An Examination of the Environment Best Suited to Treat Children with Behavioural Difficulties

Executive Summary

The purpose of this report is to examine the environment best suited to treat children with behavioural difficulties and to throw light upon the aggravations to be aware of during treatment. As a result of the increased awareness due to this examination, the objective is to implement changes and move practise forward in constructive ways, as well as to assist in the development of other homoeopathic practises by providing guidelines that can facilitate change.

A personal clinical audit was conducted in which the disparity between the treatment of children with behavioural difficulties at a school and in private practice was investigated. Furthermore, a literary review was carried out both on homoeopathic and conventional literature on the subject.

The main findings strengthened the author’s assumption that the environment is extremely important when treating children with behavioural difficulties and that a collaboration between teachers, parents and homoeopaths assists the process of treating such children. Furthermore, it became apparent that when teachers have a knowledge and experience of homoeopathy they are more likely to detect girls with problems and refer them to treatment as well as the boys.

The main conclusion is that there does appear to be a gap between treating children with difficulties at the school, and in private practise. It became clear that not only is the treatment more advantageous for the individual child at the school with the support from the teachers, and collaboration between parents, teachers and homoeopaths, but the parents are also more likely to persevere with their child’s treatment even if the process is difficult.

The main recommendations for homoeopaths are to carry out relevant research, so we can reinforce the correct treatment. As there seem to be certain factors that assist the process of the homoeopathic treatment of such children, it is important also to distribute this knowledge to other homoeopaths, and this could be done either by talks at seminars, articles or by leaflets distributed for example with the newsletters of the various homoeopathic societies.

For parents a leaflet could be made with information on the homoeopathic process, what to expect and how best to deal with difficult situations and aggravations. Furthermore, this leaflet should include guidelines for what information to give the teacher.

For teachers it is especially important to know how to care for a child who has recently had a remedy, but also to have a thorough knowledge of the homoeopathic process (including aggravations) in regard to children with special needs on the whole. This information could be distributed in a leaflet on guidelines for teachers for example, given to the child’s parents when turning up for the first appointment.

Introduction

After having treated children with behavioural difficulties for several years, the last few of which, practising at an ordinary private school, it has become apparent to the author that the environment is very important to optimize treatment for such children. The needs of these children are to be met and understood at the level they are at. If a collaboration exists between parents, teachers and the homoeopath, then the children receive much greater understanding and support. Especially when aggravations occur the process is aided by the fact that both teachers and parents know that this may happen and are able to monitor and support the child. The particular problem is a lack of understanding of the process of homoeopathic treatment. The problem has been identified because it was possible to see the difference between the processes in the children who have support from the school, and the children who have not.

Often, teachers do not know anything about homoeopathy and there is not an understanding that aggravations may occur and the child is just perceived as getting worse and more troublesome.

This paper aims to throw light upon the aggravations to be aware of in the homoeopathic treatment of children with behavioural difficulties, and to show how the process of collaboration between the home, the school and the homoeopath may aid the whole process. It also asks why this collaboration does not always exist. Furthermore, as a result of this increased awareness, the objective of this paper is to implement changes and move practise forward in constructive ways as well as to assist in the development of other homoeopathic practises by providing guidelines that can facilitate change.

Method

To examine this problem a literature review was conducted and a personal clinical audit.

Behavioural difficulties – The background

There may be a fine line between a child being just playfully naughty and actually being characterized as having a so-called behavioral difficulty. The consensus of a “normal” behaviour has changed over time and the diagnoses are many: ADD, ADHD, Asperger’s syndrome, autism, DAMP, HKD, MBD, MPD, NLD, OCD, TS etc. etc. Please see appendix 1 for the DSM-IV diagnostic criteria of the different diagnoses.

Often the criteria for the diagnoses overlap making a diagnosis very difficult and sometimes controversial. As Trillingsgaard, Dalby and Østergaard (2003, p.16) put it: “Many of the different names and descriptions which exist today hardly deserve the definition “diagnosis” in the proper meaning of the word. The phenomena may remind one of the blind who reach different perceptions of an elephant, because they only feel its tail, trunk, ears, tail, legs or its rough skin.”

The “norm” is wide regarding the development of children and their brains. Society is constantly changing, which further adds to the problems in conventional medicine of defining nosographic entities, i.e. disease entities or handicaps where causation, symptoms, the disease development and correct treatment is transparent and well known.

There seems to be a consensus, however, that several factors contribute to children’s behavioral difficulties ( Chauhan & Gupta (2004), Coulter & Fisher (1991), Damm & Thomsen (2006), Gerlach (2007), Nørby (2007), Trillingsgaard et al (2003)) The difficulties may stem from an inherited developmental disturbance, circumstances during pregnancy i.e. drug or alcohol abuse, premature birth, circumstances in the child’s life, from the influences of the environment, the food i.e. too many sweets or artificial colourings, vaccinations etc.

Usually children’s developmental disturbances are divided into 3 categories.

1) General developmental disturbances in which the child’s cognitive, linguistic as well as motor functions are delayed, compared to normal development. This may be seen for instance, in children with Down’s syndrome or mental retardation. The disturbance can be more or less severe or even border on normal or delayed development.

2) Specific developmental disturbances where the child is of average intelligence, but specific areas of development deviate. In children with dyslexia certain aspects of the linguistic development deviate whereas other areas of development are normal. Correspondingly, the development of the function of attention and the motor coordination is not consistent with the rest of the child’s development in cases of DAMP.

3) Fundamental developmental disturbances, where the child’s fundamental social functions are affected i.e. their social behaviour, to understand other people’s mental processes, and to communicate. This may be seen in children with autism-spectrum disturbances. A lot of these children are generally developmentally disturbed, but those who are not so affected may develop normally in other areas other than social.

Deviations in children may be very difficult to demarcate as well, which means that they often overlap too so that one particular child may meet the criteria of several diagnoses at the same time, co-morbidity. According to Duvner(1999), and Gerlach (2007), co-morbidities often arise in these children because they are not met with understanding by their surroundings and are under great stress. They are often told off because they do not behave themselves. As a result they feel wrong. However, even if the child does not meet all the criteria of a certain diagnosis, the diagnosis will be used to describe the child (Trillingsgaard et al, 2003).

Common to them all is that the diagnosis serves as a label of a particular child.

There are several advantages and disadvantages attached to labeling a child with a specific diagnosis.

The advantages may be:

1) There is a greater understanding that the child behaves differently

2) The school immediately is allowed extra pay to aid a child with a diagnosis

3) In severe cases the child can go to a special school

4) The parents get support

The disadvantages may be:

1) It is difficult to change or remove a diagnosis once it has been given

2) The parents or others cling to the diagnosis making it difficult for the child to break free of a certain role, once the child is better.

According to Broeng (2006, p. 49): “If new knowledge or changes occur in the process of the disease, one has to reassess the diagnosis or perhaps change it altogether. Diagnoses can be changed; after all, they are only the expression of one particular doctor’s subjective assessment of a condition at a given time.”

The implication of a diagnosis is many fold. Firstly, in the author’s experience the diagnosis is not changed by the doctor even if the child improves contrary to the statement above. Secondly, the parents tend to cling to the diagnosis, often because it makes their child kind of special, and because they have sometimes been through a lot in the system to get the diagnosis in order to meet an understanding from the surroundings, as well as getting the special treatment needed in these children.

Conventional treatment

Behavioural problems are more prevalent in boys than in girls. According to Duvner (1999) 10 times more boys are diagnosed than girls. During research, however, it appears that 3-4 boys are affected for every girl. This is reflected in the author’s audit in that 1 in 3 are girls. One explanation may be that parents of girls do not seek help as frequently, as girls are not seen to be such great troublemakers and are not as aggressive as the boys with similar problems.

Conventionally, the treatment is first of all an organization of the child’s daily routine. Everything has to be as familiar and regular to the child as possible. Secondly, a great pedagogical effort is needed, and only in very severe cases medical treatment such as ritalin is given. None of this is considered to be a cure and the child simply has to learn to live with the difficulties (Trillingsgaard et al, 2003). This may be one of the reasons why it is so difficult to change a diagnosis once it has been given, as in conventional terms there is no “cure.” This again may explain why an appreciation of other kinds of treatment is lacking, as diagnoses are seldom changed and “cure” not obtained.

Homoeopathic treatment

In this connection it is important to note that we in homoeopathy do not treat diagnoses, rather we treat the whole person. For this reason, the author has not put great emphasis on the different diagnoses during the treatment, but rather on the symptoms the individual child presented with. In some cases the parents even withheld the fact that the child had been given a diagnosis and it was not disclosed until the treatment had stopped. The author has focused on the 30 most recent cases of children with different kinds of behavioural difficulties, some with specific diagnoses some without. The tendency is for more children to get diagnoses in recent years.

The school and the practise

The school at which the homoeopathic treatment takes place is an ordinary private school, but it is unique in that it aims to be holistic. It is a small school with an objective to meet the children where they are and to encourage and strengthen the child’s individuality and promote health. Because of this declared aim, the school receives a higher percentage of children who for some reason or other find it difficult to get on in ordinary schools.

It has been a very special opportunity to practise homoeopathy at the school. Not only is it possible to treat the children in their own environment, but often also to experience the dynamics among the children in their classes, the dynamics between children and teachers, and also to have a greater collaboration with the teachers as well as the parents.

The process

It has become apparent that not only the children, but also the parents become a greater part of the process, when treating the children at the school. As several of the children with problems are referred to homoeopathic treatment and some of the teachers have chosen treatment too, there is a mutual understanding of being a part of a process. In most cases the homoeopath is given permission to discuss the child and the process with the teachers, which makes it possible for the teachers to follow the child closely. The teachers are told when the child is given a remedy and depending on the child’s state at the time advised what kind of reactions to be prepared for.

Conversely, the teachers observe the child and let the homoeopath know if perhaps the child reacts in a different way or there is no reaction at all. In this way the parents do not have to worry when the child has received a remedy. If there is a strong reaction to the remedy the teachers are aware of what is happening, and in a few cases if the reaction is too strong, it is possible to keep the child at home for a week or two as the teachers fully understand the situation. This is for the child’s own benefit, but also for the benefit of the other children in the class.

In some cases in which fear and anxiety have been very pronounced in the symptom picture, it has been possible for the parents to keep the child at home and teach the child themselves or have a teacher visit the child at home for some months to conduct the teaching until the child got better.

Consistency of symptom-picture

Another way this collaboration between the homoeopath, the parents and the school is beneficial is to elicit whether there is a consistency in the child’s symptoms at home and at school and whether the teachers’ perceptions of the child correspond with those of the parents. This is very important in relation to the diagnosis of the child and/or the homoeopathic symptom-picture, but also to discern if there is an actual problem in the home or at the school.

Teachers who understand the homoeopathic process

The children themselves also meet a greater understanding from the teachers who undergo homoeopathic treatment. They have tried the remedies on their own bodies and felt what it does physically, mentally and emotionally. They can resonate with the children. If something bothers the children they can speak to the teachers and the teachers have a great empathy with the children.

The teachers are more aware of the dynamics amongst the children and why they behave as they do. This is very valuable as the parents often do not have the chance to observe the social interactions of their own child in the same way the teachers do. Occasionally, as a result of this observation of the social skills of the child, the teachers know before the parents whether the remedy has stopped working in a particular child.

The children also talk about the homoeopathic treatment amongst themselves and tend to know which other children are seeing the homoeopath, so it is a natural part of their everyday life.

Private practise

This is in stark contrast to the parents who seek appointments for their children with behavioural problems in the author’s private practice. In these cases it is often a secret that they visit a homoeopath. As the parents do not have the support from the school the process is also more complicated if aggravations or setbacks occur. There is a greater impatience with the treatment, and a need for the child to get better quickly.

This is a great problem if the child is severely disturbed, as in those cases it is very unlikely that the process will run smoothly and the collaboration is greatly needed.

The lack of collaboration poses another problem, namely, if there is an inconsistency between the parents’ and the schools description of the child (frequently announced by the parents) Then it is very difficult to discern what’s what. Furthermore, if the child exhibits symptoms that may indicate some form of abuse, it is much easier to monitor the situation when a collaboration exists between homoeopath and teachers.

Why this great need for secrecy? The answer to this question is partly inherent in the problems described in this report, partly inherent in the lack of knowledge of homoeopathy, certainly in Denmark. Perhaps this also explains why a collaboration does not always exists – as the knowledge is lacking. This of course puts even greater pressure on parents who are in a very difficult position in the first place.

As this is a small scale project it cannot be conclusive, but it can give some valuable hints as to how homoeopathy may assist the whole process to a greater extent when collaboration occurs between teachers, parents and the homoeopath, in comparison to when such a collaboration does not occur. The point that is made here is not that homoeopathy does not work if a collaboration does not exist. There is ample documentation that it does work (Viksveen, 2007). The point is that the whole process is assisted by the collaboration. In order to be able to describe the aggravations and processes to be aware of it. is necessary to look at the ratio of girls and boys and the presenting symptoms/diagnoses.

20 boys (12 from the school marked with an *)

Age Presenting symptoms Process/aggravations

10 years*	Bully, hurting the other children, concentration difficult	Smooth process, despite difficult situation at home.Mother alcoholic, great neglect at times, great monitoring and collaboration needed
6 years	Obsessive thoughts, fear fear of parents	Fear of parents aggravated, impossible to work out why, no collaboration
10 years*	Bully, concentration difficult, naughty, fear, very bright	Smooth process
11years*	ADHD, very bright, extreme fear, paranoia, no desire to live with parents	Extremely difficult process. Great collaboration needed, different aggravations at different times
10years	Antisocial behaviour, bully,	Smooth process
7 years	Concentration difficult, fear, obsessive thoughts, restlessness	Restlessness, anger coming up in the process
7 years*	Rage, throwing things at school, fear of father	Smooth process, no aggravationsSchool queries violence at home. Great monitoring and collaboration needed
11 years	Tourette syndrome,antisocial behaviour	Smooth process, but rage coming up in the process
8 years*	Concentration difficult, rage	Rage aggravated initially, after that smooth process
9 years*	Concentration difficult, obsessive thoughts, fear	Anger and fear coming up in the process
8 years*	Deaf, motorically late developed, fear, rage	Very difficult process, great collaboration needed
9 years*	Autism spectrum, obsessive thoughts	Anger and fear coming up at different times in the process
14 years	Dyslexia, antisocial behaviour, fear of father	Easier doing schoolwork, smooth process
9 years	Concentration difficult, bad tempered, discord between parents and teachers	No support, gave up on homoeopathy
8 years	Mental development arrested, rage, concentration difficult, kicking the teachers	No support, gave up homoeopathy
8 years	Concentration difficult, fear, throwing things at school	Very difficult process, no support, gave up on homoeopathy
6 years*	Autism, antisocial behaviour, domineering	Strong aggravation initially and after the first few doses of the remedy, later on smooth process
7 years*	OCD, socially incompetent, fear, extremely bright	Smooth process, but monitoring needed as symptoms changed drastically when remedy stopped working
9 years*	Antisocial behaviour, fear	Smooth process
8 years*	Asberger syndrome, concentration difficulties	Smooth process

 

10 girls (7 from the school marked with an *)

Age Presenting symptoms Process/ Aggravations

9 years*	Tourette syndrome	Smooth process
13 years*	Concentration difficult, social difficulties	Smooth process
11 years*	Extremely introverted, fears	Smooth process
11 years*	Mental development arrested, antisocial behaviour, fear	Smooth process
7 years	Domineering, bully	Smooth process
11 years*	Concentration difficult, depressed	Smooth process
14 years	Autism, asberger syndrome, tourette, antisocial behaviour, desire to kill, cutting herself	Very difficult process, different symptoms aggravated at different times
11 years*	Runs away from school, suicidal, fears	Fears strongly aggravated
11 years	Domineering, fear, concentration difficult	Smooth process, no aggravations
12 years*	Manipulating, domineering, runs away from school and home	process very difficult every time remedy stopped working

 

What kind of process can teachers and parents expect?

As we are dealing with children with great difficulties, we cannot expect all the problems to disappear over night. In conventional terms there is no cure for these children Damm & Thomsen (2006), Nørby (2007), Trillingsgaard et al. (2003), but they have to adapt their lives to their conditions. In homoeopathic terms there can be a marked change of symptoms and behaviour when the imbalance is put right, so much so that one mother of a 7 year old boy put it : “I am not sure I like it, my boy is getting “normal” like other boys wanting to play with the others and with the computer. I much preferred it when he was a Buddhist and his room was a temple.” The mother nearly stopped the treatment altogether as she felt it was changing her son’s personality. The teachers encouraged her to carry on as they could see a great progress in the boy. In a few cases where the process was difficult and there was no support from the school in question, the parents stopped the treatment. This may have happened anyway, but perhaps if there had been a greater knowledge of homoeopathy at the different schools, the parents might have persevered.

A lot of people are very surprised that homoeopathy may help children with behavioural problems. It has become clear that parents do not seek help from a homoeopath before they have tried everything else. This is especially marked with respect to girls. From the findings it has become obvious that the teachers who have some knowledge of homoeopathy and who can see the evidence of the treatment in the children and in the group dynamic in a school class, refer girls as well as boys, when they find they have a problem.

The children whose processes run smoothly are not a problem. Those children who were great troublemakers at school or at home or both, but after the correct remedy just gradually became better and much easier, are not the focus of this report. Usually, that is a relief for their parents and others dealing with these children.

The problem arises when the children for some reason get worse after a remedy. Perhaps because the remedy was not initially the correct one, but close enough to produce a reaction, or it was too strong creating an aggravation, or a lot of repression had taken place prior to the homoeopathic treatment, either by conventional drugs or other therapy i.e. “holding therapy.” Then the cat is let out of the bag and teachers and parents have to be prepared for that.

It is not only the aggravations that may be a course for concern. The process itself can be very difficult and trying at times for all parties involved. This is why education and support is needed during the whole process. One difficult symptom may replace another difficult symptom, creating a whole new situation to deal with. I.e, a very introverted, fearful child may suddenly become very angry and wanting to smash things.

Possible aggravations:

Any behaviour the individual child exhibits may get worse and as a result affect either the surroundings, the group-dynamic at school, or the child him/herself. In either way strong aggravations do cause concern and a need for support in different ways either from the parents, teachers or the homoeopath.

Aggravations that have occurred in practise:

• Smashing things
• Smearing own faeces in the schoolyard
• Domineering behaviour
• Extreme fear making it impossible to leave home
• Extreme rage making it impossible for the school to accept the child for a period of time
• Hurting the other children
• Shouting
• Manipulating other children to run away
• Running away
• Cutting herself
• locking oneself up at school
• Difficulty in concentration
• Restlessness
• Setting fire to things
• Striking

Issues emerging from the analysis of behavioural problems in children.

From the analysis it has become evident that:

• If there is no support from the school there is a greater risk that treatment is stopped if the process is difficult.
• With knowledge of homoeopathy teachers are more likely to also refer girls who have problems.
• A difficult process is aided by collaboration between parents, teachers and homoeopath.
• A knowledge of aggravations makes it easier to react appropriately to a child.

The changes that could be implemented as a result of this report

In the authors’ own practise it has been possible to implement some changes since the findings of these gaps in practise. When taking on new children with difficulties outside the school, the parents are given more information on the process of homoeopathic treatment as well as an invitation for teachers to call if they want any information on the treatment. Obviously I emphasize that it is the parents’ free choice to do so and that all information is treated in confidence. Furthermore, it is possible for the parents to call other parents from the school (who have given their consent) to learn about their experience with the homoeopathic treatment, so they get an idea about the process and so that they do not feel entirely alone. These are reasonably easy changes that can be implemented in practise without any costs.

Recommendations for teachers, parents and homoeopaths

The more knowledge we gain, the more it is possible to distribute. This is true for both teachers, parents and homoeopaths. So, the more children we as homoeopaths treat successfully, the more experience we gain, the more information we can pass on, the more patients will talk about it and the more research we are able to carry out, reinforcing a positive circle. Important also, is the dissemination of this knowledge.

For homoeopaths it is very important to carry out relevant research, so we can reinforce the correct treatment. The more research that is carried out on behavioural difficulties in children, hopefully showing that it works, the more people will seek this treatment. This will be the most time-consuming and costly of all the proposals for change. As there seem to be certain factors that assist the process of the homoeopathic treatment of such children, it is important also to distribute this knowledge to other homoeopaths and this could be done either by talks at seminars, articles or by leaflets distributed for example with the newsletters of the various homoeopathic societies.

For parents a leaflet could be made with information on the homoeopathic process and what to expect and how best to deal with difficult situations. Furthermore, this leaflet should include guidelines for what information parents should give to give the teacher.

For teachers it is especially important to know how to care for a child who has recently had a remedy, but also to have a thorough knowledge of the homoeopathic process, including aggravations in regard to children with special needs on the whole. This information could be distributed in a leaflet on guidelines for teachers for example, given to the child’s parents when turning up for the first appointment.

Timescale

As this is not merely a process of changing individual homoeopathic practises, but a far-reaching change into established schools- and schools of thought, the timescale involved in bringing forth significant change should not be underestimated. The process alone in this practise has been under way for 16 years where the initial collaboration between homoeopath and headmaster was established. However, little steps forward lead to huge steps in the long run.

Conclusion

A problem was identified; a gap in practise between the homoeopathic treatment of children with behavioral difficulties at a school and in private practise. A personal audit was carried out to examine the difference. It became clear that not only is the treatment more advantageous for the individual child at the school with the support from the teachers, and collaboration between parents ,teachers and homoeopath, but the parents are more likely to persevere with their child’s treatment even if the process is difficult. Another very important finding is that teachers with knowledge and experience of the benefits of homoeopathy, are more likely to detect girls with problems and refer them to treatment also.

Since the discovery of these findings it has been possible to implement small changes in practise at no cost, so that treatment of children outside the school will become more advantageous too. The implementation of the more far-reaching changes is going to take more time and effort, and some of the changes needed, like more research, will be at a considerably greater cost. The main thing is that small changes are made all the time leading to greater changes over time.

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Glossary:

ADD: Attentional deficit disorder

ADHD: Attention-deficit hyperactivity disorder

DAMP: Deficits in attention motor control and perception

DSM-IV: American Psychiatric Association’s Diagnostic and statistical Manual fourth editionBottom of Form; Top of Form; Markup; ;

HKD: Hyperkinetic disorder

MBD: Minimal brain disorder

MPD: Motor perception dysfunction

NLD: Nonverbal learning disability

OCD: Obsessive compulsive disorder

TS : Tourette syndrome