Behavioural and Psychiatric Problems of Children

Introduction :

We follow a very clear pattern of working for the child guidance clinic…

First a detailed history is taken by a homoeopath, then psychologists do necessary testing, if required case is referred to a psychiatrist and then the entire assessment is compiled in the form of a case record. The detailed evaluation allows us, to plan the course of action, the counseling required to be followed and even therapeutic interviews are planned. These cases are managed, based on the evaluations, only with homeopathic medicines; no other system of medicines are used. Periodical evaluation is done of all these cases by the psychologist and the psychiatrist.

The life-cycle of a human being is broadly divided into four stages viz.

a]  Childhood

b]  Adolescence

c]  Adulthood

d]  Old age

Each of these periods & the transition to & from them have their own characteristic problems and disorders.

However,”childhood disorders” assume greater importance because of the larger influences they etch out on the later part life. This sometimes creates miasmatic or even incurable maladies in the life of the concerned person.

CASE I : Attention Deficit and Disruptive Manipulative Behavioral Disorder + Oppositional Defiant Disorder

A female child, 5 years old, was brought to me in 1982 with peculiar complaints.

The mother complained and said that her child would pass urine and stool daily as soon as she would reach the staircase of her house. Just to avoid this, the mother would daily pick up the child from the school, she would make her pass urine and /or stool in school; but still, this did not solve the problems. In spite of this, the child would still pass stool and urine on the staircase, even when there were no apparent reasons in doing so.

On detailed interview of the child separately, we came out with some interesting facts…

The child was extraordinarily intelligent, smart, witty, and showed a lot of presence of mind. When we slowly probed into the depth of the case, the child revealed that the mother would give more attention to younger brother who was 3 yrs. younger to her. Secondly, their mother would lock them and would leave them all alone in the house. Thirdly, the child always felt that her mother did not give her things desired by her, and would often hit or punish her.

The child acted in this manner on purpose. She would do this act of passing stool and urine to take revenge. The child said “it was my way of taking revenge from my mother, who is not treating me in the right way”.

Basically, the child was very mischievous and disobedient. She would never take any orders given by the teacher or anybody. Very destructive in nature, she would often tear off books or break her toys. Her attitude was very revengeful. She would often hit other children.

This picture is typical of Tarentula hispanica; a child who is intelligent and witty yet very sly, crafty, revengeful and malicious in her acts. Tarentula patients enjoy giving pain and discomfort to others and derive a lot of pleasure out of it.

Based on ‘Diagnostic and Statistical Manual of Mental Disorders’ -Fourth Edition by the American Psychiatric Association, Washington, DC, we can classify each of the cases in the following way :

This case satisfies the diagnostic criteria 313.81 of the Oppositional Defiant Disorder.

A pattern of

·        Negativistic

·        Hostile and

·        Defiant Behaviour lasting for 6 months or more in which 4 or more of the following are present :

1] The child often loses temper.

2] Often argues with adults.

3] Often actively defies and refuses to comply with adults’ requests or rules.

4] Often annoys people deliberately.

5] Often blames her mother for her misbehaviour.

6] Is often angry and resentful.

7] Is often spiteful or vindictive

This disturbance has caused significant impairment in her social and academic functioning.

Prescription 24/9/1982

Remedy Tarentula H. 200, 3 doses, 1 every night S.L 1-1-1 * 4 weeks.

Auxillary treatment : During the interview, the mother was educated to handle the child more carefully and intelligently.

Follow up 9.11.1982

Within 2 weeks, the child stopped passing stool and urine on the staircase.

Behavior >> No complaints now

Rx S.L 3 doses 3 PN                    S.L 1-1-1 * 3 weeks

13. 12. 1982 Irritability +++ Marked restlessness

Jealously, negative relationship with brother

Remedy Tarentula H. 200 3 doses 1 every night S.L 1-1-1 *      4 weeks

The remedy helped in channelising the child’s intelligence into good use, the child improved remarkably in her scholastic performance and received the best student award during the later years of her life.

CASE II : Disruptive Behavioral Disorder + Childhood Onset Alopecia Areata

A child of 8 yrs was brought to me for hair loss since 7-8 months. He also had eruptions on the head which were better by hot bath. When the child was bought to the clinic, he appeared to be very mild and very well behaved in our presence.

On interviewing the case in details, few interesting facts were revealed …This child would derive a lot of pleasure by killing lizards, chameleons, and other animals. He would tie them with strings and hang them on the door.  He would catch insects and throw them on his friends. This act would give him a lot of happiness. The child was not scared of anything. He likes people, mixes with everyone easily but does not get along well with his brother. It was quite interesting to observe this child, who was very mild and gentle in the clinic but was destructive & cruel, when he was left to himself.

It was evident from this behavior that the child had a dual personality.

Personal History
Craving                       Salty 2+           Pungent Aversion                      Fish                 Meat
Thermal Modality       Chilly
Family History Father: expired – [Heart / Kidney complaints]
Diagnosis Disruptive behavioral disorder

This case fits into the Disruptive Behavioural Disorder and satisfies the Diagnostic Crieria for 312.8 Conduct Disorder as follows:

·  Aggression to people and animals

·  Often bullies, threatens and intimidates others.

·  Often initiates physical fights.

·  Has been physically cruel to animals.

·  This disturbance has caused impairment in social and academic functioning.

·  This disorder is Childhood- Onset type since this Conduct disorder has started at 8 years.

·  It is a Moderate type of Conduct Disorder since:

Number of conduct problems and effects on others intermediate between ‘mild’ and ‘severe’.

Prescription:

Based on this PQRS symptom of dual personality, the child received Anacardium orientale

Dose               19.6.1993

Remedy          Anac 200 1 dose    S.L 1-1-1 * 7 days     S.L. 2-2-2- * 7 days

Remedy          26.6.1993 S.L 3 P.N.                  S.L. 1-1-1 * 7 days    >+

17.4.1993 Hair fall ++             Boils + Remedy          Anacardium 200 2 PN 1/week S.L. 1-1-1 * 3 weeks               S.L. 2-2-2 * 7 days

11.5.1993 >>        Hair fall >>

Remedy S.L 6 P.N.       S.L. 1-1-1 * 3 weeks         S.L. 2-2-2- * 3 weeks

3. 6. 1993 > ++                More active                        Cooperative ++

Remedy Ct all *

26. 7. 1993      > ++ Again hair falling ++ Change in behavior – child is much more calmer

Remedy Anacardium 200 1 PN S.L. 1-1-1 *  15 days                                S.L. 2-2-2 * 15 days

10. 8.1993 >>++               All right                             Cooperative

Remedy S.L 3 PN * 1week       S.L 1-1-1 * 15 days        S.L 2 -2-2 *15 days

23.4.2001 Response : Patient had called up.

He is fine now. No major trouble from that day till date.

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CASE III : Case of Masturbatory Behavior

A young boy of four and a half years was brought to me on 25.03 97. Apparently, the child appeared healthy and had no problems.

Life situation:

The child belonged to a particular Marwari community where a male child is a must to continue the family traditions. The lady from this community keeps on conceiving, till at least she has one male child. I have seen cases where even after 5or more daughters they want a male child.This child was born after 20 yrs. of married life; he has 6 elder sisters. Even though both parents were 40 +, they had gone for a male child.

The presenting complaint which the mother said was that the child would go around any corner, of a sofa, or of a chair, and rub against the sofa or chair, till he would have erections. Once he had an erection, then he would go around the whole house. This act was very embarrassing for the family members. This was a daily affair, and would be repeated quite a few times in a day. It was a big concern for parents because this community was very orthodox and such a scene was a big taboo.

The child was taken to Allopaths but there was no relief or results. The parents tried their best to make the child understand this problem, but it was of no use. The child would do it more & more frequently and in fact he would enjoy this act a lot.

Based on ‘Diagnostic and Statistical Manual of Mental Disorders’ -Fourth Edition by the American Psychiatric Association, Washington, DC, we can classify each of the cases in the following way:

Remedy: Lachesis 200, 1 dose was given which cured the case completely.

Child started behaving normally. Within 3 weeks, the child was absolutely alright.

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* S.L. – Sac Lac/Sugar of Milk/Placebo
* Ct – Continue

CASE IV : Hypersomnia with Oppositional Defiant disorder

A very naughty 3+ and stubborn 3+ five and half year old child was brought to my clinic with the complaint of Hypersomnia.  She would become unconscious while sleeping and would not come to consciousness for 2/3 days or more.

Life situation:

Mental state: This child was extremely obstinate & headstrong; whatever she said was the ultimate. If it was not accepted, then there would be trouble! Looking after her was like looking after 10 children together. When she had her mind fixed on something, she would repeat it over and over again till it got resolved. She would not listen to a single reasoning.  She would not respond to her mother’s call till she was repeatedly called at least 10-12 times. When punished by mother, the child would hit her mother back without any feeling. She was very hot tempered and would fight with everybody around. Her idea of playing was hitting, pulling and pushing around, thus irritating everyone. She could not remain in one place. She kept calling her mother to play with her and demanded a lot of attention.

The mother was so fed up with her that she decided to send the child to a boarding school. Basically, this child was very intelligent, curious and sharp, but all the faculties were used in the wrong way. Her school teacher says that her IQ is much above average, but she will only do things if she feels like doing it. She knows all her studies, but when asked, she will not reply. For e.g. she knows all the days of the week, but if you ask her what comes after Sunday, she will not answer. She never does homework work. Her handwriting is bad. She has a habit of sharpening her pencils and crayons till they are unusable. She is not scared of her class teacher / principal or anybody else. She imitates her mother or her teacher in front of other children. If she goes to the neighbor’s house and is asked to go back home as the children are studying – she would do the same when the neighbors would come to her house. She has a very bad habit of repeating everything. If her mom or teacher scolded her or hit her, it would make no difference to her at all. She was completely indifferent to it and had absolutely no feeling at all.

Obstinacy 3+, a simple example was when she came to see me. She was given placebo pills, she asked for more pills — once, twice, thrice but when she demanded plain pills for the fourth time, we refused. She was so persistent that she would not budge from that point. She has this habit of irritating the other person till he gets fed up and gives her what she wants.  She played the same trick on us, and finally we had to give her the pills on her persistence.

Generals:

Appetite                       +3,  fond of eating

Desire                          Salted food, ice creams, cold drinks, chewing gum, chocolates, non-veg

Thirst                           ++

Perspiration                 Less

Bowel                          Normal

Urine                            Bed wetting since birth

Sleep                            Good, Sleepy ++

Dreams                        Good, going to picnic, meeting friends

Thermal modality          Hot

Covering                      Up to neck

Fan                              Desires

Bath                             Cold water

Weather                       Likes winter

Past history:

Early 1993 – The child’s pupils were dilated and she was rushed to a hospital in Dubai.  She was in coma for 1 day and she had to be put on a ventilator. At this time, she was in hospital for about 1and a 1/2 months.  She was wrongly diagnosed as a case of tubercular meningitis & was put on steroids.  She was brought to India where MRI was done & she was diagnosed to have a tumour -ganglioneuroblastoma.

March 1993 – She went into coma again for 5 days. She was operated for the tumor.  After such a major operation, any normal child would have been frenzy with pain. She did not feel any pain after the operation].Even after the tumor was removed, her breathing was very shallow, her CO2 level went very high and O2 level was very low.  Doctors suggested that she should reduce weight. Her breathing was much less during sleep.

Jan 94 – Pneumonia in Dubai, for which she was admitted to hospital. She stopped breathing; she turned blue & was on the ventilator for about 2 months. After she was   discharged, she was brought to Bombay and was admitted in a hospital for a check up.

At that time, she still had Hypersomnia, was more violent and aggressive. The doctors gave an explanation that this is because of low oxygen levels reaching the brain.

Life situation:

The child’s parents got married in 1987.  Her father was a drunkard.  Mother did not know about the father’s condition when they got married. Father would regularly hit his wife, beat her and abuse her. Their home was like a big arena for fights; quarrels were an everyday affair at their house. These quarrels affected her mother a lot. Her mother would never reconcile with anybody and was disturbed and depressed since she got married.

Symptoms:

The child’s indifference, lack of reaction to surroundings and unfeeling are very striking features of the case. Also, painlessness after such a major surgery becomes the most peculiar symptom of the case. Thus, symptoms considered for the case are:

A pattern of

·        Negativistic,

·        Hostile, and

·        Defiant behavior lasting for 6 months or more during which:

1] The child often loses temper.

2] Often argues with adults.

3] Often actively defies and refuses to comply with adults’ requests or rules.

4] Often deliberately annoys people.

5] Is often touchy and easily annoyed by others.

6] Is often angry and resentful.

7] Is often spiteful or vindictive.

The disturbance in behavior causes clinically significant impairment in

A] Social and  B] Academic functioning.

Prescription                         24/4/94

Remedy (1) Opium (30) 12 P N 4/week (2) Sl 2-2-2       x3 weeks

20/8/94 Blueness of lips ++ in sleep Behavior     >>

Remedy (1) Opium (30) 12 P N 1/week (2) Sl 2-2-2    x   3 weeks

17/9/94 Slightly >

Remedy (1) Opium (1m)  1/p Night (2) S.L 2-2-2  x 1 month

11/11/94 > +3

Remedy Ct. All   x 1 month

3/12/94 > 3+ Understands   and   responds positively Does not hit people Has become much   milder Reacts positively to suggestions

Remedy Ct all   x 1 month

13/12/94 Went to school and suddenly caught infection Restless + Hypertrophied adenoids Thirst ++ takes lot of water 5 Greedy +5 on seeing food

The symptoms of Opium which were on the surface had gradually improved. On reconfirming her other basic traits of behavior like obstinacy, anger, restlessness, etc., Moschus was administered.

22/12/94          Remedy          Moschus (30) 3PN (2)   S.L. 2-2-2  x 7 days

29/12/94 Shares things with her brother   Behavior >> +5

Remedy          Moschus (30) 3PN (2)   S.L. 2-2-2  x 7 days

2/1/95 Appetite 3+                  Active +                       Playing  ++ Co-operative               Behavior >>

Remedy Mosch (30) 7 P N        (2)   SL. 1 dose  7 days

7/1/95 Listens to everyone Bows down, touches feet, does pranam No apnoea Only went to sleep  for 7-8 hours continuously  with coldness of body

Remedy Ct all.

17/2/95 Going to school, active           No hypersomnia, active playful Plays with other children           Violence  > +3 Still forgets things easily

Remedy Ct all.

20/2/95 > +3     Called from Dubai for her medicines.   No trouble Remedy Ct. all x 4 weeks

CASE V – Childhood Schizophrenia

A young child was brought to me for poor performance in exams. This child was previously a brilliant student. He would perform very well academically and always stood first in the class without any problem. He could not expect a rank lower than within the first five.

When he was 11 yrs old, the normal SSC education pattern of the school changed to a Cambridge based education which obviously is a much tougher and complex system of education. All the problems of this child started thereafter….

This change in education came as a big shock to him.

He developed this idea that he would not be able to cope up with the new education. He had a constant anxiety that he had not studied at all, and would surely fail in his exams. He felt that the other students would go ahead of him. Every half an hour, he would call up his friends to ask how much portion they had completed.

The child became very sensitive, irritable, anxious and fearful of everything.  He developed fear of studies, of dark, of lonely places, of exams, of failure. He started developing delusions and hallucinations, like he would hear noises and voices from far off places, had a feeling that there is something wrong with him or that somebody is chasing him, etc.

His concentration level dropped down, he forgot what ever he had done. He developed a lot of confusion, would read the same page again and again as if he had never understood what he had read. He did not feel like studying anymore, felt that he should leave the studies; he started praying that he should get some illness which prevents him from appearing for the exams. Sleep was disturbed; the child would often get up from sleep or would not get sleep for hours together. Sensitivity to noise increased, even if the television was on four rooms away, he could hear it, he could hear the noises from 2 or 3 buildings away. He developed marked sighing, and cried often.

It was quite evident from this case that the child could not bear the stress of the new advanced pattern of education and he was collapsing under this stress.

Calcarea  has fear  of  going  insane, or that people   will  observe  her  and suppose  her to be crazy; talks about fire and  murder;  imagines someone  is walking beside her, and even though  alone,  believes that  someone  is in the same room.

Characteristic symptoms : Two of these symptoms were present for a significant portion of time during a 1-month period or more:

1]   Delusions             2] Hallucinations

·        Social/ Occupational Dysfunction:

For a significant portion of time, since the onset of the disturbance, the major areas of functioning of  Work &  Self-care are markedly below the level achieved.

·        Duration:

Continuous signs of disturbance persist for at least 6 months or more.

This has been ruled out as a Schizoaffective and Mood Disorder Exclusion because:

No Major Depressive, Manic or Mixed Episodes have occurred concurrently with the active-phase symptoms.

Prescription                    15.03. 97

Remedy                           Calc . Carb 200 one dose S. L 2-2-2 * 3 days

17. 03.97 Depression >                                   Concentration > Was able to study, but still was worried about his position

Remedy SL. 3 powders night                        S.L 2 pills 2 hourly

21.03.97 >>                   Able to appear for the exams and no problems

25.04.97 Patient reports that he has stood 1st in the class

21.4.2001 Studying very well Has stood first in all exams without any anxiety episodes. No other complications or problems

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CASE VI : Autism – Pervasive Development Disorder

A young girl of seven years was brought to me, with the following complaints:

The child would sit in a corner, for hours and days together. She had no interest in food, play or studies. This attitude was there from childhood.

When I first saw her in the clinic, I observed that her face was flat & showed no expressions. This child would not mix or play with anybody and always wanted to stay alone. She would sit alone, as if she was in her own world and had nothing to with the worldly affairs.

She took no interest in her studies. [There was no problem of intelligence, because the IQ was 80 +] She would not emote to anything, there was no reaction from her even if she was scolded, explained or persuaded.

Physical complaints:

Constipation; could not pass stools for 6-8 days. Stools – hard with lot of pain and discomfort. Severe diarrhea when forced to eat. Perspiration offensive 3+, staining the clothes. Sleep disturbed, would get up a number of times, occasional weeping & talking during sleep.

On further detailed study, it was revealed that this child was adopted by the couple, as they did not have any children, after 10 yrs of marriage. The child was bought from an orphanage, and no details were available about her parents or about her background.

Diagnosis : Autism

Based on ‘Diagnostic and Statistical Manual of Mental Disorders’ -Fourth Edition by the American Psychiatric Association, Washington, DC, we can classify each of the cases in the following way:

A total Of 6 or more items of the following with at least 2 from [1], and one each from [2] and [3] are satisfied by the patient:

[1] Qualitative impairment in social interaction:

·        Marked impairment in facial expression.

·        Failure to develop peer relationships.

·        A lack of spontaneity in sharing interests.

·        Lack of social or emotional reciprocity.

[2] Qualitative impairment in communication:

·        Marked inability to initiate or sustain conversation with others.

[3] Restricted, repetitive and stereotyped pattern of behaviour.

·        Encompassing preoccupation with one stereotyped and restricted pattern.

Prescription

Remedy                      Mag-C, 200 one dose

Follow up

1st week Sleep >> Stools twice during the week and not very hard.

4 weeks Mother reported that the child was more playful would come on the                                           table and would have food with everybody.

10 weeks Child started playing with other children, started laughing, crying                                                            and expressing her emotions.

12 weeks The complaints of constipation & irritability relapsed back.

Mag-c, 200 3 doses were repeated. Few doses of Mag carb cured the case. The child opened up like a bud opening into a flower.

Conclusion :

Few points which are very interesting which can be concluded from running of this child guidance clinic:

1. We run a parent’s guidance clinic

2. Mind and body cannot be separated. That means the mind, body and nucleus of the remedy has to match with that of the patient. Unless you have this you cannot get the Similimum, and you cannot cure a case.

3. In cases most simple or complicated you can change the pathology at the level of mind             and body, very easily if you find a right Similimum.

4. In most of the circumstances simple indicated medicine produces better results than      searching for a rare uncommon, or lesser known medicines.

5. Substantial improvement occurs in all cases at the emotional, intellectual and   physical            level. Full potential of the individual can be realized.

Homoeopathy can be best learned, from patients, In fact I would strongly recommend, that students should be exposed to clinical homoeopathy right from day one of their studies. By adopting this procedure students will have confidence in homoeopathic system of medicine and once they see the result they will be able to help humanity in a homoeopathic way.

Every case can give us totality of learning,

1. Interview technique -diagnostic & therapeutic

2. Disease diagnosis

3. Analysis / evaluation of case

4. Approach to a case

-Repertorial                  -Non reportorial             -Intuitive

5. Differentiation between closely related remedies

6. Remedy relationships

7. Auxillary measures and management of the patient

8. Understanding of miasms and correlating with prognosis of the patient

9. Second prescription

10. Follow up

11. Following of Hering’s law of cure in patient management.