ADHD Managed with Classical Homeopathy, A Case Report-Part II

(Part I may be accessed here https://hpathy.com/clinical-cases/a-case-of-adhd-part-1/  )

Abstract:

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopment disorder characterized by inattention, hyperactivity, and impulsivity that impacts the children below 12 years of age mainly and persists into adulthood.

The prevalence of ADHD has been increasing globally in recent years and the exact cause of ADHD is unknown, although it is believed to be a combination of genetic, environmental, and social factors. Diagnosis is made through clinical evaluation, with treatment options including medication, behavioral therapy, and lifestyle changes.

Despite the availability of effective treatments, many individuals with ADHD struggle with daily functioning and social interactions, leading to negative impacts on academic and occupational performance, as well as personal relationships.

In such cases, classical homeopathy may provide an alternative treatment option by rendering a holistic approach which addresses both the symptoms of ADHD and the general wellbeing of the patient. Here, we present the second part of the case published earlier where classical homeopathy was of benefit in ADHD.

Keywords:  Attention Deficit-Hyperactivity Disorder, ADHD, homeopathy, case report

Abbreviations – 1.     ADHD – Attention deficit hyperactivity disorder 2.     COMT – Catechol O-methyltransferase 3.     ADRA2A – Adrenoceptor Alpha 2A 4.     ADRA2C – Adrenoceptor Alpha 2C 5.     DSM-5 – Diagnostic and Statistical Manual of Mental Disorders, Fifth revision 6.     ICD -10 – International Classification of Diseases, Tenth Revision 7.     MONARCH – Modified Naranjo Criteria for Homeopathy

Background:

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects both children and adults and is characterized by symptoms of inattention, impulsivity, and hyperactivity. It is estimated to affect around 5% of children and 2.5% of adults worldwide.¹

ADHD is complex and not fully understood, but there are several theories that attempt to explain the underlying biological mechanisms that contribute to the disorder. The most popular pathogenesis is thought to be related to altered catecholamine metabolism.^2,3

There is evidence to suggest that ADHD is associated with dysfunction in several neurotransmitter systems, including dopamine, norepinephrine, and serotonin in certain areas of the brain, which can contribute to symptoms of inattention, hyperactivity, and impulsivity.³

ADHD is highly inheritable, and several genes are likely contributing to its development.^4,5,6 These genes are involved in various biological processes, including neurotransmitter regulation and neuronal development.⁶

Prenatal exposure to alcohol and tobacco, premature birth, and low birth weight, have been identified as risk factors for the development of ADHD.³ It is important to note that the pathophysiology of ADHD is likely to be multifactorial, with multiple biological and environmental factors interacting to contribute to the disorder.⁷

Additionally, there may be significant variability in the presentation of the disorder across various individuals. The diagnosis of ADHD is based on clinical assessments made using the DSM-5 diagnostic criteria for ADHD.³ There are 3 types-predominantly inattentive type, predominantly hyperactive-impulsive type and the combined type (Table 1).

ADHD, inattentive type	ADHD, hyperactive-impulsive type	ADHD, combined type
Symptoms of inattention: ≥ 6 of the following symptoms and if 4–16 years of age or ≥ 5 symptoms and if ≥ 17 years of age must be present. Poor attention to detail Struggles to maintain attention Avoids activities that require uninterrupted focus or concentration Easily distracted Does not listen when directly spoken to Inability to complete tasks or instructions Forgetful Loses items used for everyday tasks Struggles with organization of tasks and activities.	Symptoms of hyperactivity and impulsivity; ≥ 6 of the following symptoms and if 4–16 years of age or ≥ 5 symptoms and if ≥ 17 years of age must be present. Struggles to remain still Fidgets, taps, or squirms when seated Standing in situations in which they should be seated Inappropriate running or climbing (or restlessness in adolescents and adults) Unable to remain quiet during play or leisure activities Excessive talking Struggles with waiting for their turn Intrudes upon others Answers questions prematurely or for others.	Fulfills DSM-5 criteria for symptoms of inattention and symptoms of hyperactivity and impulsivity.

 Table 1: DSM-5 criteria for ADHD

ADHD is often managed using medication, cognitive behavioral therapy, or a combination of both.⁸ Recent advances such as use of non-stimulant medications like Atomoxetine and digital therapeutics have become popular to improve the norepinephrine levels and may help to inform the development of more effective treatments in the future.⁹

However, there is growing interest in complementary and alternative therapies, including homeopathy, as an adjunct or alternative to conventional treatments.^10,11,12,13 While research into the efficacy of homeopathy for ADHD is limited, some studies have suggested that it may have a beneficial effect, particularly in improving cognitive function and reducing hyperactivity.^11,12,13 This case report suggests an alternative for treatment of ADHD with classical homeopathy.

 Case report:

A 12-year-old boy was diagnosed with ADHD at 8 months of age. He had learning disabilities and would not communicate properly. He also had difficulty in concentration and comprehension. He initially presented with repetitive behavior and tantrums, used to not make any eye contact and was very hyperactive.

He was on diet supplements and behavioral therapy. At this juncture, patient sought homeopathic help. First consultation took place on 07-03-2016. The part –I of the case contain detailed analysis. Here, we present to you the follow up of the case and the course of cure.

Past medical history:

• He is fully vaccinated.

• At 6 months of age, he had facial eczema which disappeared on its own.
• Developed tonsillitis at 6 months of age and he was hospitalized and took antibiotics intravenously.
• At 8 months of age, he had an ear infection and has taken Augmentin.

• Had high fever twice in April 2015 with tonsillitis and has taken antibiotics for the same.

Family history:

1. Father- Heart complaints and high blood pressure, gonorrheal infection.
2. History of cancer in both parents’ families
3. Maternal grandparents – History of diabetes and asthma

Mental/emotional history:

• During pregnancy, his mother was traumatized, and she was abused physically and verbally.
• Repetitive behavior/repeating words/hyperactive (++)
• Attention span is short/can’t fix his attention during study (+)
• Mixing words when he speaks and stammering (+)
• Distracted mind (+)
• Fear of darkness/fear of running water on his face (+++)
• Violent and destructive (+++)
• Fastidious (++)
• Fear of cats (++)
• Desires to travel (++)
• Aversion to water when it touches his head/face during the shower (+++)
• Curious/Sensitive/Obstinate (++)
• Shameless (++)

Diagnosis: ADHD (ICD-10:F90.9)¹⁴

Case analysis and prescription:

After a thorough investigation, a series of remedies were prescribed. The follow up of the case is listed in Table 2. The boy had a series of recurrent infections which were suppressed with antibiotic treatment. The frequency of the acute infections started reducing while the behavioural issues became more pronounced.

Patient exhibited strong fears which were treated using Stramonium. Once the fears started reducing, the aggressive nature became stronger and needed remedies like Veratrum album, Tuberculinum and Hyocyamus. The remedies also helped to bring down the hyperactivity and restlessness.

With a series of remedies, there were also good changes in the mind. The concentration, comprehension, the ability to reciprocate and express improved drastically. With correct homeopathic treatment, patient started developing noteworthy fevers which were treated meticulously, and the chronic disease improved invariably in conjunction to the acute diseases.

Patient also developed his old skin complaint of eczema on face during the course of treatment which was an encouraging sign that the case is progressing in the correct direction.

 

DATE	SYMPTOMS	ANALYSIS	PRESCRIPTION
23/06/2016	On 11th June, patient developed a high fever of 400C with dry cough and coryza. Patient took Belladonna 30CH for the same and it resolved. Post the acute, the mental symptoms relapsed. There was a fear of water running down his head and face while bathing.	Relapse of mental symptoms	Stramonium 1M one dose for 3 days, followed by placebo.
01/08/2016	There was not much improvement with the previous remedy. Patient had become more aggressive and tries to harm animals. He had a strong desire for ice cold water, cucumbers, and lemon.	Change in picture	Veratrum album 200CH one dose.
26/10/2016	There was an aggravation on mental and emotional level during first week after remedy, followed by improvement. His learning abilities had improved, and he was more social with people. He started to develop an old complaint – salivation during sleep. Generally better.	Aggravation followed by amelioration. Reappearance of old symptom. Case was progressing in right direction.	Nil. Veratrum album 1M one dose for 5 days was given in November 2016.
17/01/2017	There was a major improvement in his learning abilities, comprehension, and concentration. He didn’t mix words anymore.  He was more sociable. He had a dry cough with fever 38.5oC with watery nasal discharge. Generally better.	Case was doing well	Nil
15/08/2017	His fear of cats was becoming very prominent, and he couldn’t stand their presence. His desire for icy cold water and lemon decreased.	Relapse of symptoms	Tuberculinum 1M one dose for 5 days
01/12/2017	His hyperactivity decreased and the destructive aspect subsided. He was more emotionally expressive now. Bedwetting disappeared. His concentration was much better. Still had fears of cats and dogs Shameless –he walked naked in the house and touched his genitals. He behaved foolishly and laughed involuntarily.	New symptoms had appeared with change in picture.	Hyocyamus niger 1M one dose for 5 days
11/04/2018	There was a severe and long behavioural aggravation for more than 3 weeks. There was a major improvement at all levels following the aggravation. On 28/03/2018, he had a high fever of 410C and was given antibiotics. He started to develop skin eruption on face with severe itching. He had a strong aversion to eggs. He had become very lazy. He put out the feet from the bed covers often.	Skin eruptions were appearing with a change in the picture	Sulphur 200 CH one dose for 5 days
11/04/2019	Patient was exposed to cold draft, and he developed an episode of high fever.	Acute needed to be treated	Aconitum napellus 30CH one dose was given.
01/10/2019	Patient had a sudden onset of high fever which increased up to 40oC His behaviour had improved drastically. Concentration was better. He was more expressive. Fears were much better. Shamelessness was much better.	Acute needed to be treated. Chronic symptoms of ADHD were better by 90%	Aconitum napellus 1M one dose was given
06/01/2021	He developed a fever again and it reduced on its own. His behaviour improved drastically. He had more fear of dogs than cats. He had a desire for sweets and salts. Aggressiveness had mildly increased.	Case is doing well.	Bacillinum burnett 1M one dose for 5 days
04/05/2021	Aggressiveness had reduced drastically. He had improved academically. He had no symptoms of ADHD.	Case is doing better.	Nil

Table 2 – Follow up of the case.

 Discussion:

The global burden of ADHD is significant and extends beyond the individual with the condition, affecting families and society as a whole.² Children with ADHD may experience difficulties with academic and social functioning, leading to a lower quality of life.

While conventional medicine focuses on the end products of the disease, the classical homeopathic approach emphasizes the study of the genetic and epigenetic factors that contribute to the development of disease. ADHD brings a vast spectrum of symptoms on the mental and emotional level of an individual and it necessitates an individualised strategy to its treatment.³

Professor Vithoulkas, in the book- “The Science of Homeopathy” narrates that the human being functions as an integrated totality of mental, emotional and physical levels.¹⁵ The mental level of being is considered the most crucial followed by emotional and then physical level.

Furthermore, he describes a hierarchy of symptoms within each of these levels that is useful to measure progress during the treatment.¹⁵ For instance, in the above case, when fears reduced, irritability and aggressiveness increased showing that there is shift from a deeper to a superficial level.^15,16 We can also appreciate that the mental symptoms started getting better followed by emotional symptoms confirming the direction of cure.

According to the framework of “levels of health” propounded by Professor George Vithoulkas, the above case belongs to group C – level 7 and with correct homeopathic treatment the patient started to develop recurrent infections and jumped to group B – level 6.¹⁶

The theory also suggests that the appearance of an acute accompanied by high fever helps the organism to overcome the chronic disease and is considered a good response to the treatment.^16,17,18

This case report may also provide additional grounds to examine the concept of how healthier children are born as hypothesised by Prof George Vithoulkas.¹⁹ The overall condition of the mother during time of conception and pregnancy significantly influences the inborn predispositions of the child, which may alter the susceptibility of the child and make them prone to develop deeper mental or physical diseases.¹⁹

The Modified Naranjo Criteria for Homeopathy (MONARCH) causality assessment provided a score of 10/13, suggesting a significant causal relationship to the treatment (Table 3).²⁰ This case study emphasises the importance of addressing the underlying cause of the disease which may not only help to cure ADHD but also improve the overall health of the individual. Therefore, it serves as a basis for further investigation into the advantages of classical homeopathy for managing ADHD.

Criteria	Y	N	Not sure/NA	Score in case
1. Was there an improvement in the main symptom or condition for which the homeopathic medicine was prescribed?	2	-1	0	2
2. Did the clinical improvement occur within a plausible time frame relative to the drug intake?	1	-2	0	1
3. Was there an initial aggravation of symptoms?	1	0	0	1
4. Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed?	1	0	0	1
5. Did overall well-being improve?	1	0	0	1
6 (A) Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease?	1	0	0	1
6 (B) Direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms: from organs of more importance to those of less importance, from deeper to more superficial aspects of the individual, from the top downwards	1	0	0	1
7. Did “old symptoms” (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement?	1	0	0	1
8. Are there alternate causes (other than the medicine) that with a high probability could have caused the improvement? (consider known course of disease, other forms of treatment, and other clinically relevant interventions)	-3	1	0	1
9. Was the health improvement confirmed by any objective evidence? (Clinical signs and symptoms)	2	0	0	0
10. Did repeat dosing, if conducted, create similar clinical improvement?	1	0	0	0
Total				10

 Table 3: Modified Naranjo Criteria for Homeopathy (MONARCH) – for causality assessment

 Conclusion:

While the efficacy of homeopathy as a treatment for ADHD (Attention Deficit Hyperactivity Disorder) remains to be determined, this case report demonstrates a positive outcome from this therapy. It not only helped the ADHD symptoms, but also enhanced the overall quality of life. Hence, further research is needed to establish the benefits observed here.

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