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A Case Series on Homoeopathic intervention in Understanding
adult ADHD as a brain maturation delay
A Dissertation Submitted In Partial Fulfillment of the Requirement for
The Award of the Degree of
DOCTOR OF MEDICINE IN HOMOEOPATHY
(PSYCHIATRY)
OF
DR BHIM RAO AMBEDKAR UNIVERSITY, AGRA (U.P.)
AT
BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,
KNOWLEDGE PARK-I, GREATER NOIDA (U.P.)
BY
Dr Aman Goel
Session: 2012-2014
Under the guidance & supervision of
Dr. Kathika Chattopadhyay, M.D. (Hom.)
Professor and H.O.D
Department Of Psychiatry
BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,
GREATER NOIDA, U.P.
2
Prof. Dr. C.P Sharma, M.D. (Hom.)
BAKSON HOMOEOPATHIC MEDICAL COLLEGE AND
HOSPITAL
KNOWLEDGE PARK- I, GREATER NOIDA (U.P.)
CERTIFICATE
This is to certify that the dissertation entitled A Case Series oh
Homoeopathic intervention in understanding adult ADHD as a brain
maturation delay is a bonafide work by Dr. Aman Goel under the
guidance of Dr. Kathika Chattopadhyay in partial fulfilment of regulations
for the award of Degree of Doctor of Medicine in Homoeopathy [M.D.
(Hom.)] in Psychiatry.
This work conforms to the standards of Dr. B.R. Ambedkar
University, Agra. It has not been submitted partially or fully for the
award of any other Degree or Diploma.
I have great pleasure in forwarding it to Dr. B.R. Ambedkar
University, Agra.
Date:
( Dr. C.P Sharma )
Signature of Principal
3
Prof. Dr. Kathika Chattopadhyay
H.O.D
Department Of Psychiatry
BAKSON HOMOEOPATHIC MEDICAL COLLEGE AND
HOSPITAL
KNOWLEDGE PARK- I, GREATER NOIDA (U.P.)
CERTIFICATE
This is to certify that the dissertation entitled “A Case Series on
Homoeopathic intervention in Understanding adult ADHD as a
brain maturation delay”
In Its Allied Patterns is a bonafide work of Dr Aman Goel in partial
fulfillment of regulations for the award of the degree of Doctor of
Medicine in Homoeopathy [M.D. (Hom.)] in Psychiatry.
This work has been carried out under my guidance and supervision. I
am satisfied with the authenticity of the experiments, observations and
interpretations embodied in this dissertation.
The work is recommended to the Dr. B.R. Ambedkar University,
Agra for the award of the degree of Doctor of Medicine in Homoeopathy
[M.D.(Hom.)] in Psychiatry.
Date:
(Dr. Kathika Chattopadhyay)
Signature of Guide/Supervisor
4
Dr. Kathika Chattopadhyay, M.D. (Hom.)
H.O.D.
Department of Psychiatry
BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,
KNOWLEDGE PARK-I, GREATER NOIDA, U.P.
CERTIFICATE
This is to certify that the dissertation entitled Usefulness Of
Homoeopathic Medicines In Cases Of Irritable Bowel Syndrome In Its
Allied Patterns is a bonafide work of Dr. Aman Goel in partial fulfillment
of regulations for the award of the degree of Doctor of Medicine in
Homoeopathy [M.D. (Hom.)] in Psychiatry.
This work has been carried out under my guidance and supervision. I
am satisfied with the authenticity of the experiments, observations and
interpretations embodied in this dissertation.
The work is recommended to the Dr. B.R. Ambedkar University,
Agra for the award of the degree of Doctor of Medicine in Homoeopathy
[M.D.(Hom.)] in Psychiatry.
Date:
(Dr. Kathika Chattopadhyay)
Signature of H.O.D.
5
DECLARATION
I, Dr. Aman Goel, hereby declare that the dissertation entitled A Case
Series oh Homoeopathic intervention in understanding adult ADHD as
a brain maturation delay has been prepared by me under the guidance and
supervision of Dr.Kathika Chaterjee, in partial fulfillment of regulations for
the award of the degree of Doctor of Medicine in Homoeopathy [M.D.
(Hom.)] in Psychiatry of Dr. B.R. Ambedkar University, Agra. It has not
been submitted previously to any University for the award of any Diploma
or Degree nor has it been copied from any other dissertation.
Date:
(Aman Goel)
Signature of the Student
6
ACKNOWLEDGEMENTS
My thanks to the higher power, whose influence in my life must be
acknowledged, otherwise I cannot explain the many crystal clear lessons of
life that, I have been privileged to learn through my lifetime. It is easy to
reflect back and see, how many of those lessons have placed me in the
position of doing this project. At the outset, I have to acknowledge many
people for this effort of mine in compiling this dissertation - first and
foremost, the almighty for giving me this opportunity to choose this noble
profession of serving the suffering humanity with humility.
I am indebted and will remain ever grateful to Dr. Kathika Chattopadhyay,
M.D. (Hom.), H.O.D, of Department of Psychiatry, Bakson Homoeopathic
Medical College and Hospital, My guide for his relentless guidance and
valuable inputs for this project. His scientific approach towards
homoeopathy is outstanding and has been of great help for me.
I also extend my heartfelt gratitude to our Principal Dr. C.P Sharma, M.D.
(Hom.),Bakson Homoeopathic Medical College and Hospital, for his
guidance and support for this work. He has not only been a source of
inspiration but I consider him as my extended family.
I extend my special thanks to our Dr. Nilanjana Basu, our P.G. Incharge.
I am grateful to Dr.S.P.S Bakshi, CMD of Bakson Groups, for his blessings
and also for his efforts put in for the promotion of Homoeopathy and
upcoming Homoeopaths.
This project involved many people, to whom I am very grateful. In
particular, all those persons who were interviewed for this project and who
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generously gave their valuable time, without demur, answering virtually
every question that I had. Many of them welcomed me into their homes or
travelled to my office. This dissertation is about what I learned from them.
My special thanks go out to my professional friends and colleagues who
have been of a great support during my efforts.
There are many others who have influenced my professional and personal
life and who also deserve a mention: My Teachers and Colleagues at Father
Muller Homoeopathic Medical College and Hospital, Mangalore and in
Bakson Homoeopathic Medical College, Greater NOIDA;
Dr Aman Goel
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“Success lies not in achieving what you aim at,
but in aiming at what you ought to achieve….”
9
TABLE OF CONTENTS
1. INTRODUCTION : 1
2. AIMS AND OBJECTIVES : 6
3. REVIEW OF LITERATURE : 7
4. MATERIALS AND METHODS : 38
5. OBSERVATION AND RESULTS : 42
6. DISCUSSION : 50
7. CONCLUSION : 54
8. SUMMARY : 58
9. BIBLIOGRAPHY : 60
10. APPENDICES
APPENDIX A (CASE RECORD FORMAT) : 65
APPENDIX B (QUESTIONNAIRE/ SCALES) : 69
APPENDIX C (PATIENT INFORMATION
SHEET WITH WRITTEN CONSENT FORM)
: 71
APPENDIX D (FEW CASE RECORDS OF
PATIENT)
: 72
APPENDIX E (MASTER CHART) : 78
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“There is nothing more difficult to take in hand, more perilous to
conduct, or more uncertain in its success, than to take the lead in the
introduction of a new order of things.”
Niccolo Machiavell
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Attention disorders, generally categorized as Attention Deficit Disorder
(ADD) or Attention Deficit Hyperactivity Disorder (ADHD), result from
physiological differences in the brain that cause individuals to consistently
display extreme inattention and impulsivity, and in many cases,
hyperactivity. In preschool-age children, signs of inattention include
excessive distractibility and inability to follow simple directions.
Impulsivity is indicated by the inability to wait in line or take turns and
reacting to even minor frustrations with physical aggression. Constant
fidgeting, inability to settle down for quiet activities and constant motion
are signs of hyperactivity.
Attention deficit hyperactivity disorder (ADHD) is one of the most studied
and controversial disorders in child development. This disorder, which is
present in approximately 4 to 7 percent of the childhood population in the
United States, is characterized by behavior difficulties such as inattention,
impulsiveness, and hyperactivity. The child, or adult, with ADHD has
problems starting, staying with, or completing tasks. The result is a life that
may often be chaotic.
Attention Deficit Hyperactivity Disorder, one of the most common
childhood disruptive behavior disorders, is characterized by a consistent
pattern of inattention and/or hyperactivity-impulsivity. Impulsivity is
characterized by impatience and is often expressed in frequent interruptions
of others, difficulty in delaying responses, and intruding on others. Children
with ADHD typically make comments out of turn, fail to listen to
directions, initiate conversations at inappropriate times, blurt out answers
before questions have been completed, grab objects from others, touch
things inappropriately, and have difficulty waiting their turn.
DSM-IV identifies the essential feature of Attention-Deficit/ Hyperactivity
Disorder as a persistent pattern of inattention and/ or hyperactivity-
impulsivity that is more frequent and severe than is typically observed in
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individuals at a comparable level of development. Some hyperactive-
impulsive or inattentive symptoms that cause impairment must have been
present before age 7 years, although many individuals are diagnosed after
the symptoms have been present for a number of years. Some impairment
from the symptoms must be present in at least two settings (e.g., at home
and at school or work). There must be clear evidence of interference with
developmentally appropriate social, academic, or occupational functioning.
The disturbance does not occur exclusively during the course of a Pervasive
Developmental Disorder, Schizophrenia, or other Psychotic Disorder and is
not better accounted for by another mental disorder (e.g., a Mood Disorder,
Anxiety Disorder, Dissociative Disorder, or Personality Disorder).
Inattention may manifest in academic, occupational, or social situations.
Individuals with this disorder may fail to give close attention to details or
may make careless mistakes in schoolwork or other tasks. Work is often
messyand performed carelessly and without considered thought.
Individuals often have difficulty sustaining attention in tasks or play
activities and find it hard to persist with tasks until completion. They often
appear as if their mind is elsewhere or as if they are not listening or did not
hear what has just been said. There may be frequent shifts from one
uncompleted activity to another.
Individuals diagnosed with this disorder may begin a task, move on to
another, then turn to yet something else, prior to completing any one task.
They often do not follow through on requests or instructions and fail to
complete schoolwork, chores, or other duties. Failure to complete tasks
should be considered in making this diagnosis only if it is due to inattention
as opposed to other possible reasons (e.g. a failure to understand
instructions). These individuals often have difficulties organizing tasks and
activities. Tasks that require sustained mental effort are experienced as
unpleasant and markedly aversive. As a result, these individuals typically
avoid or have a strong dislike for activities that demand sustained self-
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application and mental effort or that requires organizational demands or
close concentration (e.g. homework or paperwork). This avoidance must be
due to the person’s difficulties with attention and not due to a primary
oppositional attitude, although secondary oppositionalism may also occur.
Work habits are often disorganized and the materials necessary for doing
the task are often scattered, lost, or carelessly handled and damaged.
Individuals with this disorder are easily distracted by irrelevant stimuli and
frequently interrupt ongoing tasks to attend to trivial noises or events that
are usually and easily ignored by others (e.g., a car honking, a background
conversation). They are forgetful in daily activities (e.g. missing
appointments, forgetting to bring lunch). In social situations, inattention
may be expressed as frequent shifts in conversation, not listening to others,
not keeping one’s mind on conversations, and not following details or rules
of games or activities.Hyperactivity may be manifested by fidgetiness or
squirming in one’s seat, by not remaining seated when expected to do so, by
excessive running or climbing in situations where it is inappropriate, by
having difficulty playing or engaging quietly in leisure activities, by
appearing to be often “on the go” or as if “driven by a motor,” or by talking
excessively. Hyperactivity may vary with the individual’s age and
developmental level, and the diagnosis should be made cautiously in young
children. Toddlers and preschoolers with this disorder differ from normally
active young children by being constantly on the go and into everything;
they dart back and forth, are “out of the door before their coat is on,” jump
or climb on furniture, run through the house, and have difficulty
participating in sedentary group activities in preschool classes (e.g.,
listening to a story).
School-age children display similar behaviors but usually with less
frequency or intensity than toddlers and preschoolers. They have difficulty
remaining seated, get up frequently, and squirm in, or hang on to the edge
of their seat. They fidget with objects, tap their hands, and shake their feet
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or legs excessively. They often get up from the table during meals, while
watching television, or while doing homework; they talk excessively; and
they make excessive noise during quiet activities. In adolescents and adults,
symptoms of hyperactivity take the form of restlessness and difficulty
engaging in quiet sedentary activities.
Impulsivity manifests itself as impatience, difficulty in delaying responses,
blurting out answers before questions have been completed, difficulty
awaiting one’s turn, and frequently interrupting or intruding on others to the
point of causing difficulties in social, academic, or occupational settings.
Others may complain that they cannot get a word in edgewise. Individuals
with this disorder typically make comments out of turn, fail to listen to
directions, initiate conversations at inappropriate times, interrupt others
excessively, intrude on others, grab objects from others, touch things they
are not supposed to touch, and clown around. Impulsivity may lead to
accidents (e.g., knocking over objects, banging into people, grabbing a hot
pan) and to engagement in potentially dangerous activities without
consideration of possible consequences (e.g., riding a skateboard over
extremely rough terrain).
Behavioral manifestations usually appear in multiple contexts, including
home, school, work, and social situations. To make this diagnosis, some
impairment must be present in at least two settings. It is very unusual for an
individual to display the same level of dysfunction in all settings or within
the same setting at all times. Symptoms typically worsen in situations that
require sustained attention or mental effort or that lack of intrinsic appeal or
novelty (e.g., listening to classroom teachers, doing classroom assignments,
listening to or reading lengthy materials, or working on monotonous,
repetitive tasks). Signs of the disorder may be minimal or absent when the
person is under very strict control, is in a novel setting, is engaged in
especially interesting activities, is in a one-to-one situation (e.g., the
clinician’s office), or while the person experiences frequent rewards for
15
appropriate behavior. The symptoms are more likely to occur in group
situations (e.g., in playgroups, classrooms, or work environments). The
clinician should therefore inquire about the individual’s behavior in a
variety of situations within each setting.
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AIMS AND OBJECTIVES
The great part, I believe, of the art of medicine is the ability to
observe.
Hippocrates, Father of Medicine.
17
AIM.
To understand the efficacy of homoeopathy in early
adults suffering from ADHD.
OBJECTIVES.
To access the parameters of ADHD in early adults and its
complications.
To assess the Quality Of Life in patients suffering from adult
ADHD.
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REVIEW OF LITERATURE
“Literature boils with the madcap careers of writers brought to the
edge by the demands of living on their nerves, wringing out their
memories and their nightmares to extract meaning, truth, and beauty”
Herbert Gold
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A Brief History of Attention Deficit/ Hyperactivity Disorder
ADHD is one of the most misunderstood, misinterpreted, and misdiagnosed
syndromes researched by professionals today. However, the disorder is
treated as though it were some recently discovered esoteric phenomenon
with life threatening properties; when in fact, it’s just simply a facet of
behaviour. It is not as serious as most people or researchers wish us to
believe.
Before 1900, only a few papers existed and described the cognitive and
behavioural consequences of central nervous system injuries like trauma
and infection. In the early 1900’s, Englishman George Still was one of the
first to shift attention to behavioral symptoms of the disorder as unnatural,
relative to normal children at a given age. He also described many children
coming from what Dr. R Barkley, from the University of Massachusetts
Medical School, has described as “a chaotic family life” and many others
coming from “a seemingly adequate upbringing”. The overall prognosis for
these young people was pessimistic and “special educational environments”
were encouraged.
ADHD has been prevalent for many generations, but under different names.
Ebaugh (1923) was among the first to investigate this topic. Dr. Ebaugh, a
physician and Director of the Near-psychiatric Department of the
Philadelphia General Hospital became fascinated with the disease
“epidemic encephalitis” with respect to its effect on adolescents. In North
America, a 1917-1918 epidemic of encephalitis left many children with
substantial behavioural and cognitive losses that were similar to what we
now consider ADHD symptoms. Clinicians continued to recommend
treatment and care outside the home and outside normal educational
facilities.
Ebaugh found that children afflicted with the condition were: quarrelsome,
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hyperkinetic, impulsive, talkative, moody, irritable, incorrigible, and
suffered from insomnia. His report is among the first to
hyperactivity/hyperkinesia phenomenon. During the past 70 years,
hyperactivity has shifted from one name to another. In the 30’s, the disorder
was referred to as “restlessness,” “irritability,” “over activity,” and Charles
Bradley’s term, “organic behaviour syndrome.”
Beginning in the late 1930’s, investigators here in the U.S. studied other
possible causes and behavioural expressions of brain injury in children,
noting that hyperactive children displayed similarities to those of primates
with frontal lobe lesions, suggesting pathological defects. This concept of a
“brain injured child” was popular, and it drifted into the 1940’s. Clinicians
advocated educating these children with “minimum brain damage” (MBD)
in smaller, more carefully-regulated classrooms with minimal stimuli. We
now know that more stimulation rather than less is the desired treatment
environment for these disordered children. Also in the 1940’s , the
behavioural term of choice was “distractibility” rose to popularity.
Clements indicated that since it was difficult to prove that a child was
afflicted with “minimal brain damage,” or “Strauss Syndrome” as it was
commonly called. Perhaps, the term “minimal brain dysfunction” was more
appropriate. In the 1950’s and 1960’s, the concept of MBD faded as it
became recognized as too vague, too inclusive and of little help to indicate
prognosis. More specific labels appeared to describe cognitive, learning and
behavioral disorders (cognitive disabled (CD), Learning Disabled (LD),
Behaviourally Disabled (BD), etc.). The concept of “the hyperactive child”
rose to popularity in the later 1960’s, and a description of excessive activity
level found its way into the American Psychiatric Association’s DSM-II in
1968.
Also in the 1960’s, noted researcher Stella Chess authored papers that
emphasized a behavioral syndrome that may be a result of organic
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pathology. Her description included less serious or pervasive behavioral
problems. Her recommendations for treatment encouraged a multi-modal
approach including parent counselling, behavioral modification,
psychotherapy, medication and special education.
Interestingly, Chess and others suspected that the disorder was resolved by
the onset of puberty, although Dr. Parker reflects, “...we now know that a
substantial number of hyperactive children will grow up to be hyperactive
adults”. Furthermore, Shekim contends that the course of ADD/ADHD
among adults is extremely variable. The director of Mental Retardation and
Child Psychiatry, Division of Paediatric Psychopharmacology at UCLA’s
Neuropsychiatric Institute, Shekim also argues that one group of adults may
have virtually undetectable signs and function normally, while another
group may have significant problems in difficulties at work, in interpersonal
relationships, family and marital strife, poor self-esteem, irritability, mood
swings and depressive and anxiety disorders.Over 2,000 published studies
in the 1970’s still emphasized hyperactivity but also broadened discussion
to include impulsivity, short attention span, low frustration tolerance,
distractibility and aggressiveness. Noted ADD/ADHD authority Barkley
clarifies that, “These writings emphasized the lack of evidence for a
syndrome, in that the symptoms were not well defined, did not correlate
significantly among themselves, had no well-specified aetiology, and
displayed no common course and outcome”.
During the 1970’s, rapid increase in the use of stimulant medications with
hyperactive children was noted along with increased national publicity
about this Ritalin treatment. Also during this decade, Congress passed the
Vocational Rehabilitation Act of 1973. Together these events seemed to
heighten the nation’s awareness of disabilities.
Broadly speaking, the 1980’s and 1990’s have generated considerable
literature, an explosion of learning intervention strategies and more clearly
22
defined diagnostic criteria. The Diagnostic and Statistical Manual of Mental
Disorders, Third Edition-Revised (DSM-III R), published in 1987, has four
pages of specific information, explanation and diagnosis criteria about
ADD/ADHD; the fourth edition (DSM IV), published in 1994, has eight
pages. This suggests growing public and professional concern about this
prevalent childhood disorder.
Etiology of ADHD
The etiology of this phenomenon has eluded researchers for decades.
Physiological, sociological, and environmental theoretical perspectives have
been exhausted in attempts to identify a link to the etiology of this
dysfunction. The profession is no closer to the answer of causality now than
they were half a century ago. Goodman and Poillion conducted a
comprehensive review of the literature to ascertain a professional consensus
relative to aetiology and characteristics. After surveying 39 literature
sources, they identified that 69 different characteristics were attributed to
children suspected of being ADHD. In addition, 38 possible causes were
identified for just 25 reports.
Dykman and Ackerman concluded that there were three types of attention
deficit disorder behavioural subtypes. The first was “attention deficit
disorder- without hyperactivity” (ADD/WO). The second was, “attention
deficit disorder with hyperactivity” (ADDH). The final subtype is, attention
deficit disorder with hyperactivity and aggression (ADD/HA). This study
further illustrates that if consensus is not reached soon relative to cause and
characteristics, this confusion will continue to escalate and confound this
already polemic topic. There is too much attention directed toward labelling
and classification issues and not enough energy devoted toward intervention
and remediation strategies to help parents and educators manage the child at
home and in school. Because of the attention afforded to labelling, too
many students have been misdiagnosed and labelled when most are just
23
being active healthy children. Desgranges discovered that scores of children
were mislabelled because of many problems children face today in homes
subjected to conflict. Some children identified as ADHD are actually
suffering from other complications (conduct problems, poor home
relationships, dysfunctional families, physical- sexual- verbal abuse,
depression, school anxiety, etc.). Their investigation revealed that only 3 to
5% of all school age children really suffer from ADHD.
There are several theories that attempt to explain the cause of ADHD;
however, most experts agree there is probably no single cause to explain the
disorder. Instead, a combination of factors related to hyperactivity seem to
interact in varying degrees to cause the disorder. These factors may include
brain damage; poor or inadequate prenatal nutrition and care; maternal
alcohol or drug consumption during pregnancy; malnutrition; abusive home
environments; genetic factors; high levels of stress; food additives or
allergies; and physical, neurological, or psychiatric conditions. For
educators and school counsellors, causal factors have minimal, if any,
impact on interventions; however, acknowledging the aetiology often
facilitates acceptance of the disorder and promotes willingness to try
various interventions.
Dr. John Durall proposes that, neurobiological, there is a developmental
delay in very specific self-regulatory management areas within the
prefrontal cortex of the brain. Research has begun to compare anatomical
pictures of the brain, MRIs, with score on psychology tests measuring
inhibition response. (Response inhibition is the initiating major problem in
ADHD). Researchers have found a significant correlation between lower
scores of response inhibition on psychology tests and MRIs that often show
a smaller right Caudate Nucleus and right Globus Pallidus in the right
cortical- striatal-thalamic-cortical circuitry of the brain. This points to the
possibility that people with ADHD may have functional and behavioral
deficits that are related to anatomical variances in their brains.
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In addition, during the infancy stages of development, the brain produces
many excitatory messages causing a high level of motor activity with
resultant increased drives for exploration. As the individual moves into and
through the childhood years, these excitatory messages decrease and are
replaced with inhibitory messages. Inhibitory messages allow the child to
pause, think, recall, and resolve. (Remember that ADHD is a problem of
inhibition.) This change parallels a normal maturational reduction of levels
of dopamine concentrations from initial high levels to later reduced levels.
Dopamine is a neurotransmitter that carries communications across
synapses in the brain and is very important to the brain’s braking or
inhibiting system. Of significance is the fact that researchers have found
that dopamine concentrations remain high and do not become age
appropriately diminished in the brains of ADHD hyperactive boys. Other
brain imaging studies, PET and SPECT scans, have also shown support of
either structural or functional differences in an ADHD child’s brain.
David Henley reports that ADHD is a spectrum disorder, manifested in a
variety of subtypes which are widely considered to be neurodevelopmental
in nature. The salient feature-attention deficits with or without
hyperactivity- is “embedded in a complex array of neurocognitive and
psychiatric vulnerabilities and complications”. Without co-morbidity,
ADHD’s features include inattention to others’ instructions or interactions,
forgetfulness, impulsiveness, difficulties with organization or structure,
mood liability, and low frustration tolerance, which may result in
behaviour. These neurobiological dysfunctions may be the result of
dysregulation of certain neurotransmitters, such as dopamine or
norepinephrine, which modulate information processing to the brain.
Although the exact frequency of convergence of learning disabilities and
ADHD is unclear, there is a high correlation between the two disabilities.
Frequently, learning disabilities manifest themselves with situational
variability, i.e., some areas of learning are easily mastered, while others
25
remain elusive. For this reason, investigators, such as Barkley, view ADHD
as a motivational deficit, rather than purely a problem of attention.
Deviations in behaviour may not be apparent when the child is alone,
engaging in activities that reflect a personal interest. With no demands
placed on them, children with ADHD may not present with behavioral
difficulties until they interact with others, such as a teacher, a parent or a
peer. Here, conflicts inevitably arise, for the child with ADHD has great
difficulty dealing with what Barkley terms “rule governed behaviour.” The
incapacity to accurately interpret, and then follow, established rules
required in social or school situations often results in interpersonal conflicts
with authority figures or peers. The results may be non-compliance or
manipulative-type responses, which are tied to the child’s inability to self-
regulate. Without self-regulation, a cycle of conflict and negativity becomes
inextricably bound up with the child’s relationship to others.
Further complicating this spectrum of difficulties are the co-morbid
psychiatric or neurological disorders, which often accompany ADHD.
Emotional disturbance and oppositional defiance disorders are found in
44% of children with ADHD, while obsessive-compulsive disorders with
ADHD are found in 13%. Anxiety disorders also fall within the 13% range.
The complex interrelationship between ADHD and other psychiatric
illnesses underscore the need for multi-modal diagnostic and treatment
strategies.
Treatment and Interventions
Children diagnosed with ADHD need a comprehensive treatment-
intervention plan that may or may not include the use of medication. When
medication is indicated however, the most commonly used are central
nervous system stimulants that include methylphenidate (Ritilan),
dextroamphetamine (Dexedrine), and pemoline (Cylert). Ritilan and
Dexedrine are usually dispensed to the student twice daily as directed by the
26
physician. The peak effects of these medications occur in 2 hours after
ingestion and dissipate within 4 to 5 hours. Cylert is a steady-state
medication with effects lasting 7 to 8 hours.
Of the stimulants, Ritilan is usually the medication of choice and prescribed
for more than 90% of children receiving medication intervention. In
assessing the efficacy of stimulant medication, DePaul reported that
between 70% and 80% of children treated with stimulant medications
respond positively to one or more doses. The remainder of the children
(20% to 30%) treated with stimulant medications exhibited no response or
their ADHD symptoms worsen.
When a child responds positively to medication, the observed effects
include the ability to sustain attention to task and the inhibition of impulsive
responding. Medication also reduces a number of types of activity,
especially task-irrelevant, non-productive movements during work
situations. Problems with aggression, classroom disruptive behaviours, and
noncompliance with authority figures have also been shown to improve.
Additionally, the quality of interactions between children with ADHD and
their parents, teachers, and peers may improve significantly.
The use of medication intervention is not without some side effects. Some
side effects may include appetite reduction and insomnia. Other, less
frequently reported effects include increased irritability, headaches,
stomach-aches, and motor and vocal tics. In addition, behavioural rebound
has been found to occur in about one third of the students taking
medication. The rebound is a deterioration in conduct that occurs in the late
afternoon and evening following daytime administrations of medication. To
date, the only documented long-term side effect associated with stimulant
medication is suppression of height and weight gain. With discontinuation
of treatment, however, normal growth resumes. Researchers continue to
study the effects of medication interventions.
27
Alternative medications, used less frequently than stimulants, include
antidepressants, clonidine, and monoamine oxidase inhibitors. Clonidine is
gaining recognition as a drug of choice for those individuals for whom
Ritilan is deemed inappropriate because of side effects (e.g., tics). Studies
are currently being conducted to substantiate the efficacy of its use.
Regardless of the medication used, it is imperative that the effects be
continually monitored and the data be reported to the physician and the
family. School counsellors may be in a position to observe these medication
effects or, as the coordinator of the school team, the school counsellor may
gather this information and report it to the parents or physicians. Objective
methods of conducting ongoing assessments of children on medication
should include teacher ratings, direct observation measures, curriculum-
based measures, and assessment of behaviour to discern possible side
effects. In addition to medication therapy, other interventions to assist the
student in social and academic skill building are necessary. Critical to the
success of any intervention plan is the understanding that no single
treatment modality is sufficient to bring about durable reductions in ADHD
symptoms.
Another common intervention for children with ADHD is behavioral
interventions. Essentially there are two areas of behavioral interventions
that focus on (a) antecedents of behaviour and (b) consequences of
behaviour. The antecedents deal with characteristics of the environment, the
task, and the events that proceed the behaviour. Antecedent conditions
include setting and environmental design issues such as type of type of
class, for example, regular versus special class; the structure of the setting;
seating arrangements; and characteristics of the task.
Consequence interventions involve the use of contingency management.
The application of consequences contingent on specific child behaviours, or
contingency management, has consisted of interventions such as token
economy, contingent attention, and home-based contingencies. Additional
28
strategies include group contingencies (strategies in which consequences for
the whole group are contingent on specific behaviours of individuals), peer
mediated interventions, time-out, response-cost, and over- correction.
Contingent attention is the most universally used management technique. In
this technique, teachers and/or counsellors give both positive and negative
verbal feedback with a high degree of frequency. Negative consequences,
such as reprimands, may be needed in addition to positive reinforcement for
satisfactory behaviour management. Reprimands are most effective when
they are given in a calm, firm, consistent, and immediate fashion.
Additionally, eye contact, proximity, and overall professional posture
increase the effectiveness of the reprimands.
Token economies are an example of a consequence management program.
A token economy involves awarding or removing token points to children
depending on predetermined desirable or undesirable behaviours. The
power of this approach to motivate children and to achieve an excellent
level of on-task behaviour and academic achievement is well documented.
Combined with contingency management from counsellors, teachers, and
parents, token economies may significantly improve peer sociometric and
teacher ratings of hyperactive behaviour.
Another intervention, home-school contingencies, consist of programs that
combine school and parent efforts to improve children’s social behaviour.
Typically, a teacher completes a 3 to 5 item checklist that specifies whether
the child has met identified behavioural goals for the day. The report is sent
home, signed by the parents, and returned. The parents provide the
appropriate consequence at home by applying contingencies that have
already been developed. Advantages to this approach include daily
communication between parent and teachers, it is not time consuming or
costly, parents have access to a wider variety of potential reinforces, and
generalization of treatment may be enhanced because of the requirement of
delayed gratification. The success of this intervention seems to be
29
dependent on all involved parties understanding the procedure and on close
cooperation between teachers and parents.
Peer-mediated interventions have several advantages over
counsellor/teacher-mediated strategies and may result in significant positive
behaviour changes. Advantages include the fact that students themselves
may more closely observe each other’s’ behaviour, generalization of
behaviour across settings may be facilitated, and peer-mediated
interventions are less time consuming for the counsellor/teacher. Peer-
mediated reinforcement and group contingencies can be divided into three
types including:
(a) Interdependent, in which the behaviour of the entire group determines
whether the group receives reinforcement;
(b) Independent, in which a set of contingencies is applied to the entire
group, but each child’s behaviour determines his or her eligibility to receive
reinforcement; and
(c) Dependent, in which the behaviour of one or several target children
determines reinforcement for the entire group.
Time-out, response-cost, and overcorrecting are all punishment techniques.
Time-out from positive reinforcement is a well-documented and effective
technique for reducing undesirable behaviours. Caution should be used,
however, and careful planning and implementation are essential for the
success of such a program. Response-cost. a preferable type of contingency,
is the withdrawal of privileges or rewards from the student. Over-
correction, another negative consequence, requires the student to make
restitution or engage in a more appropriate form of behaviour.
Human Pubertal Development
The lack of a clear and consistent pattern of results across studies
30
examining symptom, behaviour, neuropsychological and neuroanatomical
profiles of individuals with ADHD can at least partly be attributed to
developmental factors. Adolescence marks a major developmental
milestone, involving dramatic changes in physical, psychological, and
social maturity. These developmental changes make adolescence a “period
of vulnerability and adjustment”. Reflecting this vulnerability, this
developmental period is a time of increased prevalence of several
psychiatric illnesses and risky behaviours. Fundamental to the changes
occurring in adolescence are sex specific effects presumed to be caused, at
least in part, by the increase in secretion of circulating sex steroids with the
onset of puberty.
Puberty, functionally coupled with adolescence, is defined as a period of
elevated secretion of gonadal steroid hormones. The onset of puberty marks
the start of a ‘sensitive period’ in the development of and changes to the
structural organization of the nervous system. In humans, pubertal
maturation begins with hypothalamic gonadotropin releasing hormone
(GnRH) secretion, which activates the hypothalamic-pituitary-gonadal
(HPG) axis. This period is “characterized by a gradual increase in the
frequency and amplitude of intermittent episodes of GnRH release”. In turn,
GnRH stimulates the production and secretion of luteinizing hormone (LH)
and follicle stimulating hormone (FSH), pituitary gonadotropins, which
promote release of sex steroid hormones (i.e., estradiol in females and
testosterone in males), and completion of gamete development (i.e., egg
and. The higher levels of estrogen and androgen in turn, trigger the
development of secondary sex characteristics. It is important to remember
that while a hallmark of puberty is the production and secretion of gonadal
steroids, puberty is not only a gonadal event. Rather, it should be viewed as
a “brain event”; a period when sex hormones interact with the developing
adolescent nervous system. In fact, puberty-related changes continue into
the third decade of life, thus corresponding to the lengthy maturation of the
31
brain, in particular of the frontal cortex that continues to develop well into
the twenties. Relatedly, the nervous system has a reciprocal influence on
gonadal development and maturation.
The developing adolescent brain is highly receptive to the effects of
gonadal steroid hormones. Circulating steroids (e.g., estradiol and
progesterone) act in a time- sensitive and graded manner to shape
adolescent brain development during a protracted process that spans more
than a decade. This process is highly individualized. As such, variation in
the age of puberty onset contributes to individual differences in
developmental course and behavioural maturation. Relatedly, differences in
the timing of puberty will contribute to the diversity of adult psychological
characteristics, behaviours, and relative risks for psychopathology. Finally,
given the permanent organizational influence of gonadal hormones, effects
dependent on the timing of puberty are likely to be permanent and
observable in adulthood.
The start of puberty in females is defined by the appearance of breast
development, with a median age of onset of 10.0 years. Yet most studies
examining the effects of timing of puberty onset typically use age at
menarche as the marker of puberty onset, which has a median age of onset
of 12.5 years. Although the physiology of puberty is common to all
individuals, its onset occurs across a wide range of ages in the normal
population (i.e., 11 years or earlier to 14 years or older). Several pathologic
conditions, such as central nervous system tumours or systemic illnesses,
can influence timing of puberty. Moreover, the decrease in the age of
pubertal onset over recent decades had been attributed to changes in family
structure (e.g., father absence), better nutrition, and increased obesity in
childhood, and reductions in levels of childhood illness. Yet, most variation
in pubertal timing has no known etiology, and much of this variation stems
from differences in the reactivation of the HPG axis.
32
Variation in sex steroid exposure has been used to explain sex differences in
neuroanatomy and cognitive function. For instance, it has been reported that
females undergo an earlier peak in brain volume, greater growth in some
structures over males, and less white matter growth than males during
adolescence. Given that circulating sex hormones influence virtually all
mechanisms involved in the remodelling of the adolescent brain (e.g.,
dendritic elaboration, synaptic pruning, and axonal sprouting), it is not
surprising that estrogen also plays a role in modulating cognition in the
developing human brain. Relevantly, typical behavioural and cognitive
changes noted in adolescence, such as risk-taking, reward sensitivity,
sensation/novelty seeking, and basic cognitive abilities have been linked to
pubertal maturation. For example, imbalance with the front limbic circuitry
has been used to account for the greater prevalence of risky behaviours
among adolescents and young adults, with only subcortical structures being
directly linked to pubertal maturation. Whereas the cognitive functions most
likely to be affected will be those linked to neuroanatomical areas with the
highest concentration of estrogen receptors, the scientific community
remains uncertain regarding the role of sex hormones in cognition.
Attention Deficit/Hyperactivity Disorder and Pubertal Development
As discussed above and in common with many neurodevelopmental
disorders, the prevalence of ADHD differs in males and females. In
addition to the limitations inherent in the DSM-5 nomenclature and
proposed inadequacy of current rating scales in capturing symptom severity
among females, this sex discrepancy may, in part, be driven by hormonal
influences. ADHD in females presents at a later onset and with more subtle
clinical symptoms, often of the predominantly inattentive subtype. The
direct assessment of subtype differences is essential when investigating the
hormonal influences on ADHD symptom manifestation. It has been
33
suggested that while females may be protected to some extent from the
symptoms of ADHD pre-puberty because of their earlier brain maturation,
increased release of estrogen with puberty, and corresponding increase in
dopamine receptors, may lead to a subsequent increase in ADHD
symptoms. That is, deficits in cognitive control may be the result of the
direct influence of sex hormones on the dopaminergic neural circuitry in the
nucleus accumbens, striatum, and prefrontal cortex. Animal models reveal
female specific modulatory effects of estrogen and progesterone on
dopamine in the striatum and nucleus accumbens. Similarly, higher levels
of extracellular estrogen during the oestrous cycle in female rats are
accompanied by greater dopamine release in the striatum. It is also
interesting to note that the amygdala, hippocampus, and orbital and medial
prefrontal cortices, and the hypothalamic-pituitary-adrenal axis are targets
of estradiol at puberty. Therefore, previous reports of remitting symptoms
in ADHD into adolescence and young adulthood may be more reflective of
the trajectory of male ADHD symptoms. Conversely, just when male
symptoms begin to diminish, female symptoms begin to be more apparent
and reported. Relatedly, it has been noted that increased hormonal
fluctuations throughout the phases of the menstrual cycle are associated
with increased symptomatology. Further supporting the existence of a link
between hormones, particularly estrogen, and ADHD in females is the
existence of ADHD comorbidities known to be influenced by pubertal
onset. That is, given that the manifestation of many of the known common
comorbidities in females with ADHD have been shown to be affected by
pubertal timing it seems highly plausible that a correlation between pubertal
onset and ADHD exists. Finally, similar to the imbalance noted within the
frontolimbic circuitry used to account for the greater prevalence of risky
behaviours among adolescents and young adults, it is likely that the neural
circuits implicated in the inattentive symptoms and emotional dysregulation
of ADHD (i.e., frontal-striatal and frontal-limbic circuits) would also be
affected by the puberty-dependent imbalance in maturation between
34
subcortical and cortical regions.
The Present Study
The literature reviewed above indicates that puberty is a key time for
neuroanatomical changes and that circulating sex steroids likely play a
significant role. Moreover, data suggest that circulating sex steroids
modulate cognition, especially those cognitive functions that are
underpinned by anatomical structures richest in estrogen receptors, such as
the frontal cortex. The frontal lobes sub serve various functions (e.g.,
affective regulation, attention/arousal, and impulse control), and the
prefrontal area, particularly involved in executive function, has been chiefly
implicated in ADHD. There is growing evidence that subtle sex differences
exist in the symptom profile, neuropathology and clinical sequelae of
ADHD, and that hormonal factors may play an important role in
understanding ADHD in females. Yet, to date, there has been little research
on this topic. The present study sought to address the current gaps in our
understanding of how female pubertal maturation influences the extent of
ADHD symptoms in a nonclinical female sample. This was primarily an
exploratory study. Nevertheless, given the noted negative consequences of
early puberty onset, such as disordered eating and anxiety, sexual risk
taking, substance use and anti-social behaviour, it was predicted that
aberrations from typical pubertal onset, specifically early maturation
relative to peers, would be associated with elevated levels of ADHD
symptoms, impairments in daily functioning, and difficulties in emotion
regulation. The findings from the study were aimed to add to the general
understanding of the relationship between puberty onset and executive
functioning. Further, the study was designed to add to our understanding of
ADHD prevalence rates among females, and the potential female-specific
adolescent onset of presenting symptoms.
35
Measures
Barkley Adult ADHD Rating Scale-IV (BAARS-IV; Barkley, 2011a).
Designed with consideration of DSM-IV diagnostic criteria, the BAARS-IV
is a self-report questionnaire in which the participants were asked to report
their current ADHD symptoms. Specifically, with regards to the current
symptoms interview, the participants were asked to indicate to what extent
each item described their behaviour during the past six months. The
possible response for the questionnaire ranged from “Never/Rarely” (1) to
“Very Often” (4). A total ADHD score and symptom count was calculated
by adding up the scores for each item answered. From the BAARS-IV –
current symptoms questionnaire, 4 subscale totals were calculated related to
the four recognized ADHD symptom dimensions: Inattention,
Hyperactivity, Impulsivity, and Sluggish Cognitive Tempo (SCT). The
internal consistency, construct validity, discriminant validity and criterion
validity are all reported to be satisfactory.
How Much Is Technology to Blame for ADHD?
No one knows for sure to what degree these rising rates can be ascribed to
technology, but some believe that combined media are having a noticeable
effect. A recent study assessed the viewing habits of 1,323 children in third,
fourth, and fifth grades over 13 months and found that children who spent
more than two hours a day in front of a screen, either playing video games
or watching TV, were 1.6 to 2.1 times more likely to have attention
problems.
The study, also found that exposure to “screen media” was associated with
attention problems in a sample of 210 college students. “This study
36
contributes to a growing body of research that shows media may have an
effect on attention,” says Dimitri Christakis, MD, MPH, director of the
Child Health Institute at the University of Washington in Seattle.
Dr. Christakis, who has spent the last decade studying how entertainment
affects children’s mental processing, believes that overstimulation from
media may be a possible cause of ADHD. In one study, Christakis found
that kids under the age of 5 who watched two hours of TV a day were 20
percent more likely than kids who watched no TV to have attention
problems at school age. Christakis concedes, however, that the science in
this area is still emerging. “If I thought I knew the answer definitively, as to
what was causing ADHD," he notes, "I would not still be doing research."
The American Academy of Paediatrics is persuaded enough of the
detrimental effect that it recommends that children spend no more than one
to two hours a day interacting with screen-based media, such as TV and
video games. And the recommendation for children under the age of two is
no TV at all. The brain is a highly adaptive and sensitive organ, so it makes
intuitive sense that something like fast-paced video games could alter the
way it reacts to stimuli.
“In the last 50 years we have created platforms in which we present things
in surreal time,” says Christakis, who is also the author of The Elephant in
the Living Room: Make Television Work for Your Kids. “When you
condition the mind to become accustomed to high levels of input, there’s a
chance that reality can just become boring.”
ADHD is a neurobehavioral developmental disorder. People with ADHD
have difficulty staying focused on one task and controlling their impulses
and are often fidgety or hyperactive. They have a hard time synthesizing
facts, so they tend to have trouble seeing the forest for the trees. Brain scans
37
show that people with the disorder actually work harder than average to
absorb what must feel like a barrage of information. Symptoms usually
appear between the ages of 3 and 6. Poor attention is one of the most
notorious signs of ADHD, but it is really part of a constellation of
symptoms.
While technology does seem to have some effect on attention span, many
researchers balk at saying outright that technology and media cause ADHD.
“Technology does not cause ADHD,” says Jacquelyn Gamino, PhD, head
of ADHD research at the University of Texas Dallas School of Behavioural
and Brain Sciences.
While the research showing that kids who watch TV have poorer attention
spans later in life is compelling, it’s difficult to establish that TV or video
games were responsible for those problems. “Which caused which?” Dr.
Gamino asks. Perhaps parents of restless kids are more likely to sit them in
front of the TV to calm them down. Or perhaps children with ADHD
gravitate toward over-stimulating media as a way of self-medicating. After
all, many medications for ADHD are actually stimulants. The Web site of
the National Institute of Mental Health does not list technology and media
as probable causes of ADHD.
Researchers who dismiss the technology-ADHD link point to the fact that
genetics plays a large role in the disorder. Kids with ADHD are more likely
to have parents and siblings with the disorder. Scientists are finding that
kids with ADHD have brains that are different from those of kids without
the disorder. “People with ADHD have, by chance, ended up with
combinations of genes that lower attention capacity,” says Chandan Vaidya,
PhD, a cognitive neuroscientist and associate professor of psychology at
Georgetown University. These combinations of genes influence
neurotransmitters like dopamine and norepinephrine that regulate attention.
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An NIMH study published in the Archives of General Psychiatry in 2007
found that kids with ADHD who carry a particular version of the dopamine
receptor D4 (DRD4) gene have thinner brain tissue in the areas of the brain
associated with attention. However, the brain tissue and ADHD symptoms
tended to improve as the children grew older.
Environmental toxins may also contribute to ADHD. For example, prenatal
exposure to cigarette smoke and alcohol, and early childhood exposure to
lead, may increase a child’s risk for developing the disorder. A recent
analysis of data from the 2001-2004 National Health and Nutrition
Examination Survey (NHANES) found that children who were exposed to
tobacco in utero were 2.4 times more likely to have ADHD than children
who were not. The same study, which was conducted at Cincinnati
Children's Hospital Medical Center, found that kids exposed during early
childhood to lead, which is sometimes found in plumbing fixtures or paint
in old buildings were 2.3 times more likely to have ADHD than those who
were not exposed.
Pesticides are another possible culprit. Another NHANES analysis
conducted at the Harvard School of Public Health found that children
whose urine contained traces of organophosphate pesticides were more
likely to be diagnosed with ADHD than other children. The more of the
metabolites that were present, the more likely the child was to have ADHD.
It seems as if all sorts of bad things are being linked to ADHD. Researchers
found that a Western fast-food diet (which some might consider toxic) full
of highly processed, fried and refined foods was associated with a high risk
of being diagnosed with the disorder. A "fast-food" diet tends to be higher
in total fat, saturated fat, refined sugar and sodium than a diet based on
fruits, vegetables, and whole grains. The study, which was conducted in
Australia and examined the eating habits of 1,800 adolescents, was
39
published in the Journal of Attention Disorders. But as with the media
studies related to attention, it’s difficult to establish a cause-and-effect link.
It is possible that kids with attention problems eat more fast food because it
requires less attention. Or perhaps a fast-food diet is simply a marker of
lower socioeconomic status and parental education levels, which have also
been associated with ADHD.
With so many possible causes, what can parents do to limit the chance that
their kids will develop the disorder? Some things, like genetics, can’t be
controlled. But even if your child does have some of the genetic variants
linked to ADHD, it doesn't mean he or she will definitely end up with
ADHD. “The environment in which you live can make up for or exacerbate
the problem,” Dr. Vaidya notes. Kids with ADHD who are given help with
organization and planning, for instance, tend to function better in school
than kids left to founder on their own.
It’s probably wise to limit your child’s time with screen media. While these
media may not cause ADHD, they could very likely exacerbate a problem
that’s already there — or simply lead to poorer attention overall.
Researchers are still not sure what kind of media content, exactly, affects
attention. Some video games are even considered useful, because they
improve hand-eye coordination and critical thinking. To be on the safe side,
try to limit young children’s exposure to fast-paced television shows and
video games to less than two hours a day.
Homoeopathic View-Point
Attention deficit hyperactivity disorder (ADHD) is the most commonly
diagnosed psychiatric disorder of children, afflicting about 35% in the U.S.
It is often believed to be a physiological brain disorder with a genetic
40
component. Children with ADHD are impulsive, overactive, inattentive,
poor learners, and are frequently disruptive, aggressive and uncontrollable.
ADHD is treated medically with stimulant drugs such as Ritalin, oral anti
hypertensive and antidepressants. While these medications can at times be
effective if carefully monitored, side effects are possible, and most of these
drugs should not be (though sometimes are) given to children under age six
because of risk of toxicity or lack of dosage information due to inadequate
testing for adverse drug reactions in this population. Twenty percent of
ADHD children do not respond to the first stimulant drug tried, or have a
negative reaction to it.
Clinicians using homeopathy for ADHD have reported good results, but
objective evidence has been lacking. Now, a double blind, placebo-
controlled study of 43 children with ADHD shows that homeopathy can be
effective in treating the disorder.
In a study published in the British Homeopathic Journal, Oct 1997, children
afflicted with ADHD were given either a homeopathic treatment or a
placebo for ten days, then parents or caregivers rated the children on the
amount of ADHD behaviour they displayed. Those receiving homeopathic
medicines showed significantly less ADHD behaviour than those given
placebos.
When evaluated in a follow-up interview two months after the study's end,
57% of the children showing improvement with homeopathy had continued
to improve, even though they had discontinued the homeopathic medicines;
twenty-four percent relapsed by the time of the follow-up; and the
remaining 19% continued to experience positive results, but only while
taking the homeopathic medicines.
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The homeopathic medicines found most helpful for ADHD were
Stramonium, Cina and Hyoscyamus niger. Stramonium was specifically
indicated when children had many fears, or suffered symptoms of post-
traumatic stress disorder; children who were physically aggressive benefited
most from Cina; and, children with manic or sexualized symptoms
responded most favourably to Hyoscyamus niger.
Below is an alphabetic listing of homeopathic remedies and a brief
summary of how each might be applied to children with ADHD or ADHD
symptomology.
Therapeutics for ADHD
Aconite:
Indicated especially for those who often have strange and irrational fears,
fears and sweating at night, a tendency to fevers, croup, and thirst.
Anacardium:
Indicated especially for those who feel put down, isolated, and separated
from the world; for those who feel pathological inferiority; those who feel
need to prove themselves; test-taking anxiety in which the person goes
blank.
Argentum nitricum:
42
Indicated when there is antagonism within the self, the mind is of two wills,
the person imagines devils speaking in one ear and angels in the other, like
Jekyl and Hyde. It is indicated for people who can be cruel and malicious,
often after a history of being abused or belittled; for those who swear; and
for those who act as if they lack a conscience.
Aranea ixabola:
Indicated for excessive teasing, especially teasing and manipulating by
acting cute; for those who act as a mischievous leader, inducing others to
disobey; and for those who are fascinated with spiders.
Arnica:
Used for children in shock, or who have never been well since a shock or
trauma, even trauma from a difficult birth. It is often confused with
Sulphur.
Aurum metallicum:
Used for children who act like little adults; who want affection, but don't
know how to express emotional needs; for those who can be cold to their
family, and have a hard time making friends. It is indicated for those who
are perfectionist, and who can be bitter and negative; for those who try hard
and don't want to fail; for those who tend to sinus problems, nasal
congestion, and moaning in sleep; and for those who feel better from music.
Baryta carbonica:
Used for those who can be sweet, timid and fearful or be the class clown,
acting goofy and acting out. It is indicated for apparent arrested or delayed
mental, physical or social development; for children who are shy, self-
43
conscious, with self-limitation, feeling defective. It is used for those with
the fear of looking bad, being laughed at, and criticized; for those who feel
incompetent and incapable. It is indicated for those who feel that they are
being laughed at, mocked, or criticized; and for those who are timid due to
fears, especially the fear of making a mistake. It is used for those who feel
that they are being watched; for those who dare not look up; for those who
act childish and immature; for those who have difficulty with schoolwork. It
is used for those who are backward or behind; for those who are often the
teacher's pet; and for those who tend to tics and glandular swellings.
Baryta iodatum:
Used for those who are irritable, hurried, restless, and nervous; who have
difficulty concentrating; and who have a canine-like appetite.
Belladonna:
Used for those who are forgetful, slow, and have a poor learning ability;
sensitive to noise and light; have night terrors and fear of ghosts; look wild
when angry; have large heads, with bright red cheeks. The belladonna
person often looks well, even when sick; tends to otitis media; complains of
hot and throbbing discomfort; and often craves cold drinks, especially made
from lemons and oranges.
Bismuthum subnitricum:
Indicated for children who cling desperately to their mothers and are
terrified when alone and who tend to be thirsty for cold water, but can have
acute stomach pain in which even water is vomited as soon as it reaches the
stomach.
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Bufo:
Used for those who have difficulty relating well to others; have narrow
focus; don't understand danger; have seizures or autism; have a slow, coarse
appearance; can hug or bite you; masturbate or show a premature interest in
sex. These children rely on basic instincts and need instant gratification; are
upset when not understood; cannot tolerate music or bright objects; often
present with eczema, nail biting, and may have protruded tongue or a gaunt
face with stupid expression.
Calcarea bromatum:
Indicated for restlessness in flaccid, chubby children.
Calcarea carb:
Indicated for those who feel unsafe; are afraid of robbers, dogs, heights, and
airplanes -- any situation with potential risk to physical safety; are cautious
and protective; fear that others will perceive their confusion and think them
insane; feel as if everything is horrible; are stubborn and methodical; are
obstinate and strong-willed; can be slow, hesitating; and of a chunky build;
and sweat on the head as infants.
Calcarea phosphorica:
Indicated for those who feel frustrated and dissatisfied; act fussy and
peevish; for young children who are restless, shy, and fearful, but who love
to take chances and play tricks, even act like daredevils. These children feel
as if they are away from home and must get home; are athletic; love travel,
change, and new experiences; complain of growing pains, especially in the
45
bones; desire smoked meats; tend to have abdominal gas, colic, slightly
swollen abdomen; and often have tonsillar hypertrophy.
Cannabis indica:
Used for those who feel isolated, disconnected, anguished, terrified, and
even sometimes ecstatic. This remedy is indicated for those who feel spacy,
confused, and inattentive; have time and space disorientation; fear going
insane; feel like everything is a dream with even familiar things which seem
strange or unreal (derealization); act as if in a dream or off in space; can't
pay attention for long; but are good at science projects until theorizing
causes them to lose touch with reality; are absent-minded; can be obsessive-
compulsive; appear as if on drugs with a "stoned" look in eyes; and have
parents who used marijuana excessively. There are three common
behavioral variations of this remedy: (1) presenting as laughing, giggling,
and clowning around; (2) presenting as ethereal and airy; and (3) presenting
as brassy, loquacious, and liking to dress up in olden-day clothes.
Capsicum:
Indicated for those who are intensely homesick, discontented, brooding,
irritable, absent-minded, disobedient, and angry; who appear extremely
obstinate; who are contrary, even against something they want if suggested
by someone else. Capsicum is prescribed for those who fear being censured
and are easily offended; who are restless, clumsy, and run into things; who
have difficulty sleeping at night, but yawn during the day. It is used for
those who can wake in a fright, screaming, or full of fear and who are worse
form any draft, even warm air. Capsicum children are often seen in daycare
with frequent otitis and bright red ears. They can have a pale face and
puffiness under the eyes, as well as rashes.
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Carcinosinum:
Indicated for those who are fearful, timid, unhappy, worried, and obstinate,
yet sensitive to reprimand and music; appear dull of mind, disinterested,
and averse to conversation. They can be very sympathetic to others; can be
very tidy or very messy; love to travel and will over-extend themselves;
frequently suffer from insomnia; and strongly crave or dislike salt, milk,
eggs, fat meat, and/or fruit. The onset of symptoms often occurs after a
severe reaction to a vaccination. Frequently there is a family history of
cancer. These individuals may have brownish cafe-au-lait complexion with
many pigmented moles, bizarre tics, or blinking eyes.
Chamomilla:
Indicated for those with bad temper, who are very irritable and impatient;
who are complaining, frustrated, restless, and thirsty; who are contrary, not
knowing what they want; who demand one thing and then want something
else. The chamomilla child is fidgety and quiets down once he has attracted
attention. He wants to be carried everywhere, but will whine and scream.
He will settle down if carried, jiggled, or rocked. These children show
aversion to being touched with hypersensitivity to pain, feel pain is
unbearable, feel that everything is intolerable, and can become so
hyperactive that he will get exhausted and begin to cry. The child shows
dullness of the senses with a diminished power of comprehension, as if they
were hard of hearing. All symptoms are worse at night
Cina:
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Indicated for children who are cross, contrary, and disobedient with very
difficult behaviour. These children do not want to be touched or looked at
and turn away when approached. Nothing satisfies them for long. They are
restless, fidgety and fretful, especially during sleep. They grind their teeth at
night and wet the bed, and may have parasites, such as pinworms. Their
sleep is restless, accompanied by jerking, frequent swallowing and
coughing. They often sleep on their abdomen or the hands and knees
(Medorrhinum). They may have an irritated nose causing a constant desire
to rub, pick, or bore into it until it bleeds. Their ears can be itchy. They
often show twitching of the face muscles and eyelids, and are even inclined
to seizures. Their appetite can be ravenous with strong thirst, and craving
for sweets. These children often have large bellies.
Colocynthis:
Indicated for those who are easily offended, especially by feeling
unappreciated, by insults, or humiliations. They are moody and overly
sensitive, and want to be alone. They tend to have abdominal cramps and
sciatic pain, and may bend forward for relief.
Cornus circinatus:
Indicated for those who don't want to think, read or work. They have an
inability to concentrate on thoughts, don't understand what they are reading,
and tend to aphthous stomatitis, flatulence, and weakness upon waking.
Crotalus horridus:
Indicated for those who are intense, animated, hurried, restless, and
talkative. They have many fears, especially that someone might be
following them or that they hear footsteps behind them. They fear being
48
alone, spirits, ghosts, snakes; and can strike out in fits of rage. They resent
and blame other children for getting them into trouble, report dreams of
hairy spiders, and tend to have hives and epistaxis.
Cuprum metallicum:
Indicated for those with anxiety at night, fears of kidnappers or the house
catching fire, and are known for sticking their tongues out.
Ferrum metallicum:
Indicated for those who are strong-willed and persistent, fight for their
beliefs, have a sluggish mind with difficulty collecting their thoughts, tend
to anemia and headaches, are often obese, with an aversion to eggs, and
crave or detest tomatoes.
Gallic acidum
Indicated for those who will hurt their loved ones.
Helleborus:
Indicated for those who feel stupid, that they cannot cope with life's
challenges, and that their mind is sluggish. They appear dull and
unresponsive; often have a history of encephalitis or head injury, and have
difficulty memorizing or articulating thoughts. They have a tendency to
despair and a strong aversion to making any effort, yet are easily angered.
They have been observed to bite their spoon when eating without being
aware of it, have a history of fever and/or head injury. One often needs to
follow quickly with Hyoscyamus. This remedy picture is often easily
confused with Sulphur and Med.
49
Hyoscyamus:
Indicated for difficult children with poor impulse control, even though
engaged in premeditated actions; talk excessively with episodes of mania
and rage that might include hitting and screaming, also inclined to
depression after manic phase; can be manipulative, lying, and violent; seem
unable to think; unresponsive to questions or cannot bear anyone talking to
them; intense and violent excitability with fear, delirium, and the delusion
of being poisoned; feelings of abandonment, jealousy, suspicion; fears of
dark, dogs, water; delirious; delusions of animals, of being pursued by
enemies, as if s/he might be injured by surroundings; sees ghosts, specters;
very animated, seeming silly and foolish; smiling and laughing at
everything, often inappropriately; talks nonsense; acts out ridiculous
gestures like a dancing clown or monkeys, trying to be centre of attention,
often with sexual overtones; giddy; love to run around naked, can be a
totally shameless exhibitionist with bizarre behaviours for shock value,
including cursing; tries to embarrass parents; jealous of their siblings, often
may injure them; cannot tolerate being covered up.
Kali bromatum:
Indicated for restless children, who always have to be doing something,
especially with the hands, including activities like throwing.
Lachesis:
Indicated for those who are loquacious, agitated and hyperactive, and
restless and moody with strong emotions. They may be very jealous of
siblings, or even of the same sex parent, and tend to be vengeful, sarcastic
and nasty. They can be especially hurtful (and intuitively accurate) with
50
insults; and can have a self-destructive personality, with a marked lack of
confidence and a tendency to severe depression, withdrawal, and
hopelessness. They hate any kind of physical or behavioural restriction, like
tight clothing or being "grounded; and cannot bear authority and run away
from home. They tend to self-criticism and irritability; often reproach
themselves severely; and may also show aggression which surfaces easily
and makes them difficult to live and work with. They are known for
suspicion with a marked preoccupation about others; and frequently feel
that others are often criticizing them and putting them on the defensive. All
symptoms are worse upon waking, when they typically feel unrefreshed and
even more agitated, often complaining of a suffocative feeling.
Lycopodium:
Indicated for those who are insecure, who act like bullies, and are cocky
and boastful, often with overcompensation. They may show a marked lack
of confidence and many fears, with underlying cowardice; can be dictatorial
and bossy at home where they feel safe; and may have delusions of being a
great person. They fear looking bad, need to cover up; are afraid of failure;
are afraid to try anything new or to try again having failed once. They fear
being injured; may see phantoms and other images; displays both fear and
bravado; are usually intelligent and may look older than his years, but often
suffers from dyslexia, confusing words or letters. They may show
performance anxiety, prefer younger friends, want to please authority
figures, tend to have abdominal gas; get more tired, restless, and irritable
between 4 and 8 p.m. These children don't want to sit down at the dinner
table, but prefer to run around.
Lyssinum:
51
Indicated for those who bite, growl, snarl, scratch, and act rabid. They are
easily enraged; angry, but repent quickly, have remorse. They feel
tormented and abandoned, as if he has suffered some wrong. These children
feel as if they have been injured or abused. They often have a history of
abuse, and may be children of violent parents. They strike out at presumed
tormentors; and are self-destructive, with an impulse to cut his or her self.
They can be defensive, as if being attacked or insulted. They may have a
history of dog bite; animal-like behaviour; aggravated by sound of running
water; may have fears of water or reflected water, dogs, small rooms. They
may crave chocolate and salt and have enuresis.
Mancinella:
Indicated for those who fear of evil, devils, and being possessed; may
develop fears or obsession with evil after seeing a scary movie; and may
have delusions that his or her soul has been surgically removed. The child
says someone is taking things away. They may have asthma or bronchitis.
Medorrhinum:
Indicated for those who are irritable, agitated, and in a hurry. They may
have a racing mind and lust for experience, especially sensual. They may
feel a need to hide her/himself, because s/he has a defect or is somehow
flawed. They have anticipatory anxiety; delusions that someone is behind
him or her or that someone is touching their head; fear that something
dreadful has happened; a sense that everything is strange or unreal; a fear of
going insane; a terrible memory, and may be forget. They may be mentally
dull, unstable emotionally, have fits, can be reckless and impulsive;
52
obsessive-compulsive, rigid; may be cruel or loving to animals; want to stay
up late at night, feels better at night, yet can fear dark and monsters. They
may have a history of diaper rash as a baby, and later skin rashes and
asthma; nail biting; hot feet; and may sleep with their knees to the chest.
Natrum muriaticum:
Indicated for children who act like "little adults," display extreme
watchfulness; sit in their mother's laps during the interview; are often tidy,
not wanting to lose control; and are sweet, except with their family. They
may show silent grief or may have shrieking tantrums; may be confidante to
one parent and nasty to other; may have concomitant anorexia; may display
shyness with urination, especially in a public place; may crave salt,
worsened by the sun; and may dislike slimy foods and fat.
Natrum sulphuricum:
A specific remedy for depression after head injury. It is often seen with
grief after parents' divorce. Children who want this remedy have a strong
sense of duty to family; can be suicidal; suffer existential anxiety and may
have a nihilistic attitude toward life; have sadness relieved by music; often
experiment with drugs; are born older; and tend to have asthma and warts.
Nux moschata:
Indicated for children who pass out with the slightest injury or no obvious
provocation; are giddy, spacy, and mentally confused. These children can
be the perfect child - cooperating with parents, sharing, doing chores, going
to bed on time; and tend to sleepiness, constipation and dryness of eyes,
mouth and tongue.
53
Opium:
Indicated for children with difficulty concentrating; painlessness of an
obviously painful complaint; being out of touch; having complaints from
fright or after head injury; having constipation; having sleep apnea; and the
mother often having been given drugs during pregnancy or labour.
Phosphorus:
Indicated for children with the fear of being unloved, isolated, and having
lost all their friends; children who are psychic; and children who see ghosts,
spirits, specters. They may have a sense of being on a distant island; are
concerned that they have an incurable disease; are gregarious, bubbly, and
good-natured; are sensitive, sympathetic, and kind; are sweet and
compassionate; and can be spacy.
Platina:
Indicated for children who are insecure, volatile, flirtatious, arrogant and
contemptuous (usually girls); are forsaken and unloved with a need to
reconnect to people, but have the illusion that others are physically and
mentally inferior; and underneath have feelings of failure, rejection, and a
lack of confidence. These children want to look good; and can be very
forward with even young girls putting out a sexual message and tend to be
jealous of other women. These children may be emotionally stuck, tending
to live in and dwell on the past. They can have strong feelings of anger,
indignation and paranoia. They may have overwhelming and aggressive
impulses that provoke the most severe depression and confused states,
alternately indescribably happy and laughing at the saddest thing, then
insufferably sad, hopeless and terrified by any serious thought. They need
excitement or melodrama; can be very restless children who cannot remain
54
in one spot and may experience marked anxiety with trembling, as well as
oppressed breathing and violent palpitations.
Scorpion:
Scorpion is used for children who are violent if provoked or just for the fun
of it, for children whose parents fear being harmed by the child; for children
who lack conscience and compassion for the suffering of others. These
children are detached, like solitude, can attack if bothered; and are
indifferent to pain or pleasure.
Stramonium:
Indicated for children who are violent or fearful; who are severely
hyperactivity, easily terrified, and inclined to violent agitation and fits of
rage; and whose speech is loud, fast, and possibly incoherent. These
children show feelings of terror and abandonment; are afraid of the dark,
dogs, evil, suffocation and abandonment. Their thirst is great, yet they dread
water. They have fears of death; believe s/he is always alone, and are
especially afraid to be alone at night, become overly vigilant to combat
these fears and become violent if controlled. They have nightmares and
night terrors that become increasingly worse between midnight and 2 a.m.
They often awake screaming; see ghosts, specters, spirits; have a horror of
glistening objects; have delusions of animals, of danger; are clinging. They
are aggressive; bite, kick, strike; use threatening language; can have
seizures or personality change after a head injury, frightful episode, or
trauma (especially being chased by dogs). They can be useful in autism or
Tourette's. These children can be sweet all day and have terrors at night.
Sulphur:
55
Used for children who are egotistical; try to control feeling with mind; hate
being scared; feel as if they are being scorned; have delusions that s/he has
been disgraced; are messy and tattered but think they look fine. These
children can be lost in thought, absent-minded, spacy; forgetful, loses
things; has visions; full of theories and dreams, loves science fiction; can be
a loner with limited social skills; prefers computers, reading, mechanical
things.
Tarentula hispania:
Indicated for children who are frenzied, are worse with music; act wild and
crazy; love to sing and dance; feel as if never enough time; feel as if s/he
has been insulted; sense of a stranger in the room. They see faces on closing
eyes; have episodes of raving delirium; are mischievous and sneaky; tease
and hide; cut things; hurried, always restless.
Tuberculinum:
It is indicated for those who revolt against restriction and need to feel free.
They always desire and seek change, travel and new experiences; always
feel dissatisfied; and feel as if there is never enough time. They are afraid of
(and often torment) dogs, cats; have delusions that s/he can fly, that
someone is following her/him, that he is surrounded by animals; feel
everything is strange; are compulsive and uncontrollable; are destructive;
throw tantrums; break things; are precocious; and are often malicious.
Tuberculinum aviare:
Indicated for those who show extreme restlessness with great weakness;
diminished appetite of long duration; and a tendency to otitis.
56
Veratrum album:
It is indicated for those who are inconsolable after fancied misfortune; have
a racing mind and agitated actions; and are driven to act on impulses. They
may show religious mania; are overly religious; feels s/he is in
communication with God; delusions that s/he is a great person or somehow
distinguished. They have delusions of animals; are always busy but often
fruitlessly so; have impulses to kiss or touch others; are hurried, restless,
and fidgeting, poking others; and are precocious.
Zincum metallicum:
Indicated for children who are fidgety and restless, and especially known
for restless feet and legs. These children have an overactive nervous system;
twitch, jerking, and even have convulsions; and are sensitive, irritable, and
prone to rage. They often make mistakes in writing and speaking; feel like
they have committed a crime; can have tendency to lick everything; and
may look like little old people.
57
MATERIALS & METHODOLOGY
58
MATERIALS:
Study Setting:
Bakson Homoeopathic Medical College & Hospital O.P.D, I.P.D,
P.O.P.Ds.
Study Duration:
59
The study was conducted for a period of 18 months
Selection of Samples:
• A minimum of 5 detailed cases based on inclusion and exclusion criteria
will be selected for the study using purposive sampling technique.
• All cases will be taken as per the Standardized Case Record of Bakson
Homoeopathic Medical College and Hospital.
• The period of study will be 10 months.
•Psychiatric evaluation will be done every 6th
month.
•Homoeopathic prescription will be based on availability of patient
specific or characteristic symptoms. Due reference to the Homoeopathic
Materia Medica and Repertory will be made as required by the case. The
potency selection and repetition of the medicine will be done according to
the demand of the case.
METHODOLOGY:
Study Design:
Prospective Observational Single Blind Clinical Study.
Patients were selected from cases who qualified the inclusion criteria.
On selection, the detailed case of each patient was recorded on a structured
performa and then evaluated.
Homoeopathic medicine was selected for each individual after careful analysis,
repertorisation and individualization.
Cases were followed up weekly, fortnightly or monthly for improvement.
INCLUSION CRITERIA:
• Diagnosed cases of ADHD according to DSM- IV criteria.
60
• Both genders of age group 18 to 24years.
EXCLUSION CRITERIA:
•Cases of Schizophrenia – mental retardation, down syndrome or autism.
•Those with congenital brain anomaly.
INTERROGATION:
o As per the case taking Performa given at Appendix – 1.
INTERVENTION:
o Any medicine available from the Bakson Homoeopathic Medical
College and Hospital dispensary according to the symptom totality
after full case-taking of the patient.
Potency: 30C, 200C &1M potencies were used following
homoeopathic principles according to the case.
Dose: was given according to the homoeopathic principles.
Selection Of Tools:
The following tools would be used during study:
• Case taking format and Questionnaires.
• Screening procedures to fulfill the inclusion/exclusion criteria.
• Homoeopathic Medicines from Bakson Homeopathic Pharmaceuticals at
Bakson Homoeopathic College
Outcome Assessment:
Patient improvement was assessed clinically by the re-assessment of the
case.
Patient’s symptoms diary was maintained for better assessment.
The various outcome measures have been listed in the Table
Table 1. POST TREATMENT OUTCOME MEASURE
61
IMPROVEMENT STATUS GRADE
Clinical examination indicating palliation of the signs and
symptoms of the patient or status quo condition or
worsening of the condition + No improvement of the patient
as a whole.
0
Clinical examination supporting MILD improvement of
the signs and symptoms of the patient + Improvement of
the patient as a whole.
I
Clinical examination supporting MODERATE
improvement of the signs and symptoms of the patient +
Improvement of the patient as a whole.
II
Clinical examination supporting MARKED improvement
of the signs and symptoms of the patient + Improvement
of the patient as a whole.
III
DISCUSSION
The present study was to see efficacy of homoeopathy upon the
patients affected from Irritable Bowel Syndrome. The title of the
dissertation “A Case Series on Homoeopathic Intervention in
Understanding adult ADHD as a brain maturation delay.” The study
was confined to selected subjects of both sexes, both religion and of all
age groups.
62
Single blind, prospective observational study design was adopted for
evaluating the efficacy of homoeopathic treatment in cases having ADHD.
Total 5 patients were selected for the study. These patients were collected
from the O.P.D/ I.P.D./ P.O.P.D. of Bakson Homoeopathic Medical College
and Hospital, Greater Noida. These patients came from various areas of N C
R and its surrounding areas mainly Ghaziabad, Ladhpura and Dadri.
Complete case history of every patient attending the O.P.D/P.O.P.D. of
Bakson Homoeopathic Medical College and Hospital was taken for this
study, as per the case taking Performa (as per Appendix-A). The cases,
whether they belonged to study group or not, were assessed by a special
questionnaire set by the experimenter. Every enrolled patient was shown the
Patient Information Sheet and a written informed consent was taken as per
the Informed Written Consent Form (Appendix-C).
After the interrogation as per the Case Taking Performa, one dose of
selected medicine and one dose of placebo was given to the patients
respectively. The medicines were selected on the basis of totality of the
symptoms of individual cases. The Centesimal Potencies were selected
according to the individual case. The medicines were dispensed from the
dispensary of Bakson Homoeopathic Medical College and Hospital.
Hygienic and dietetic measures were advised in every case. The outcome
measures were assessed on the basis of the clinical parameters and also by
the improvement of the patient as a whole. In every case, three months
follow- up has been done. The interval between the two follow-ups was
more or less 30 days. On feedback reporting the cases were followed up
properly and results were evaluated on the basis of enquiry about the
present state of health, physical and mental general symptoms as well as
physical examinations and improvement of the patient as a whole. No
supplementary, intermittent therapy or acute remedies were adopted for any
63
types of casualties or adverse or undesirable symptom–spectra during the
treatment span, as these might affect the inferential quality of the study.
The efficacy of the Homoeopathic treatment in cases of ADHD was
demonstrated by the results of the grading. Based on the data collected from
the study, In this study it has been observed that the maximum number of
patient belongs to the age groups 25-40yrs. This suggests that the disease is
more prevalent in teenage group and adult’s age groups. Among both the
sexes, it was noted that the female patients were more in number than the
male patients. This data thus suggests that in India, adult ADHD is more
prevalent in males than in females.
After thorough case taking of each and every study group, miasmatic
analysis was done. In 5 cases according to the totality of the symptoms,
most indicated medicines were selected. Out of the total patient cured with
constitutional homoeopathic medicines, some medicine found more
frequently in treatment of adult ADHD these are Veratrum Album, Platina,
Sulphur and Lycopodium etc.
In the study it was found that patients were most vulnerable to stress related
disorder due to fast modern life, competition in every field due to vast
population, nuclear family system, family pressure to do well in every
aspect, lack of parental care and in some cases lack of affection, tension
regarding career etc. This vulnerability gave birth to depression and
frustration among them. Thus stress is certainly a major health problem
among patients, which affects their overall development.
64
65
CONCLUSION
The incidence of adult ADHD is on the rise owing to stress due to various
social, personal, reasons.
This study, although over a very small group of patients over small period
of time, has definitely shown some rays of hope for further studies. The
present prospective uncontrolled study was undertaken with the aim to
explore the scope of various constitutional homoeopathic medicines in the
treatment of adult ADHD. 5 patients of various ages and sexes were taken
in to consideration during this study. Majority of cases were found to
belong to the age group of 25 - 40 years and prevalence of disease was seen
female preponderance.
Most of the patient who visited the hospital for treatment during the study
period hailed from middle and lower class groups. Duration of illness of the
patient in most of the cases was more than two years.
The efficacy of the Homoeopathic treatment in cases of adult ADHD was
demonstrated by the results of the grading based on the data collected from
the study.
In the study it was found that patients were most vulnerable to stress related
disorders due to fast modern life, competition in every field due to vast
population, nuclear family system, family pressure to do well in every
aspect, lack of parental care and in some cases lack of affection, tension
regarding career etc. giving birth to depression and frustration among them.
66
The therapeutic capabilities are mainly dependent on mental generals,
physical general, characteristics particulars, characteristics pathological
general symptoms to, which constitute the totality of symptoms are there is
no other shortcut root for homoeopathic prescriptions, which reconfirms the
observation of our great masters. The result obtained from the present study
was very encouraging especially confirming the already known fact that
well selected constitutional homoeopathic medicines are capable of tackling
enumerable acute as well as chronic disease Homoeopathy is a natural
system of medicine. Its strength lies in its marked effectiveness as it takes a
holistic approach towards the sick individual to through promotion of inner
balance at mental, emotional, spiritual levels. Homoeopathy recognizes the
inseparability of body and mind. Homoeopathy treats the patient as a whole
and not just the disease. It believes in a holistic, totalistic and individualistic
approach. Along with Homoeopathic medicines, psycho-therapy and
counselling will definitely prove beneficial in cases of ADHD and will give
better quality of life to the patients.
Scopes and Limitations
Homoeopathy is holistic in nature. A proper similimum chosen will
suit the patient as a whole; it will help the complaints with which the
patient came to us for consultation as well as improve the general
health of the patient.
Modern medicine has no answer to adult ADHD. At best, they can
give psychotherapy. Homoeopathy has a very important and
impressive role to play in such psycho physiological cases. It is
important here to note that there is no detectable pathology in these
patients; what the allopath cannot diagnose, they cannot treat. On the
other hand, homoeopathy insists on diagnosing patient instead of the
disease being suffered, and in this way the constitutional approach
67
homoeopathy adopts in treating such patients comes across
beautifully.
We are unable to foretell the patient the duration for which he will
have to take medicine.
It is difficult to treat cases associated with other psychological/
psychiatric disorders.
68
SUMMARY
The present study was conducted at the OPD/ IPD and POPDs of
Bakson Homoeopathic Medical College and Hospital, Greater
NOIDA (UP).
For the study, 5 cases of adult ADHD were analysed and examined
taking into consideration their presenting complaints, past history,
physical and mental generals and carefully repertorised.
Following observations were made during the study:
1. Majority of patients fall under the age group 25-40 years.
2. In maximum number of cases, features of ADHD in childhood and
history poor parenting, anxiety or depression were found. Such
patients have a more tendency towards adult ADHD.
3. The main causative factor is continuous stress. Stress being the
main symptom; if we qualify its dimensions it becomes easy to
individualize the case and finding the similimum.
4. It is seen that auxiliary modes of treatment such as lifestyle
management, dietary modifications and psychotherapy helps a lot in
improving the health of the patient.
5. Majority of patients reported symptomatic relief.
The basic objective of the study was to evolve a group of remedies
with reliable indications for various presentations of adult ADHD.
In consecutive order Veratrum Album, Platina and Sulphur are most
commonly indicated constitutional remedies.
69
70
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APPENDICES APPENDICES
78
Appendix: A
CASE TAKING PERFORMA
BAKSON HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL
GREATER NOIDA, U.P.
PERSONAL DATA
Name :
Age/Sex :
Registration No. :
Occupation :
PRESENTING COMPLAINT
Pain abdomen / bloating / flatulence
Loose stools
Constipation
Any other
HISTORY OF PRESENTING COMPLAINT
Pain abdomen
o Location
o Onset
o Sensation
o Modalities
o Extention of pain
o Relation of pain to defacation
Stool
o Frequency – day / night
o Quantity
o Character
79
o Pain in relation to stools
Any precipitating factor
Any other complaint
PAST HISTORY
Any similar previous episode
Treatment taken
H/O recurrent gastrointestinal infections
Any other major illness and treatment taken
PERSONAL HISTORY
Vaccination
Allergy to any substance/drug
Addictions
Accidents/surgery
Occupation
Marital status
Diet – veg/non-veg
FAMILY HISTORY
Gastrointestinal disorders
Psychogenic disorders
Allergy
Asthma
Diabetes mellitus
Hypertension
Tuberculosis
Malignancy
Endocrine disorders
Any other
PHYSICAL GENERALS
1. Thermal reaction
80
Hot/chilly/ambi/sensitive to both
Any seasonal aggravation
2. Laterality
Position you like most
Sensitivity to particular side
3. Sensation in general
4. Appetite
Quantity
Food preferred: warm/normal/cold
Reaction if has to go without food
Food intolerance
Relationship of complaints to meals
Desires: sweet/salty/spicy/fried/any other
Aversion
5. Thirst
Quantity
Frequency
Preference: warm/normal/cold/chilled/hot drinks/aerated
drinks
6. Sleep
Refreshing/disturbed/sleeplessness
Dreams
7. Perspiration
Scanty/profuse/normal/parts where excessive or less
Offensive/non-offensive/leave stain
GYNAECOLOGICAL / OBSTETRIC HISTORY
Menarche
Cycle/duration
Character of flow
Any complaints – before/during/after
Any other discharge
81
MENTAL GENERALS
GENERAL PHYSICAL EXAMINATION
Pallor
Pulse
B.P.
Weight
SYSTEMATIC EXAMINATION
INVESTIGATIONS
Haemogram CBC ESR
Stool examination – micro,macro
Ultrasonography
DIAGNOSIS
MEDICINE PRESCRIBED
BASIS OF PRESCRIPTION
GENERAL MANAGEMENT
FOLLOW
82
Appendix- B
SUBJECTS INFORMED CONSENT FORM Participant Informed Consent Document
I have volunteered to participate in the study USEFULNESS OF
HOMOEOPATHIC MEDICINES IN CASES OF IRRITABLE
BOWEL SYNDROME IN ITS ALLIED PAATERNS
I understand that I am required to complete questionnaires at each
consultation and that the information in the questionnaires will be
regarded as strictly confidential and will be used for research purposes
only.
I understand that I may withdraw from the study at any time by
informing in writing of my desire to do so.
I agree to participate in this study.
Signatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of the Patient . . . . . . . . . . . . . . . . . . . . . .
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Signatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of the Witness. . . . . . . . . . . . . . . . . . . . . .
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
83
Appendix- C
CASE RECORDS
CASE 1
PERSONAL DATA
Name- Miss Pallavi Gupta
Age- 95 Years
Sex- Female
Ref. No.: 211/13
Occupation- Student
PRESENTING COMPLAINT
Classical symptoms of ADHD presenting with its realisation and
suffering from depression.
HISTORY OF PRESENTING COMPLAINT
Mother narrates:
P was first diagnosed with ADHD and received medicine in 2008. At
first they gave her Ritalin, then Motiron, then Concerta, but none of the
drugs worked very well. After the Concerta she became very quiet and
introverted and now for a year she has been on 25 mg Strattera.
She came off the Concerta in the autumn of 2011. Before she came off it
she had no facial expression, no happiness or sorrow. When she came
off it she slept 13/14 hours a day and she would not go to school. She
only receives the medicine in order to be able to concentrate. When she
started on the medicine she lost weight and lost her appetite. She was on
a protein drink for a year. On Concerta and the other 2 types of medicine
she had diarrhea and headache. She does not get that on Strattera.
We used to find it very difficult to get her to calm down and we spent
ages to try to get her to fall asleep in the evenings.
84
Taking a lot of trouble regarding her looks. If she looks good the other
kids cannot tease her.
She never undertakes anything before she is able to do it properly.
P cannot listen to anybody who talks for a long period of time. She finds
it very difficult in the classroom if the teacher has to explain anything in
detail. She has to fiddle with something in her hands.
Troubled or restless when about to relax.
Very disturbed if she has to plan anything when about to sleep. If she is
looking forward to a birthday party the next day for instance, then she
cannot settle. She needs a lot of time to prepare herself for an
engagement. She can become frustrated, sad and angry if she is actually
looking forward to something.
Anticipatory anxiety. Expectations. A lot of expectations of herself. She
has to fulfill other’s expectations of her.
Started to do boxing in a sports club. Desires to hit things. A bit
frightened of the dark. When she was younger she wanted total darkness
when going to sleep.
Desires warm food. Brings her own cooked food, and heats it at school.
Hits on a particular kind of food. Eats that for a while and moves on to
something new. Very irritable when hungry.
PAST HISTORY
History of right sided renal calculi 4mm 6months ago expelled with
homoeopathic medicines.
PERSONAL HISTORY
Occasional alcohol intake.
FAMILY HISTORY
Father- Hypertension, recurrent GI infections
Mother- Renal calculi
85
PHYSICAL GENERALS
Thermal Reaction is towards hot
Appetite and Thirst is normal
The patient desires sweets
Sleep refreshing
Perspiration normal
MENTAL GENERALS
Angered easily especially when contradicted.
Lacks confidence. Anxiety of and avoids social gatherings.
There is marked fear of undertaking any responsibility alone at home as
well as workplace.
Generally serious disposition.
Cries when talks about his bad childhood due to financial problems.
GENERAL PHYSICAL EXAMINATION
Pulse-70 per minute
Blood Pressure- 134/88 mmHg
Weight- 62Kg
SYSTEMIC EXAMINATION
Respiratory System- NAD
Cardiovascular System- NAD
Gastrointestinal System- NAD
INVESTIGATIONS
Stool Examination- NAD
Ultrasonography- Normal Scan
86
DIAGNOSIS
Adult ADHD
ANALYSIS
Mind, concentration difficult
Mind, concentration difficult- children in
Mind, spoken to; being-aversion
Mind, restlessness – children in
Mind, restlessness – sleep before
Mind, ailments from – anticipation
Mind, anxiety – anticipation; from – engagement; an
Mind, striking – children in
Generals, food and drinks – warm food – desire
Generals – heat- lack of vital heat
MEDICINE PRESCRIBED
Medorrhinum 1M one dose daily for 3 days
BASIS OF PRESCRIPTION
Medorrhinum also has a “changeable state of mind- one moment sad the
next mirthful”.
Medorrhinum has of course the fear of the dark, but as importantly
according to Kent they also have “nausea after eating,” and “agonizing
pains in the stomach.” Kent elaborates that “Children of a sycotic father
are especially subject to attacks of vomiting, diarrhea and emaciation”
and they look pale (ibid). Furthermore in medorrhinum there is a
tendency to asthma in children of sycotic parents.
Catherine Coulter has it that “it is possible that a sycosis miasm
underlies “anxiety anticipating engagement”, And she explains that
talking or even thinking about his troubles only makes him worse.
87
Med. is well known for its extreme restlessness which is present also in
arg-nit. In arg-nit, however, it is related more to a state of anxiety. In
med. the restlessness is characterized by a strong inability to concentrate
and to keep focused.
GENERAL MANAGEMENT
Psychotherapy to build confidence in the patient
Yoga: Deep breathing exercises to manage anxiety
FOLLOW UP
09-05-2014 Patient Better. SL thrice a day for one week.
16-05-2014 Improvement Continues. SL thrice a day for one week.
23-05-2-14 Anxiety is reduced with much relief to the patient. SL
prescribed.
07-06-2014 Improvement Continues. SL thrice a day for 15 days.
21-06-2014 Patient much better. SL TDS for 15 days
05-07-2014 Patient much better. SL TDS for 15 days. Follow up
continues.
RESULT- Marked Improvement
88
CASE 2
PERSONAL DATA
Name- Mhd. Mujeeb Khan
Age- 21 years
Sex- Male
Ref No.- 653/13
Occupation- Student
PRESENTING COMPLAINT
Difficulty in concentration, fits of anger, fights with siblings.
HISTORY OF PRESENTING COMPLAINT
Patient was apparently well 4 years back. He started getting troubles
with lack of concentration and fits of anger. He also started fighting
with his sibling with matter of no concern. He started visiting mosque
and started behaving as a learned priest. He got hard-hearted and started
cursing his family members. He also suffers from disturbed sleep due to
his complaints.
PAST HISTORY
Recurrent GI infections in childhood treated with allopathic medicines.
PERSONAL HISTORY
Habituated to 4-5 cups of tea/day
FAMILY HISTORY
Father- Hypertension
Mother- Diabetes
89
Sister- Allergic Rhinitis
PHYSICAL GENERALS
Thermal Reaction is hot
Appetite and Thirst is normal
Perspiration is profuse, especially on forehead; non offensive
Sleep- non refreshing
MENTAL GENERALS
The patient says he never expresses his displeasure at home or at the
workplace. Congenial relations at the workplace.
Dominating at home. Wants everything according to his schedule. Gets
angry when things do not happen according to his demands.
There is fear of not meeting deadlines at the workplace and not being
appreciated.
GENERAL PHYSICAL EXAMINATION
Pulse- 70/minute
Blood Pressure- 122/70 mmHg
Weight- 72Kg
SYSTEMIC EXAMINATION
Respiratory system- NAD
Cardiovascular System- NAD
Gastrointestinal System- NAD
INVESTIGATIONS
CBC- Hb: 13gm% TLC: 7200/mm3 ESR: 08 1st hour
Stool Examination- Normal
Ultrasonography- Normal scan
90
DIAGNOSIS
Adult ADHD
MEDICINE PRESCRIBED
Veratrum Album
REPERTORIAL ANALYSIS
Mind- Abstraction of mind
Mind-Abusive-insulting
Mind- Carefulness
Mind-Censorious-silent, disposition to be fault-finding
Mind- Delusion- Christ, himself to be
Mind-Despair-religious despair of salvation
Mind- Somnambulism
GENERAL MANAGEMENT
The patient is advised:
Regular meals; low in fat content
To reduce the amount of tea intake
Regular brisk walking in open air and deep breathing exercises to better
manage stress.
FOLLOW UP
04-06-2015 Slightly better. No panic attacks. SL thrice a day for a week.
11-06-2015 Patient is better. SL thrice a day for a week.
18-6-2015 Patient coping better with daily stressors.
16-07-2015 Patient better. SL thrice a day for 15 days.
RESULT- Marked Improvement
91
CASE 3
PERSONAL DATA
Name- Mrs Sushma
Age- 24 Years
Sex- Female
Ref. No.: 451/13
Occupation- Home-maker
PRESENTING COMPLAINT
Classical symptoms of ADHD presenting with its realisation and
suffering from acute attacks of mania.
HISTORY OF PRESENTING COMPLAINT
Patient was apparently well 3 years before. Gradually, her family
members started observing some kind of abnormal behaviour with her
social interactions. She developed anxiety about her health and started
visiting doctors for matter of no concern.
PAST HISTORY
History of right sided ovarian cyst 6months ago expelled with
homoeopathic medicines.
FAMILY HISTORY
Father- Hypertension, recurrent GI infections
Mother- Renal calculi
PHYSICAL GENERALS
Thermal Reaction is towards hot
92
Appetite and Thirst is normal
The patient desires sweets
Sleep is unrefreshing
Perspiration normal
Habit- Nail biting
LIFE SPACE INVESTIGATION
Patient belongs from a middle class family got married recently 6
months back. She is a homemaker. As a child patient was shy and calm.
She was not good in studies and used to get scolding from teachers. One
day, she got punishment from her teacher in from of entire school and
this incident gave her a shock. She somehow managed it and after
marriage, her mother in law started behaving as like her teacher. This
attitude of her mother in law, reminded of her old incident and patient
started behaving abnormally and started seeking attention from her
husband and doctors. She answers irrelevantly when asked and gets
thoughts of death in near future.
She gets a delusion as her legs are cut off. She feels better after dancing
and has become abusive and insulting in nature
GENERAL PHYSICAL EXAMINATION
Pulse-70 per minute
Blood Pressure- 134/88 mmHg
Weight- 62Kg
SYSTEMIC EXAMINATION
Respiratory System- NAD
Cardiovascular System- NAD
Gastrointestinal System- NAD
INVESTIGATIONS
93
Stool Examination- NAD
Ultrasonography- Normal Scan
DIAGNOSIS
Adult ADHD
REPERTORIAL ANALYSIS
MIND: Abusive- insulting
MIND-Ailments from- punishment
MIND-Answering-irrelevantly
MIND-Anxiety- hypochondrical
MIND- Biting-nails
MIND-Death-thoughts of
MIND-Dancing-amel.
MIND-Delusion-legs-cut off; legs are
MIND-Somnabulism
MEDICINE PRESCRIBED
Tarentula Hispanica 1M one dose daily for 3 days
GENERAL MANAGEMENT
Psychotherapy to build confidence in the patient
Yoga: Deep breathing exercises to manage anxiety
FOLLOW UP
09-03-2014 Patient Better. SL thrice a day for one week.
16-04-2014 Improvement Continues. SL thrice a day for one week.
23-05-2-14 Anxiety is reduced with much relief to the patient. SL
prescribed.
07-06-2014 Improvement Continues. SL thrice a day for 15 days.
21-07-2014 Patient much better. SL TDS for 15 days
94
05-08-2014 Patient much better. SL TDS for 15 days. Follow up
continues.
RESULT- Marked Improvement
CASE 4
PERSONAL DATA
Name- Mr Akash
Age- 25 years
Sex- Male
Ref No.- 756/15
Occupation- Student
PRESENTING COMPLAINT
Anger with anxiety in darkness. Behavioural problems such as causeless
laughing and fits of anger to break things.
HISTORY OF PRESENTING COMPLAINT
Patient was apparently well 5 years back. He got a intern job in
Bangalore in July 2013 where there was peer pressure to perform and
patient was unable to adapt himself into the new circumstances.
Gradually to out –perform he started influencing his seniors and
colleagues to stay in their company. When patient returned back home
after 2 years, he started observing excessive anger in him and fear of
darkness. To cope up his problems he started seeking attention from
people by excessively getting happy and exhilarated and laughing
causelessly. This used to get alternated with sadness. Patient was
brought by his father in our hospital Psychiatric ward OPD.
PAST HISTORY
Recurrent GI infections in childhood treated with allopathic medicines
95
PERSONAL HISTORY
Habituated to 4-5 cups of tea/day
FAMILY HISTORY
Father- Hypertension
Mother- Diabetes
Sister- Allergic Rhinitis
PHYSICAL GENERALS
Thermal Reaction is hot
Appetite and Thirst is normal
Perspiration is profuse, especially on feet; non offensive
Sleep- unrefreshing
GENERAL PHYSICAL EXAMINATION
Pulse- 70/minute
Blood Pressure- 122/70 mmHg
Weight- 72Kg
SYSTEMIC EXAMINATION
Respiratory system- NAD
Cardiovascular System- NAD
Gastrointestinal System- NAD
INVESTIGATIONS
CBC- Hb: 13gm% TLC: 7200/mm3 ESR: 08 1st hour
Stool Examination- Normal
Ultrasonography- Normal scan
DIAGNOSIS
96
Adult ADHD
MEDICINE PRESCRIBED
Stramonium
REPERTORIAL ANALYSIS
MIND- Ailments from- anger-fright with
MIND- Ailments from-domination
MIND- Anxiety- dark in
MIND-Breaking things
MIND-Delusion- injury- being injured; is
MIND-Exhilaration-alternating with-sadness
MIND-Laughing-causeless
GENERAL MANAGEMENT
The patient is advised:
Regular Psycho-analysis
Counselling Sessions
Regular brisk walking in open air and deep breathing exercises to better
manage stress.
FOLLOW UP
04-06-2013 Slightly better. No panic attacks. SL thrice a day for a week.
11-06-2013 Patient is better. SL thrice a day for a week.
18-6-2013 Patient coping better with daily stressors.
16-07-2013 Patient better. SL thrice a day for 15 days.
RESULT- Marked Improvement
97
CASE 5
PERSONAL DATA
Name- Miss Aakansha
Age- 29 Years
Sex- Female
Ref. No.: 457/15
98
Occupation- Homemaker
PRESENTING COMPLAINT
Patient presents with the symptoms of sudden attacks of seeking
attention from her husband, quarrelling unnecessary from her family,
uncaring towards her children etc.
HISTORY OF PRESENTING COMPLAINT
Patient was apparently well 3 years back. She got married at an age of
26 years. She is brought to our OPD by her husband, who narrates her
history.
Husband says: Aakansha is an independent women. She got orphaned at
an age of 10 years, when her mother died accidentally. Her father
married again and she was left to neglecting by her step mother.
Gradually she started developing aversion towards family. She doesn’t
like to be cared and is every possessive about her belongings and
towards her husband. Time often she broods about her past disagreeable
incidences in life and feels sad and frustrated. She is CEO of a travel
agency and is very dictatorial by nature. For a new person, she desires to
influence and manipulates things. She is a very fearful person and gets
startled easily. She gets delusions after any fright, such as seeing a
snake, after a rash drive, in darkness etc.
PAST HISTORY
History of right sided renal calculi 4mm 6months ago expelled with
homoeopathic medicines.
PERSONAL HISTORY
99
Occasional alcohol intake.
PHYSICAL GENERALS
Thermal Reaction is towards hot
Appetite and Thirst is normal
The patient desires chicken
Sleep refreshing
Perspiration normal
MENTAL GENERALS
Angered easily especially when contradicted.
Overconfidence. Anxiety of and avoids social gatherings.
There is marked fear of undertaking any responsibility alone at home as
well as workplace.
Generally serious disposition.
Cries while remembering her childhood and parents.
GENERAL PHYSICAL EXAMINATION
Pulse-70 per minute
Blood Pressure- 134/88 mmHg
Weight- 55Kg
SYSTEMIC EXAMINATION
Respiratory System- NAD
Cardiovascular System- NAD
Gastrointestinal System- NAD
INVESTIGATIONS
Stool Examination- NAD
Ultrasonography- Normal Scan
100
DIAGNOSIS
Adult ADHD
ANALYSIS
Mind, concentration difficult
Mind, concentration difficult- children in
Mind, spoken to; being-aversion
Mind, restlessness – children in
Mind, restlessness – sleep before
Mind, ailments from – anticipation
Mind, anxiety – anticipation; from – engagement; an
Mind, striking – children in
Generals, food and drinks – warm food – desire
Generals – heat- lack of vital heat
MEDICINE PRESCRIBED
Platina 1M one dose daily for 3 days
ANALYSIS
MIND- Ailments from-neglected being
MIND- Answering-dictatorial
MIND-Aversion-family to; members of
MIND-Delusion-fright after
MIND-Grief-past events about;
GENERAL MANAGEMENT
Psychotherapy to build confidence in the patient
Yoga: Deep breathing exercises to manage anxiety
FOLLOW UP
09-05-2014 Patient Better. SL thrice a day for one week.
101
16-05-2014 Improvement Continues. SL thrice a day for one week.
23-05-2-14 Anxiety is reduced with much relief to the patient. SL
prescribed.
07-06-2014 Improvement Continues. SL thrice a day for 15 days.
21-06-2014 Patient much better. SL TDS for 15 days
05-07-2014 Patient much better. SL TDS for 15 days. Follow up
continues.
RESULT- Marked Improvement
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