Homoeopathic management of attention deficit hyperactive disease

Dr Maria Shaju

ABSTRACT
Attention Deficit Hyperactivity Disorder is a neuro-behavioral disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. It carries a high rate of co-morbid psychiatric problems like oppositional defiant disorder, mood and anxiety disorders, and cigarette and substance abuse disorders. Since the Swiss ADHD double-blind trial ^[1] has proved significant effects of homeopathy on attention deficit and hyperactivity, the demand for this treatment has clearly increased. This article is intended to focus on ADHD and homoeopathic management for the treatment of Attention Deficit Hyperactive Disease.

KEYWORDS: Attention Deficit Hyperactivity Disorder (ADHD), Homoeopathy

INTRODUCTION

In DSM-5, ADHD is described as a neuro developmental disorder with a persistent behavioral pattern of severe inattention and or hyperactivity or impulsivity. ADHD is one of the most common disorders of childhood, that impairs social, academic, and occupational functioning that occurs in 3%–5% of children, with male to female ratios ranging from 3:1 to 9:1. ^[2]

Worldwide, the prevalence of ADHD is estimated at 5.3% according to an analysis of 102 studies representing 171,756 children and adolescents from seven regions; North America, Europe, Latin America, Asia, Oceania, Middle East, and Africa. The highest rates of ADHD emerged from South America (11.8%) and Africa (8.5%), whereas estimates in Asia (4.0%), Europe (4.6%), and North America (6.2%) were lower. ^[3]

Children with ADHD are at greater risk than children without ADHD for substance abuse because of long-term medications. Early treatment with psycho education as well as behavioral intervention may decrease the negative outcomes of ADHD.

Homeopathy is a medical practice based on the belief that ‘‘like treats like’’ and that the energetics of a small amount of a substance can have healing effect on individuals. Thus this article is focused on the management of ADHD by Homoeopathy.

ETIOLOGY
The cause and risk factors for ADHD are unknown, but recent studies show the link between genetic factors with ADHD.

In addition to genetics, other possible factors include;

• Brain injury
• Exposure to chemicals and other toxins during pregnancy or at a young age
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

SYMPTOMS

Symptoms related to Inattention

• Fail to pay close attention or make careless mistakes in schoolwork.
• Difficulty in focusing on tasks and activities.
• Not listening even when spoken to.
• Difficulty in following instructions and fail to finish schoolwork.
• Have trouble in organizing tasks and activities.
• Avoid activities that require concentration and mental effort.
• Lose items needed for tasks or activities.
• Be easily distracted.
• Forgets to do daily activities.

Symptoms related to Hyperactivity and impulsivity

A child may show following pattern of hyperactive;

• Fidget of hands or feet.
• Have difficulty to stay in one position.
• Be in constant motion.
• Run around or climb everywhere.
• Difficulty to play or to do activities quietly.
• Talk much and irrelevant topics.
• Interrupting the questioner while asking.
• Difficulty to wait for his or her turn.
• Interrupt on others conversations, games or activities.

DIAGNOSIS

ADHD is a disorder that is diagnosed clinically and does not have any specific laboratory or radiologic tests.

DSM 5: Types of ADHD

1. Predominantly inattentive
2. Predominantly impulsive or hyperactive
3. Combination of the above

Diagnostic criteria
DSM-5-TR – ^[4] The American Psychiatric Association has defined consensus criteria for the diagnosis of ADHD. For children <17 years, the DSM-5-TR diagnosis of ADHD requires ≥6 symptoms of hyperactivity and impulsivity or ≥6 symptoms of inattention.

For adolescent’s ≥17 years and adults, ≥5 symptoms of hyperactivity and impulsivity or ≥5 symptoms of inattention are required.

• The symptoms of hyperactivity/impulsivity or inattention must occur often.
• Be present in more than one setting (eg, school and home).
• Persist for at least six months.
• Be present before the age of 12 years.
• Impair function in academic, social, or occupational activities.
• Be excessive for the developmental level of the child.

TREATMENT
ADHD respond to behavioral management, including structure, routine, consistency in adult responses to their behaviors, and appropriate behavioral goals. Children also benefit when parents and clinicians work with teachers to address the child’s needs.

Stimulant medications (methylphenidate or amphetamine compounds) are the first-line agents for treatment of ADHD due to extensive evidence of effectiveness and safety.

Nonstimulant medications, including atomoxetine (norepinephrine-reuptake inhibitor), guanfacine, or clonidine (alpha agonists), may be helpful in situations such as nonresponse to stimulant medication, family preference, concerns about medication abuse or diversion, and coexisting tic or sleep problems.

HOMOEOPATHIC APPROACH
Homoeopathy has great scope in the treating ADHD. Studies showed positive effect of homoeopathy in the treatment of ADHD. Strauss reported improvements on the Conners’ Parent Symptom Questionnaire for children treated with homeopathy for 2 months. In another randomized, partially blinded, placebo controlled crossover trial with 43 children by Lamont who found significant treatment effects ^[5]. In an observation study with open label treatment, Frei and Thurneysen observed in 86 of 115 children an improvement of 55% in the Conners’ Global Index (CGI) rated by parents ^[6].

Homoeopathy is a psychosomatic medicine. It recognizes the role of mind in the genesis, maintenance and the development of a disease and gives prime importance to mental expression, disposition and state that expresses in the form of behavioral expression.

Organon of medicine (6th edition, § 211) ― This state holds good to such an extent, that the disposition of the patient often chiefly determines the selection of the homoeopathic remedy, as being decidedly characteristic symptom which can least of all remain concealed from the accurately observing physician. This pre-eminent importance of the emotional state holds good to such an extent that the patient‘s emotional state often tips the scale in the selection of homoeopathic remedy. This is a decidedly peculiar sign which among all the signs of disease, can least remain hidden from the exactly observing physician.

A detailed case history (Aphorism-218) about the health of the child and the family, the pregnancy and delivery, early development, vaccinations, life events, schooling, favorite foods, drinks to mention just a few points. The more information gathered, the easier it is to find that the remedy.
Being fundamental cause of mental disease is Psoric miasm, so patient should be subjected to a radical anti Psoric treatment (Aphorism-227).

RUBRICS RELATED TO ADHD FROM DIFFERENT REPERTORY
KENT REPERTORY
1. Anger, irascibility: Acon., Anac., Bry., Cham., Hepar., Ign., Kali-c., Kali-s., Lyc., Nat-m., Nit-ac., Nux-v., Petr., Sep., Staph., Sulph.
2. Conscientious about triffle: Ign., Sil.
3. Contradict disposition to: Hep.
4. Contradiction intoleranr of: Ambr., Ign., Nat-m.
5. Distructiveness: Bell., Hyos., Stram., Tarent., Vert.
6. Discontended, dissatisfied: Anac., Calc-p., Merc., Nat-m., Sulp.
7. Disobedience: Tarent.
8. Escape attempt to: Bell., Hyos.
9. Frightened easily: Arg-n., Ars., Bar-c., Lyco., Nat-m., Stram.
10. Hurry: Nat-m., Sulph., Tarent., Stram.
11. Loquacity: Hyos., Lach., Stram.
12. Mischivious: Hyos.
13. Obstinate: Alum., Arg-n., Bell., Calc., Cham., Nux-v., Tarent.
14. Quarrelsome: Aur., Ign., Nux-v., Sulph., Tarent.
15. Restlessness: Acon., Arg-n., Ars., Bell., Calc., Hyos., Lyco., Merc., Puls., Sep., Sili., Stram., Sulph., Tarent.,
16. Violent, vehement: Aur., Bell., Cic., Hyos., Nux-v., Stram.

SYNTHESIS REPERTORY RUBRICS

1. Mind, restlessness, children, in.
2. Mind, anger, children in.
3. Mind, concentration difficult.
4. Mind, forsaken feeling.
5. Mind, gestures, makes- strange attitudes and positions.

MURPHY REPERTORY

1. Children, anxious children.
2. Children, autistic children
3. Children, concentration difficult studying while.
4. Children, Hyperactive children.
5. Children, obstinate.
6. Children, quieted child cannot.
7. Children, restless children.

HOMOEOPATHIC THERAPEUTICS

Cina

• Child is very cross, ugly, does not want to be touched, caressed or carried, and wants to be rocked.
• Very touchy, petulant, dissatisfied
• Irritability > rocking fast.
• Cannot bear to be looked at
• Desires many things, but rejects everything offered, throws things away.
• Violent screaming attacks at night, the child lying on the back, striking and kicking with hands and feet.

Stramonium

• Intense emotions in a child lead to violence, which is out of control.
• Sudden anger. Can be destructive with striking, biting, tearing, smashing, strangling.
• Strong fears at night. Wakes with terror, the wild look in the eyes. Half awake, half dreaming. The child wants to sleep with the parents.
• The sight of water or anything glittering brings on spasms.
• Rapid changes from joy to sadness. Laughs at night weep during the day.

Tuberculinum

• Hyperactivity, restless.
• Despondent and morose Disposition to use foul, filthy language; to curse and swear.
• Every trifle irritates him.
• Anger wants to throw things away. Bangs the head when angry.
• Malicious behavior breaks things, breaks other’s valuables.
• An obstinate and disobedient child.
• Dissatisfied, always wants a change.

Tarantula

• Suddenly changing moods, fancies
• Hateful throws things away.
• Rolls on the ground from side to side or strikes relieve her distress.
• Hurried, intense, excited and restless.

Veratrum alb

• Hyperactive, restless, disobedient.
• Mania with desire to cut and tear everything, especially clothes.
• Cannot bear to be left alone, yet persistently refuses to talk.

Agaricus

• Morose, self-willed, stubborn Awkward, clumsy.
• Pressure on the spine causes involuntary laughter.
• Convulsions after being scolded.
• Sings talks, but does not answer.
• Loquacity, but answers no questions. Disinclined to answer questions

Medorrhinum

• Impulsive, abrupt, rude, mean, cruel.
• Cross by day, merry at night.
• Weeping ameliorates symptoms.

Lachesis

• Passionate, expressive, Creative, vital, lively.
• Constant overflowing ideas.
• Loquacity, Jumps from one subject to another.
• Mocks make odd notions, crawls on the floor, hides, spits, laughs or is angry during spasms. Talking, singing, and whistling constantly.

Lycopodium

• Inferiority complex. Egotism. Lack of discipline.
• Irritable, peevish and cross on waking. Kicks and screams.
• Easily angered, cannot endure opposition or contradiction.
• Weeps all day, cannot calm herself, very sensitive.

Phosphorous

• Great loquacity and vehemence.
• Oversensitive to external impressions
• Destroys everything.
• Anxious, restlessness, the patient cannot sit or stand still for a moment, especially in dark or twilight.

CONCLUSION
Homoeopathy is the system of medicine where we focus on mind- body relationship. ADHD is a neurobehavioral disorder, where we can see the disorder of mind and body. Since Conventional treatment cause certain side effects, parents are turning towards homoeopathic mode of treatment for ADHD. So there is an increasing scope for Homoeopathy especially in treating children.

REFERENCE

• Frei H, Everts R, von Ammon K et al (2005) Homeopathic Treatment in Children with Attention Deficit Hyperactivity Disorder – a Randomized, Double-Blind, Placebo Controlled Trial. Eur J Ped 164: 758-767.
• Lahey BB, Applegate B, McBurnett K, Biederman J, Greenhill L, Hynd GW, Barkley RA, Newcorn J, Jensen P, Richters J (1994) DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents. Am J Psychiatry 151:1673–1685.
• Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. The American journal of psychiatry. 2007;164:942–948. doi: 10.1176/ajp.2007.164.6.942. [
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™(5th ed.). Arlington, VA: Author. [Crossref], [Google Scholar]
• Lamont J (1997) Homeopathic treatment of attention deficit disorder. Br Hom J 86: 196–200
• Frei H, Thurneysen A. Treatment for hyperactive children: homeopathy and methylphenidate compared in a family setting. Brit Hom J 2001; 90: 183–188.

Dr Maria Shaju
MD part 2
Department of case taking and repertory
Under guidance of : Dr Munir Ahmed R
GHMCH, Bengaluru