A Case of Autism

NAME – Master. S. T.
AGE (DOB)-12/11/1999, (3yrs )
SEX – M
CASTE – Malayali
Language spoken at home – Malayalam
Father – Businessman
Mother – Housewife

CHIEF COMPLAINT:

The child was brought to us with various complaints:

1. Speech – speaks nonsense, irrelevant talk, not comprehensible, only the words- papa, mama are clear. Mutters to himself occasionally, keeps on repeating the same words again and again. If asked any question, he would repeat the same question (Echolalia). He expresses his needs by pointing and by dragging the person or at times throwing tantrums especially if hungry.

2. Does not interact with people or children. Does not play with other children. Will not talk to strangers and will not pay heed to them. He has a very poor eye contact. He will keep on playing by himself or with inanimate objects. He imitates his father and grand father.

3. He is unable to follow commands and responds to his name very rarely. He recognizes only family members and only one or two friends. He understands very few words.

4. He does a repetitive whirling movement in a circle. Occasionally he keeps on hitting things together to make a banging noise; with a spoon etc. He makes various facial expressions and eye expressions repeatedly.

5. He is very restless and will not sit at one place. His attention span is very poor.

6. He has good urine and bowel control.

7. Child has recurrent cold and cough for which homoeopathic treatment was going on.

OBSTETRIC HISTORY

The child was born after 8 yrs of marriage. This is a consanguineous marriage.

Mother was operated for a fibroid and ovarian cyst prior to conception.

BIRTH DETAILS

Full term caesarean delivery. Cried immediately after birth.
Birth weight – 3 kg
No immediate post natal problems.

DEVELOPMENTAL DETAILS

Teething – 1^ST Teeth at 8-9 month
Walking – After one year without support
Speech – monosyllables at 2 yrs
Echolalia – repetitive speech.
Bladder and bowel – Normal
Social smile – less
Response to name – occasional
Understanding simple instructions – -2
Vaccination – N (no problems)

SCHOOL HISTORY

H/O going to Play School.
Would not play with children. Would not interact with others. Plays by himself only.

PHYSICAL GENERALS

Appetite – fussy about eating yet cannot remain hungry (2).
No specific craving, likes cold water
Perspiration – profuse (2)
Sleep – deep sleep, changes position frequently. Occasionally smiles in his sleep, Dislikes light while asleep
Thermal – ambithermal to hot

LIFE SITUATION

This child was born after 8 yrs of marriage and he is a precious child.

The Father runs a printing press. He is a very anxious person. He gets spells of anxiety and nervousness and is dependent on many tranquilizers as well as homoeopathic treatment. He had faced a lot of problems in adjusting with the family and he gets irritated very fast. He is very fond of his child and is quite attached to him. The Mother is very quiet and docile. She has adjusted very well with her husband and the family. Both the parents are very affectionate and loving towards their child.

The child has developed a good relationship with both his parents. But he recognizes non family people with difficulty. He does not talk to strangers and in fact fears them. He is shy and does not interact easily with his peer group. His eye contact is very poor. He often returns home beaten by other friends. He is timid when scolded and his response is to keep quiet and cry.

He remains in his own world and plays with inanimate objects. He does not obey commands and his response to anyone calling his name is also delayed or absent. Occasionally he may laugh without reason.

He has fear of sudden and loud noises (3). He fears the noise of crackers, whistles of the pressure cooker, sound of the airplanes, etc. On hearing such sounds, he will run and cling to his parents. He has fear of moving objects. He has fear of jumping from heights, walking on stools and sliding down slides in the park. He will not stand on a stool because of the fear of falling down. He will cling to his mother while getting down staircases. He fears animals and persons who may harm him.

He is very restless and cannot sit at one place. He likes to go out and can be easily diverted. He likes to listen to music and watch TV. He imitates his father and grand father. He does not like to be touched and dislikes wearing full sleeve shirts and trousers. He dislikes washing his face or hair and also dislikes brushing his teeth and having a hair cut.

He expresses his needs by pointing or dragging the person towards them and at times throws tantrums when hungry. He is in dependent on others for his eating, dressing bathing etc.

ON EXAMINATION

N.A.D.

PROVISIONAL CLINICAL DIAGNOSIS

Autistic features with Hyperactivity

INVESTIGATIONS

23/8/2002 : PSYCHOLOGY ASSESMENT REPORT

Testing Done: VSMS, CARS (Childhood Autism Rating Scale)

Conclusion: On VSMS IQ is found to be 68 which falls in the range of (50- 70) indicating mild retardation in social functioning. His social age is 1 year and 10 months which is below his chronological age.

A CARS score of 34 indicates mild degree of autism in child.

Observation of the child and interview with the parents are correlated with the test findings.

RECOMMENDATION

v PARENTAL COUNCELLING

v SPECIAL SCHOOL

v OCCUPATIONAL THERAPY

v SPEECH THERAPY

v HOMOEOPATHIC TREATMENT

v REASSESMENT AFTER ONE YEAR

13/8/2002 : OCCUPATIONAL THERAPY REPORT

RECOMMENDATION-

v SENSORY INTEGRATION THERAPY

v SPEECH THERAPY

CLINICAL DIAGNOSIS

MILD DEGREE OF AUTISM

TREATMENT PLAN FOR THE CASE

v Homoeopathic remedy

v Occupational therapy-sensory integration therapy.

v Speech therapy

v Autism (special education) school

HOMOEOPATHIC MANAGEMENT

Analysis : The case resolves around a SENSORY PATTERN & MOTOR PATTERN

Apart from the diagnostic symptoms, the child is very timid and comes home beaten by other children. He is very fearful but the fears are quite characteristic. There is a very specific fear of falling down and downward motion. This fear will not allow the child to enjoy playing on swings, slides etc in the park. He will not jump and needs assistance while going downstairs. Also his sensitivity to sound is very intense and he runs and clings to his parents. This response is to sudden sounds and not routine sounds. The sensitivity to touch however is found in many autistic children. He is also very restless and will not sit at one place.

TOTALITY  of the case for reportorial analysis

Fearsome – Fear of falling down (3)
Fear of downward motion (3)
Fear of sudden noise (3)
Fear of loud noise

Timidity

Restlessness in children (3)

< Hunger (2)

Ambithermal to hot

Reportorial syndrome

Borax                 6/12
Silica                  4 /9
Gelsemium        4/7
Lyco                    4/7
Stramonium      4/7

SILICA – Covers the shy timid nature of the child. But the qualified mental state – fear of falling down and downward motion is not covered by Silica. Also the ambithermal to hot thermal state contraindicates silica.

GELSEMIUM – Gelsemium comes very close to this case but the other qualified mentals – fear of sudden and loud noise – are  not covered by it.

LYCOPODIUM – Again does not cover the qualified mental state.

STROMONIUM – Is another very close remedy but sensitivity to noise is not characteristically covered by it.

Hence BORAX is the only drug which stands very high in the reportorial syndrome and which covers the qualified mental state of the child.

MIASMATIC DIAGNOSIS – Tubercular

SUSCEPTIBILITY ASSESMENT

Qualified characteristics are present at mind
Sensitivity is very high
Vitality is good
Hence susceptibility falls into a moderate to high zone

Hence potency selection is 200

15/11/02  – Borax 200 1p was given

FOLLOW UP synopsis

Date	Restless ness	fears	speech	Eye contact	Repetitive Action/ imitation	Interaction/Response to commands	Cold /cough	RX
15/11 to 20/12/02	>>	>>90%	Speech clear Tries to make sentences Will talk what he wants,  will not answer questions	>	+/+	>/s	One attack which was > with puls 200	Borax 2oo 1dose
17/1/03	>	>	Repeats ++	>	+	Plays alone		Borax 200 1phs
21/2/03	>	>	Limited to need, makes sentences	>	+	mixing	Cough ++ intermittently	Borax 200 is given almost  every fortnight
7/3 to 4/4							Cold cough++	> with Cocculus 200
11/4/	>	> but screams	Not clear, Stammering Irrelevant talking		Car movement >	fluctuating	>>	Borax 1m 1p hs
23/5	>2	>2	Speaks sentences repeats	>	+/>	Songs TV/follows instructions	Had cold cough > with Cocculus 200	Borax 1m 1phs
23/5 to 22/8	>>	>>	Makes sentences Echolalia >> Gives answer +	>>	>/>		Advice CARS and ATEC	Borax 1m 4 doses is given in this period

ATEC REPORT – (Autism Treatment Evaluation Checklist)

Patient has shown improvement in three areas:

Speech-echolalia has decreased
He responds to name and instruction
Imitation has improved

17/10/03	>>	>>	No repetition Answers all questions Makes his own sentences	normal	>	>>	>>	Borax 1m monthly given
3/04 to 6/04 started going to normal school	N	?2 swimming2	Asks questions	?	>	shy	recurrent	Borax 1m, 3wkly given
hence 23/7/04								Borax 10m 1phs
7/04 to11/04	N	>>	N, talkative	N	Occ	N	>>	Borax 10m 2 doses

17/7/04 : PSYCHOLOGICAL ASSESSMENT REPORT

CONCLUSION

Patient shows dull – normal intelligence according to his IQ of 80-85.
There is adequate social functioning.
He shows curiosity and asks meaningful questions.
He expresses his need properly
Remarkable improvement in his communication and social interaction

Advice: Normal school, speech therapy, sensory integration therapy, homoeopathic medication.

Within one year as there was marked improvement in his autistic features and the report also showed progress he was sent to normal school for an admission interview. He passed the interview well and since March 2004, he started attending a normal school routine.

At present homeopathic management continues while the child attends regular school. His tendency for recurrent cold cough has also improved.

Dr. Praful M Barvalia
Shalibhadra Society
148, Hingwala Lane Extention
Near Popular Hotel
Ghatkoper (East)
Mumbai 400 077
Ph: 022 – 2516 5885
022 – 2513 4467

Email: [email protected]
Website: www.holisticfoundation.org