Homeopathy and ADHD E-Book

Heiner Frei

• Herausgeber: Narayana
• Kategorie: Ratgeber
• Sprache: Englisch

Seitenzahl: 290

Veröffentlichungsjahr: 2025

Beschreibung

HOMEOPATHY – PRECISE AND EFFECTIVE Attention deficit hyperactivity disorder (ADHD) constitutes one of the major challenges of our time. The experienced Swiss paediatrician Heiner Frei has developed Polarity analysis – a highly efficient and systematic approach for the treatment of hyperactive children. This new method is based on Boenninghausen’s Therapeutic Pocket Book, using polar symptoms such as amelioration or aggravation as cornerstones of the prescription. Heiner Frei was able to demonstrate the efficacy of this specific homeopathic treatment in ADHD children in a controlled five-year clinical study, which is documented in this book. According to Dr Frei’s approach, the disturbances of perception (e.g. visual or tactile) are the most reliable symptoms for case analysis. Their modalities are crucial for the evaluation of the case and they also rule out contraindicated remedies. Heiner Frei is a born teacher. His method is easy to understand and each chapter is followed by concise quizzes with answers. The book contains questionnaires developed for polarity analysis and uses the Conners’ Global Index (CGI) as an efficient means to evaluate case progress. There is also a unique materia medica that highlights perception symptoms and their grades with accompanying notes from Hering, Guernsey, Lippe and Hahnemann. Polarity analysis has remarkably quickly become a valuable tool for many practitioners. It shortens the time needed to find the simillimum, achieving an astonishing hit-rate of 75% in children with ADHD. “This book is a must for anyone who treats children with ADD/ADHD, and of great benefit to any homeopath.” Ralf Jeutter, Homeopathic Links

Leseprobe

HEINER FREI

HOMEOPATHY AND ADHD

A NEW TREATMENT CONCEPT WITH POLARITY ANALYSIS

Heiner Frei

HOMEOPATHY AND ADHD

A New Treatment Concept with Polarity Analysis

First English Edition 2015

ISBN 978-3-95582-288-0

© 2015 Narayana Verlag

Original Title:

Die homöopathische Behandlung von Kindern mit ADS/ADHS

© 2009 Karl F. Haug Verlag in MVS Medizin Verlage Stuttgart GmbH & Co KG

Translated by Aidan Constable

Design: Chragokyberneticks & Coboi

Typefaces: Ideal Sans & Din

Cover Photo: Fabian Oefner

NARAYANA VERLAG

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Phone [phone]

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The recommendations in this book have been compiled and checked to the best knowledge of the author and publisher. There is nevertheless no guarantee provided. Neither the author nor the publisher shall be held liable for possible detriment or damage resulting from the instructions in the book.

TABLE OF CONTENTS

ABBREVIATIONS

PREFACE

1 MEDICAL PRINCIPLES OF ADHD/ADD

1.1 THE HYPERACTIVE CHILD – FROM FIDGETY TO HYPERACTIVE

1.2 CURRENT THERAPEUTIC AND SOCIAL PROBLEMS

1.3 DEFINITION OF ATTENTION DEFICIT HYPERACTIVITY DISORDER

1.4 SYMPTOMS

1.4.1 THE SUBJECTIVE EXPERIENCE OF PATIENTS

1.4.2 EARLY SYMPTOMS

1.4.3 COMPLETE CLINICAL PICTURE OF ADHD/ADD

1.4.4 AETIOLOGY

1.5 PATHOPHYSIOLOGY OF ADHD/ADD

1.5.1 PRINCIPLES OF NEUROANATOMY, PHYSIOLOGY AND BIOCHEMISTRY

1.5.2 DISTURBANCES OF PERCEPTION

1.5.3 SECONDARY PSYCHOLOGICAL SYMPTOMS

1.6 FREQUENCY OF ILLNESS

1.7 DIAGNOSIS

1.7.1 HYPERKINETIC DISTURBANCES ACCORDING TO ICD-10

1.7.2 HYPERKINETIC DISTURBANCES ACCORDING TO DSM-IV

1.7.3 DIFFERENTIAL DIAGNOSES

1.8 TREATMENT OPTIONS

1.8.1 EDUCATIONAL THERAPEUTIC MEASURES

1.8.2 TREATMENT WITH MEDICATION

1.8.3 OTHER TREATMENTS

1.9 PROGNOSIS

1.10. QUIZ 1

2 HOMEOPATHIC TREATMENT OF ADHD/ADD

2.1 PROBLEMS WITH CONVENTIONAL HOMEOPATHIC TREATMENT

2.1.1 HIT RATE, EFFICACY AND PERIOD OF IMPROVEMENT FOR TREATMENT WITH SINGLE DOSES

2.1.2 DIFFICULTIES IDENTIFYING THE CORRECT REMEDY

2.2 OPTIMISATION OF ADHD/ADD TREATMENT: A NEW TREATMENT CONCEPT

2.2.1 STANDARDISED CASETAKING

2.2.2 IDENTIFICATION OF UNRELIABLE SYMPTOMS

2.2.3 SIGNIFICANCE OF PATHOGNOMONIC SYMPTOMS

2.2.4. WEIGHTING OF SYMPTOMS ACCORDING TO BOENNINGHAUSEN

2.2.5 POLARITY ANALYSIS

2.2.6 EXAMPLE CASE: CASETAKING TECHNIQUE

2.2.7 EVALUATION OF OPTIMISATION MEASURES

2.2.8 OPTIMAL DOSING WITH Q POTENCIES

2.2.9 ASSESSMENT OF PROGRESS

2.2.10 DEALING WITH INTERCURRENT ILLNESSES

2.2.11 STIMULANTS AND HOMEOPATHY

2.3 OVERVIEW OF THE METHOD

2.4 QUIZ 2

3 TOOLS

3.1 THE BOENNINGHAUSEN SOFTWARE

3.2 ADHD/ADD ASSESSMENT SHEET (CONNERS’ GLOBAL INDEX)

3.3 QUESTIONNAIRE FOR DISTURBANCES OF PERCEPTION AND ADHD/ADD

3.4 QUESTIONNAIRE FOR ADDITIONAL COMPLAINTS

3.5 ADMINISTERING Q OR LM POTENCIES

3.6 ADVICE ON EDUCATIONAL MEASURES, NUTRITION AND SPORT

4 TEN PRACTICE CASES

4.1. HOW TO FIND THE REMEDYA REMEDY

4.2. THE SIGNIFICANCE OF CONTRAINDICATIONS

4.3 NUANCES WHEN JUDGING THE EFFECT OF A REMEDY

4.4 TOTALITY OF SYMPTOMS OR KEYNOTES?

4.5 THE SIGNIFICANCE OF ADDITIONAL COMPLAINTS

4.6 TREATING RITALIN PATIENTS

4.7 THE EFFECTS OF POORLY MOTIVATED PARENTS

4.8 JUDGING PROGRESS AND EXTERNAL CONDITIONS

4.9 HOMEOPATHY AND INTELLIGENCE

4.10 HOMEOPATHY AS THE FINAL CHANCE OF CURE

4.11 WHAT NEXT?

4.12 QUIZ 3

5 COMPARATIVE MATERIA MEDICA OF THE MOST COMMON REMEDIES FOR CHILDREN WITH ADHD/ADD

5.1 CHARACTERISTIC PATIENT SYMPTOMS AND THE GENIUS OF THE REMEDIES

ACONITUM

AGARICUS

ARGENTUM NITRICUM

ARNICA

ARSENICUM ALBUM

AURUM METALLICUM

BARIUM CARBONICUM

BELLADONNA

BRYONIA

CALCIUM CARBONICUM

CAPSICUM

CAUSTICUM

CHAMOMILLA

CHINA

COCCULUS

FERRUM METALLICUM

HEPAR SULPHURIS

HYOSCYAMUS

IGNATIA

IODIUM

LACHESIS

LYCOPODIUM

MAGNETIS POLUS ARCTICUS

MERCURIUS SOLUBILIS

NATRIUM CARBONICUM

NATRIUM MURIATICUM

NUX VOMICA

PHOSPHORUS

PHOSPHORICUM ACIDUM

PULSATILLA

SEPIA

SILICEA

STAPHISAGRIA

STRAMONIUM

SULPHUR

VERATRUM ALBUM

6 SCIENTIFIC EVIDENCE FOR THE EFFICACY OF HOMEOPATHIC REMEDIES IN PATIENTS WITH ADHD/ADD

6.1 HOMEOPATHIC TREATMENT OF ATTENTION DEFICIT HYPERACTIVITY DISORDER

6.1.1 INTRODUCTION

6.1.2 METHODS

6.1.3 RESULTS

6.1.4 DISCUSSION

6.2 COMPARISON OF HOMEOPATHY AND METHYLPHENIDATE IN THE TREATMENT OF HYPERACTIVE CHILDREN (PRE-STUDY)

6.2.1 INTRODUCTION

6.2.2 METHOD

6.2.2.1 STUDY AIMS AND QUESTIONS

6.2.3 RESULTS

6.2.3.1 DEMOGRAPHIC PARAMETERS OF STUDY PARTICIPANTS

6.2.3.2 RESPONSE RATES TO HOMEOPATHIC TREATMENT

6.2.3.3 DEGREE OF IMPROVEMENT WITH HOMEOPATHY AND METHYLPHENIDATE

6.2.3.4 TIME REQUIRED

6.2.3.5 REMEDY LIST

6.2.4 DISCUSSION

6.3 HOMEOPATHIC TREATMENT OF CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER: A RANDOMISED, PLACEBO CONTROLLED DOUBLE-BLIND STUDY WITH CROSSOVER

6.3.1 INTRODUCTION

6.3.2 METHODS

6.3.2.1 STUDY DESIGN

6.3.2.2 STUDY AIMS

6.3.2.3 INCLUSION CRITERIA

6.3.2.4 TREATMENT INTERVENTIONS

6.3.2.5 MEASUREMENTS: OUTCOME PARAMETERS

6.3.2.6 STATISTICAL CONSIDERATIONS

6.3.2.7 ETHICS

6.3.2.8 PILOT TEST

6.3.3 RESULTS

6.3.3.1 RECRUITMENT, PARTICIPANT FLOW CHART AND BIOMETRIC PARTICIPANT DATA

6.3.3.2 TREATMENT RESULTS FROM THE SCREENING PHASE

6.3.3.3 COMPARISON BETWEEN SUBOPTIMAL AND OPTIMAL HOMEOPATHIC PRESCRIPTIONS

6.3.3.4 PREREQUISITES FOR AN RCT WITH PRIMARY BLINDING

6.3.3.5 RESULTS OF THE CROSSOVER PHASE

6.3.3.6 RESULTS AFTER 1 ½ YEARS OF TREATMENT

6.3.3.7 RESULTS OF LONG-TERM FOLLOW-UP

6.3.4 COSTS OF HOMEOPATHY VS. COSTS OF ALLOPATHY

6.3.5 DISCUSSION

6.4 QUIZ 4

EPILOGUE

APPENDIX

QUIZ ANSWERS

LIST OF TABLES

FIGURES

LIST OF PICTURES OF REMEDY

BIBLIOGRAPHY

REMEDY INDEX

SUBJECT INDEX

ABOUT ME

ABBREVIATIONS

ADHD

Attention Deficit Hyperactivity Disorder

ADD

Attention Deficit Disorder (without hyperactivity)

BPB 2000

Boenninghausen

Therapeutic Pocket Book 2000

CGI

Conners’ Global Index

CI

Confidence interval

CD

Hahnemann

The Chronic Diseases

CPRS

Conners’ Parent Rating Scale (long form)

CTRS

Conners’ Teacher Rating Scales (long form)

DSM-IV

Diagnostic and Statistical Manual of Mental Disorder

s

EEG

Electroencephalography

GS

Hering

Guiding Symptoms

HAWIK-III

Hamburg-Wechsler-Intelligenz-Test für Kinder III

IQ

Intelligence Quotoent

K-ABC

Kaufman Assessment Battery for Children

MAO

Monoamine oxidase

MMP

Hahnemann

Materia Medica Pura

MMRH

Materia Medica Revisa Homoeopathiae

MPD

Methylphenidate

MRI

Magnetic resonance imaging

NRI

Norepinephrine reuptake inhibitor

ORG

Hahnemann

Organon

QCB

Questionnaire on change of behaviour

PET

Positron emission tomography

RCBF

Regional cerebral blood flow

SD

Standard deviation

SPECT

Single photon emission computed tomography

TAP

Test battery for Attention Performance

VLMT

German Version of the Rey Auditory Verbal Learning Test (RAVLT)

WHO

World Health Organisation

WISC-III

German version of Wechsler Intelligence Scale for Children

PREFACE

Attention deficit hyperactivity disorder (ADHD) and the associated syndrome without hyperactivity, attention deficit disorder (ADD), constitute one of the major challenges of our time. The affected children and their families often suffer greatly. In conventional medicine, patients are frequently treated with stimulants, i.e. amphetamine derivatives. These substances have a high potential for abuse and are subject to narcotics legislation in many countries. The exponential increase of stimulant treatment in the West is a major cause of concern since the long-term effects are not well understood. Therefore, it is no surprise that there is a search for effective alternative treatments.

In this book we would like to present our extensive experience with homeopathic treatment of hyperactive children, gathered over many years. In the majority of patients homeopathy leads to impressive results and – with continuing treatment – to enduring improvement. The prerequisite is that the doctor and the family observe the child’s symptoms closely and have the patience to reach a successful outcome.

The aim of this work is to assist homeopathic practitioners in the treatment of hyperactive children, pointing out the potential pitfalls and thereby enabling more affected children to enjoy the benefits of this premium treatment, tailored precisely to their individual needs. The book contains clear guidelines for taking the case effectively as well as hints on the reliability and weighting of symptoms. It describes dosing regimes that lead to stable improvement, and how to fine-tune the treatment. Yet it is not a self-help manual: homeopathy is demanding and the treatment of ADHD/ADD especially so. It requires considerable experience to achieve the results presented here.

Paediatricians, child psychiatrists and general practitioners who do not currently use homeopathy and who are looking for alternatives to treatment with stimulants will find here details of the scientific work concerning the effects of homeopathy on ADHD/ADD together with the necessary basic knowledge to start using this method of treatment.

For parents and patients interested in homeopathy, it is important to appreciate the kind of observation a practitioner requires to achieve successful treatment, how the casetaking proceeds, and the kinds of obstacles that may crop up. At the same time, we would like to encourage you to request homeopathy for your child. The results are well worth it: with ongoing treatment, the child’s perception returns to normal. And there is a cumulative effect over the years, which can lead to considerable and long-lasting reduction of the ADHD/ADD symptoms, even after treatment has ceased. It is often a cause of great joy for all concerned to see how children master their difficulties and are able to live a normal life once more.

I would like to extend my warmest thanks to all those who have helped with this work. This includes my friends Dr Klaus-Henning Gypser and Dr Dominik Müller, who have supported me in word and deed, critically appraising the manuscript, correcting the errors and clarifying the weak points. Many thanks also to Dr Franz Kaufmann for the scientific checking of the neuropsychology sections and to Aidan Constable for the careful translation. And a big thank you to all in the team at Narayana Verlag, especially Dr Katrin Sigwart, for the harmonious collaboration resulting in this work.

I would also like to thank my wife and children from the bottom of my heart. It is they who have accompanied me most closely on the long and winding path of the homeopathic treatment of hyperactive patients with all its ups and downs, occasionally suffering from my tenacity to reach the goal of this book. Their patience and empathy have been an invaluable support to me during this work — indeed, without them it would scarcely have been possible.

Laupen, Switzerland, December 2014

Heiner Frei, MD

1 MEDICAL PRINCIPLES OF ADHD/ADD

1.1 THE HYPERACTIVE CHILD – FROM FIDGETY TO HYPERACTIVE

Since the middle of the nineteenth century, many psychiatrists have been interested in the clinical picture of the restless, inattentive, and maladjusted child. The first precise descriptions of attention deficit hyperactivity disorder in the English clinical literature were by Ireland (1877)1 and Still (1902)2, who made recommendations for educational and psychotherapy measures to treat the illness, especially a well structured approach to the patient, who was to be encouraged to adapt to the conventional rules of social intercourse. The use of medication can be traced to Sargant, who first prescribed stimulants (Benzedrine®) from 1936.3 In 1942 Bender described the effect of amphetamines in hyperactive children4, and in 1944 Panizzon synthesised methylphenidate, still commonly known today as Ritalin®, the most frequently prescribed medication for such patients5. With the development of modern child psychiatry in the twentieth century, several child psychiatrists introduced initial diagnostic terms for the restless child with poor concentration: “minimal brain dysfunction” (Bax and McKeith, 1963)6 or “hyperkinetic syndrome of childhood” (Stewart, 1966)7. Today the terms attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) are widely accepted.8

1.2 CURRENT THERAPEUTIC AND SOCIAL PROBLEMS

In paediatric practice, attention deficit disorders (ADHD/ADD) are the most common serious psychosocial problems prompting parents to seek help for their children. Since the ability to pay attention and concentrate is a basic prerequisite of child development, forming the foundation of all learning and thinking as well as of emotional and social interaction, the suffering of these children as well as their siblings, parents, teachers, and fellow pupils is often considerable. Whether ADHD/ADD is expressed as a mild disturbance or a severe disability depends on the child’s personality, temperament, talents and abilities.

Even today the usual treatment approach consists of educational and psychotherapy measures, increasingly combined with stimulants. In emergencies, these stimulants are often the only way of quickly defusing the situation. Since stimulants are amphetamine derivatives, and therefore frequently subject to narcotics legislation in most countries, the rapid increase in prescriptions in recent years has led to widespread disquiet. Doubts and questions arise, such as: Can it be right to treat children with such powerful drugs? What are the goals of such treatment? What are the social problems requiring such an approach? Are there not more subtle methods available to deal with the problem?

Unsure which way to turn for help, parents often seek assistance from complementary medicine, which claims to offer an important contribution in addressing this issue. Unfortunately, however, there is very little research to scientifically validate the effect of complementary medicine for ADHD/ADD. In this book we will take a detailed look at the data on homeopathy and ADHD/ADD.

1.3 DEFINITION OF ATTENTION DEFICIT HYPERACTIVITY DISORDER

ADHD/ADD consists of a combination of attention deficit and impulsivity, as well as hyperactivity or passivity. There are a series of underlying disturbances of perception – sight, hearing, touch, balance, proprioception, smell and taste – with varying degrees of functional impairment. There is no disturbance in peripheral sense organs: the problem is not the primary sensitivity to stimuli but rather the pathological way in which these sensory stimuli are processed in the brain. The filtering of stimuli may be diminished or absent, so that the patient is flooded with stimuli, or the processing of incoming stimuli may be poor due to inadequate coordination of the two hemispheres of the brain. This makes an appropriate reaction to sensory stimuli difficult or impossible, leading to the development of secondary problems such as symptoms of hyperactivity and impulsivity, which are required for confirmation of the diagnosis. The World Health Organization (WHO) stipulates that the disturbance must begin before the age of six and it must last for at least six months before the diagnosis can be made.

Confirmation of the diagnosis is difficult since extraneous disturbances need to be ruled out, such as excessive demands at school, difficulties in socialisation, deprivation, mental disorder, specific learning difficulties and developmental delays. To avoid giving concerned parents an insufficiently reliable diagnosis, it is important to conduct a neurological and neuropsychological examination with the necessary tests. The resulting treatment strategies can vary greatly according to the diagnosis.

1.4 SYMPTOMS

1.4.1 THE SUBJECTIVE EXPERIENCE OF PATIENTS

The following descriptions illustrate the challenging problems that confront patients and their siblings, parents, teachers and fellow pupils on a daily basis. (All patient names have been changed).

The mother of 11-year-old Reto puts it like this:

“We find it a big struggle living with Reto. By the time he leaves the house in the morning, we have usually already had one or two arguments. Sometimes we just can’t stand his continuous babble and his moodiness. He can’t be depended on to do the simplest of things; the resulting arguments sap our energy and don’t make things better. So we mostly end up with a crying child and a feeling of helplessness because we don’t really know whether he’s burdened by ADHD or whether he just doesn’t want to do things because he’s too lazy. So we are often at the end of our tether – the only way out is to send him to his room, otherwise we’ll lose our temper …”

Reto himself complains:

“I don’t find it so great that I’m always getting on people’s nerves. Then I have to go to my room. I don’t want that any more. At school I can’t sit still and concentrate, which also gets to me …”

And the parents of 7-year-old Lars describe their son’s problems, which are also typical of very many children, as follows:

“Lars sits restlessly at the table, sometimes so restlessly that he falls off the chair. He also eats messily and his t-shirt is always dirty. He keeps the food in his mouth for ages but without chewing it properly. He is pretty unsure of himself but tries to cover up by horsing around and not listening. If he’s then told off, he feels he’s been mistreated, becomes impossible to talk to, gets furious, and hits the wall or whatever. His expression is then grim and very unhappy. He rarely quarrels with other children but when he does, he really whacks them. We think that Lars doesn’t feel his body properly and he can’t express his feelings, so his anger just builds up. He likes playing with smaller kids, where he feels safe and doesn’t need to stand up for himself.”

Observations of a primary school teacher about 7-year-old Damian:

“Damian is a restless child who has difficulty sitting still. His considerable strength and energy are often expressed in an uncontrolled and powerful way. Drawing lines and holding the coloured pens, he is uncertain, shaky and cramped, and his hand is not sufficiently supported. His drawing is therefore delayed and he is unwilling to draw. He is also unsure of himself with scissors, paintbrush and clay. If he does not want to do something, he works in a careless way without concentration or stamina, quickly becoming tired and losing interest in finishing whatever he is doing. He is easily distracted and quickly satisfied with his results. Yet when he’s interested in something, he can concentrate on it properly. Damian has many original and creative ideas. Often he has difficulty putting off his needs or adapting, and he sometimes tries to get round the group rules. His behaviour is moody and not infrequently egoistic. Damian is not good at sharing and he reacts to conflicts in an exaggerated and impulsive way.”

And a teacher says this of 7-year-old Marco:

“He interrupts the lesson with his behaviour to such an extent that it is impossible to continue with him. Marco comes across as provocative, disrespectful to adults, dominant to other children, and he is quick to harm them in a serious way. Yet he is very sensitive and is often very frustrated.”

1.4.2 EARLY SYMPTOMS

Prenatal

• Increased movement by the child during pregnancy (not always experienced)

Infancy (up to one year of age)

• Restlessness or passivity

• Inconsolable screaming (colic)

• Nervousness, irritability

• Dislike of touch, rejection of body contact

• Sleep disturbances (late development of circadian rhythm)

• Feeding difficulties (poor drinking, rejection of solid food)

• Leapfrogging of developmental steps, for example, no crawling, direct transition from lying position to standing

• Delayed psychomotor development, delayed speech

• Unusual muscle tone (hypotonia or hypertonia)

Pre-school (one – five years of age)

• Restlessness or passivity

• Stubbornness, difficulties with new situations

•Intense frustration leading to fits of anger

• Continual demands on mother, cannot let go of her

• No stamina or concentration, switch rapidly from one game or task to another

• Impatience, throw things around if they do not succeed immediately

• Rough handling of toys, take everything to pieces

• Motor clumsiness, including in everyday situations, such as getting dressed

• Do not notice dangers, increased risk of accidents

• Hit other children

• Noticeably clean children (for example, dislike dirty or sticky hands)

• Unbalanced eating, prefers solid food but not too hard, no sauces

• Psychomotor development severely delayed for long periods

• Sleep disturbances

Intelligent ADHD/ADD children have a hard time because they recognise the goal but cannot take the necessary steps to reach it; children with learning disabilities on the other hand are quiet, passive, and therefore do not stand out.

1.4.3 COMPLETE CLINICAL PICTURE OF ADHD/ADD

The main times of crisis are as young children, when parents realise for the first time that something is not right with their child, when first starting school or kindergarten, when the child has to adapt to a structured environment, and during adolescence, when even healthy children have many conflicts and it is not unusual for matters to reach crisis point in families with ADHD/ADD patients.

The symptoms presented here do not all need to be present.

Kindergarten and School

• Constantly on the move (ADHD), as if driven, “inner motor”, but not anxious restlessness

• Or dreamy, too passive, sunk in thought (ADD)

• Need for movement is only present at certain times in many cases

•Inattentiveness

• Easily distracted, short attention span

•Memory often poor, though sometimes very good in specific areas

•Impulsivity – acting before thinking

1. Jumping from one task to another without ever finishing anything, hasty

2. Difficulty writing due to impulsive motor movements

3. Lacking in empathy, do forbidden things on impulse, tactless, become outsiders

4. Superficial emotionality; very curious, always looking for something new, tend to horse around, get into nerve-racking situations, do not recognise danger, insatiability

5. Mood swings, fits of anger, stubbornness

6. Poor structuring of work (problems in organising)

Adolescence

Motor restlessness generally diminishes with time but impulsivity and attention disorders persist, possibly with reduced intensity because the child has learned how to deal with the problems better. The aggressiveness and emotional immaturity can also persist.

Adults

It is now thought that the disorder persists into adulthood for 70-75 % of patients. The frequency of ADHD/ADD in adults is estimated to be 2-6 % of the population. In these patients too the symptoms reflect those found in children, and are characterised by marked problems in training and career as well as difficulties in getting on with other people (Weiss).9

1.4.4 AETIOLOGY

There have been many attempts to explain the origin of ADHD/ADD. The following aetiological factors are confirmed:

• Genetic factors

• Prenatal and perinatal problems, lack of oxygen, and so on

• Trauma to skull and brain

• Inflammation of the central nervous system

• Malnutrition in babies

• Stimulus satiation in modern society

The following are unconfirmed:

• Nicotine and alcohol abuse by the mother during pregnancy

• Chronic heavy metal poisoning (lead, mercury, and so on)

• Various allergies (to phosphates, sugar, preservatives, and so on)

Our current knowledge of the pathophysiology of ADHD/ADD consists of little more than hypotheses based on certain neuroanatomical, neurophysiological, and neurochemical findings.

1.5 PATHOPHYSIOLOGY OF ADHD/ADD

1.5.1 PRINCIPLES OF NEUROANATOMY, PHYSIOLOGY AND BIOCHEMISTRY

Neuroanatomical Changes

In a study using magnetic resonance imaging (MRI), Hynd and colleagues discovered changes in the extent of the right lobus frontalis compared to controls. In another study they found a diminished size of the corpus callosum.10,11

Neurophysiological Changes

The research conducted by Lou using regional cerebral blood flow (RCBF) and single photon emission computed tomography (SPECT) showed that there is hypoperfusion of the lobus frontalis (especially the nucleus caudatus) and excessive blood supply to the occipital region of the brain.12

Zametkin discovered with investigations using positron emission tomography (PET) that there is a reduction in the total metabolism of glucose in the premotor and upper prefrontal cortex.13

Neurochemical Findings and Hypotheses

Young, Brown and Shekim discovered that the reduction in monoamine oxidase (MAO) activity between childhood and adolescence does not occur in hyperactive children. Stoff also found that MAO activity in the thrombocytes of ADHD/ADD children is elevated. The finding has been replicated for adults and in certain types of personality disorder. Due to this discovery and to the fact that methylphenidate restricts, among other things, monoamine oxidase, it was hypothesised that increased MAO activity might be the cause of ADHD/ADD. Of all current somatic explanatory models, this appears the most promising.14,15,16

The older hypothesis of an intrasynaptic lack of dopamine has not gained traction since dopamine antagonists (haloperidol, chlorpromazine, and thioridazine) in low concentrations have a positive effect on ADHD/ADD.17

1.5.2 DISTURBANCES OF PERCEPTION18

DISTURBANCES OF PERCEPTION ARE EXCEPTIONALLY IMPORTANT FOR HOMEOPATHIC CASETAKING.

As already mentioned, the functional expression of ADHD/ADD is in the form of disturbances of perception, whereby the filtering of stimuli and the processing of sensory stimuli as well as the ensuing reaction are affected. The child perceives all stimuli in the environment and these are transmitted to the brain. Since there is an inability to filter out unimportant stimuli, the result is a flooding of stimuli with consequent disorientation, disturbed concentration, restlessness, and rapid fatigue.

Disturbances of perception can affect all sensory modalities to a differing extent, causing impairment to all or some of the following: visual (perception and reproduction of form), tactile (touch stimuli), auditory (hearing), proprioceptive (inner-body sensitivity), vestibular (balance), olfactory (sense of smell) and gustatory (sense of taste). Disturbances of perception are also the primary phenomena found clinically and in neurophysiological and neurological tests with ADHD/ADD children. The people in contact with these children regard these disturbances their most important problem. They are responsible for all secondary problems such as restlessness and poor concentration, as well as disturbances of learning, behaviour and socialisation.

The disturbances of perception are exceptionally important for homeopathic casetaking. They are easier to ascertain than the often unreliable secondary psychological symptoms.

We will now throw some light on the individual modalities of perception and their effect on the symptoms of these children, and also show which symptoms are of importance for homeopathic casetaking.

Sight

RELEVANT VISUAL SYMPTOMS:LIGHT: WORSELOOKING AT SOMETHING CLOSE UP: WORSEREADING: WORSE

Visual dysfunction expresses itself in problems perceiving and reproducing form. Young children show delays in drawing and for schoolchildren dyslexia is common (difficulty reading and writing despite average intelligence), with letters written back to front, for example. It is not unusual to find disturbances in perceptions of space. The affected children have difficulty finding their way around unfamiliar places and are therefore afraid in new situations.

For homeopathic casetaking, the following symptoms are relevant:

•Light: worse (oversensitivity to light)

•Looking at something close up: worse (for example, restlessness and irritability after watching TV or playing computer games)

•Reading: worse (dyslexia)

Touch

RELEVANT TACTILE SYMPTOM:TOUCH: WORSE

Disturbances of tactile perception lead either to an over- or an undersensitivity to touch stimuli. A child can be, for example, especially ticklish or deliberately and constantly seek excessive tactile stimuli by fidgeting on the chair or stepping on everyone’s toes. Often we can observe cramping in the fine motor movements with difficulty adjusting the strength of a movement as well as problems writing. Certain clothes are experienced as unpleasant. For babies who react to their parent’s caresses by pushing away and who reject being held or cuddled, always wanting to get away, this can have serious repercussions for the mother-child relationship, affecting the child’s entire development. It is important to know that light touch stimuli are felt far more intensely than strong ones. A child may, for example, very much like to be firmly squeezed whereas light caresses are experienced as unbearable.

For homeopathic casetaking, the following symptom is relevant:

•Touch: worse is to be used. Touch: better is, on the other hand, to be viewed as a normal phenomenon.

Proprioception – Inner-Body Sensitivity

RELEVANT PROPRIOCEPTION SYMPTOM:WRITING: WORSE

The proprioceptive receptors responsible for inner-body sensitivity transmit to the brain 3-D information about the position of the body. These disturbances can be clinically assessed by asking the patient to lie down straight with their eyes closed on the examination couch. If there is a problem with proprioception, this proves to be impossible because the visual feedback is missing. If we correct the position of the patient while the eyes remain closed so that the position is now straight and we then ask the patient to tell us how he is now lying, he will say that he is now lying crooked. Disturbances of proprioception generally lead to apraxia, i.e. manual and motor clumsiness. This is expressed by the feeling that the patient has to learn the most basic practical tasks – such as getting dressed – anew each day.

For homeopathic casetaking, the following symptom is relevant:

•Writing: worse (is difficult, cramped, tiring). Formulations such as clumsiness or liable to fall easily / frequently have proved to be unreliable and are therefore a potential source of error in identifying the remedy.

Hearing

RELEVANT AUDITIVE SYMPTOMS:TALKING: WORSESYMPTOM OF LIMITEDRELIABILITY: NOISE: WORSE

Disturbances of the auditory system are expressed especially as difficulties in the acquisition of speech. The patient has difficulty synthesizing what is heard and responding appropriately. These children not infrequently have oversensitive hearing and react negatively to noise from other people (but not to noise they themselves create; they can behave in a very loud way). Diminished hearing ability (that is, simply being hard of hearing) must be distinguished from disturbances of the organ of perception and from simple disturbances in attention (“not listening”).

For homeopathic casetaking, the following symptoms are relevant:

• The symptom talking: worse can be used for speech disturbance such as stammering.

•Noise: worse is a symptom of reduced reliability only to be used in oligosymptomatic cases

Vestibular System – Balance

VESTIBULARY SYMPTOM OF LIMITED RELIABILITY: TRAVELING IN CAR: WORSE

Vestibular disturbances of perception lead to problems of balance. Babies start to scream in panic when tested for the Landau reflex (the child is held horizontally in the air in the prone position). Older children tend to became nauseous when travelling by car or rocking. Walking along a line or on a beam causes great difficulty. Occasionally there is a strong need for vestibulary stimulation, such as children who always want to be rocked.

• The only vestibulary symptom we find in the repertory is traveling in car: worse. It is a symptom of reduced reliability, only to be used in oligosymptomatic cases.

Smell

OLFACTORY SYMPTOM OF LIMITED RELIABILITY: SMELL: HYPERSENSITIVE

Some ADHD/ADD children react oversensitively to smells and are easily irritated. Sometimes the affected child has the habit of smelling everything they encounter first – in other words, they like to perceive things initially via the sense of smell. The opposite, a diminished sense of smell, is also found.

• For homeopathic casetaking, the symptom smell: hypersensitive is relevant, but it has only a reduced reliability.

Taste

GUSTATORY SYMPTOM OF LIMITED RELIABILITY: SENSE OF TASTE: REDUCED

An exaggerated sense of taste may be expressed by the patient perceiving that the food is too strongly flavoured or too salty, although most people find it acceptable. On the other hand, a reduced sense of taste causes the patient to add excessive amounts of flavouring and salt to the food.

• For homeopathic casetaking, the symptom sense of taste: reduced is relevant, but it has also a reduced reliability.

Processing Disturbances

RELEVANT PROCESSING SYMPTOM:UNDERSTANDING DIFFICULT LIMITED RELIABILITY: MEMORY WEAK

Processing disturbances can affect the filtering of sensory impressions, for example when too much information is absorbed or rejected, or they can affect structuring of sensory impressions, whereby the information offered cannot be categorised and dealt with by the appropriate area of the brain.

• For homeopathic casetaking, the symptom understanding difficult is relevant, while memory weak is only of limited reliability.

•Distraction is an unspecific symptom that contributes little to the differentiation of remedies.

• The frequently encountered phenomenon of increased tiredness, mental effort: worse, is unreliable and should not be used.

Motor Function

RELEVANT MOTOR SYMPTOMS:WRITING: WORSE, MUSCLES: FLABBY AND MUSCLES: TENSE

Due to the disturbed tactile, proprioceptive and vestibular perception and the anomalies in tone (muscle tone is too low or too high), there is often impairment in fine motor function (application of strength, dexterity of fingers, writing), gross motor function (clumsiness, frequent falls) and balance (falls, exaggerated fear of heights, which the child is in reality perfectly able to cope with).

• For homeopathic casetaking, writing: worse is a relevant symptom.

•Muscles: flabby and muscles: tense can only be used with care and should be assessed by the doctor since the parents often have trouble making an objective assessment.

• As already mentioned, clumsiness or liable to fall frequently are a source of error and should not be used.

1.5.3 SECONDARY PSYCHOLOGICAL SYMPTOMS

Constant criticism by those in contact with the child, poor school marks, and punishment at home and school frequently lead to a feeling of poor self-worth, which can in turn cause depression, refusal to go to school and other psychological reactions, even going so far as suicidal thoughts. In older children, these symptoms are frequently the most prominent and are what prompts them to seek help. It is extremely important that – despite this “chief cause of suffering” – the underlying disturbances of perception are not overlooked. Successful treatment of the primary symptoms generally leads to significant improvement in the secondary symptoms.

1.6 FREQUENCY OF ILLNESS

New studies of prevalence (Table 1), as well as earlier work, show that the frequency of illness differs greatly from country to country as well as, for example, inside the USA. These differences are partly caused by differing judgement criteria and partly by genuine ethnic differences. With high prevalence rates (16-18 %), borderline cases are included. According to our experience, these figures are realistic. In Switzerland, where we practise, we expect that about 5-6 % of children require treatment for ADHD/ADD if the DSM-IV criteria are strictly applied. Including the borderline cases, the figure in Switzerland rises to over 10 %. In most studies, boys are considerably more commonly affected than girls: in the Bern ADHD/ADD study, the ratio was 4:1. It is difficult to give a conclusive answer to the question of whether the observed steep increase in the number of ADHD/ADD cases since the 1990s is genuine or whether people are simply more aware of the issue. The increase is partly due to adult patients who require treatment. The fact is that societies in the West are becoming steadily more unsettled, which has the effect of lowering the threshold of tolerance for children who stand out.

Table 1: ADHD/ADD Prevalence, an Overview of the Literature

COUNTRY

AUTHOR

YEAR

PREVALENCE

Brazil

Vasconcelos et al.

2003

17.1 %

Columbia

Pineda et al.

2003

16.4 %

Thailand

Benjasuwantep et al.

2002

6.6 %

Venezuela

Montiel-Nava et al.

2002

7.2 %

USA

Barbaresi et al.

2002

7.4 - 16.0 %

USA

Rowland

2002

2.0 - 18.0 %

USA

Rowland

2001

12.0 %

Canada

Brownell

2001

1.5 %

USA

Brown

2001

4.0 - 12.0 %

USA

Scahill

2000

2.0 - 17.0 %

Brazil

Guardiola

2000

18.0 %

1.7 DIAGNOSIS

Before treatment commences, the patient should undergo thorough testing so that a precise diagnosis can be made and other causes excluded. The diagnosis of ADHD/ADD generally results from comprehensive psychosocial and medical casetaking and observation of the child in the consulting room.

The Conners’ Global Index20 (see Chapter 3.2) is a suitable screening test. This questionnaire is also very well suited to judge the child’s progress during homeopathic treatment. More comprehensive questionnaires are time-consuming and therefore of only limited use for paediatric screening and treatment follow-up.

The physical examination includes a clinical and neurological assessment, including sight and hearing.

Since a diagnosis of ADHD or ADD excludes other causes of illness, it is important to conduct neuropsychological tests, especially a determination of IQ, such as with the K-ABC21 or the HAWIK-III Test22, which also provide information about disturbances of perception. It is also desirable to conduct a battery of tests to check attention (for example, TAP)23, which provides additional possibilities for assessing progress.