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Clinical Cases

Two Cases of Autism Spectrum Disorder with Delayed Speech

Dr. Vanita Rajiv Johari shares two brief cases of autism spectrum disorder with delayed speech.

Autism, or autism spectrum disorder (ASD) is understood to be a lifelong, developmental condition characterized by challenges with social skills, repetitive behaviours, speech and nonverbal communication. The description and understanding of autism has changed over the decades and could change in future years as we comprehend more.

Autism prevalence as available in statistics may not be correct, as many autistic people might not have been identified. As autism understanding has grown, the estimated prevalence has also changed; particularly more so after the Covid pandemic

The current framework for diagnosing autism identifies two main groups of characteristics. The first concerns social communication and interaction: autistic people find it hard to interact socially with others or to make friends. They have communication difficulties.

Some can’t speak at all; others develop speech later than usual; others can speak perfectly well, but have problems with the social aspects of communication. I have seen many cases of ASD with speech delay, where the child had apparently normal development, but developed regression in growth following exposure to long hours of screen time due to lock-down.

The second group of characteristics is ‘non-social’: autistic people tend to have narrow or unusual interests, such as acquiring lots of information about just one type of dinosaur or penguins! They often repeat the same activity, ranging from constantly rocking backwards and forwards or flicking the fingers, to always eating the same foods, or repeatedly watching the same video. These traits are collectively known as restricted and repetitive behaviours and interests.

Finally, most autistic people also have unusual sensory responses, such as being overly sensitive to particular sounds, sights or smells, or quite the opposite, for instance being insensitive to sensory inputs such as pain. They do not have any sense of impending danger when they leap from heights.

Children with ASD develop at different rates in different areas of growth. They might present with immense delays in language, social, and cognitive skills, while their motor skills might be about the same as other children their age.

They might be very good at things like putting puzzles together or solving computer problems, but not be apt at some things most people think are easy, like talking or making friends. A child may be able to say many words, but later stop talking altogether.

Leo Kanner described neglectful parenting as the cause of Autism in his paper “Autistic Disturbances of Affective Contact”, attributing cold, distant parenting to be responsible for behavioural and emotional problems in children. “Refrigerator Parenting” theory supported by Bruno Bettelhelm, also endorsed poor parenting as a cause of Autism.

ASD like other neurodevelopmental disorders is fundamentally syphilitic in nature. The failure to develop the structure and/or function of the neural tissue signifies the destruction of normal processes of mind and intellect thereby suggesting a predominantly syphilitic state which may have started during fetogenesis.  Thus, a probe into the mother’s mental state during pregnancy can provide an answer to the origin of such syphilitic processes which cause neurodevelopmental anomalies.

The treatment of ASD in homoeopathy varies from case to case. Depending on factors such as the causative emotions, miasm, susceptibility, constitution, personality traits and physical generals, a constitutional medicine is prescribed to stimulate the growth and function of the neural tissue. Such individualized homeopathic treatment offers an improved prognosis in cases of neurodevelopmental disorders.

TWO CASES

I’m sharing, two cases of mild to moderate autism with speech delay. The mother’s history during pregnancy helped in arriving at a constitutional remedy for the patient. Early exposure and prolonged use of screen time due to lock-down during the Covid pandemic seem to be responsible for onset of ASD in both cases.

Case – 1

Name- Miss Z N C

Age- 4 years   Sex- Female   Religion- Islam

Occupation- Nursery school

Date of consultation-30/10/2021

CHIEF COMPLAINTS

K/C/O Autism Spectrum Disorder, diagnosed in 2020 at 3 years of age by consulting neurologist. CARS SCORE – 38 suggestive of Mild- Moderate Autism

Baby ZC was apparently normal, reacting and responding to parents till the age of 18 months. There was history of overuse of mobile phone during lock-down. After the lock-down was lifted, the child stopped responding to being called altogether and did not speak at all. Her speech is delayed, she attempts to utter words but with great difficulty. Words said are incomprehensible.

No H/O hyperactivity

No H/O fall or injury to the brain

No H/O birth trauma

Associated complaint: Tendency to recurrent colds. Pain in throat with dry cough

PHYSICAL GENERALS

Appearance – tall, lean dark complexioned with fine eyelashes

Appetite- Good cannot tolerate hunger. Likes- Egg3+, Cheese3+, Chicken+

Dislikes – Vegetables. Thirst- 1litre/day, normal tap water, small quantities at short intervals

Dairy milk causes Urticaria. Urine – NS. Perspiration- Profuse on scalp.

Sleep – 8 hours/night, no specific position, no habits during sleep. Can do with less sleep

CHILD DEVELOPMENT & GROWTH

Delivery – Vacuum suction delivery – swelling over left side of head

Talking – Delayed

Walking – 15 months.

MENTAL CHARACTERISTICS DERIVED FROM LIFE SITUATIONS

Baby ZC stays with her parents and a younger brother. Is obstinate, conveys her demands by taking the parent to the desired object.  She is very restless, cannot sit in a place. Her latest fad is to be taken on rides on her father’s two- wheeler. Parents mentioned that though she has not developed on her speech yet, but she is bright and has good memory for things related to her.

She apparently had normal progress in her growth and development till the age of 18 – 20 months. After this Covid pandemic broke down and parents got busy. She was exposed to gadgets and family did not interact with her for most part of the day. It was noted that she stopped responding to being called after this and her speech was delayed.

Mother’s mental state during pregnancy

Child’s mother had had a miscarriage in her first pregnancy, so she was very cautious regarding everything in this pregnancy. Also, during the 8th month of her pregnancy her sister-in-law died following post partum complications. Sudden shock3+ due to this incident.

Mother had grief2+ about sister- in-law’s death. She was anxious3+ all the time since this incident. Her frequent queries were “Who will look after SIL’s child? Who will look after my child if I die?” Fear of death2+ – Fear that she will also die during or after delivery like her SIL.

Dreams during pregnancy – Dreams as if she is paralysed in the dreams- “I want to speak something in my dreams but cannot. Want to move but cannot”. Felt helpless and paralysed during dream. Had frequent dreams of snakes2+  during pregnancy.

GENERAL REACTIONS

Thermal state – Hot. No reaction to noise, light, height, bus riding, though she enjoys long drives on two wheelers.

DIAGNOSIS – Autism Spectrum Disorder and recurrent upper respiratory infections

First prescription:  Before starting with treatment, it is necessary to understand the soil, the very dyscrasia of the person, and the miasm, which represents the stigma, groove or pollution in the system, which can only be corrected through constitutional, anti-miasmatic treatment.

This not only removes the surface symptoms but also the corresponding miasmatic dyscrasia, which was being manifested on the surface at that time. Once the outer layer of the dyscrasia is removed the second layer is revealed.

Dr. Kent guides us here, stating that there now has to be a change in the plan of treatment. The totality of the case needs to be reassessed and the next prescription selected on the basis of the totality of symptoms. The remedy selected should not only cover the symptomatic totality as manifested through the surfacing of symptoms in the outermost layer but also the miasmatic totality. We can see traits of ‘Tubercular dyscrasia’ in the following symptoms

  • Restlessness, variability/changeability, anger
  • Mentally as well as physically variability or changeability
  • Desire to travel.
  • Intellectually keen.
  • Fear of apprehensionto lose something.
  • Constant hunger
  • Fear of animals
  • Recurrent infection, pharyngitis, tonsillitis.

PRESCRIPTION:  The case was opened with Tuberculinum

          Rx: Tuberculinum 200 III DOSES.  SL 30 BD for 2 weeks

 First follow up on 29/1/22.  Speech improved- SQ. Cough better. General – Normal.  Case was further understood especially with respect to mother’s state during pregnancy. Constitutional totality is as shown in the reportorization below.

Borland has pointed out in “Borland’s Children types” that there will be a history of delayed development in the Natrum Mur child, particularly when the child is slow in learning to speak. It may also have been slow in starting to walk but that is not nearly so constant. Often the Natrum Mur child’s speech is faulty.

There are only three remedies in the rubric `Grief, silent’, Ignatia along with Natrum Mur and Pulsatilla; but whereas Ignatia is basically a hysterical patient, Natrum Mur. uses hysteria as a channel for emotional discharge.

Ignatia is the “acute” of Natrum mur.  The two remedies are closely allied, especially in the mental and nervous spheres. Sadness, tearfulness, nervous sensitiveness, alternation of opposite moods, hysterical faintness, numbness, and ailments due to strong emotional disturbances are common to both.

Ignatia and Natrum mur, are very efficacious in melancholia, particularly after any shock, grief or bereavement when patients are very much depressed, moody, always brooding, sigh and sob but do not like to speak or to be spoken to.

Nat. mur is the chronic of Ignatia. Certainly, the emotional Natrum family shows the effects of emotional strain or shock as much as Ignatia.

Rx: Natrum Mur1 M tds was prescribed as constitutional remedy. Parents were advised to continue with therapies she was receiving.

DATE

 

22/2/22

 

 

 

12/3/22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31/04/2022

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

16/4/22

 

 

 

 

3/5/22

 

 

 

 

14/7/22

 

 

 

 

 

28/7/22

 

 

18/8/22

 

 

 

3/09/2022

 

 

 

 

 

 

 

 

                               FOLLOW UP

 

Speech improved ->>- Speaks words better than before

NC- Cries on waking up in the morning

General – Normal

Speech improved ->>- Can speak 3-4 words at a time.

Generals – Normal

CARS Assessment

1.     Relationship with people – 1

2.     Imitation- 2

3.     Emotional response – 2

4.     Body use – 1

5.     Object use – 1

6.     Adaptation to change- 2

7.     Visual response – 2

8.     Listening response – 2

9.     Taste-Smell-Touch response and use – 3

10.            Fear and Nervousness- 1

11.            Verbal communication- 3

12.            Non-verbal communication – 3

13.            Activity level – 2

14.            Level & consistency of intellectual response -3

15.            General impression – 2

TOTAL – 30

 

Speech improved ->>-

Crying in the morning – SQ-

CARS ASSESSMENT

1.     Relationship with people – 1

2.     Imitation- 2

3.     Emotional response – 2

4.     Body use – 1

5.     Object use – 1

6.     Adaptation to change- 2

7.     Visual response – 2

8.     Listening response – 2

9.     Taste-Smell-Touch response and use – 3

10.                        Fear and Nervousness- 0

11.                        Verbal communication- 2

12.                        Non-verbal communication – 2

13.                        Activity level – 2

14.                        Level & consistency of intellectual response -2

15.                        General impression – 2

TOTAL – 26

 

Follow up

Speech improved->>-

Behaviour – good

Visual and listening response ->>

Follows commands

Speech improved->>-

Behaviour – improved

Visual and listening response ->>

Follows commands

Speech improved ->-. She replies in full sentences now.

Behaviour- improved. She has started going to school and mixing with other children.

Follows commands

Communication with people ->>-

Activity much better

Overall 50-60% better

Gets scared easily since last 15 days. 15 days ago, school bus driver forgot to pick her up from school. Since then she gets scared easily and gets up at night and cries.

Overall better. Generals – normal

Self talking ->- 60%

Communication has improved but unable to form full sentences

Generals – normal

Obstinacy – -<-

CARS ASSESSMENT                                                             TOTAL- 4

1.     Relationship with people – 0

2.     Imitation- 0

3.     Emotional response – 0

4.     Body use – 1

5.     Object use – 0

6.     Adaptation to change- 0

7.     Visual response – 0

8.     Listening response – 0

9.     Taste-Smell-Touch response and use – 0

10.            Fear and Nervousness- 0

11.            Verbal communication- 1

12.            Non-verbal communication – 1

13.            Activity level – 1

14.            Level & consistency of intellectual response -0

15.            General impression – 0

 

4/10/2023                                                   Tub 1 M III doses

Has started attending normal school

CARS ASSESSMENT

1.     Relationship with people – 0

2.     Imitation- 0

3.     Emotional response – 0

4.     Body use – 1

5.     Object use – 0

6.     Adaptation to change- 0

7.     Visual response – 0

8.     Listening response – 0

9.     Taste-Smell-Touch response and use – 0

10.Fear and Nervousness- 0

11. Verbal communication- 0

12.Non-verbal communication – 0

13.Activity level – 0

14.Level & consistency of intellectual response-0

15.General impression – 0

 

TOTAL – 1

She was regular in her follow ups till date and has progressed in her speech, communication and vocabulary.

Her last CARS assessment done in November 2022 was 0. She does not exhibit any traits of ASD any longer.

    PRESCRIPTION

 

Nat mur 1M tds x 14 days

 

 

 

Nat mur 1M tds x 14 days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stramonium 1 M III doses

 

 

 

 

 

Nat mur 1M tds x 14 days

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Natrum mur 1M tds x 14 days

 

 

 

 

Natrum mur 1M tds x 14 days

 

 

 

 

Natrum mur 1M tds x 14 days

 

Stramonium 1M tds x 14 days

 

 

Natrum mur 1 M tds

 

CASE 2

A 3 -year-old male patient was brought to our OPD by his parents on 10/09/22 with C/C of restlessness since infancy. His parents complained that he cannot sit in one place for more than 1-2 minutes and he also troubled his teachers for the same. He has short span of concentration. He use to constantly change videos on YouTube. He fails to respond to his name and behaves indifferently with his parents.

His development was normal till 1 yr of age after which his parents started noticing his withdrawn behaviour.  His parents also complained that he has stopped speaking/making any attempts to speak since lockdown.

During the lockdown he was confined to his room and both his parents continued to attend work. He had no interaction with anyone. His mother has recently quit her job to be with him.  He only calls out for mother or father when he needs something.

He could recognize colours and followed commands well. Because of poor verbal expression he use to point out his needs through gestures. He imitates the tune and sound of nursery rhymes or any song that he hears. He makes sounds of conversation or sings continuously for a long time.

He does not attempt to talk at all. He had no fear of strangers and used to run around and touch things whenever they would go outside on roads, shops etc. No desire for any toys, food, chocolates etc. Surprisingly, he had excessive possessiveness for his car toys. He cannot bear anyone touching him or any kind of stickiness or dirt on his hands or clothes and wants to get rid of it immediately.

As observed by mother, he would start laughing suddenly without any apparent reason. Mother is worried that he never asks for any food and can do without eating if not fed.  Annoying obstinacy in behaviour is seen in the form of banging his head on the door in anger. He also had obsession with his pillow and blanket and would play with those all day in solitude and would refuse to part with them.

O/O – Physical hyperactivity and no eye contact on communication.

On investigation the ISAA Score was 97 and he was diagnosed with Mild Autism.
Totality :-
1) Mind : Asks for nothing
2)Mind : Indifference
3)Mind : Restlessness
4) Mind : Absentminded
5) Mind : Obstinate
6) Mind : Thoughts persistent
7) Mind : Fearless
8)Mind : Company aversion to

Indications for Rheum :
1) Indifference, Indolence, dislike to conversation.
2) Restlessness
3) Impetuous desire for particular objects.
4) Obstinate

Rheum is suited to children with dentition problem associated with sourness. Rheum has many symptoms characteristically seen in those falling in the Autism Spectrum Disorder. Some of them are:

  • Silence, nothing makes an impression on him; Silent and sulky.
  • Does not like to play with other children
  • Not inclined to talk much, ​asks for nothing
  • M -INDISPOSITION to PLAY [in children], Require very little sleep, Does not eat much food, he cannot eat much because they become repulsive.
  • Talking nonsense.
  • Gloomy, cannot continue long at an occupation.

He was prescribed Rheum 200 tds for 15 days.
On first follow up 15/10/22 his parents reported that his concentration level had increased and his restlessness was better. He also attempted to speak a few words and there was improvement in his anger.

He was prescribed Rheum 200 tds again for 15 days. On 1/11/22

The patient was better and there was further improvement in concentration level although the there was no further attempt at speaking new words. Rheum 1M tds was prescribed.

Patient‘s mother has quit her job to be with him and she believes that he is suffering because they had neglected him completely during lockdown. During his last visit he was reported to have improved considerably in response to being addressed as well as he attempted to talk. Efforts of Mother along with regular therapy and Rheum brought remarkable changes in patient’s speech and communication. Parents discontinued treatment after 4 months due as they shifted out of town.

Lessons from the case:

  • As described in Spirit of Homeopathy by Dr Rajan Sankaran “Rheum is placed in the Materia Medica between Magnesium carbonicum and Chamomilla. Magnesium carbonicum is the orphan child who demands nothing, who needs little sleep and little food. On the other hand, the Chamomilla child is not being given any attention even though his parents are in the house. Rheum is the child who is orphaned sometimes and at other times needs to demand attention. It is like the children whose parents are away for work but are also sometimes present in the house; when they are at home the child demands their attention”.
  • Correlating to the above situation of a typical Rheum child we can see the initial theory of origin of Autism as seen by Leo Kanner, where he called attention to lack of warmth among the fathers and mothers of autistic children. In a 1949 paper, Kanner suggested autism may be related to a “genuine lack of maternal warmth”, noted that fathers rarely stepped down to indulge in children’s play, and observed that children were exposed from “the beginning to parental coldness, obsessiveness, and a mechanical type of attention to material needs only…. They were left neatly in refrigerators which did not defrost. Their withdrawal seems to be an act of turning away from such a situation to seek comfort in solitude.

BIBLIOGRAPHY

1) The Diagnostic & Statistical Manual of Mental Disorders, 5th edition.

2) Kaplan & Sadock’s Synopsis of Psychiatry

3) Websites – www.medscape.com & www.mentalhelp.net

About the author

Vanita Rajiv Johari

Dr Vanita Rajiv Johari M.D. (Hom) and MSc, is a classical homeopath, teacher, life coach, trained counselling psychologist and an artist at heart. She graduated from the prestigious CMPH Medical College Mumbai in 1989. She is Professor and HOD of Homoeopathic Materia Medica, at her Alma mater pursuing her passion for healing and teaching for more than 30 years. Her speciality interests are paediatrics and psychiatry. She strongly believes that homoeopathy is a unique combination of art and science. Dr Johari is an ardent writer and has contributed many articles in various national and international journals. She is an exceptional orator and has flair for making materia medica come alive during her lectures at various national and international platforms.

2 Comments

  • Why Natrum MUr 1M was given TDS on a continued basis instead of giving it for a day and waiting for recovery

    • Good question, Dr. Patil. It seems clear that in the education of homeopaths nowadays, study of our founding books, like The Organon by Samuel Hahnemann, is not given high priority. For example, to Hahnemann, all remedies should be in water with 2-10 succussions before each dose. In chronic disease, potencies should start low and be raised slightly at suitable intervals. A striking improvement means stop dosing and wait, as does an aggravation mean stop dosing. The doctor here was taking a big risk, prescribing so high and so often.

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