Behavioural Disorders in Children

Behavioural disorders in children are an expression of the disturbances of the central nervous system structurally or functionally. Genetic, acquired etiological factors during pregnancy or delivery or psychological factors later on in life can be responsible for these disturbances. These disorders are very common in the developmental period of the child and pose a major challenge for the parents in upbringing. They are more common in children with mental and other developmental disorders. If we go by proper psychological diagnosis (DSM V) we have the most common, ADHD ,that is attention deficit hyperactive disorder which may be predominantly inattentive type or hyperactive impulsive type or combined type. Others are disruptive behaviour like Oppositional Defiant Disorder (ODD), Conduct Disorder and Impulse Control Disorder. Apart from these, there are many other behavioural problems which may not fulfil the criteria for the above mentioned diagnosis but are present in many children with autism, intellectual disability etc. Autistic children have a rigid pattern of stereotypical repetitive activity, while children with intellectual disability may have behaviour related to the deficient cognition and regressive behaviour like laughing without reason, putting everything in the mouth, playing with their own stool and saliva etc. Behaviour may range from mild to very destructive, and be violent and unmanageable at home or outside. There are other behaviours which may speak about the personality, like attention seeking, narcissism or dominating personality.

If these disorders (ADHD, ODD, CONDUCT) and many others are not controlled in time, these children may develop learning disorders, academic difficulties and difficulty of social adjustment. Later they may lead to faulty ego development, fragile image, anxiety and mood disorder as well as personality disorder in adolescence. We also see that children with ODD and conduct disorder have the risk of developing into antisocial personality in adolescence. On the other hand, destructive and violent behaviour are more painful for parents and the children.

We know from our experiences that ADHD, ODD, conduct disorders, repetitive behaviour, etc can be treated with homoeopathy with great success. In autistic children treated homeopathically, behaviours start improving first, then the other features of autism. We have limitations (of improvement) at the level of cognitive deficiency but if we are able to relieve the behavioural disturbances in these patients, we have achieved a lot for the patient as well as for the parents. Sometimes parents come and say, “see doctor we know our child is not going to be a normal child but we will be highly obliged if you can relieve his destructive self injurious behaviour.”

I will cite one example of an autistic child with moderate mental retardation. If you act against her wish or if she is prevented from doing anything she will scream loudly, beat the mother, pinch and scratch herself and others. She will scratch herself to the extent that blood will come out and there were scratch marks all over her body, especially on her extremities. This was more troublesome for the mother than mere speech or socialisation. Another example is an autistic child with moderate mental retardation who used to roam around his home naked. Even if a guest will come, it will not affect him and on force he will become violent. This was very embarrassing for parents. With great difficulties this behaviour was controlled with Tuberculinum with other indications for Tuberculinum.

Thus we see that homoeopathic medicines have the power of controlling these behaviours which otherwise remains a serious concern for the parents. Here is one cases which shows the scope of homoeopathy in behavioural disorders. Other cases will follow in coming months. Autism cases with behaviour problems will be given in the future.

 

 Case 1 –ADHD With Borderline Intelligence  With Lichen Planus

Vijaya Patil

 

[email protected]

 

 

Master A.M., 6yr 10 month old boy from a Muslim family, staying with his Grandmother, parents, aunty and elder brother and sister was brought to our clinic for behavioural problems and delayed speech.

As reported by mother, he is a known case of borderline intelligence (IQ -72). He is very restless, doesn’t sit in one place for long. He sits for some time to watch T.V. but in that also, he is very fidgety. Outside he is always running here and there, will not stay with parents and is difficult to control. He has no sense of fear or danger. He does cycling very recklessly. He is very restless during sleep and changes position frequently. He is stubborn and does not listen to anyone. He will never answer anybody even though he can. He always says ‘no’ for everything or any work given. He throws tantrums when his demands are not fulfilled and always he has demands when outside. His parents tried occupational therapy which was not of much help.

 

He also has delayed speech and pronunciation and is not clear. He is taking speech therapy very irregularly. There he sits with difficulty and is often distracted easily.

There are academic difficulties. He does not like to study. He is going to a normal school (grade 1) but not able to cope as he’s very restless with poor concentration. He cannot copy from the board, cannot read and is very slow at writing. He is independent in wearing clothes, eating and partially dependent for washing.

Associated complaints:

He has multiple small round violaceous patches on the face and upper and lower extremities with lots of itching since 6 months. It is diagnosed as lichen planus and treatment is going on, but it is not improving. Also his appetite is very poor. He is underweight and his mother is worried about his height also.

On further enquiry, it was found that he has a history of convulsions which started at 4 months of age. He was on medication with Valparin till 3 ½ yrs of age. No convulsion reported from 1yr of age. Low calcium and hypo parathyroid levels were reported at that time.

Obstetric and birth history –

He is born to consanguineous parents (marriage in relation), both parents being first cousins. He is the third child. The first two deliveries were forceps deliveries and both are absolutely fine. Age of mother during conception was 30 yrs. Mental and physical health of mother during pregnancy was normal. There was no unusual stress or anxiety or any specific cravings/aversions.

Birth was full term, planned c-section delivery as it was breech presentation.  He was CIAB (cried immediately after birth).  His Birth weight was 2.4kg. There were no problems immediately after birth. Motor milestones were delayed like walking after 2 yrs. Speech monosyllables –after 3 ½ yrs, full sentences 5 ½ yrs, still pronunciations are not clear. Speech therapy was started at 5 yrs of age.

Family history of Diabetes mellitus and hypertension. His father was reported to be academically behind.

Behaviour in more detail –  He is obstinate by nature and will keep making demands. He shows aggressive behaviour towards both adults and children especially when prevented from doing something. He will throw tantrums, shout, run, irritates till his demands are fulfilled. Nobody can handle him outside. If he wants to see T.V. and somebody else is watching, he will shout so much that everybody will leave the remote. He likes to play outside, cricket football etc. and wants to do batting. If he sees that other children are not cooperating he will leave the game. If somebody beats him at home except mother, he will beat 4 times more and with great force. He is thin but his beatings are very strong. He likes cycling and does cycling so fast that others get scared and move away, but he is not bothered. No fears of dark, animals, being alone, etc. He always says no at first for any kind of work. Never obey instructions and never answers any question. He troubles his sister very much because she does not beat or shout at him and pampers him a lot.  At school there are many complaints about his behaviour. He could not read or write without the teacher’s personal assistance. He has no interest in reading, writing etc.

Our Observation –

He was reluctant to comply for instructions like answering questions, sitting on a chair, physical examination.  He was fidgety and restless. He was irritating his mother, asking her to leave the cabin and go home. He missed letters while writing his name. With lots of effort he could name all the days of the week correctly.  He did not have fluent speech.

Physical generals –

Perspiration: profuse, on full body

Hunger: cannot bear hunger

Liking for sweets and sugar

Thermals- Covering – bed sheet in both the seasons,

Fan – seasonal, bathing – seasonal

O/E—Ht-108 cm, Wt—16 kg.      Skin-lichen planus

 

 

Investigations:

• 7/o6/08    –   IQ  Assessment

Estimated mental age based ON RAVEN and SEGUIN GODDARD FORM BOARD TEST

Is 3.6 yrs and estimated IQ is 72 which is in the BORDERLINE RANGE

• BOHEMS TEST OF BASIC CONCEPT (BTBC) is below average level of concept formation for his age. His attention and concentration skills are below average.
• Oct-2010-REPORT BY DEVELOPMENTAL PAEDIATRICIAN— he  presents with delay in cognitive adaptive skills, higher order of language skill and fine motor skills. He also presents with signs and symptoms of ATTENTION DEFICIT HYPERACTIVE DISORDER.(ADHD)
• 26/7/2004   – Parathyroid ——–6.85pg/ml——-BELOW N
• 17/11.2007    parathyroid—–      16.3pg/ml——– (WNL)
• 16/10/2010—Thyroid level —-N
•                           Parathyroid ———–N
•                           Calcium———–N

Case analysis

Our clinical diagnosis – ADHD combined type

BORDERLINE IQ

Lichen planus

PRESENTING TOTALITY- apart from the symptoms of ADHD (that is restlessness, concentration poor), dullness at intelligence level and learning poorly, the most charachtriatic symptom is fearlessness – he does not have any fears or sense of danger. He is obstinate and screams a lot.  He was slow at learning to talk and walk.

Hence totality

Fearlessness

Speech slow learning to

Walk slow learning to

Answers refuse to -defiant

Obstinate- –shrieking

Phatak materia medica describes in Agaricus –Morose, self willed, stubborn, slow in learning to walk and talk and fearlessness. (Kindly read Allen’s encyclopaedia, chronic diseases and Hering’s guiding symptoms for the remedy reference)

Other symptoms are all covered by Agaricus like:

Restlessness, fidgety in children

Concentration difficult reading studying

Dullness in children, learning poorly

Hunger cannot bear

Lichen planus

Based on the presenting totality he was given Agaricus muscarius 200 from 22/6/10. (once in 15 days and later on once/month). He used to have occasional cold coughs which were controlled with Pulsatilla 200. From 5/11 he was on Agaricus 1m (monthly and later on once in 2-3 months)

Follow up after 1 year

His restlessness is much better. He can sit for studies, speech therapy, and school and in the clinic. He completes the task given. He follows instructions most of the times. His obstinacy has reduced, but he is a little moody at times. He is cooperative with us. He answers all questions, allows physical examination. He is now going to a special school. He copies from the board. His writing is improved and he can write from his memory. He can write an essay of 4 lines, can identify familiar images and write from his memory. He can write numbers up to 10 but with errors. His speech is improved, can speak in sentences, though his pronunciation is still not very clear.

His appetite has improved and there is constant gain in his height and weight.

Skin complaints (lichen planus) is completely better and only few white discolorations can be seen.

Psychological report says—23/8/11– ADHD quotient is 83—which shows below average. Possibility of ADHD. His behaviour in school and difficulty in remaining seated has improved. He copies from the board.

On 7/11—ht-114 cm   wt –18 kg

On 1/12-ht –117      wt-20kg

Treatment was irregular after Feb. 2012 and they stopped Rx after 8/12 as there were not much problems.

Follow up on March 2013

We evaluated him again on March 2013 for ADHD and informal assessment, though treatment was not going on since 8/2012.

Psychological Report says—16/3/2013—-Restlessness and impulsivity has reduced more from before. He can copy from board, can name objects and colours. He can do simple counting. He can do a few basic single digit additions without assistance. He can write 3 letter words and 4 letter words. He can copy a square but not a diamond. He can read short simple sentences with assistance

ADHD quotient–79 (reduction of 4 from previous report)

Overall patient has shown improvement in his hyperactivity, inattention and obstinate behaviour. He is more compliant now. His academics are improving. His general health is improving. His skin disease is no longer there. This patient will need continuous special education as he has borderline intelligence.