friendships)

When the brain hears a loud bang, the soundWhen the brain hears a loud bang, the sound comes in through the ears to the hearing part ofcomes in through the ears to the hearing part of the brain that acknowledges sounds. Thethe brain that acknowledges sounds. The information is then split for processing. Aboutinformation is then split for processing. About 10% of the signal goes to the amygdala in the10% of the signal goes to the amygdala in the limbic system, and 90% to the cerebral cortex.limbic system, and 90% to the cerebral cortex.

The limbic system is the primitive processingThe limbic system is the primitive processing part of the brain that holds some memories andpart of the brain that holds some memories and assesses threats. The bang may trigger theassesses threats. The bang may trigger the amygdala to send a signal to the neighbouringamygdala to send a signal to the neighbouring © Deb Gilbertson, 2003© Deb Gilbertson, 2003 cells to release adrenalin for fight or flight.cells to release adrenalin for fight or flight. This process is very fast.This process is very fast.

This inability to put adrenalin away again This inability to put adrenalin away again leadsleads

to high levels of adrenalin in the system. Into high levels of adrenalin in the system. In my view this explains some of themy view this explains some of the hyperactivity in ADHD people.hyperactivity in ADHD people.

‘‘AttentionAttention

deficit’ he redefines as ‘noticing everything’.deficit’ he redefines as ‘noticing everything’.

As a hunter heads off across the savannah, heAs a hunter heads off across the savannah, he

is constantly looking out for what might eatis constantly looking out for what might eat

him and what he could catch and eat. In thehim and what he could catch and eat. In the

classroom this is seen as being distracted byclassroom this is seen as being distracted by

noises and activities instead of focussing on thenoises and activities instead of focussing on the

student’s own work.student’s own work.

The hunter may get hurt when they pull downThe hunter may get hurt when they pull down the prey, yet the next day they will do it again.the prey, yet the next day they will do it again. Consequences lead to awareness of the risksConsequences lead to awareness of the risks but do little to stop them from taking thosebut do little to stop them from taking those risks. For ADHD children this means that therisks. For ADHD children this means that the normal behavioural modification technique ofnormal behavioural modification technique of applying natural and logical consequences hasapplying natural and logical consequences has little effect. This characteristic can also beenlittle effect. This characteristic can also been seen as resilience to setbacks, a critical qualityseen as resilience to setbacks, a critical quality in entrepreneurship.in entrepreneurship.

Hunters need high levels of energy for theHunters need high levels of energy for the hunt. This is seen in the classroom ashunt. This is seen in the classroom as hyperactivity, with energetic childrenhyperactivity, with energetic children struggling to sit quietly. For the struggling to sit quietly. For the

entrepreneurentrepreneur high energy is an essential quality for high energy is an essential quality for

businessbusiness success.success.