Case of Attention Deficit Hyperactivity Disorder
by Dr. Jayesh Dhingreja M.D. (Hom). M.Sc. (Counseling Psychology)
Summary: The case highlights the effects of a mother’s state during pregnancy on the fetus. The case also highlights the importance of a thorough anamnesis in a case to arrive at the indicated remedy.
Key Words: Restlessness, Attention, Stubborn, Fear, Pregnancy, Stramonium.
Mst. K. S., 8 years, male
4th Standard Student
Father – Mr. S. S. – Business.
Mother – Mrs. S. S. – Homemaker.
Date of Consultation: 05 / 12 / 07
Chief Complaints:
The child is very restless. He keeps on running and jumping the whole day from here to there. Also, he cannot concentrate on his studies. While reading something his attention gets diverted to other things and so he does not finish his school work.
A lot of complaints have come from school: that he does not complete his homework, does not pay attention in class, and also does not copy down whatever is written on the board. He gets distracted very easily to noise outside the house.
Associated Complaints:
He has recurrent tendency to catch cold since infancy. Starts with a running nose and then proceeds to block the nose, a cough and fever.
During fever he clings to the person around him and becomes very loquacious.
Also has styes in both eyes since 3-4months.
Physical Generals:
Stools – Unsatisfactory.
Urine – Occasional burning.
Sleep – On abdomen; talks in sleep ++.
Thermal modality – Hot patient.
Birth History:
Full term normal delivery; cried immediately after birth.
Birth weight – 2.8 kg.
Vaccinations given. No complaints after vaccination.
Developmental History:
Dentition – 6 months
Walking – 11 months
Talking – 10 months
Mental state of the child:
Very stubborn behavior. He does not listen to anyone. If his wishes are not fulfilled, then he comes near us and threatens us that he will beat us. He gets violent and bites, spits and hits the person. Also, when his demands are not met with, he shouts loudly. He has also been punished in school for hitting and pushing his classmates.
Also because of his restless behavior, he disturbs everyone else in the class.
When he plays with the other children, he tries to be bossy with them too, grabs their toys and does not give his toys to them. He is also a bad loser. Whenever he loses, he will hit the other child who has beaten him.
He loves to watch WWF program on the television and even tries to imitate the wrestlers many times.
He has a marked fear of staying alone in the dark.
Basic Personality of Mother:
She is a sensitive person and cannot bear any sort of reprimand or rudeness. She has an elder sister who is schizophrenic. She is a timid person and gets frightened easily. She is a very homely person and is very much dependent and attached to her parents and husband.
Mother’s History during Pregnancy:
Mother’s age during pregnancy: 21 years
During pregnancy, she stayed with her mother and sister. She had an argument with her Mother-in-law just prior to coming to her mother’s house.
Her mother-in-law blamed her for certain things going on in their house, which she could not take. She was very much affected and she even tried to harm herself and the unborn child by cutting her wrist.
In her mother’s house, she was staying with her mother and elder sister. Her elder sister is divorced and a schizophrenic who used to become violent and constantly had to be kept on sedatives. The mother used to be terrified and was constantly in fear of her sister.
In the 3rd month she developed vaginal bleeding. She was advised complete bed rest.
She also had nausea during the whole period of gestation, and because of which she was quite uncomfortable.
Past History:
No major medical or surgical disease.
Family History:
Aunty (Mother’s sister) - Schizophrenia.
On Examination:
Lean and thin, Weight – 22 kg.
General Examination:
T. – afebrile; P. – 84 / min.; R. R. – 19 / min.; Pallor/Icterus/Cyanosis/Clubbing/
Lymphadenopathy/Edema – absent; Skull/Skin/Spine – NAD
Systemic Examination:
CNS/CVS/RS/GIT – NAD
Clinical diagnosis:
Attention Deficit Hyperactive Disorder with Behavior Disorder with Recurrent Upper Respiratory Tract Infections.
Totality of Symptoms (Mother’s state during pregnancy):
Reproached by mother-in-law which affected her badly.
Tried to harm her and the baby by cutting her wrist.
Constant state of fright.
Repertory sheet (Mother’s state during pregnancy):
Totality of Symptoms (Patient):
Extremely restless child, cannot sit in one place, always jumps about.
Behavioral problems.
Stubborn child.
Temper tantrums.
Aggression is shown by biting.
Striking.
Threatening.
Spitting.
Talks in sleep.
Fear of being alone in the dark.
Loquacious during fever.
Sleeps on abdomen.
Repertory sheet (Patient):
Miasm:
Psora
Remedy selected:
Stramonium, 1M, I dose.
Follow up:
20 / 12 / 07
No cold and cough.
Styes on eyelids – same.
Mental State – No change.
Weight – 22 kg.
Rest – NAD
Placebo.
10 / 01 / 08
No cold and cough.
Styes – same.
Mental State – No change.
Weight – 23 kg.
Rest – NAD.
Stramonium 1M, I dose
31 / 01 / 08
No cold and cough.
Styes – better. No new styes.
Restlessness – slightly better.
According to his teacher, he is concentrating to some extent in the class now.
Aggression – better than before.
Weight – 23 kg.
Rest – NAD
Placebo
29 / 02 / 08
No cold and cough.
No styes.
Restlessness – better.
Aggression – still there, but now does not bite or spit on the person.
Weight – 24 kg.
Rest – NAD
Placebo
31 / 03 / 08
No cold and cough.
No styes.
Restlessness and concentration – much better.
Temper tantrums – better.
Weight – 24 Kg.
Rest – NAD.
Placebo
Discussion:
From the anamnesis of the case, we can very well understand the state in which the mother was during her whole gestation period. Initially, she was very much affected by the reproach by her mother-in-law, followed by a constant state of fear she was in at her mother’s house. She used to remain under a constant threat of being injured by her sister who was schizophrenic. The fetus growing in an environment of constant threat compensates for it by developing an exact opposite attitude of aggression and attack once it is out of the womb.
The mother also had nausea throughout the gestation period, which further enhanced the hyperactivity of the child.
Taking the mother’s state and the child’s state, Stramonium was prescribed as the indicated remedy.
