Homeopathic Treatment as an Aid to Inclusive Integration of Children with Autism Spectrum Disorder

A Retrospective Study Report of 20 years of Clinical Experience in the Treatment of Children with Autism

Abstract

• Background:One of the main areas of concern for parents of children diagnosed with Autism Spectrum Disorders (ASD) is in dealing with the educational needs of the child. Children with autism (Homeopathy Treatment for Autism) have a number of issues that make it difficult for them to do well in a regular school set up. Although neuropsychological therapies help deal with these issues, it is a long-term process. Many mainstream schools do not have the appropriate resources or staff to help provide therapies or support for children with autism while in a busy school setup especially in India.Homeopathic treatment at this stage may not only help speed up the process of integration but also help children who are already integrated to continue being part of the mainstream. This paper is an attempt to retrospectively look at how homeopathic treatment has helped children with autism get integrated into mainstream schools and also how homeopathy could contribute to help deal with issues faced by these children while at school.
• Methods:An informal before and after quasi experimental study design was used. This involved both quantitative analysis and qualitative observation.A non-probability purposive/convenience sampling method was applied. This is a retrospective study of homeopathic clinical case studies of forty children with ASD seen by this author in private practice (both direct and online consultation) over the past 20 years, who were on homeopathic treatment and were integrated into mainstream schools.
• Results:The quantitative analysis found that there was a statistically significant reduction in the mean Autism Treatment Evaluation Checklist (ATEC) scores of children after the homeopathic treatment (33.17) when compared with the scores before starting the homeopathic treatment protocol (78.15). The retrospective qualitative analysis of the children who were integrated into mainstream schools found that there was an improvement in areas that could help them be part of a regular school setup such as better communication skills, reduction in hyperactivity, better concentration and focus, better peer group interaction, better group learning abilities, team work, compliance and ability to follow instructions.
• Conclusion: Homeopathic treatment is a promising approach in helping children with autism spectrum disorders reach an optimal level of functioning and in helping them integrate into the mainstream.

Keywords: Autism Spectrum Disorder; Autism; Inclusive Integration; Homeopathy for Autism

INTRODUCTION

Integration of children with Autism Spectrum Disorder (ASD) or autism (the two terms have been used interchangeably throughout to mean the same syndromic presentation), into the regular mainstream of education has been found to be a challenge in most parts of the world. This is especially true in the case of a vast and diverse country like India with different cultures and value systems.Inclusive integration into regular schools is difficult to achieve due to a number of different factors. Many of the schools do not have the resources or manpower to accommodate children with special needs into the mainstream setup. In many cases children who are attending a regular school program may not be able to continue due to a number of different reasons including attention deficit, communication skill deficits and sensory issues. Although this is true of most countries, this is more so the case in a country like India.

The three major barriers to an effective integration of children with ASD are communication difficulties, hyperactivity and social skill deficits including poor group interaction, difficulties with group activities and problems with carrying about instructions as part of a group rather than on a one to one basis. In the course of a clinical practice over the last 20 years this author had the opportunity to see children with autism across the spectrum ranging from mild, moderate to severe. The children seen also had different levels of communication skills, social abilities and sensory issues. Some of them were high functioning, some low functioning, some of them were verbal, some non-verbal. In most of the cases the major concern for parents was that the child should reach an optimum level of functioning that could facilitate their integration into society as independent individuals who could manage on their own. All the children with autism referred to the clinic were already undergoing various neuropsychological therapies or attending a special school. Despite this there were persistent issues such as sensory issues, communication difficulties, behavioural issues and even physical complaints that could not be resolved and had prompted the parents to seek other alternative therapies including homeopathic treatment.

Generally, the term inclusive integration of children with autism or other types of developmental difficulties is used in the context of integration into a regular school setup. In the context of this paper the term inclusive integration is used not just to mean integration into a regular school but also societal and familial integration. The children with autism included in this study are not just children who were able to be integrated in terms of educational integration but also children with autism who were already in an integrated educational program but had social skill deficits or other issues such as behavioural or sensory issues due to which the parents could not continue with their normal social activities or were contemplating changing or removing the child from the school. The qualitative reports explain these issues and how homeopathic treatment in conjunction with other therapies helped these children.

ETHICS STATEMENT

This is a retrospective study based on clinical practice of this author. The information was collated from case reports already available. There is no identifiable information used in this study. Homeopathic treatment was given to children after informed consent of the parents who had voluntarily consulted this author.

MATERIALS AND METHODS

This study is a retrospective look at the author’s database of homeopathic clinical case studies of children with Autism Spectrum Disorder (ASD). Parents usually approach this author after a complete evaluation of their child has been done either by a developmental paediatrician, a child psychiatrist or a clinical psychologist that confirmed the diagnosis of autism.

Over the past 20 years of clinical practice from 1998 to 2018, the major portion of which involved seeing children with developmental disabilities, this author had occasion to see more than 300 children with ASD.Most of these 300 children showed significant progress with homeopathic treatment when seen through qualitative observations by the author, reports from the teachers and by the parents themselves.  The children who were on therapies or going to a special school were regularly evaluated by their speech therapists, occupational therapists or child psychologists where progressive changes could be seen in the children based on the evaluation reports. There have been many instances of children being integrated into the mainstream. One of the difficulties of keeping track of the child, to know if integration has happened, is that parents stop coming for follow-ups once the child reaches a level of functioning according to their expectations or when they get admitted into a regular school setup. Once this happens, follow up evaluation is also not possible as parents usually stop taking their children for therapy sessions or evaluations. In such instances   reports that certify the child as neurotypical or reduction of scores such as the Childhood Autism Rating Scale(CARS) to the non-autistic range are not available.

In this study 40 children who were regularly followed-up and where the parents were in touch with this author even after they were attending a regular school program were selected. There have been instances especially in children with autism who are on the severe end of the spectrum where inclusive integration is not possible in spite of the improvements seen in communication skills, sensory integration, social skills and reduction of behavioural issues due to a number of other factors. There are also some instances where children remain at the same level in spite of being on therapies and homeopathic treatment for a long period of time.

In this paper there is first a brief overview of the symptom pictures of the children with autism from the homeopathic perspective. This is followed by the main remedies used and the changes seen in these children. The pre-treatment and post treatment scores of the children are reported in the next section followed by the statistical analysis of the same. This is followed by sample qualitative case reports and a summary of the results.

HOMEOPATHIC CLINICAL CASE STUDY AND SYMPTOM PICTURE TABLE

Homeopathy is based on the principle of “Similia SimilibusCurantur” or like cures like. This postulates that substances that can cause symptoms in a healthy individual are used to cure the same symptoms in a diseased individual. To find the matching remedy requires a detailed history-taking and clinical case study by the homeopath. The homeopath looks at what is known in homeopathic parlance as the “Peculiar, Queer, Rare or Strange Symptoms” (PQRS), in each particular case, in order to find the matching remedy or the simillimum.  An explanation of the principles of homeopathy including the case taking process can be found in another research paper by this author “Healing Autism with Homeopathy in Synergy with Other Therapies (Rajalakshmi, 2015).

Homeopaths look at the individual variations in each particular patient even in the common symptoms that help distinguish one individual from the other and also to help find the appropriate remedy. For example, if a child has a trait of getting upset easily, the homeopath will try to find if the child is better with consolation or feels better when left alone. This qualifies the symptom and also makes it easier to select the remedy as there are different remedies for better with consolation and worse with consolation. This is just a small example of the detailed case history that needs to be taken to find the suitable remedy for each child.

The following table is a brief overview of the psychological and physical symptoms of the children with ASD as elicited from a homeopathic perspective of PQRS.

Table 1:

Sl. no.	INITIALS,GENDER,AGE, DIAGNOSIS	PQRS-PSYCHOLOGICAL SYMPTOMS	PQRS-PHYSICAL SYMPTOMS
1	AG- Male (M) -4 years 5 months – ASD	Expressive Speech absent, Better interaction with adults, crying refused things when, better consolation Loves playing in water, likes riding in cars, trains or buses, Prenatal stress in the mother during pregnancy, is ok with noisy and crowded places, knocking things with knuckles	Frequent tendency to catch cold, Tendency to recurrent boils and rashes, chewing on indigestible things like paper, cloth etc. desires chips and chocolates, perspiration-head, hands and feet
2	AN- Female (F) -4years 10months-ASD	Sound sensitive extreme, anger with hitting and beating when spoken to in a loud voice, speech wanting, using 2 words at a time, laughing spells of with cheerfulness alternating with spells of irritability with temper tantrums	Headache, worse from change of tone, shrill sounds, reprimands from, constipation, desires spicy and salty food, ice creams, cold things
3	AS-M-2 years 9months- ASD	Sensitive offended easily, crying, pulling hair, throwing things when angry, better consolation, speech wanting, receptive and expressive uses 5-6 words, anger contradiction from, otherwise mild and cheerful, sound sensitive to mixer, toilet flushing, vacuum cleaner, closes ears, hair cutting and nail cutting difficult	Blowing and spitting cannot do, desires milk, chocolates, juicy fruits, does not like to touch sticky foodstuff, cannot tolerate sitting in swings or slides
4	AM-M-3years 9months-ASD	Speech regression probably from emotional trauma, transition difficult, sensitive to change of tone, rudeness, weeps easily, consolation aggravates confidence wanting, fear of insects, likes playing with sand, drawing, painting, gardening	picky eater, reduced food intake, aversion to head bath due to sensory issues, dry skin, tendency to dermatitis, decreased thirst, past h/o severe constipation, perspiration more on head and hands
5	AT-M-2years 8months-ASD	Sensitive, weeping easily, Sensory issues- will cry if blindfolded for games in school, fixated on spoons and Cars, Hyperactive, Poor Sitting Tolerance and Attention Span, Poor eye contact, No expressive language skills,Does not use gestures or pointing	Constipation, Dislikes Sticky food especially Bananas, Pica-Craving for Raw Rice
6	AH-M-2years 9months- ASD	Humming, makes sounds but no words, fear of injury, tapping, beating refused things when, likes to play with water, sand, rolling objects with fingers, likes music-soft melodies, cannot spit, sensitive to haircut, nail cutting and brushing	Bowel movements immediately after food, has to rush to the toilet, desires spicy and salty food, chips, vegetables, lentil soup, aversion to sweets, biscuits, milk and curd, head sweating, increased thirst, allergic to eggs
7	DK- M – 5 years -ASD	Eye contact poor, biting self when angry or when forced for activities, weeping reprimands from, like to play with light switches, curiosity makes him excited and hyperactive	Will not pass motion when outside, nocturnal enuresis, thirst for small quantities at small intervals
8	CD-5years 4 months- ASD	Timid, fearful, cannot see cruelty, clenching of fists and tightening of facial muscles, stiffening when afraid, sensitive to noise especially when people screaming and fight, squishes insects, pushing other children, fear of dark	Desires sweets, ice creams, chips, cold drinks, frequent tendency to catch cold, poor appetite, head sweating at night
9	PR- M – 4years 11months – ASD	Speech regression, poor attention span, focus good for activities of interest, restless runs about and jumps, likes travelling, sudden screaming or shouting while doing activities, crying refused things when, consolation aggravates, stimming fingers with, prefers playing with older children	Picking of lips, desires rice, sweets, ice-cream, wants to eat all the time, aversion to milk, sleep delayed, teeth grinding
10	DY-M-2 years 6 months -ASD	Speech regression of, hyperactive, poor eye contact, crying refused things when, better consolation, fear of loud sounds occasional, likes playing with, water and sand, listening to music, likes cars, poor response to commands, thumb sucking, moody, poor sitting tolerance	Perspiration more on face, occasional constipation, not toilet trained, likes crunchy food
11.	PN- M – 5 years 4 months -ASD	Echolalia, speech only on prompting, hyperactive, restless, throwing things against the wall, uses single words, lost in own world, likes hugging and cuddling, jumping, spinning, likes to put light switches on and off, mouthing, biting, responds when called for preferred activities, capricious, fear of dark and thunderstorms	Frequent tendency to catch cold, dry cough, desires sweets, chocolates, spicy food, sour curds, aversion to milk and vegetables, dermatitis in the legs, diarrhea occasional, head sweating
12	SK- M – 4years 6months-ASD	Speech regression of, speaks 3-4 word or small sentences but on prompting, wants parents to be with him but will not interact, crying when forced to do things, throwing things, banging the door, beating others when upset, separation anxiety, better rapport with older children, shyness, fears firecracker sounds, balloons and fire, rigid routines	Low immunity with frequent attacks of viral fever, likes sweets, fried food, curd and milk
13	SB- M – 8years 8months-ASD	Poor fine motor abilities, speech regression of, uses 2-3 words occasionally, no sense of danger, aversion to haircut, loud sounds like crackers, blowing of the conch, disinclination to mingle with unknown people, sensitive offended easily with weeping, lethargic, fear of being in the dark, likes looking at picture books	Cannot tolerate extremes of heat and cold, likes spicy and salty foods, cold drinks, will eat salt directly, aversion to meat, fish and eggs, sweating more on the head, palms and feet, Increased appetite
14	VJ- M – 3years-ASD	Poor expressive language ability, speaks 2-3 words, poor response to parents, attention span good only for preferred activities, good self-help skills, throwing things, biting pillows when upset, wants to be hugged and consoled when upset, like to watch lights go off and on	Constipation episodes of, lack of focus during these episodes, frequent episodes of conjunctivitis, pica, peels wall plaster and eats it, desires spicy, hot food and sweets, likes sour food, likes to suck raw lemons
15	SD- M – 2 years 5 months – ASD	Speech delayed, uses single words, delayed development, microcephaly, poor response to commands and name, sensitive to haircut and nail cutting, likes to play in the swing and slide, pacing up and down, cannot suck, spit or blow	Sleep disturbed, frequent tendency to catch cold with watery coryza, hard stools, desires spicy food, wheat products, vegetables and milk, aversion to fruits curd and buttermilk
16	SN-F-4years 10months-ASD	Speech regression of, uses single words or gestures to communicate, obsession with spinning things, round objects red colors, curious, constantly climbing up and sown staircases, like to go upside down in the swing, poor attention span and focusing ability, plays with saliva, likes to apply cream and powder to the face	aversion to food with certain textures spicy food, past history of bronchitis, teeth grinding while asleep, cannot bear the sight of blood, fear of darkness, constipation, bowel movements on alternate days, desires chocolates, chips, biscuits
17	TS-F-7years-ASD	Verbal but no meaningful communication, self-talk when idle, uses 2 words, need-based communication, mood swings, adamant, self-willed, good memory, watches other children play but will not join them, fear of coconuts, cautious, fear of injury	Appetite poor, very limited choice of foods, will eat only crunchy foods and curd, constipation, flatulence with, aversion to milk, rice, vegetables, thirst increased, sleep disturbed
18	TV-F-3years-ASD	Speech-regression after major LRT infection, loves to dress up, fear of dogs, travelling desires, wants to go out, likes to play in the swing and slide, good memory and grasping capacity, poor focus and attention span, no stranger anxiety, Mouthing objects	Delayed dentition, poor appetite, desires chocolates, biscuits, food needs to be mashed, aversion to food in general, frequent tendency to catch cold, head sweating, ability for sustained physical activity
19	KV-M-4years- ASD	Speech wanting, uses gestures to communicate, intelligent, good at task completion, hyperactive good with numbers, stubborn, cheerful, cannot tolerate contradiction, consolation aggravates, aversion to black color, fear of the dark, curious, tears paper when unoccupied	Previous history of poor sleep patterns, desires curds, milk, salt, sugar, hearing acute sense of, tendency to catch cold with coryza and mild LRT infections
20	BV-M – 3years-ASD	Poor expressive and receptive language ability, tries to use single words when prompted, likes to look at picture books, play with water and on the swing, ride on tricycle, sensitive to loud sounds and change of tone, shouts, screams and clenches fists when angry, sometimes lost in his own world, tendency to lie on the back and move backwards, jump, Indifferent if parents leave	Feels better in winter, occasional nocturnal enuresis, head sweating, desire sweet, sour and spicy food, aversion to fried rice, fruits and curd, cough with wheeze and nasal obstruction
21	AV-5years 3months-ASD	Speech poor, few words on prompting, sensitive offended easily, weeping with worse when consoled, does like others to sing unfamiliar songs, like cycling, playing in water, aversion to haircut and nail cutting, spinning, looks at the fan more when nervous, cannot tolerate pressure cooker and conch shell sounds	frequent tendency to catch cold, allergic rhinitis, desire for salty food, oily food and chocolates, picky eater, aversion to sweets, heat of palms and foot
22	SM- M – 4years- ASD	Head banging mild-reprimands from, uses single words, fear of drum sounds, certain songs, learns at his own pace, loves open spaces, prefers playing with adults, want people around but will not interact	Appetite average, desires sweets, oily fried food, curd, wheat and milk products, aversion to spicy food and vegetables, midnight hunger pangs
23	SK- M – 2 years 7 months -ASD	Lack of eye contact, poor grasping capacity, poor expressive and receptive language, plays with other children, poor sitting tolerance and attention span, likes playing in water, likes building blocks, watching songs on TV, screaming, throwing things when angry, sympathetic, cries when he sees other children crying, sensitive to shrill sounds, tactile sensitivity to fur clothes	Want to eat independently, likes sugar, sweets and milk, bowel movements on alternate days
24	AY-M-2 years 7 months – ASD	Speech wanting, use gestures, poor response to commands, poor receptive language ability due to lack of attention span, social with known people, playful, throwing things as a game, capricious, head banging and spitting when angry or when refused things, does not want to be carried when upset	Past history of febrile convulsions at 18 months, heat of head and feet, desires salty, spicy food, sweets, milk. Fried snacks, allergic to milk causes rashes, frequent tendency to respiratory infections, Increased thirst
25	JN- M – 2years 6months- ASD	Speech wanting, regression, developmental delay, occasional use of gestures and pointing, head banging occasional, crying when refused the things he wants, better consolation, likes playing with spoons and cups, shyness, hides when he sees strangers, good memory and grasping capacity	Frequent tendency to lower respiratory infections, nose block, emaciated, lack of appetite, perspiration more on head, skin dry and rough with itching-more on hands, feet and abdomen, fanning desires, does not want blankets while sleeping
26	RH-F-5years-ASD	Speech difficult, poor expressive language, sensitive impatient sympathetic, does not like to be spoken to in a loud tone, sensitive to criticism, restless, has to walk around, retorts back when reprimanded, crying when upset, has to be left alone, like doing puzzles, climbing, screams suddenly in the middle of classroom activities	Thirst decreased, desires salty food, cold food, head sweating
27	RN-M-4years 8months-ASD	Need-based communication, uses 2-3 words only on prompting, hyperactive when idle, screaming, impatient, friendly demeanor but no social interaction, crying refused things when, consolation aggravates, likes playing in the swing, playing with water, solving jigsaw puzzles, spinning, irritability in crowds, separation anxiety when father is away	Sleeps light, wakes up from slight sounds, desires sweets, tea, chips, groundnuts, dry fruits, tendency to mouth ulcers, aversion to fruits, juices and milk, frequent tendency to catch cold with nasal obstruction and thick coryza
28	SR-M-9years-ASD	Poor expressive language ability, screaming contradiction from, wants to be appreciated, curious, laughing spells of, anxious, fear of loud sounds, startled easily, lost in his own world, likes drawing and coloring, emotionally sensitive weeping with	Constipation occasional, sleeps late, heat intolerance of, desires salt, chocolate, chips, pizza, aversion to vegetables, tendency to cough with high fever, past history of diarrhea alternating with constipation
29	TJ- M – 4years-ASD	Poor expressive language ability, has started using single words and gestures to communicate recently, like to explore, do puzzles, cycle, writing numbers and counting, likes to play in the park and be around people but no social interaction, shows attachment to family members, attention seeking, screams when upset	Frequent tendency to catch cold with cough and nasal obstruction, fever with head hot and cold hands and feet, desires sweets, head-sweating, face becomes red when heated, constipation
30	JB- M – 5years9months-ASD	Speech-Regression of, uses few words on prompting, Restless, Better Consolation, Stacking, Escape Desire to, Poor attention span, Sound sensitive-loud sounds to, spinning, likes playing with sand	Constipation, hard stools, passes on alternate days, dry skin, likes spicy food, chocolates, fried food, better in cool climates, poor fine motor abilities
31	VK- M – 3years 4months-ASD	Poor expressive language, uses 2-3 words but out of context, likes playing in water, wants to be hugged, attention and focus only for preferred activities, spinning cars, sometimes sings first 2 words of a song, screaming and crying, better consolation, sensitive to loud sounds such as firecrackers, sensitive – offended easily, poor response to commands	Likes cookies, nuts, biscuits, wafers, aversion to vegetables, fruits, does not like wet and slimy stuff, sleeps late after 1 am, poor appetite
32	HR- M – 5years 6months-ASD	Poor expressive language ability, apparent deafness, poor response to commands and name calling, lost in his own world, weeping and throwing things, worse consolation, wants to be left alone when upset, prefers to play in open spaces, likes music, hyperactive, jumping, fear of firecracker sounds, does not want to be alone but poor social interaction	Lack of appetite, does not ask for food,desiressweets, chocolates,chips, apples, pancakes, aversion to rice and fruits, cannot tolerate heat, worse in summer
33	SY- M – 5 years 8 months – ASD	Speech wanting, regression with, no stranger anxiety, poor task completion, likes writing, likes playing in the slide, swings, cycling, doing jigsaw puzzles, fascinated by words, likes writing words, pinching and scratching when upset, hyperactive, inquisitive	Adenoids, frequent tendency to catch colds with nasal obstruction and allergic rhinitis, snoring,thirst increased, desires rice, lentil soup, milk, curd, chocolates, aversion to vegetables, certain type of sweets
34	HV- M – 4years-ASD	Speech wanting, continuous weeping, no response when called, irritated in crowded places, biting and scratching when irritated, lack of sense of danger, possessive about his things, fastidious about placement of his things, likes to play in water, laughing spells of, sensitive to haircut and brushing teeth, fear of balloons	Increased appetite, Desires sweets and cold food or drinks, thirst decreased, frequent tendency to catch cold, tendency to dry skin with decreased perspiration, skin rashes
35	AL- M – 3years-ASD	Poor expressive language ability, humming, curious, screaming excited when, problems with fine motor abilities, humming, tendency to bite and head banging when angry, fear of sitting in the swing, loves to travel especially by bus or three wheelers, pulls or hugs children	Past history of hard stools, teeth grinding while asleep, tactile sensitivity, does not like the sensation of sand on the feet, desires sweets, chips, jaggery, milk and curd
36	DS- M – 4years 7months-ASD	Poor expressive language ability, delayed echolalia, sensitive to haircut, poor sense of danger, tactile sensitivity, cannot bear to be touched, does not like getting wet in general but likes to play with water while bathing, likes riding in cars, cycling, enjoys watching children play but will not join them, spells of causeless weeping	Fungal infection of the skin, desires bananas, vegetables, eggs, aversion to apples, bowel movements regular, sleep sound but takes time to go to sleep
37	PV- M – 3years 6months-ASD	Poor expressive language ability, speech regression of uses small sentences on prompting recently, will not share his things, stubborn, manipulative, self-willed, possessive, good memory and grasping capacity, fear of darkness, sensitive to loud noises	Constipation-bowel movements on alternate days, frequent episodes of respiratory infections with coryza, cough and high temperature with febrile convulsions, thirst absent, perspiration decreased, tendency to body heat, desires chocolates, sweets and juices, tendency to agglutination of eyelids
38	SC- M – 2years 3months-ASD	Speech wanting, Poor eye contact, No response to name calling, Shouting and laughing for no reason, poor focus, obsessed with gadgets, prefers to be alone, causeless weeping, likes to listen to music and watch rhymes on T.V.	Toe-walking, sleep disturbance, constipation, fussy eater, limited choices in food,
39	AR- M – 2years3months- ASD	Lack of expressive language, tightening facial muscles when excited, obsessed with cars, sensitivereprimands to temporary regression with, prefers visual cues rather than auditory, watches T.V but fear of certain ads or pictures closing eyes with,	Frequent tendency to catch cold with coryza and cough, desire s cakes, crispy food, juice, sweets, milk, thirst decreased, perspiration more on head, sweating while asleep
40	AA- M – 7years-ASD	Jumping and screaming excited or happy when, Lack of Expressive Speech, uses 2-3 words,Likes playing in water, jigsaw puzzles, music, restless, pacing about, fear of dark, sensitive to loud sounds, anger refused things when, pinching, pulling hair, consolation aggravates	Thirst increased, desires milk-based sweets, toilet trained, sleep sound, perspiration normal

 MAIN HOMEOPATHIC REMEDIES USED AND CHANGES SEEN

The following table (Table 2) gives a brief overview of the main remedies that were used for each child along with the approximate period of time that they were on homeopathic treatment and the improvements seen in their presentations. The children were reviewed once a month and the remedy for each child was either changed or continued based on the assessment and current symptom picture of the child. The homeopathic remedies were given in a regular dosage. The potency selection was based on the level of sensitivity of the children.  The time period of homeopathic treatment after which major changes were seen is mentioned. Many of the children continued to be on homeopathic treatment as a supportive measure for some period of time. The children were on a series of different remedies based on the presenting symptoms. They were also given homeopathic remedies for their acute symptoms. Only the main remedies used are listed here. The changes seen have been compiled from parent reports during follow ups, school reports shared by the parents and observations by the treating physician.

This section is followed by a section providing brief descriptions of some of the main homeopathic remedies that were used.

Table 2:

Sl. no.	INITIALS,GENDER,AGE, DIAGNOSIS	MAIN REMEDIES USED (TIME PERIOD)	CHANGES SEEN
1 1	AG- Male (M) -4 years 5 months – ASD	Puls, Silicea, Lycopodium, Agaricus (1year)	Reduction in hyperactivity, better social interaction, better expressive language ability, has started to imitate,
2	AN- Female (F) -4years 10months-ASD	Belladonna, Staphysagria, Nux Vomica, Sepia(1 year)	Reduction in sound sensitivity, throwing, beating reduced considerably at home, she is trying to ask questions, considerable reduction in constipation, reduction in one sided headache
3	AS-M-2 years 9months- ASD	Silicea, Calcarea Carb, Zincum Met, Belladonna (1year)	Improvement in expressive language ability, uses sentences reduction in hyperactivity, sensory issues, better comprehension and school performance
4	AM-M-3years 9months-ASD	Pulsatilla,Belladonna, Stramonium,Agaricus (18months)	Improved language ability, able to express himself well, more confident, good social interaction, good understanding capacity, improved performance in school in reading and writing
5	AT-M-2years 8months-ASD	Belladonna, Calcarea Carb, Agaricus (18 months)	Improvement in speech, attention, socialization,he socializes with other children by speaking little words, running, playing, Learning subjects well in school
6	AH-M-2years 9months- ASD	Belladonna, Calcarea Carb, Silicea (1 year)	Improvement in  expressive language ability,Started writing without support, improved social skills, interacts with peers, improvement in appetite and sleep patterns, better social skills, peer interaction
7	DK- M – 5 years -ASD	Nux Vomica, Staph., Glonine, Stram. (18months)	Improvement in language, speaks small sentences, better social skills and interaction, improved sleep, reduction in constipation, improved attention span and focus, better understanding
8	CD-5years 4 months- ASD	Silicea, Calcarea Carb, Stramonium (18 months)	Reduction in destructive behavior, is gentle with insects, does not squish them like before, better expressive language, less fearful, more confident
9	PR- M – 4years 11months – ASD	Pulsatilla, Belladonna, Stramonium (1 year)	Reduction in temper tantrums, aggressive behaviors, better expressive language ability, uses sentences, reduction in hyperactivity but runs about to play, good eye contact and social skills
10	DY-M-2 years 6 months -ASD	Calcarea Carb, Pulsatilla, Agaricus, Silicea (18 months)	Started using sentences to communicate, able to sit for longer periods, better performance in school, better eye contact, good response to commands
11.	PN- M – 5 years 4 months -ASD	Lycopodium, Belladonna, Ars Alb, (1year)	Reduction in aggression, throwing things, improved language ability, able to write independently, better performance in school, still bangs things against the table but in a playful way
12	SK- M – 4years 6months-ASD	Pulsatilla, Calcarea Carb, Lycopodium (1 year)	Has become talkative and playful, good observer, no anger or stubbornness, improved task completion, attention and academic performance in school.
13	SB- M – 8years 8months-ASD	Natrum Mur, Calcarea Phos, Nux Moschata, Lycopodium (18 months)	Improvement in expressive language, reduction in episodes of causeless laughing, improvement in sleep patterns, better attention span and focus
14	VJ- M – 3years-ASD	Pulsatilla, Calcarea, Lycopodium, Colocynthis(18 months)	Reduction in hyperactivity, improved eye contact, reduction in episodes of abdominal pain and constipation, speech improved, has started to use sentences with 3 or 4 words, good report from school
15	SD- M – 2 years 5 months – ASD	Calcarea Carb, Agaricus, Silicea (2 years)	Developing normally, increase in eye contact, reduction in hyperactivity, better understanding, memory and grasping capacity, using small words to communicate, better attention span
16	SN-F-4years 10months-ASD	Hyosycamus, Stramonium, Staphysagria (1 year)	Reduction in hyperactivity, better eye contact, improvement in speech, uses sentences but incompletely, improved school performance and attention
17	TS-F-7years-ASD	Stramonium, Lac-caninum, CoffeaCruda, Lycopoodium (1year)	Reduced self-talk when unoccupied, reduction in obsessive behavior, less anxious, improved attention span, improved school performance, tries new foods, bowel movements regularized
18	TV-F-3years-ASD	Calcarea Carb, Pulsatilla, Belladonna, Bacillinum (Intercurrent) (1 year)	good improvement in expressive language ability, is able to speak complex sentences, improvement in appetite, dentition completed, going to an integrated school, immunity has to improve
19	KV-M-4years- ASD	Lycopodium, Pulsatilla, Ars. alb (1 year)	Spurt in expressive language ability, has joined an integrated school, improvement in social skills, eye contact, attention, good performance in school, hyperactivity still persists but reduced from previously
20	BV-M – 3years-ASD	Belladonna, Calcarea Carb (1 year)	Improvement in expressive language, asks for things he requires, improved eye contact, shows interest in watching children play, more patient, improved writing ability
21	AV-5years 3months-ASD	Pulsatilla, Silicea, Nux Vomica, Natrum Sulph (18 months)	Improvement in speech, uses sentences, better social communication, regular bowel movement even if there is changes in sleep and eating schedule, reduction in obssesive behaviors, reduction in allergic rhinitis, better immunity
22	SM- M – 4years- ASD	Belladonna, Lycopodium, Silicea (1 year)	Noticeable reduction in head banging, has progressed to using sentences to communicate, improvement in learning but has to be allowed to learn at his own pace, integration into a regular school
23	SK- M – 2 years 7 months -ASD	Calcarea Carb, Silicea(1year)	Noticeable improvement in expressive language ability, improved eye contact and attention span, still needs focus to complete tasks has been able to join an integrated school
24	AY-M-2 years 7 months – ASD	Pulsatilla, Silicea, Agaricus, Bacillinum (Intercurrent) (1 year)	Started using small sentences to communicate, cheerful, improved pretend play, better eye contact, improved sitting tolerance and compliance, appetite has to improve, sleep sound but delayed
25	JN- M – 2years 6months- ASD	Silicea, Pulsatilla, Calcarea Phos, Natrum Mur(1year)	Improvement in speech, sudden spurt in expressive language, better response to commands, improved social skills, has become more interactive, still prone to episodes of fever with cough and cold
26	RH-F-5years-ASD	Pulsatilla, Calcarea Carb, Belladonna, Silicea (18 months)	Is able to sit in class, improvement in spontaneous speech and clarity of speech, more complaint, is able to participate in school activities without getting overwhelmed, better attention span
27	RN-M-4years 8months-ASD	Pulsatilla, Belladonna, Agaricus (18 months)	Reduction in hyperactivity, improvement in understanding and grasping capacity, improvement in expressive language ability, speaks in sentences, doing well at school, impatience persists
28	SR-M-9years-ASD	Pulsatilla, Aethusa, Kali Brom, Agaricus (1 year)	Anxiety reduced but still persists, improvement in communication, speaks few lines, tries to narrate, reduction in laughing spells, improvement in learning ability, restlessness at certain times
29	TJ- M – 4years-ASD	Belladonna, Ars. Alb, Stram, Agaricus (1 year)	Improvement in expressive language ability, reduction in episodes of crying, better immunity, improved attention span and eye contact, hyperactivity reduced but still persists, reduction in anxiety
30	JB- M – 5years9months-ASD	Stramonium, Silicea, Lycopodium, Agaricus(2years)	Improved communication in school but speech still not spontaneous, need improvement in writing ability, fine motor skills, better eye contact, attention span, improvement in academics, social interaction better but need improvement
31	VK- M – 3years 4months-ASD	Pulsatilla, Belladonna, Silicea, Kali Carbonicum (18 months)	Improvement in receptive and expressive language ability, use small sentences, more responsive, follows commands, still screams when forced to do work, social skills better but needs to improve
32	HR- M – 5years 6months-ASD	Lycopodium, Silcea, Staphysagria, Belladonna (18 months)	Improved sitting tolerance, reduced hyperactivity, speech improved but still not spontaneous, improved response to commands, good memory, better social interaction with peers
33	SY- M – 5 years 8 months – ASD	Calcarea Carb, Staph, Stramonium (1year)	Improvement in expressive language but need-based and on prompting, good response to commands, better understanding and eye contact, stubbornness persists, improved bowel movements, appetite and sleep
34	HV- M – 4years-ASD	Belladonna, Zincum Met, Lycopodium, HeparSulph  (18 months)	Improvement in expressive language, speech is more meaningful, has started asking questions, improved academic performance in school, shows interest in participating in school activities, better peer group interaction, eye contact, attention span and writing ability
35	AL- M – 3years-ASD	Belladonna, Kali Carb, Staphysagria (1 year)	Reduction in hyperactivity but still persists in unfamiliar surroundings, better understanding, improvement in expressive language ability, uses sentences but on prompting or when he needs something, improved pretend play and imitation
36	DS- M – 4years 7months-ASD	Pulsatilla, Agaricus, Kali Carb, Lycopodium, Silicea (18 months)	Improvement in expressive language ability, has progressed to complex sentences, improved writing ability, better social interaction, reduction in obsessive behaviours, better eye contact and attention span
37	PV- M – 3years 6months-ASD	Pulsatilla, Calcarea Carb, Lycopodium, Natrum Carb (18 months)	Good improvement in speech language and communication skills, has become very talkative, good social interaction with peers, improvement in writing ability, concentration and focus, improved school performance
38	SC- M – 2years 3months-ASD	Pulsatilla, Belladonna, Kali Carb, Argentum Nitricum (1 year)	Improved verbal skills, reduced hyperactivity, better eye contact, tries to mingle with other children, good response to commands, better sleep patterns, more cheerful and engaged
39	AR- M – 2years3months- ASD	Calcarea Carb, Pulsatilla, Staphysagria (1 year)	Improvement in spontaneous communication, asks questions, better eye contact, attention span improved, has been integrated into a regular school, more confident, immunity has to improve, prone to bouts of fever with cough and cold
40	AA- M – 7years-ASD	Belladonna, Calcarea Carb, Pulsatilla, Silicea (1 year)	Improvement in communication, is able to use complex sentences, has started going to school, improved writing ability, better attention span,focus and eye contact, improved appetite, bowel movements and sleep patterns

BRIEF DESCRIPTIONS OF THE MAIN REMEDIES USED

The following is a brief overview of the main homeopathic remedies that were used. Remedies for physical complaints and acute episodes were given as and when required. Only the psychological and certain relevant aspects of the symptom picture of the remedies is excerpted from the “Lectures on Homeopathic Materia Medica by James Tyler Kent” and the “Homeopathic Materia Medica by William Boericke” which are two classic and authoritative references. The actual symptom picture of each remedies is very vast and includes the psychological symptoms and physical symptoms of each anatomical system in great detail.

1. AgaricusMuscarius(Toad Stool-Bug Agaric)

“Great changeability, irritability, mental depression and complaints which come on from overexertion of the mind and prolonged study. The brain seems to be developed tardily. Children are late in learning to talk and walk, thus combining the features of two remedies, Natrum muriaticum, which has the symptom “late learning to talk,” and Calcarea carb.,which has the symptom “late learning to walk.” Children with twitching and early fainting, nervous girls prior to puberty who have convulsions from being scolded, from excitement and shock; late in mental development.Children who cannot remember, make mistakes and are slow in learning. Nervous patients who on going over their manuscripts find out their mistakes in writing and spelling.The condition of the mind is one in which they are slow to grasp ideas. Difficulty in coordinating the movements of the muscles of the body. Incoordination of brain and spinal cord.” (Kent)

2. Belladonna(Deadly Nightshade)

“Great children’s remedy. Epileptic spasms followed by nausea and vomiting. Patient lives in a world of his own, engrossed by specters and visions and oblivious to surrounding realities. While the retina is insensible to actual objects, a host of visual hallucinations throng about him and come to him from within. He is acutely alive and crazed by a flood of subjective visual impressions and fantastic illusions frightful images; furious; rages, bites, strikes; desire to escape. Loss of consciousness. Disinclined to talk. Perversity, with tears. Acuteness of all senses. Changeableness.” Complaints from Apoplexy at birth.”  (Boericke)

Adapted to persons who are lively and entertaining when well, but violent and often delirious when sick. Sensitive, nervous, threatened with convulsions. Great liability to take cold. Sensitive to drafts of air, especially when uncovering the head. Worse from having the haircut. Tonsils become inflamed after riding in a cold wind Belladonna is the acute of Calcarea, which is often required to complete a cure. (summarized from combined sources)

3. Calcarea Carbonicum(Carbonate of Lime)

“This great Hahnemannian anti-psoric is a constitutional remedy par excellence. Its chief action is centered in the vegetative sphere, impaired nutrition being the keynote of its action, the glands, skin, and bones, being instrumental in the changes wrought. Increased local and general perspiration, swelling of glands, scrofulous and rachitic conditions generally offer numerous opportunities for the exhibition of Calcarea. Gets out of breath easily. A jaded state, mental or physical, due to overwork. Easy relapses, interrupted convalescence. Persons of scrofulous type, who take cold easily, with increased mucous secretions, children who grow fat, are large-bellied, with large head, pale skin, chalky look, the so-called leuco-phlegmatic temperament; affections caused by working in water. Great sensitiveness to cold; partial sweats. Children crave eggs and eat dirt and other indigestible things; are prone to diarrhea. The Calcarea patient is fat, fair, flabby and perspiring and cold, damp and sour.Apprehensive, worse towards evening, fears loss of reason, misfortune, contagious diseases. Forgetful, confused, low-spirited. Anxiety with palpitation. Obstinacy; slight mental effort produces hot head. Averse to work or exertion.” (Boericke)

4. Hyoscyamus Niger (Henbane)

“Disturbs the nervous system profoundly. It is as if some diabolical force took possession of the brain and prevented its functions. It causes a perfect picture of mania of a quarrelsome and obscene character. Inclined to be unseemly and immodest in acts, gestures and expressions. Very talkative, and persists in stripping herself, or uncovering genitals. Is jealous, afraid of being poisoned, etc. Its symptoms also point to weakness and nervous agitation; hence typhoid and other infections with coma vigil. Tremulous weakness and twitching of tendons.Muscular twitchings, spasmodic affections, generally with delirium. Non-inflammatory cerebral activity. Toxic gastritis.Very suspicious. Talkative, obscene, lascivious mania, uncovers body; jealous, foolish. Great hilarity; inclined to laugh at everything. Delirium, with attempt to run away. Low, muttering speech; constant carphologia, deep stupor. Feels light and confused. Vertigo as if intoxicated. Brain feels loose, fluctuating. Inflammation of brain, with unconsciousness; head is shaken to and fro.” (Boericke)

5. Kali Carbonicum(Carbonate of Potassium)

“The weakness characteristic of all Potassium Salts is seen especially in this, with soft pulse, coldness, general depression, and very characteristic stitches, which may be felt in any part of the body, or in connection with any affection. All Kali pains are sharp and cutting; nearly all better by motion. Sensitive to every atmospheric change, and intolerance of cold weather. Early morning aggravation is very characteristic. Sweat, backache, and weakness. Throbbing pains. Tendency to dropsy. Tubercular diathesis. Pains from within out, and of stinging character. “Giving-out” sensation. Fatty degenerations. Stinging pains in muscles and internal parts. Twitching of muscles. Pain in small spot on left side. Despondent. Alternating moods. Very irritable. Full of fear and imaginations. Anxiety felt in stomach. Sensation as if bed were sinking. Never wants to be left alone. Never quiet or contented. Obstinate and hypersensitive to pain, noise, touch.Backs and legs give out. Uneasiness heaviness, and tearing in limbs and jerking. Tearing pain in limbs with swelling. Limbs sensitive to pressure. White swelling of knee. Tearing in arms from shoulder to wrist. Lacerating in wrist-joint. Limbs go to sleep easily. Tips of toes and fingers painful. Soles very sensitive. Itching of great toe, with pain. ” (Boericke)

6. Lycopodium Clavatum(Club-Moss)

“In nearly all cases where Lycopodium is the remedy, some evidence of urinary or digestive disturbance will be found. Corresponds to Grauvogle’s carbo-nitrogenoid constitution, the non-eliminative lithemic. Lycopodium is adapted more especially to ailments gradually developing, functional power weakening, with failures of the digestive powers, where the function of the liver is seriously disturbed. Atony. Malnutrition. Precocious, weakly children. Symptoms characteristically run from right to left, acts especially on right side of body, and are worse from about 4 to 8 pm. Intolerant of cold drinks; craves everything warm. Best adapted to persons intellectually keen, but of weak, muscular power. Deep-seated, progressive, chronic diseases. Emaciation. Debility in morning. Marked regulating influence upon the glandular (sebaceous) secretions.  Lycopodium patient is thin, withered, full of gas and dry. Lacks vital heat; has poor circulation, cold extremities. Pains come and go suddenly. Sensitive to noise and odors.Melancholy; afraid to be alone. Little things annoy, Extremely sensitive. Averse to undertaking new things. Head strong and haughty when sick. Loss of self-confidence. Hurried when eating. Apprehensive. Weak memory, confused thoughts; spells or writes wrong words and syllables. Failing brain-power (Anac; Phos; Baryta). Cannot bear to see anything new. Cannot read what he writes. Sadness in morning on awaking.” (Boericke)

7. Nux Vomica(Poison-nut)

“It is the greatest of polychrests, because the bulk of its symptoms correspond in similarity with those of the commonest and most frequent of diseases. It is frequently the first remedy, indicated after much dosing, establishing a sort of equilibrium of forces and counteracting chronic effects.

Nux is pre-eminently the remedy for many of the conditions incident to modern life. The typical Nux patient is rather thin, spare, quick, active, nervous, and irritable. He does a good deal of mental work; has mental strains and leads a sedentary life, with its cares and anxieties. he takes preferably rich and stimulating food, thick head, dyspepsia, and irritable temper are the next day’s inheritance. Now he takes some cathartic, liver pills, or mineral water, and soon gets into the habit of taking these things, which still further complicate matters. Since these frailties are more yielded to by men than women. Nux is pre-eminently a male remedy. These conditions, produce an irritable, nervous system, hypersensitive and over-impressionable, which Nux will do much to soothe and calm. Especially adapted to digestive disturbances, portal congestion, and hypochondriacal states depending thereon. Convulsions, with consciousness; worse, touch, moving. Zealous fiery temperament. Nux patients are easily chilled, avoid open air, etc. Nux always seems to be out of tune; inharmonious spasmodic action. Very irritable sensitive to all impressions. Ugly, malicious. Cannot bear noises, odors, light, etc. Does not want to be touched. Time passes too slowly. Even the least ailment affects her greatly. Disposed to reproach others. Sullen, fault-finding.” (Boericke)

8. Pulsatilla Pratensis/Nigricans (Wind-Flower)

“The weather-cock among remedies. The disposition and mental state are the chief guiding symptoms to the selection of Pulsatilla. It is pre-eminently a female remedy, especially for mild, gentle, yielding disposition. Sad, crying readily; weeps when talking; changeable, contradictory. The patient seeks the open air; always feels better there, even though he is chilly. Mucous membranes are all affected. Discharges thick, bland, and yellowish-green. Often indicated after abuse of Iron tonics, and after badly-managed measles. Symptoms ever changing. Thirstless, peevish, and chilly. When first serious impairment of health is referred to age of puberty. Great sensitiveness. Wants the head high. Feels uncomfortable with only one pillow. Lies with hands above head.Weeps easily. Timid, irresolute. Fears in evening to be alone, dark, ghost. Likes sympathy. Children like fuss and caresses. Easily discouraged. Morbid dread of the opposite sex. Religious melancholy. Given to extremes of pleasure and pain. Highly emotional. Mentally, an April day.” (Boericke)

9. SiliceaTerra(Silica, Pure Flint)

“Imperfect assimilation and consequent defective nutrition. It goes further and produces neurasthenic states in consequence, and increased susceptibility to nervous stimuli and exaggerated reflexes. Diseases of bones, caries and necrosis.Periodical states; abscesses, quinsy, headaches, spasms, epilepsy, feeling of coldness before an attack. Keloid growth. Scrofulous, rachitic children, with large head open fontanelles and sutures, distended abdomen, slow in walking. Ill effects of vaccination. Silica patient is cold, chilly, hugs the fire, wants plenty warm clothing, hates drafts, hands and feet cold, worse in winter. Lack of vital heat. Prostration of mind and body. Great sensitiveness to taking cold. Intolerance of alcoholic stimulants. Ailments attended with pus formation. Epilepsy. Want of grit, moral or physical.Yielding, faint-hearted, anxious. Nervous and excitable. Sensitive to all impressions. Brain-fag. Obstinate, headstrong children. Abstracted. Fixed ideas; thinks only of pins, fears them, searches and counts them. ” (Boericke)

10. Staphysagria(Stavesacre)

“Nervous affections with marked irritability, diseases of the genito-urinary tract and skin, most frequently give symptoms calling for this drug. Acts on teeth and alveolar periosteum. Ill effects of anger and insults. Very sensitive. Lacerated tissues. Pain and nervousness after extraction of teeth. Sphincters lacerated or stretched.Impetuous, violent outbursts of passion, hypochondriacal, sad. Very sensitive as to what others say about her. Prefers solitude. Peevish. Child cries for many things, and refuses them when offered.Worse, anger, indignation, grief, mortification, loss of fluids.”(Boericke).

“The mental symptoms are very important, and the impressions made upon the mind and thence upon the body guide to Staphysagria as a remedy.Excitable, easily aroused to anger, but seldom irascible, that is, easily disturbed and excited, but seldom manifests it. Suitable in cases where complaints come from pent up wrath, suppressed anger, suppressed feelings. The person becomes speechless from suppressed indignation, anger with indignation. Complaints brought on by these causes; irritable bladder with frequent urging to urinate, lasting many days after suppressed wrath, after insults. Great indignation about things done by others or by himself; grieves about consequences.” (Kent)

11. Stramonium(Thorn-Apple)

“The entire force of this drug seems to be expended on the brain, through the skin and throat show some disturbance. Suppressed secretions and excretions. Sensation as if limbs were separated from body. Delirium tremens. Absence of pain and muscular mobility especially of muscles of expression and of locomotion. Gyratory and graceful motions. Parkinsonism.Devout, earnest, beseeching and ceaseless talking. Loquacious, garrulous, laughing, singing, swearing, praying, rhyming. Sees ghosts, hears voices, talks with spirits. Rapid changes from joy to sadness. Violent and lewd. Delusions about his identity; must have light and company. Sight of water or anything glittering brings on spasms. Delirium, with desire to escape (Bell; Bry; Rhus).” (Boericke)

Adapted to ailments of young plethoric persons especially children. Desires light and company. Cannot bear to be alone. Worse in the dark and solitude. Cannot walk in a dark room. Obsession with switching lights on and off. (summarized from combined sources)

12. Zincum Metallicum(Zinc)

“The provings picture cerebral depression. The word “fag” covers a large part of zinc action. Tissues are worn out faster than they are repaired. Poisoning from suppressed eruptions or discharges. The nervous symptoms of most importance. Defective vitality. Impending brain paralysis. Period of depression in disease. Spinal affections. Twitchings. Pain, as if between skin and flesh. Great relief from discharges. Chorea, from fright or suppressed eruption. Convulsions, with pale face and no heat. Marked anemia with profound prostration. It causes a decrease in the number, and destruction of red blood corpuscles. Repercussed eruptive diseases. In chronic diseases with brain and spinal symptoms, trembling, convulsive twitching and fidgety feet are guiding symptoms.Weak memory. Very sensitive to noise. Averse to work, to talk. Child repeats everything said to it. Fears arrest on account of a supposed crime. Melancholia. Lethargic, stupid. Paresis.” (Boericke)

“It is an antipsoric, suitable in broken down constitutions, feeble constitutions; enfeeblement characterizes the whole proving.The Zinc. patient is nervous and extremely sensitive, excitable, trembling, quivering, twitching of muscles, tearing pains along the course of the nerves, tingling, excited on the least provocation; over sensitiveness in one part and lack of feeling in another. This extreme over sensitiveness is like Nux; which is inimical. The overworked and excitable persons belong to Nux and Zinc. All the functions are slow; eruptions appear slowly. The whole economy seems to be tired and feeble.Sensitive to every little noise, to people talking in the room, to crumpling of paper.Talking or listening is distressing; much talking of other people, even of those of who he is fond, affects his nerves and makes him morose. Feeble children, feeble girls, mind feeble, memory poor. Tendency to be docile, but when aroused irascible. Inability to throw eruptions to the surface.” (Kent)

QUANTITATIVE MEASUREMENT: PRE-TREATMENT AND POST-TREATMENT AUTISM TREATMENT EVALUATION CHECKLIST (ATEC) SCORES

The following table (Table 3) shows the scores on the Autism Treatment Evaluation Checklist (ATEC) of the children before starting homeopathic treatment and after homeopathic treatment respectively.

The Autism Treatment Evaluation Checklist (ATEC): The ATEC”is a one-page form developed by Dr.Bernard Rimland and Dr. Stephen M. Edelson of the Autism Research Institute, USA, for measuring and evaluating the effectiveness of autism treatments.The test consists of 4 sub-tests namely Speech/Language/Communication (14 items), Sociability (20 items), Sensory/Cognitive Awareness (18 items), Health/Physical/Behavior (25 items). Unlike other tests that help in diagnosing autism, this helps to evaluate if the treatment is effective.” (Autism Research Institute)

The time period of improvements with homeopathic treatment for these children ranged from an average of 12 months to 18 months.Most of the parents came with a prior diagnosis of ASD or autism in their child along with reports from developmental paediatricians, clinical psychologists or psychiatrists. These included psychological and other comprehensive assessments that confirmed the diagnosis of autism in the child. The parents were asked to complete the ATEC by the author for the purpose of monitoring progress. In most instances the ATEC form had been completed by the parents while some of the ATEC assessments were administered by the author herself who is a qualified psychologist.

Table 3

Sl no	ATECPRE-TREATMENT	INTENSITY	ATECPOST-TREATMENT	INTENSITY
1.AG	60	MODERATE	37	MILD
2.AN	60	MODERATE	35	MILD
3.AS	54	MODERATE	30	MILD
4.AM	73	MODERATE	35	MILD
5.AT	107	SEVERE	41	MILD
6.AH	78	MODERATE	40	MILD
7.DK	106	SEVERE	43	MILD
8.CD	80	MODERATE	40	MILD
9.PR	91	MODERATE	43	MILD
10.DY	74	MODERATE	31	MILD
11.PN	89	MODERATE	42	MILD
12.SK	71	MODERATE	25	MILD
13.SB	67	MODERATE	30	MILD
14.VJ	76	MODERATE	27	MILD
15.SD	94	MODERATE	34	MILD
16.SN	92	MODERATE	42	MILD
17.TS	69	MODERATE	25	MILD
18.TV	90	MODERATE	30	MILD
19.KV	69	MODERATE	21	MILD
20.BV	78	MODERATE	32	MILD
21.AV	75	MODERATE	30	MILD
22.SM	69	MODERATE	25	MILD
23.SK	80	MODERATE	32	MILD
24.AY	79	MODERATE	35	MILD
25.JN	61	MODERATE	31	MILD
26.RH	72	MODERATE	26	MILD
27.RN	84	MODERATE	37	MILD
28.SR	92	MODERATE	40	MILD
29.TJ	80	MODERATE	35	MILD
30.JB	74	MODERATE	38	MILD
31.VK	78	MODERATE	32	MILD
32.HR	87	MODERATE	32	MILD
33.SY	82	MODERATE	37	MILD
34.HV	113	SEVERE	43	MILD
35.AL	82	MODERATE	40	MILD
36.DS	58	MODERATE	25	MILD
37.PV	70	MODERATE	28	MILD
38.SC	85	MODERATE	30	MILD
39.AR	67	MODERATE	18	NORMAL
40.AA	60	MODERATE	30	MILD

ATEC SCORING KEY:

ATEC < 30: This level places the child in the top 10 percentiles. A child with score of less than 30 – or, better still, less than 20 – would have some ability to conduct normal, two-way conversations, and more or less behave normally. Such children have high chances of leading normal lives as independent individuals.

ATEC < 50: This places the child in the 30th percentile level. The child has good chances of being semi-independent.More importantly, he or she will not likely need to be placed in an institution.For many parents of autistic children, being able to achieve improvement up to this level is already considered very significant.

ATEC > 104: Even though the maximum score is 180, any person with a score of more than 104 would already be in the 90th percentile, and be considered very severely autistic. QUANTITATIVE DATA ANALYSIS

Quantitative analysis of the pre-treatment and post treatment scores of children was done using the SPSS statistical analysis software. A paired sample t-test for correlated samples and a One-way Repeated Measures Analysis of Variance (RM-ANOVA) for correlated samples was done to see if there were any significant changes after homeopathic treatment.

Paired Sample t-test of the ATEC Score

Table 4.1

Paired Samples Statistics

		Mean	N	Std. Deviation	Std. Error Mean
Pair 1	ATECPRE	78.15	40	13.477	2.131
	ATECPOST	33.18	40	6.429	1.016

Table 4.2

Paired Samples Test

		Paired Differences					t	df	Sig. (2-tailed)
		Mean	SD	Std. Error Mean	95% Confidence Interval of the Difference
					Lower	Upper
Pair 1	ATECPRE ATECPOST	44.975	10.618	1.679	41.579	48.371	26.789	39	.000

The results of the paired sample t-test  (Table 4.1-4.2) that was conducted to determine if there was a significant effect of the homeopathic treatment in children with autism spectrum disorders on  speech language and communication skills, sociability, sensory and cognitive abilities and health and behavioural issues as measured by their overall  posttreatment scores on the ATEC  determined that there was a significant reduction in the mean post treatment scores (M= 33.17, S.D=6.42) as compared to the mean pre-treatment ATEC scores ( M=78.15, S.D.=13.47)of children with autism who were on homeopathic treatment t(39)=26.8 p =000. Reduction of scores on the ATEC signifies improvement in speech language and communication skills, improvement in sociability, reduction of sensory issues, improvement in cognitive awareness and improvement in physical health and behaviour.

The p value is less than .001 therefore it can be surmised that there was a statistically significant effect of the homeopathic treatment in improvement in speech language and communication skills, sensory and cognitive abilities, sociability, overall health and reduction in challenging behaviours of children with autism.

Figure 1: A Bar-Graph showing the difference in the Means of Pre-Treatment and Post-Treatment ATEC Scores

Repeated Measures One-Way ANOVA Of Pre-Treatment and Post-Treatment ATEC Scores

Table 5.1

Descriptive Statistics

	Mean	Std. Deviation	N
ATECPRE	78.15	13.477	40
ATECPOST	33.18	6.429	40

Table 5.2

Tests of Within-Subjects Effects

Measure: ATEC

Source		Type III Sum of Squares	df	Mean Square	F	Sig.
factor1	Sphericity Assumed	40455.013	1	40455.013	717.650	.000
	Greenhouse-Geisser	40455.013	1.000	40455.013	717.650	.000
	Huynh-Feldt	40455.013	1.000	40455.013	717.650	.000
	Lower-bound	40455.013	1.000	40455.013	717.650	.000
	Greenhouse-Geisser	2198.488	39.000	56.371
	Huynh-Feldt	2198.488	39.000	56.371
	Lower-bound	2198.488	39.000	56.371

The results of the Repeated Measures ANOVA (Table 5.1- Table 5.2) that was done todetermine the effect of the homeopathic treatment on children with autism with Sphericity assumed found that there was a statistically significant difference in the mean total posttreatment ATEC scores of the children as compared to the baseline (pre-treatment) ATEC scores, F value (39,1) =717.65, p=.000. It can therefore be concluded that there was a statistically significant effect of the homeopathic treatment in children with autism.

QUALITATIVE CASE REPORTS

Many schools in India do not have special facilities or shadow teachers to help children with developmental issues cope in a regular school set up. Some schools do have a special educator but it is difficult for them to give individual attention to children with special needs due to the huge numbers and other issues. Despite this schools do take in children with special needs. One of the difficulties is that most teachers do not know how to deal with children with special needs or do not have the time or resources to give individual attention to these children. Many schools admit these children on a trial basis. The result of this is that many times schools ask that parents take these children out of the school or that parents themselves work towards dealing with the issues faced by their child in school. This becomes highly stressful for parents as they would prefer their child to be in a mainstream school rather than in a special school. They are also looking at ways to help their child cope with these issues. It is in these instances also that parents seek alternative methods apart from neuropsychological therapies to help their child with autism.

The following qualitative case reports are of three children who were already in an integrated school and one child who was in a residential setup where inclusive integration was made possible. All these children had difficulties in communication, social skills behavioural or sensory issues that was making it difficult for them to continue in the school and how they could be helped with homeopathic treatment.

1.Miss R:  A 5-year-old female child with a diagnosis of Autism. She was going to an integrated school. She was verbal but was only using minimal words to communicate. The main issue parents were facing with this child her high level of emotional and physical sensitivity apart from her communication difficulties. It was difficult to get her to do tasks as she would immediately stop doing any activity if she was criticized or if spoken to in a louder than normal tone. This was also a problem reported at the school. She also had the habit of moving around the classroom in school. One peculiar habit she had was to suddenly scream in the middle of a class. The school was finding it difficult to manage these issues and the parents would receive multiple complaints from the school about this. She also had poor expressive language ability and could not take part in school programs due to her sensory issues. Homeopathic treatment was started for her.  The parents reported that there was an improvement in her expressive language ability, reduction in sensory issues, she was calmer, less restless and was able to sit through classroom activities without disrupting the class. The school assessment report reported positive changes in her school performance. Her progress assessment showed that her level of academic achievement and other skills was age appropriate. Parents reported that she also took part in the school annual day program and performed on stage which was not possible for her previously.

Main Remedies used:Pulsatilla, CalcareaCarbonica and Belladonna

2. MasterP: A five-year-old male child with a diagnosis of PDD. He was attending an integrated school setup. He was also attending therapy sessions after school. The main issues with this child were hyperactivity, echolalia and disruptive behaviours. He had a habit of throwing things or hitting things against the wall, breaking things. He was prone to temper tantrums and was extremely aggressive at times. He also had poor expressive language ability and poor compliance. The school was not able to cope with these behaviours and the parents were asked to consider taking him out of the school. There was an improvement in communication skills, reduction in hyperactivity, better compliance, a reduction in aggressive behaviour and reduction in temper tantrums in this child after a few months of homeopathic treatment along with other therapies. He was much calmer. There was an improvement in his sitting tolerance and focusing ability which helped improve his performance and continuance at the school. Parents reported that his expressive language abilities and attention span had improved. He had also started to write independently.

Main Remedies used: Belladonna, Lycopodium and Arsenicum Album

3. Master N: A five-and-a-half-year-old male child with a diagnosis of autism. He was verbal but was not using his knowledge of words to communicate. He would talk to himself when unoccupied. His response to questions and communication with parents or teachers would consist of meaningless jargon. Wanted to keep going out and moving about. He was obsessed with elevators. Would love to travel in three-wheelers and cars that used to make him feel calm. Had periods of being lost in his own world. Used to scream when upset or criticized He was extremely stubborn, self-willed, could not tolerate contradiction.  This was leading to compliance issues at the integrated school he was going. Along with these issues he also had sensory issues. He was also prone to frequent episodes of lower respiratory infections, dust allergies and tonsillitis that was adding to his difficulties in coping.  The parents were concerned about his poor expressive language ability, inability to use speech in a meaningful way, his obsessive behaviours, his sensory issues and his physical complaints as well. After homeopathic treatment for a few months, parents reported that there was a change in his communication from meaningless jargon to meaningful communication and was in context. There was a reduction in his sensory issues, he was more complaint and cheerful. There was also an improvement in his immunity that helped reduce his allergies as well. He was also doing better at school.

Main Remedies Used:Hyosycamus, Lycopodium, Pulsatilla

4. Master A: A 14- year old male child with a diagnosis of autism. He had a history of delayed speech development. He started communicating only at the age of 4 years. He was prone to frequent meltdowns that were difficult to handle. He still had problems with expressive language. His communication was need-based. His sleep was disturbed and he would sleep for only 2-3 hours at a stretch. Poor social skills and interaction.  His sitting tolerance and attention span were very poor. His immunity was poor. He had asthma with frequent episodes of lower respiratory tract infections. He also had obsessive behaviours. He was prone to temper tantrums with destructive and violent behaviour including beating others, throwing and destroying things. He was very sensitive and would get offended easily. Due to these issues parents were finding it difficult to manage the child at home and had placed him in a residential set up in a different city.  After homeopathic treatment there was a remarkable change. He became calmer, there was an improvement in his understanding, better social interaction.  His expressive language ability improved. There was an improvement in his sleep patterns and immunity. He became more calm and compliant. Due to these improvements the parents were able to take him out of the residential school. These changes could be seen with a single remedy that was prescribed based on his psychological symptoms within a few months of starting homeopathic treatment.

Main Remedies Used: Staphysagria

 SUMMARY OF RESULTS

From the quantitative analysis it can be seen that there was a significant overall reduction in the mean ATEC scores of the children with autism who were on homeopathic treatment. There was a significant reduction in the ATEC scores from a mean pre-treatment score of 78 to a mean posttreatment score of 33 (mean average reduction of 45 points)within a year to one-and-a-half years of homeopathic treatment along with other therapies. A child with an ATEC score below 30 is considered to be in the normal range or neurotypical. A mean ATEC score of 33 would mean that the children were almost near the normal range. The intensity of autism in these children has come down from the moderate or severe range to the mild range. These results were also corroborated by the qualitative observations by the clinician, the teachers and the parents. Parents reported significant improvements in speech, language and communication skills, reduction in hyperactivity, sensory issues, temper tantrums and other behavioural issues. There were also improvements in their overall health and reductions in their physical discomfort as well. The children could be thus integrated into mainstream schools in most instances.

DISCUSSION

The children in this study who ranged from moderate to severe levels on the spectrum had different levels of difficulties when it came to integration either into mainstream schools or in society as a whole. Several of these children had major issues with speech language and communication skills, sensory issues, social skills and even health issues such as problems with eating, bowel movements and sleep problems among others. These children were either in special schools or were undergoing therapy sessions at different locations. Even in children below three years, who had some level of speech, integration into preschools was difficult because of other health, physical, behavioural, sensory issues and difficulties in coping with group activities as compared with one to one teaching. Homeopathic remedies helped accelerate the process of development of speech language and communication skills, reduce their sensory issues, stranger and other anxieties, improve their social skills and the ability to cope with multiple sensory inputs and being in a group without becoming overwhelmed.

This study looked at the possibilities of inclusive integration of children with autism not just into mainstream schools but also integration into society as well. As can be seen from the qualitative case reports transition from a special school with one to one training or even from therapy sessions into a fulltime school is a difficult process. Children with developmental difficulties especially autism get overwhelmed by the whole process of getting into a new set up with unfamiliar people and environments. They have to get used to group training as compared to one to one training that they are used to.

Another factor is the ability to process multiple sensory and other inputs while learning or taking part in school activities as compared to their previous special school set up where educational and other activities are individualized based on the child’s needs. It is also not possible to continue with full time therapy sessions such as occupational therapy, speech therapy and remedial teaching after a busy day at school. Although some schools have provisions for special classes and remedial teaching to cater to children with special needs, they are very few in number and not accessible to most children at least in India.  Homeopathic treatment can act as a both as an effective treatment and supportive modality in such a scenario to help these children cope and also remain integrated both in main stream schools and as valued members of society.

One of the other issues to look at is ways to identify children at risk for autism at an earlier age, so that early intervention strategies can be used before they reach the school going age.  There is also a need to look at causative factors for autism from a much broader perspective. The role of exposure to environmental toxins, heavy metal toxicity and chemical exposure both prenatally and in new-borns and toddlers also needs to be looked into. One of the recent research studies have looked into prenatal stress in the mother as one of the risk factors for the development of autism in the child (DK Kinney et al, 2008, Van Der Bergh et al, 2005). From the homeopathic perspective the history taking of the child’s symptom picture also involves looking into the state of the mother including the emotional state, the physical health and medications taken during pregnancy. In my experience of seeing children with started seeing children with autism spectrum disorders over the past 20 years (1998-2018), first as consultant at a special school for 4 years along with my private practice, I have observed that many of the mothers reported emotional stress during pregnancy. Parents also reported some major emotionally or physically traumatic event in the child’s life just before the onset of symptoms of autism in the child or before regression took place. Whether this was a coincidence or was connected with these events requires further research.

Recent research has also focused on the importance of social-emotional nurturing especially in toddlers as an important factor in fostering normal brain development and reducing the risk for developmental disabilities including autism at a later age (A. Denham et al, 2012, St. Petersburg Orphanage Research Team, 2008).  Looking at a number of children with similar traumatic physical or psychological insults before the onset of autism prompted this author to do a more in-depth study into this which was reported in a paper presented by this author in 2003, titled “Theory of Suppression and Miasms as a Cause for Autism” which discusses probable factors such as physical suppression and emotional repression that could lead to autism.

One of the children with severe autism and associated mental retardation that this author had seen in the beginning of her practice was non-verbal, could not distinguish primary colours, would sit in a corner, cry when touched, also had a history of witnessing a traumatic event (unnatural death of a close family member) in his family when he was a 3-year-old boy. The parents felt that his issues started after this event as he was developing normally till that time. He showed very good improvements with homeopathic remedies. There was an improvement in his receptive and expressive language ability. He became cheerful, interactive, would play drums and would pull people to come and play with him. There was reduction in his peripheral nervous sensitivity and pain as well. The homeopathic remedies also helped improve his emotional strength.

In the case of children below the age of five, emotional resilience has not yet developed fully. Children first have to be able to identify and understand the emotions and then learn how to deal with them by observing the reactions of others around them. It may be possible that adverse psychological events or even physical events such as toxic chemicals in medications or foods, before the age of five may lead to delays in brain development or put them at risk for developing autism at a later stage

A number of other homeopathic physicians and researchers have also reported similar findings in their research studies.  It is important to focus not just on the emotional and psychological aspects as a causative factor but also to look at the role of physical factors such as toxic chemicals, food additives, toxic additives in certain medications and environmental factors that could lead to the development of autism in the child.

While working as a consultant at a special school for children with autism, this author had occasion to see the difference between children with autism who were on homeopathic treatment along with other therapies and children who were not on homeopathic treatment.  One of the parents reported a noticeable reduction in self-injurious behaviours after starting homeopathic treatment. There was also a sudden spurt in speech, language and communication skills in some children a few months after starting homeopathic treatment as compared to before starting treatment. It could be that homeopathic treatment helped provide the push to accelerate the process of development in these children. It was seen that children with autism who were not on treatment were still struggling with the same issues after a year as compared to the children with autism who were on homeopathic treatment. Although the children who were on homeopathic treatment were more manageable and there were significant improvements reported by both parents and therapists, further research studies with a comparison group is required to corroborate these findings.

LIMITATIONS

This is a retrospective clinical observational report and not an experimental study. The limitation of this study is that there is no comparison group of children with autism on therapy who are similar in all respects to children who underwent homeopathic treatment in addition to attending therapy sessions.

CONCLUSIONS

Homeopathic treatment could be a helpful, harmless and non-invasive treatment modality both during the initial stages of autism, whether the child is undergoing early intervention, going to a special school, attending therapy sessions, or at a later stage, to help integrate into the mainstream school or to help continuance in an integrated school. Homeopathic treatment can aid in inclusive integration of children with autism by helping to accelerate the pace of development of communication skills, reducing anxiety, behavioural issues, disruptive behaviours and helping them deal with situations that could be overwhelming under normal circumstances.

Of note is a research study that looks into the neuroprotective and stress protective effects of homeopathic remedies (Prakash DJ et al, 2010).  Future research studies on the use of homeopathy as a preventive modality in the prenatal period for at-risk mothers and also in other areas as a neuroprotective and stress protective modality could be helpful.

Homeopathic treatment is just one part of a multidisciplinary approach to the management and integration of children with Autism Spectrum Disorders.  In a music intervention study on preschool children conducted by this author, two children, one with delayed development and difficulties in gross motor abilities, and another with speech difficulty, showed improvements with a combined therapy with homeopathy and passive background music intervention within a short period of time (Rajalakshmi, May 2017). This goes to show that there is a need for an integrative approach to healing, whether it is autism or any other kind of aberrant development or for that matter chronic conditions, so that patients can get faster and better relief from their afflictions.

One of the major factors for the changes seen in these children is also due to the hard work and sincere efforts of the parents in continuing with therapies, looking at different options that can be helpful for their child and tirelessly providing home-based intervention as well.

ACKNOWLEDGMENTS

I would like to acknowledge the support and encouragement of my family. I wish to acknowledge the support and guidance of my mentor, senior homeopathic physician, the late Dr. D.S. Rama Rao, DHMS, under whom I trained. He taught me the nuances of case taking and practical application of the principles of homeopathy during the initial period of my practice.

COMPETING INTERESTS

There are no competing interests

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