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A Case of ADHD

Girl (S), 12 years of age. Presenting symptom: ADHD

First appointment 2.11.2012

f-adhd.jpgMother narrates:

S was first diagnosed with ADHD and received medicine in 2008. At first they gave her Ritalin, then Motiron, then Concerta, but none of the drugs worked very well. After the Concerta she became very quiet and introverted and now for a year she has been on 25 mg Strattera.

She came off the Concerta in the autumn of 2011. Before she came off it she had no facial expression, no happiness or sorrow. When she came off it she slept 13/14 hours a day and she would not go to school. She only receives the medicine in order to be able to concentrate. When she started on the medicine she lost weight and lost her appetite. She was on a protein drink for a year. On Concerta and the other 2 types of medicine she had diarrhea and headache. She does not get that on Strattera.

Before the medicine she was unable to concentrate or sit down for long periods of time. She could not play games or become absorbed in anything. If S had a friend over, she might suddenly lash out at her friend or hit her in her head with a doll. (Here the girl becomes very uncomfortable and does not want her mum to elaborate on it, and says that she herself cannot remember such episodes.)

We used to find it very difficult to get her to calm down and we spent ages to try to get her to fall asleep in the evenings.

(The mother never thought she would get pregnant.  Suddenly pregnant at 41. Very emotional during the pregnancy and had a lot of mood swings. The mother is not aware of family history of diseases. I asked if either she or her husband have had any venereal diseases. She has not, but was unaware if husband has had any and not comfortable about asking.)

Bronchial asthma at 18 months. She received medicine for that. The asthma stopped again when she started kinder garden at the age of 3. Sometimes S is very provocative and enjoys provoking her mother so that the mother becomes angry and upset.

Food poisoning on a few occasions.  Was admitted to hospital in 2006 or 2007 with what they then found to be Yersinia.

Great problem getting her to sleep.

Taking a lot of trouble regarding her looks. If she looks good the other kids cannot tease her.

She never undertakes anything before she is able to do it properly.

S wakes up with a headache that is worse on eating breakfast. She cannot describe the pain. (She has recently received braces for her teeth from her dentist. She has to wear them at night and they are increasingly tightened and the headaches have started since the onset of using the braces.)

S cannot listen to anybody who talks for a long period of time. She finds it very difficult in the classroom if the teacher has to explain anything in detail. She has to fiddle with something in her hands.

Troubled or restless when about to relax.

Very disturbed if she has to plan anything when about to sleep. If she is looking forward to a birthday party the next day for instance, then she cannot settle. She needs a lot of time to prepare herself for an engagement. She can become frustrated, sad and angry if she is actually looking forward to something.

Anticipatory anxiety. Expectations. A lot of expectations of herself.  She has to fulfill other’s expectations of her.

Started to do boxing in a sports club. Desires to hit things. A bit frightened of the dark. When she was younger she wanted total darkness when going to sleep.

Desires warm food. Brings her own cooked food, and heats it at school.

Hits on a particular kind of food. Eats that for a while and moves on to something new.  Very irritable when hungry.

She has a sleeping tablet (melatonin) nearly every evening in order to fall asleep.

Comment:

The mother has rung the clinic for about a year trying to find out about homeopathy, not being able to decide whether or not to start treatment. She would like S to come off the conventional medicine eventually, but is also very anxious about the homeopathic treatment. We discuss the fact that the first step is probably to stop the melatonin if the remedy works, but S is not willing to try that as she is very anxious about the whole sleeping ritual. I try to explain that we can see what happens when she takes the remedy and decide what to do according to S’s reaction. S is not certain she wants to take the remedy at all, and if it is going to affect her sleep, she thinks perhaps it is better to wait and take the remedy in the summer holiday next year. They are both very indecisive and we agree that I work on the case and they will go home and discuss whether to leave it all together. I stress, however, that if S does decide to take it, that it is important to come back in a month so that I know how the remedy worked in case she ever decides to have homeopathic treatment again. 

Objective:  S is a blond, skinny girl. She is very pale. She has a nearly white, see-through complexion. It makes her appear very frail. S does not want to have eye contact. She does not want to answer the questions. The mother does all the talking. She is very fidgety and keeps saying she wants to leave now.

 

Repertorization:

Mind, concentration difficult

Mind, concentration difficult- children in

Mind, spoken to; being-aversion

Mind, restlessness – children in

Mind, restlessness – sleep before

Mind, ailments from – anticipation

Mind, anxiety – anticipation; from – engagement; an

Mind, striking – children in

Generals, food and drinks – warm food – desire

Generals – heat- lack of vital heat

The repertorization was carried out entirely on mental and general symptoms. The reason for this was that S was not able to elaborate on her physical symptoms. I therefore decided to see which remedies most closely corresponded to her mental and general state and then peruse the materia medica to see if the remedy found also included her physicals.

It was necessary to bear in mind the asthma at 18 months and also the recurrent incidents of food poisoning especially the last attack which happened either in 2006 or 2007, prior to the girl’s ADHD diagnosis in 2008. The mother was unsure whether S’s mental symptoms had changed after the stay in the hospital where S had had a lot of conventional drugs to treat the symptoms.

START

To not confuse matters the symptoms of the headache in the morning were left out for now, as it seemed reasonable that the braces were the origin of that.

The remedies that came up on repertorization were : gelsemium, argentum-nitricum and medorrhinum.

Gels and arg-nit did not seem quite appropriate in this case. None of them would tend to be malicious as was the case with S before she begun the conventional treatment, nor would they normally display the provocative action towards her mother that still exists along with the desire she still has to strike. I did, however, consider the arg-nit or gels in case it may be needed acutely, i.e. to help S sleep or in case she had a strong aggravation from the constitutional remedy. Gelsemium and arg-nit both have diarrhea from anticipation and as Kent (1988, p.546) puts it in relation to gelsemium: “The anticipation brings on the diarrhea. Such is the state of arg-nit. These medicines are so closely related to each other that there are times when they will appear to do the work for each other.”  In arg-nit., however, one would normally expect to see a strong desire for sugar, sweets and salts and the person would tend to be worse from heat and better for cold which is not the case with this patient. Also an arg- nit person would tend to be much more outspoken and over- emotional as there is a weakening of the central controlling influence (Vithoulkas, 1995). It is quite the opposite in this case where the girl is very self-contained and controlling. In regard to gelsemium Kent (1988, p. 546) writes:”In lingering acute troubles and in those resembling the chronic it is very useful, but in chronic miasms it is not the remedy.” Also gels would tend to be worse for motion and have a hot head with the cold hands and feet. I have seen it work in chronic cases, but in this case I would tend to go for a deeper acting remedy first.

According to Kent (1988, p728) medorrhinum has a “fear of sensation,” and a “great difficulty stating her symptoms.”

Med also has a “changeable state of mind- one moment sad the next mirthful” (ibid).

Medorrhinum has of course the fear of the dark, but as importantly according to Kent (1988, p.229) they also have “nausea after eating,” and “agonizing pains in the stomach.”  Kent elaborates that “Children of a sycotic father are especially subject to attacks of vomiting, diarrhea and emaciation” and they look pale (ibid). Furthermore in medorrhinum there is a tendency to asthma in children of sycotic parents.

Catherine Coulter (1988, p. 207) has it that “it is possible that a sycosis miasm underlies “anxiety anticipating engagement”,  And she explains that talking or even thinking about his troubles only makes him worse.

Medorrhinum is well known for its extreme restlessness which is present also in arg-nit. In arg-nit, however, it is related more to a state of anxiety. In med. the restlessness is characterized by a strong inability to concentrate and to keep focused.

 

Prescription:

The mum phoned to say that they had decided to try the homeopathic treatment and see how it goes.

Med 1m evening and med 30c the following morning was prescribed and sent by post on 5.11.12

The posology was decided upon as there was a lot of pathology on the mental level, but also a lot of pain physically, so in my experience it is a very gentle way of addressing the whole system and to avoid severe physical aggravation as well as being more gentle on the mental plane.*

 

I talked to the mum about the possibility of buying some Bach Rescue Remedy to give S in the evenings instead of the melatonin if they decided to try to leave it out and she needed a substitute that did not antidote the remedy. We discussed the fact that S was afraid of the phase in which the sleep comes. She has never been accustomed to the transition of being awake to being asleep and that it was a part of the healing process to actually sense what happens, and that she might need help with that until she gets used to the actual process of falling asleep.

Follow up 30.11. 2012

Much more lively. She has laughed a lot more.

Had a headache.  Massive headache 8 days after taking the remedy. It was an old familiar headache and it lasted for 4 days.

No change in appetite. Still prefers warm food and white bread.

Has also eaten a lot of soft boiled eggs and rye bread.

She has not had so many mood swings and the irritability has not been a problem when she has not eaten.

During the last months she was invited to two birthdays and she was not restless or anxious beforehand. On the other hand she had to cancel boxing training twice as she did not feel like it. A couple of times she has shown that she was sad. She has cried on two occasions, and that is new. More sensitive, able to show her feelings, more brave in that way.

For 11 days we managed to get her to sleep on Bach Rescue Remedy. Twice she has had a melatonin tablet.

Diarrhoea just after taking the remedy. It squirted out in the night.

S does not want to come off her ADHD medication as she wants to be special.

Comment: Return of old symptoms; the headache and the diarrhea. At the same time S has been happier in herself and the mood swings have not been as severe and she has been able to sense herself, her feelings but also the transition from being awake to being asleep. On top of that her anticipatory anxiety is better.

The mother still does the talking, but S is a bit more attentive to the conversation. Still fidgety.

 

No Rx

Follow up 23.2.2013

I am fine.  Sleep is fine. She does not have to take anything to sleep anymore. In some ways it seems like she is more rested in less time. Still less mood swings. She is much more stable in herself.  She still needs us to be in the room with her when going to sleep during school days. Falls asleep at 22.30. Sleeps until 8 in the morning.

The last month it has become difficult for me to concentrate. It was better.  But not so worried about things anymore. And I do not want to be special in this way anymore. It does not matter anymore.

Not stressed last weekend when we were off to a new place we had never been before. More able to endure situations. Beforehand we could hardly go shopping. She became restless and wanted to go home. Can better stand external impressions. Does not want to go boxing so often anymore. She is in a better mood.

She can accept a “no” from her mother now. Before it would ruin her whole day if mother said “no” to something she had set her mind to. It is slightly easier for her to listen to other people. Still very difficult to get her going in the mornings.  She is extremely slow. Has to have a set time otherwise she does not do what she has to do. I am very sad that I cannot get going in the morning.

Still prefers warm food. Appetite is good, but very difficult to find something I like. Has become better at remembering practical stuff.

 

Comment: S is generally better. In fact, S even volunteered some information this time and answered some questions, but as her concentration had been better and had become gradually worse the last month I decided to repeat the remedy. She still wants to leave the clinic quite quickly.

 

Prescription:  Med 1m evening and med 30c the following morning.

 

Follow up 5.4.2013

Stomach ache on Saturday. She has a very sensitive stomach. Perhaps she swallowed too much water in the swimming pool. Nausea in the morning. Ice cold hands and feet. Became sad. Forehead warm to the touch. Wanted a hot water bottle on the stomach and on her feet. Very chilly in her body.

 

I have not suffered from headaches.  I have been able to recall things I had not been able to remember before. This has been a very nice experience and I have decided that I want to come off the medicine. We have discussed it with the psychiatrist and I have stopped the medicine today.  I sleep well now and I am happier. My appetite was a bit better before I got ill.  My balance is not so good. When I cycle I can only indicate with my right hand not with my left hand.

I am not tired during the day anymore. I am not angry. The happy girl has appeared in me. No mood swings.  I still have a problem with time. Time is my enemy. But despite of that my restlessness is better.  More outspoken. I am secure sitting here talking to you. Not so stressed and the tension in my neck has gone. Things are going reasonably well at school. Concentration is increased.

The majority of evenings she falls asleep on her own now. Mum or dad sits with her approximately once or twice a week now.

Comment: As she is still improving so no prescription is necessary, but watching symptoms closely as the conventional drugs stop working. Medorrhinum to give in case of a relapse.

 

No Rx

Telephone call 15.4.13

Stomach is worse. Diarrhoea. No appetite. Nausea when eating. Very sensitive at school. Restless. Going down hill.

Med 1m evening and med. 30 c morning.

 

Follow up 3.5.13

 

Going well.  My stomach is better. No diarrhea. A little nausea, but just on eating breakfast now. I feel more now. I can be very happy, but also sad now. But generally more happy.

She is more aware when the restlessness appears now. When it comes she goes into the garden and jumps on the trampoline. That makes her feel better. We have been to a parental meeting and the teachers say she is doing better. She is engaged in the classes now. She has, however, become a bit more teasing. This was how she used to be before the medication. Beforehand it was worse though. The teachers said if it did not get worse than this, then they would be able to cope with it. The teachers were surprised that she can suddenly sit quietly, absorbed in solving difficult equations.

One day last week she played with Lego for 4 hours nonstop with her dad. That has never happened before. The last couple of weeks S has been able to concentrate for more than an hour on several occasions. It is easier for S to get out of the house in the morning and go to school. Suddenly, wants to cycle to school by herself.  Sleeps now every evening on her own.  Appetite a lot better. Has put on 4.5 kilos

 

No rx

Telephone call 27.5.2013

Terrible headache at the weekend. Generally going downhill, difficulty concentrating.

 

Med 1M and med 30c repeated

 

Follow up 3.6.2013

No headache since the weekend before the 27.5

 

I am able to concentrate again. Better at keeping focused.

It was my birthday so a little unsettled. But it was fine having visitors. Mum had discussed with her the fact that she should not act as a “policeman” during her birthday, deciding what her visitors should or should not do. That went quite well.

I want things done my way. Sometimes because it annoys me how it is done otherwise.

Mum thinks that S is less controlling at home generally.  Accepts things in a different way. A bit more relaxed about things. One of her birthday presents was broken when she un-wrapped it. In the past she would have been in a state about it, but it was actually okay.  More outgoing. More energy and balance  One of the teachers views her as a completely normal positive girl with drive.  S does not consider herself to be a girl with problems anymore. No pain in the stomach. No nausea. Eating loads.  Bp more stable and lower when measured at the psychiatrist’s.  Psychiatrist discharged S. The psychiatrist said she was a completely different girl she saw, so she did not need to come anymore.

Objectively: She has a sparkle in her eye.

 

Follow up 23.8.2013

Concentration better, but more difficult in the afternoon, the last 2 lessons at school.

No nausea  No stomach pain. Sleep is fine Can use both arms when cycling now. More balanced. More daring. Challenge my own capabilities, but therefore also have more accidents.

Mum thinks it is positive as S is not so controlling anymore. Things go wrong as well, but S takes it well. She still expects high standards. She has to look perfect especially at school. In the school holidays she did not have to look perfect all the time. Wore casual clothes and did not bother about her hair. More relaxed about her looks and other things.

When I am at school I have to be aware of every little detail, and be in control.

Schoolwork also has to be perfect. I wear mascara every day. It is important as one is allowed to wear mascara at 13, then one has to wear it. I cannot explain why. Now, it is much easier to get up in the morning. Now I even wake up mum sometimes. Manage everything on my own in the morning. I won’t go as far as to say that I sing in the morning, but I do not have conflicts with my mum as I used to and I manage okay. My self confidence is fine. I think I look nice. A lot of the other girls at school admire me, and I like that.  The sensation in my brain has changed. I am not tired and have to keep going in order to keep the brain going.

I do not have a sensation of restlessness in my body anymore.

 

No Rx

Telephone call 13.9.2013

S had a bad stomach ache at school. The school gave her a painkiller and straight after that she vomited. Headaches have returned again. Feeling tense and more frequent stomach aches.

Med 1M and med 30c repeated

Follow up 25.10.2013

Had the flu a couple of weeks ago. Recovered after a week, but since then have felt my symptoms returning. Can have severe stomach pain and nausea. Also a feeling that the symptoms of the ADHD have returned. Headaches have returned too.

Sudden presentiment of death. Thought I was going to die. Thought my guinea pig was going to die. Thinking about death (an old symptom- has had that on and off in the past). Sometimes I find out why I am sad, but I cannot remember, and I do not want to talk about it.

This year I do not box. I think it is boring. Have decided to sing in a choir instead. I am not as cold as I used to be. I am not so cold in bed either. Do not sleep with as much clothes as I used to and also not so sensitive to weather changes.

Comment: The medorrhinum did not have the same effect last time as it used to, and her symptoms have returned after the flu, so it is time to change the potency as the medorrhinum is still indicated.

Medorrhinum 10M and med.50c

Follow up 5.12.2013

After the remedy a little bit of headache, but that has disappeared.

No stomach pain No restlessness No anxiety I have not thought about death. Sleep is fine. I do not need to sleep as early as before. No anxiety before sleep. Concentration is okay, but if the other pupils distract her she is easily led astray.

Comment:  For the first time, S opens up and we have a very constructive talk about the fact that S is very concerned about her mathematics classes. She cannot live up to her teachers’ expectations of her and that angers and worries her. We actually have a conversation with all three of us together, where S describes her feelings and needs. As she is explaining the way the mathematics teacher puts pressure on her she weeps. Afterwards she says she feels better as it has been playing on her mind for a very long time. The mother and S agree on a way they can put the problem to the school to try to take some of the pressure off S.

The case is still ongoing, but from being on medication, and despite of that, not being able to concentrate, having a lot of anxiety, and not thriving, S is gradually growing up and becoming able to live her life, sensing both herself and life around her as well as becoming aware of her own needs and limitations. While this is happening her concentration and sleep are improving.

 

References:

Coulter, C.R. (1988) Portraits of homoeopathic medicines (vol.2), California, North Atlantic Books

Kent, J. T. (1988) Lectures on Homoeopathic materia medica (reprint), New Delhi, B.Jain Publishers

Vithoulkas, G. (1995) Materia medica viva (vol.2), London, homeopathic book publishers

*Method taught by Anthony Bickley at The British School of Homoeopathy