Adhd & homoeopathy

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Adhd & homoeopathy

  1. 1. ADHD: HOMOEOPATHI C PERSPECTIVE PRESENTED BY: Dr. BIPIN JETHANI ASSISTANT PROF., DEPT. OF ORGANON OF MEDICINE NEHRU HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL EMAIL: drbipin.jethani@gmail.com
  2. 2. It is thought that many great people such a Winston Churchill, Leonardo De Vinci, Einstein, and Benjamin Franklin had the classic characteristics of ADHD. This suggests ADHD people have some exceptional qualities with exhausting side effects.
  3. 3. Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) refer to a range of problem behaviours associated with poor attention span. These may include impulsiveness, restlessness and hyperactivity, as well as inattentiveness, and often prevent children from learning and socialising well.
  4. 4. Attention Deficit Disorder (ADD) is the most commonly diagnosed behavioral disorder of childhood, affecting an estimated 2 - 4% of school aged children. Boys are more likely to be affected than girls. What is important for our understanding is that for these problems to be diagnosed as ADHD, they must be out of the normal range for the child's age and development.
  5. 5. Clinical features and criteria for diagnosis The Diagnostic and Statistical Manual (DSM-IV) divides the symptoms of ADHD into those of INATTENTIVENESS and those of HYPERACTIVITY AND IMPULSIVITY.
  6. 6. SUBTYPES OF A.D.D. SPECTRUM OF DISORDER Some children with ADHD primarily have the Inattentive Type, some the Hyperactive-Impulsive Type, and some the Combined Type. Those with the Inattentive type are less disruptive and are easier to miss being diagnosed with ADHD
  7. 7. ADHD often occurs alongside other difficulties and is not the sole cause of problem behaviour. Children may exhibit temper tantrums, sleep disorders, and be clumsy.
  8. 8. ETIOPATHOGENESIS OF ADHD The wholistic perception of ADHD demands proper understanding of the multifactorial nature of this disorder
  9. 9. ETIOLOGICAL BASIS OF ADHD: HOST ENVIRONMENT AXIS HOST FACTORS ENVIRONMENTAL FACTORS  ORGANIC BASIS FAMILIAL INHERITANCE   PERSONALITY TYPE PRENATAL & POST NATAL INFLUENCES
  10. 10. ODE TO HAHNEMANN: UNDERSTANDING HOST ENVIRONMENT AXIS ……For as two things are required for the production of these as well as all other morbid alterations in the health of man - to wit., the inherent power of the influencing substance, and the capability of the vital force that animates the organism to be influenced by it - the obvious derangements of health in the so-called idiosyncrasies cannot be laid to the account of these peculiar constitutions alone, but they must also be ascribed to these things that produce them, in which must lie the power of making the same impressions on all human bodies. …......... (§ 117 of Organon of Medicine, 6th edition)
  11. 11. ORGANIC BASIS OF ADHD Neuroimaging studies suggest that the brains of children with ADHD are different from those of other children.
  12. 12. In ADHD children, the frontal lobes are immature or sluggish, so they appear to act without thinking. The judgement and control of their action is seen as limited, much like a child half their age.
  13. 13. FUNCTION OF FRONTAL LOBE This is the executive management part of the brain that forms a judgement from all of the information that has been sent from around the brain.
  14. 14. FAMILIAL INHERITANCE Studies of twins suggest a genetic link to ADHD . In 80-90 per cent of identical twins where one has ADHD so does the other. Recent research also suggests there is a greater chance of inheriting the condition from male relatives such as grandfathers.
  15. 15. IN UTERO INFLUENCES PREDISPOSE TO DEVELOPMENT OF ADHD Intra-uterine life is the earliest phase of life spent by an infant in the quiet, dark atmosphere of mother’s womb (from the moment of conception uptil its exposure to the outside world)
  16. 16. ‘ wITHIN THE wOMb’ DEVELOPMENT IS A PHENOMENON OF RAPID PROLIFERATION AND DIFFERENTIATION It is the stage at which the enormous potential of an individual to grow and evolve is realized and therefore is extremely susceptible to varied environmental influences especially mother’s feelings, attitudes and intra-natal exposures.
  17. 17. INSIGHT OF HAHNEMANN Much ahead of his time, he epitomized the importance of intra-uterine life in ontogenesis as well as utilized it as basis of prescribing. A philanthropist, a man of truth and courage ….. Samuel Christian Friedrich Hahnemann.
  18. 18. PRESCRIBING IN PREGNANCY Hahnemann has lucidly explained this in 'The Chronic Diseases - Their Peculiar Nature and Their Homoeopathic Cure' where he states that: 'Pregnancy in all its stages offers so little obstruction to an anti-psoric treatment that this treatment is often most necessary and useful in that condition'
  19. 19. He emphasises upon this fact in footnote of §284 of 6th edition of ‘Organon of Medicine’ as ‘…………But the case of mothers in their (first) pregnancy, by means of a mild antipsoric treatment,……..is indispensable in order to destroy the psora – that producer of most chronic diseases – which is given to them hereditarily; destroy it both within themselves and in the foetus, thereby protecting posterity in advance………..’
  20. 20. EMBRYOLOGICAL ONTOGENESIS
  21. 21. DOCUMENTED INTRA-UTERINE INFLUENCES PREDISPOSING TO ADHD    ALCOHOL MENTAL STRESS   SMOKING ULTRASOUND EXPOSURES MOBILE PHONES
  22. 22. EFFECT OF SMOKING Smoking during pregnancy is an independent risk factor in the etiopathogenesis of ADHD
  23. 23. The University of California have found that using mobile phone while pregnant could cause behavioural and emotional problems in children The study of more than 13,000 children found that pregnant women using the handsets just two or three times a day was enough to raise the risk of their babies developing hyperactivity and difficulties with conduct, emotions and relationships by the time they reached school age.
  24. 24. A new study warns that exposure to repeated ultrasound can affect fetal brain development. The study, funded by the National Institute of Neurological Disorders and Stroke revealed that when pregnant mice were exposed to ultrasound, a small number of nerve cells in the developing brains of their fetuses failed to extend correctly in the cerebral cortex and led to development of hypersensitive mice. EffEct of ultrasonic wavEs Most importantly, it was assessed that damage was analogous to the neurophysiological changes in children with ADHD.
  25. 25. Research shows that the ultrasounded population have a quadrupled perinatal death rate, increased rates of brain damage, dyslexia, speech delays, epilepsy, learning difficulties, and a 32% increase in left handedness (which is thought to be caused by brain damage).
  26. 26. MENTAL STRESS DURING PREGNANCY D.H. Stott in a series of papers has showed that psychological stress during pregnancy may predispose the child to react in an undesirable way to subsequent adverse environment and so predispose to behavioral problems and in particular to juvenile delinquency. Stott, D.H. “Evidence for a congenital factor in maladjustment and delinquency”, American Journal of Psychiatry
  27. 27. BIRTH PROCESS: natural transition of a neonate from the darkness of the in-utero environment to the illumination of the external world HIStoRY of BIRtH tRAumA , AS duE to foRCEPS dElIvERY oR PRoloNGEd lABouR, IS A mAjoR fACtoR tHAt REquIRES ExPloRAtIoN IN CASES wItH AdHd. tHE BRAIN StRuCtuRES BElIEvEd to BE lINkEd to tHE dEvEloPmENt of AdHd ARE vulNERABlE to HYPoxIC dAmAGE duRING BIRtH.
  28. 28. The brain structures believed to be linked to the development of ADHD are vulnerable to hypoxic damage during birth. The damage is caused by inadequate oxygen reaching parts of the brain while blood flow is reduced. A Good NumBER of BEHAvIouRAl PRoBlEmS IN CHIldREN CAN BE lINkEd to BIRtH tRAumA, EmotIoNAl dIStRESS of tHE motHER duRING PREGNANCY
  29. 29. ‘Attention Deficit Disorder – A Different Perspective’ Hartmann (1999) in his book ‘Attention Deficit Disorder – A Different Perspective’ argued that ADHD is the original hunter’s genes. He reframes the characteristics of ADHD as positive qualities for hunting.
  30. 30. The symptoms of Attention Deficit Hyperactivity Disorder principally evolved as adaptive behaviors. It has been suggested that the behaviors of ADHD evolved to serve a functional purpose in the distant past but may not fit well within current culture and expectation (Hartmann, 1993; ShelleyTremblay & Rosen, 1996).
  31. 31. ADHD: ANTHROPOLOGICAL PERSPECTIVE ‘Attention deficit’ he redefines as ‘noticing everything’. As a hunter heads off across the savannah, he is constantly looking out for what might eat him and what he could catch and eat. In the classroom ADHD child is seen as being distracted by noises and activities instead of focusing on the student’s own work
  32. 32. When the hunter sees prey, they become single minded, focussed on pursuit and capture. This characteristic in ADHD people shows up in their mono-focus on those things that interest them. Hunters will take some personal risks to catch their prey, while those with peasant farmer genes would prefer to stop for a strategic plan. This behaviour is seen as impulsiveness and risk taking.
  33. 33. ADHD: MALADATIVE DISEASE OF CIVILISATION The ADHD needs to be considered as maladaptative disorder in children rather than as an isolated psychiatric illness. In the background of the fact that ADHD is ontogenically malprogrammed disorder; the evolutionary history of each and every child with ADHD assumes utmost importance, especially from the most initial stage of development i.e. INTRA-UTERINE LIFE.
  34. 34. PERSONALITY PROFILE OF ADHD ADHD should instead be called Latent Entrepreneur Personality Type (LEPT) The name LEPT conveys the idea that this is a personality type at one end of a spectrum rather than a brain disorder.
  35. 35. CHARACTERISTICS that drives entrepreneurs to pursue their business when others would have given up       INSATIABLE CURIOSITY , bored by mundane tasks but enthusiastic to explore new ideas. MODERATE RISK TAKING , disregarding the obstacles that prevent others from Starting. ADAPTABILITY AND RESILIENCE TO SETBACKS, learning as they go to overcome difficulties. INTENSE BURSTS OF ENERGY INDEPENDENT - needing autonomy and often preferring to be a leader or a loner than a cog in a large wheel. ACTION ORIENTATION
  36. 36. CLINICAL EXPERIENCES A 6 year old male child with fair complexion and red lips presented with combined type of ADHD. Features s/o ADHD were noticed around 2-3 years of age with marked restlessness, very easy distractibility and striking lack of perceptions of impending dangers.
  37. 37. INTRA-UTERINE HISTORY  The INTRA-UTERINE history revealed marked hyperemesis during entire 9 months. Had developed severe cough for which she took only home remedies. Cough subsided immediately after delivery.  It also revealed H/o constant stress of mother which started during early months of pregnancy – feeling of anger due lack of moral support and unco-operative attitude of inlaws.
  38. 38.  The child was born full term LSCS with mild IUGR.  H/o chicken pox (well erupted) at age of 2 years.  Developmental milestones normal  Desire salty foods and paneer  DESIRE SLEEP ON ABDOMEN  Family history of CAD, DM and Hypertension
  39. 39. CASE ANALYSIS The case analysis underlined the fact that that mental stress during early months of pregnancy would have had enormous dynamic influence on the organ-system which begins developing in the most initial period of organogenesis – the Central Nervous System, as can be deciphered from the presenting complaints (ADHD) of the patient. Hence the mental trauma during pregnancy needed to be especially taken into consideration.
  40. 40. CASE ANALYSIS  Besides this, her intra-uterine tendency to ‘THROW UP’ in form of hyperemesis and cough was interpreted as somatic manifestation of her deep subtle desire to ‘THROW UP’ the foetus. The emotional drain on the system with lack of catharsis and resultant suppressed anger was manifested by the child in his misdirected bursts of energy.
  41. 41. CASE ANALYSIS The understanding of case in terms of intra-uterine effect of deep seated emotional trauma resulting in affection of Central Nervous system with concomitance of red lips and desire to sleep on abdomen pointed to the remedy THYROIDINUM as mentioned by Clarke, Boericke, S.K.Ghosh and L.M. Khan in their respective works on Materia Medica.
  42. 42. In Boger’s ‘Synoptic Key of Materia Medica’, Central Nervous System is one of the principal areas of affection in the pathogenesis of drug Thyroidinum. Thyroidinum was prescribed in LM potency and patient has become more settled and most importantly now involves himself in more constructive daily activities.
  43. 43. CASE STUDY Case of 8 year old male child, lean thin, sharp nose presented with Inattentive predominance ADHD.
  44. 44. PRENATAL & POST NATAL HISTORY Patient had h/o grief during pregnancy due to detection of cancer of mother some time after her conception and her death 1 month just 2 weeks before delivery of child. Intra-uterine history revealed gestational hypertension with development of pedal edema in the last trimester. Forceps delivery due to obstruction of head. Birth cry delayed
  45. 45. PRESCRIBING CLUE {§ 153} – ‘PECULIAR’ Tendency to cough and cold with every change of weather with hyperpyrexia but playful even in this state NON COMPLAINING ATTITUDE
  46. 46. A very practical tip by Dr. L.M. Khan is that in case of a child born of a prolonged labour where he/she had to bear the undue stresses and trauma of the birth passage, think of Arnica montana as constitutional remedy especially if there be history of delayed crying. Absence of cry immediately after birth can be analogically considered as NONCOMPLAINING ATTITUDE OF CHILD, a hallmark feature of Arnica Montana.
  47. 47. TRAUMA OF PREGNANCY IN FORM OF GRIEF AND ITS EFFECT ON CARDIOVASCULAR SYSTEM WITH ATTITUDE OF ‘NO COMPLAIN’ ARNICA MONTANA Arnica Montana 200 {9 doses} were prescribed. As narrated by mother, patient has become more receptive to command following. The tendency to cough and cold showed significant improvement
  48. 48. CASE STUDY A stout looking 9 year old child presented with ADHD with marked destructiveness and hyperactivity. Intra-uterine history did not provide any significant clue. FTND with no immediate post natal complications.  Precocious developmental milestones.
  49. 49. SIGNIFICANT POINTS   H/o typhoid at 4 years of age. Family history of alcoholism and Ulcerative colitis. Recurrent tendency to coryza   Appetite decreased. Desire for cold drink even in attacks of acute cold which made it worse.  Chilly patient with dry deep cracked tongue.
  50. 50. Started with Phosphorous in LM potency on the basis of:  Tubercular diathesis  Desire cold drinks  Chilly patient However there was not much improvement even in 30th potency.
  51. 51. CASE ANALYSIS  Keeping in mind lack of further guiding symptoms and strong SYPHILITIC TAINT (Family history of alcoholism, DESTRUCTIVENESS in form of cold drink even when it aggravated complaint and deep cracked tongue); I prescribed Syphilinum LM1/ OD
  52. 52. CASE STILL UNDER PROGRESS but according to mother, appetite has increased and patient is slightly better with regards to his degree of hyperactivity.
  53. 53. GENERAL MANAGEMENT Create a daily routine for the child, eg homework schedules, bedtime and mealtime routines. Plan structured programmes aimed at gradually lengthening the child's concentration span and ability to focus on tasks.
  54. 54. IMPORTANCE OF ACCESSORY CIRCUMSTANCES (§5) Remove disturbing or disruptive elements from their daily routine. For example, remove siblings from the room when they are doing homework or turn off the TV. Ensure environment is friendly and conducive to better concentration. Communicate with the child on a one-to-one basis and avoid addressing other children at the same time.
  55. 55. BEHAVIOUR THERAPY  POSITIVE RE-INFORCEMENT Use rewards consistently and frequently to reinforce appropriate behaviour such as listening to adults and concentrating so as to ensure reinforcement of positive traits.
  56. 56. HOLISTIC PRESCRIBING WITH GOOD GENERAL MANAGEMENT CAN MAKE THE BEHAVIOURAL DISORDER BEHAVE.
  57. 57. THANKS FOR YOUR PATIENT LISTENING
  58. 58.  Attention Deficit Hyperactivity Disorder, more commonly known as ADHD, is a medical condition that has observable symptoms such as uncontrollable hyperactivity or inattention and impulsivity that causes disruption to the daily functioning of a person in a number of settings such as home, school, work or in the community .                           There are three types of ADHD, each with their own distinctive behaviours. Inattentative type, with signs that include: unable to focus on details or a tendency to make thoughtless errors in schoolwork and other activities trouble with continuous attention in play activities or tasks obvious listening difficulties difficulty following instructions trouble with organization avoidance or dislike of tasks that requires thinking or focus tendency to misplace belongings such as toys, notebooks, or homework easily distracted and distracting forgetfulness in daily activities Hyperactive and impulsive type, with signs that include: squirming or fidgeting trouble remaining still and seated constant running and climbing find it hard to play quietly seem to be constantly "on the go" continuous talking blurting answers out find it hard to wait in turn tendency to interrupt or intrude Combined type, which is made up of a combination of the other types and is the most common form . back to top
  59. 59.    How is it diagnosed? Diagnosis is dependent on a full evaluation as there isn't a test that detects the presence of ADHD. Diagnosis can be a difficult process, as factors such as Tourette syndrome, depression or a learning difficulty may influence the results. Referral to a specialist such as a psychologist, neurologist or psychiatrist can help dismiss alternative diagnosis . To be considered for a diagnosis of ADHD there are four boxes that need to be ticked:     a child must display behaviours from one of the three types of ADHD before age 7 behaviours must be more severe than in other children of the same age behaviours must be evident for at least 6 months behaviours must take place in and have negative affects on at least two areas of the child's life (such as school, home, day-care settings, or friendships)
  60. 60.       When the brain hears a loud bang, the sound comes in through the ears to the hearing part of the brain that acknowledges sounds. The information is then split for processing. About 10% of the signal goes to the amygdala in the limbic system, and 90% to the cerebral cortex.
  61. 61.        The limbic system is the primitive processing part of the brain that holds some memories and assesses threats. The bang may trigger the amygdala to send a signal to the neighbouring © Deb Gilbertson, 2003 cells to release adrenalin for fight or flight. This process is very fast.
  62. 62.  This inability to put adrenalin away again leads  to high levels of adrenalin in the system. In  my view this explains some of the  hyperactivity in ADHD people.
  63. 63. ‘Attention deficit’ he redefines as ‘noticing everything’. As a hunter heads off across the savannah, he is constantly looking out for what might eat him and what he could catch and eat. In the classroom this is seen as being distracted by noises and activities instead of focussing on the student’s own work.
  64. 64.           The hunter may get hurt when they pull down the prey, yet the next day they will do it again. Consequences lead to awareness of the risks but do little to stop them from taking those risks. For ADHD children this means that the normal behavioural modification technique of applying natural and logical consequences has little effect. This characteristic can also been seen as resilience to setbacks, a critical quality in entrepreneurship.
  65. 65.  Hunters need high levels of energy for the  hunt. This is seen in the classroom as  hyperactivity, with energetic children  struggling to sit quietly. For the entrepreneur  high energy is an essential quality for business  success.

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