Homeopathy Papers

Global Developmental Delay  Holistic Evidence-based Homoeopathic Approach

Global Developmental Delay  Holistic Evidence-based Homoeopathic Approach

Dr. Neha Patel presents a plan for the holistic assessment and homeopathic treatment of developmental delay. Case analysis helps form an Essential Evolutionary Totality that leads to selection of the simillimum.

Definition

Global Developmental Delay is a term used to describe a developmental delay in children less than 5 years old in two or more of the following domains: gross/fine motor, speech/language, cognition, social/personal and activities of daily living.

Prevalence

Developmental disabilities are relatively common in children, with 5-10% prevalence. GDD is estimated to be prevalent in 1-3% children < 5 years of age.

Causes

Genetic causes
1.Metabolic syndrome
2.Down’s syndrome
3.Fragile X syndrome
4.Rett syndrome
5.22q11 deletion syndrome
6.Prader-Willi and Angelman syndromes
7.Neurocutaneous Syndromes
8.Leukodystrophy

 

Acquired causes 
Prenatal intrinsicCentral nervous system malformations
Metabolic
Prenatal extrinsicTeratogens/toxins (drugs of abuse, medications, etc.)
Infections
PerinatalAsphyxia
Prematurity
Intracranial haemorrhage
Neonatal complications
Birth trauma
Congenital Hypothyroid
PostnatalNeglect/psychosocial environment
Infections
Trauma
Toxins
Poor nutrition

Evaluation

Summary Chart from American Academy of Neurology Practice for evaluation of the child with GDD [1]

Holistic Evidence-based Homeopathic Approach to GDD

Problems to be addressed in the approach of GDD

The indefiniteness of the clinical condition makes it challenging to zero down the criteria for diagnosis which are uniform and which are comparable.

Thus the difficulties faced are:

1.Defining the condition and evolving objective criteria for accurate diagnosis and assessment of the nature of the problem 2. Understanding what is to be treated 3.Understanding the nature of case definition and the approach to be adopted to understand the child in his/her environment

1.Defining the condition and evolving objective criteria for accurate diagnosis and assessment of the nature of the problem:

Although in defining the condition only the delay in developmental domains is focused on, the holistic approach must define the problem as a whole. As the causes for such a challenging conditions are genetic or acquired in the prenatal, prenatal or postnatal phases, defining the problem at that level would help us evolve the objective criteria and assess the nature of the problem.

2.Understanding what is to be treated

Despite the guidelines given by Dr Hahnemann, still, at times the therapeutic approach adopted to treat such a condition is focused only on the distressing symptoms. Thus the aim is to treat the child who is sick, to take care of the disordered sensitivity – susceptibility complex.

3.Understanding the nature of case definition and approach to be adopted to understand the child in his/her environment

  1. Detailed case definition beginning from LSMC (Location, Sensation, Modalities, and Concomitant) including the Onset, Duration and Progress of the presenting manifestations.
  2. Investigating through
    1. Prenatal, perinatal, birth history –

Include questions about: pregnancy complications; maternal medical conditions; maternal use of medications, alcohol, tobacco, and illicit drug use during pregnancy; preterm or term labour; any complications during delivery; Apgar scores; duration of postnatal hospital stay.

  1. Postnatal history,

Any hospitalizations, surgeries, medical conditions, current medication use; any seizures or feeding difficulties

  • Developmental history
    1. Assess the child’s developmental progress in each of the Denver Developmental Scale categories
    2. Specifically, ask about any loss of milestones or developmental regression (couldsuggest neurodegenerative or metabolic disorder)
    3. Also ask specifically about the presence of any autistic features, i.e. poor eye contact, repetitive behaviours, or lack of appropriate social interaction.
    4. Ask about any co-existing behaviours, such as epilepsy, sleep disturbances, behavioural problems, and feeding difficulties.

iv.Psychosocial history elaboration and detailed family history (a pedigree of at least 3 generations), immunization history, history of suppression if any.

  1. Life space investigation of each patient through detailed case receiving, with special emphasis on the mother’s mental state during pregnancy and to understand the child in his/ her own environment.
  2. Examination :
    1. Weight and height (also look at growth charts) – for growth deficiency. (See our Height Calculator)
    2. Head circumference       –        for     microcephaly        or macrocephaly
  • Look for dysmorphic features – i.e. coarse facies, low-set ears, upslanting palpebral fissures
  1. Skin exam – for neurocutaneous lesions such as cafe-au-lait spots (neurofibromatosis) or hypopigmented “ash leaf spots” (tuberous sclerosis); findings over the spine/lower back can suggest spinal dysraphism
  2. Abdominal exam – for HSM (seen in storage disorders)
  3. Neurologic exam – for reflexes, tone, symmetry, strength
  • Also, observe the child’s spontaneous interaction with the environment and exploration of play opportunities
  1. Case processing, selection and administration of the simillimum based on the totality and susceptibility. The above data would help form an Essential Evolutionary Totality which would include the predominant features pertaining to qualified affect and mood, behavioural and sensory patterns, kinetic and regressive state, current mental state, sectors involved, which would help us form a Repertorial syndrome, which would give the group of remedies and Materia Medica is the final court. Assessment of the disorders sensitivity – susceptibility would help in the selection of the posology.
  2. Individual case-based parameter for assessment including subjective and objective symptoms must be prepared. It must include:

a.Developmental domains

  1. Gross/fine motor,
  2. Speech/language,
  • Cognition,
  1. Social/personal and
  2. Activities of daily living.
  1. Emotional response, behavioural and sensory patterns
  2. Kinetic and regressive states
  3. Associated complaints (intensity and frequency)
  4. Generals

 

  1. Further action would be as per the response accessed. Use of Objective parameter made and developmental scales would be helpful at this stage in the evaluation of the remedy response.
  2. Along with the medicine ensure to:
    1. Enroll child in an early intervention program
    2. Develop an individual family service plan (IFSP) if the child is <3

y.o.a, or an individualized education plan (IEP) if the child is older.

iii.Provide supportive services: physical therapy, occupational therapy, speech and language.

The Holistic Evidence-based homoeopathic approach would indeed help in managing the myriad problems that these children pose.

References:

  1. Practice parameter: Evaluation of the child with global developmental delay: http:///www.neurology.org/content/60/3/367.full
  2. Global developmental delay evaluation: Evidence-based approach: https;//pedclerck.bsd.uchicago.edu/page/global developmental delay evaluation- evidence-based approach.
  3. Neeraj Gupta M.D, Homoeopathic Approach for the Management of Symptoms of Autism Spectrum Disorder: A Four Years of Experience of Controlled Clinical Study Conference Paper December 2011, Conference: LIGA, At New Delhi.
  4. Praful M Barvalia, Effectiveness of homoeopathic therapeutics in the management of childhood autism disorder, 25th September 2014, Indian journal of research in homoeopathy.
  5. R. Mohan, A Clinical Study of the Role of Homeopathy in Cerebral Palsy Syndrome, Homeopathic Links 2005; 18(3): 149-152, available at https://www.thieme-connect.com/products/ejournals/10.1055/s-2005-

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About the author

Neha Patel

Neha Patel

Dr Neha Patel, M.D Homoeopahtic Psychiatry, Assistant Professor, Department of Case Taking and Repertory, Smt. C.M.P. Homeopathic Medical College, Consultant at Shree Mumbadevi Homeopathic Hospital and Homeopathic Psychiatric Consultant. Mumbai, Maharashtra, India. Dr. Patel studied at
Maharashtra University of Health Sciences, Dr M. L. Dhawale Memorial Homoeopathic & Research Institute, Chandaben Mohanbhai Patel Homeopathic Medical College and Mumbadevi Homeopathic Hospital. Her dissertation was on Psychosomatics of patients with Essential Hypertension and studying the emerging Homoeopathic remedy profiles. Dr. Patel’s research work has included exploring the role of homoeopathy in management of malnutrition in children and exploring the role of homoeopathy in children with cerebral palsy, learning disability and Attention Deficit Hyperactive Disorder.

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