Why ADHD misdiagnosed with other disorders? Homeopathic Treatment.

- Article by Dr Sunitha Devi Vannemreddy MD(Hom)

                                        drsunithavannemreddy@gmail.com

What is life? We always wanted a safe, secured and hassle free life. We want to work hard, earn enough money for our livelihood and extend our family with joy filled life. Offspring are the major asset for every parent. We will face each and every hurdle in our life to improve the future of our kids. Every mother and father feels proud to see their children development in right way. We want to learn about kid’s growth in mental, physical and emotional levels.

Sometimes things go in another direction. Our cute loving children will leave behind in education and we will watch different changes in the behaviour of children, and in schools complaints are increasing, teacher’s wants parents meeting in school to discuss about our children behaviour; which makes us feel tensed and insecure.  Some children face different behavioural, learning problems, which we don’t know what is going on in minds of our children. To enlighten parents I would like discuss one behavioural and learning problem called as “Attention Deficit Hyperactivity Disorder”

Attention Deficit Hyperactivity Disorder (ADHD):

ADHD is neuro behavioural disorder characterised by inattentiveness, distractibility, hyperactivity and impulsivity. There is significant problem in executive functions like, attention control and inhibitory control that causes hyperactivity, impulsivity and inattentiveness, which are not appropriate for their age.  Mostly symptoms will find at the age of six to twelve years and should be persists for more than six months to undergo for diagnosis.

But some people think that is it really a disease to be treated or simply a personality which is not acceptable to this modern, busy and high demand world. Some scientists come up with different theories, what triggers ADHD in brain to executive functions like, attention, emotion control and decision making is invariably affected.

The prevalence of ADHD in India, among primary school children was found to be 11.32%. Prevalence was found to be higher among the males (66.7%) as compared to that of females (33.3%). The prevalence among lower socio-economic group was found to be 16.33% and that among middle socio-economic group was 6.84%. The prevalence was highest in the age group 9 and 10 years.

Signs and symptoms:

ADHD, also known as attention deficit disorder (ADD) or hyperkinetic disorder. ADHD was described by Hippocrates. The name Attention Deficit Disorder (ADD) was first introduced in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. In 1994 the definition was altered to include three groups within ADHD:

1)      The predominantly hyperactive-impulsive type

2)      The predominantly inattentive type

3)      The combined type

ADHD symptoms may start from childhood but it may continue in adolescence and older people but the presentation will be more towards the “restlessness”.

The predominantly hyperactive-impulsive type:

Most of the symptoms are associated with hyperactive and impulsive and very few symptoms belong to inattentiveness.

fidgeting or squirming, restless

difficulty remaining seated

excessive running or climbing, touching and playing everything which comes in their way

difficulty playing quietly

always seeming to be "on the go"

excessive talking or talks nonstop or talks abruptly

blurting out answers before hearing the full question

difficulty waiting for a turn or in line

Problem with interrupting or intruding on others, grabs the things from others.

The predominantly inattentive type:

Most of the symptoms are associated with inattentiveness and lesser or fewer symptoms are with hyperactivity and impulsiveness. Children with this subtype don’t get along with other children, they sit quietly but doesn't pay attention to what they are doing. Therefore, child may be may overlooked and difficult to diagnose that they ADHD child for teacher or parent.

Trouble paying attention to details or a tendency to make careless errors in schoolwork or      other activities, forgets to do homework, and often looses the things needed.

difficulty staying focused on tasks or play activities

apparent listening problems

difficulty following instructions

problems with organization

avoidance or dislike of tasks that require mental effort

tendency to lose things like toys, notebooks, or homework

Distractibility, miss the details, forgets the things, frequently switch from one activity to another. Distracted from irrelevant sights and sounds.

forgetfulness in daily activities

Difficulty in processing the problem accurately compared to other children.

Day dream, become easily confused.

Easily get bored, but if it enjoyable for him shows lot of attention, completes it accurately without the help of others.

The combined type:

Both hyperactivity- impulsiveness and inattentiveness seen in this type. Most of the ADHD cases are combined type only.

ADHD in adults:

The hyperactivity tends to go away with the age and turn into “inner restlessness” in teens and adults with ADHD.

Be very impatient

Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences

Have difficulty waiting for things they want or waiting their turns in games

Often interrupt conversations or others' activities

People with ADHD have difficulty in social skills like, social communication, interaction and forming and maintaining friends. People with ADHD have attention deficits which cause difficulty processing verbal and nonverbal language which can negatively affect social interaction. They also may drift off during conversations, and miss social cues. Therefore, most of them are rejected by peers.

Difficulty to maintain anger is more common with ADHD, which in turn make them more rejected by others. People with these tendencies are addicted to smoking, drinking or substance abuse. People with ADHD may also develop mood disorders and obsessive-compulsive disorders.

Disorders associated with ADHD:

Most of the ADHD cases associated with hypokalemic sensory overstimulation in 50% of children. Hypokalemic sensor overstimulation is a form of attention deficit disorder in which the sensory stimulation goes away abruptly after taking potassium supplements. The sensory overestimation triggered by large carbohydrate meals, sodium chloride intake and period following exercise. 

ADHD also accompanied by mood disorders, bipolar disorder, major depressive disorder. Anxiety is also one of the factors associated with ADHD.

Conduct disorder and oppositional defiant disorder occurs with ADHD in 50% cases which expresses as antisocial personality in adult ADHD cases.

Learning disabilities and primary disorder of vigilance, it is characterised by poor attention and concentration; as well as difficulties in swaying away.

Obsessive compulsion also co occur with ADHD and restless leg syndrome is commonly associated with ADHD.

In adolescents and adults, substance abuse is commonly associated with ADHD.

Along with these conditions, difficulty in sleep, persistent bed wetting, language delay, developmental coordination disorders are commonly associated with ADHD cases.

Causes for ADHD:

Exact cause for ADHD is unknown. But certain things play a role like during pregnancy, if mother smoke or drink alcohol may have higher risk of having ADHD child. Children born with low birth weight, premature birth or whose mother had difficult pregnancies have higher risk for ADHD.

Children with head injuries to the frontal lobe of brain or areas which controls impulses and emotions become ADHD. During pregnancy mother exposed to lead, PCB’s or pesticides also may causes ADHD in children. Researchers believe that, some toxins may interfere with brain development, could lead to hyperactivity, rash behaviour and trouble paying attention. 

ADHD runs in families. Parents with ADHD have children with the disorder in 50-75% cases. If older sibling with ADHD, then younger one may be in 30% cases born with ADHD.

Studies shows that brain chemical called as neurotransmitters don’t work same in children and adults with ADHD. There also tend to be differences in the nerve pathway works. Brain chemical Dopamine also plays a role. It carries signals between nerves in brain and is linked to movement, sleep, mood, attention and learning. 

Diagnosis of ADHD:

There is no single test involved to diagnose ADHD in children and adults. ADHD diagnosed after person shows some or most of the symptoms of ADHD in regular basis for more than six months. Depending on the number and type of the symptoms, person will be diagnosed with one of the subtypes of ADHD.

Paediatrician or child psychologists, can diagnose ADHD with the help of standard guidelines from American academy of paediatrics or the American psychiatric associations’ diagnostic and statistical manual (DSM). The diagnosis involves gathering information from several sources including schools, care takers and parents. Child behaviour will be compared with other children of same age and standardized rating scales.

To diagnose ADHD, child will receive full physical examination including vision and hearing tests. Neuropsychiatric EEG based assessment aid (NEBA) system, non-invasive scan that measures theta and beta brain waves. The theta/beta ratio shown to be higher in children and adults with ADHD.

Paediatrician also screens the complete medical history for other conditions that may affect child’s behaviour. Certain conditions that could mimic ADHD or cause the ADHD like behaviours are,

1)      Recent major life changes like (death in family, recent migration from one place to another)

2)      Undetected seizures

3)      Thyroid problems

4)      Sleep problems

5)      Anxiety

6)      Depression

7)      Lead toxicity

Diagnosing ADHD in adults:

It is not easy to diagnose adult with ADHD, unless it is diagnosed in their children. Other times they seek professional help for problems like depression, anxiety, then it might diagnosed as ADHD.

Symptoms like, chronic lateness, forgetfulness, anxiety, poor organizational skills, low self esteem, employment problems, short temper, difficulty in finishing a task, unthinking and immediate response; difficulty controlling behaviour and restlessness can be noted in adult ADHD.

In order to be diagnosed with ADHD, an adult must have persistent, current symptoms that date to childhood. For accurate diagnosis,

1)      A history of adult’s behaviour in childhood

2)      An interview with the adult’s life partner, parents, closes friends or other close associates.

3)      A thorough physical examination that may include neurological testing.

4)      Psychological testing. 

Diagnostic scales for ADHD:

Standard diagnostic scale for ADHD is “VANDERBILT ADHD Diagnostic Parent Rating Scale”.

Each rating should be considered in the context of what appropriate for the age of the child.

Frequency code: never=0; occasionally=1; often=2; very often=3.

Sr No	condition
1	Doesn’t pay attention to details or mistakes, careless mistakes, such as home work
2	Doesn’t seem to listen when spoken to directly
3	Doesn’t follow through on instructions and fail to finish school work.
4	Has difficulty sustaining attention to tasks or activities
5	Has difficulty organising tasks or activities
6	Avoids, dislikes or reluctant to engage in tasks that requires sustained mental effort
7	Loses things necessary for tasks or activities
8	Is easily distracted by external stimuli
9	Is forgetful in daily activities
10	Fidgets with hands or feet, squirms in seat
11	Leaves seat when remaining in seat expected.
12	Runs about or climbs excessively in situations when remains seated is expected
13	Has difficulty playing or engaging in leisure activities quietly
14	Is “on the go” or often acts as if “driven by motor”
15	Talks too much
16	Blurts out answers before questions have been completed
17	Has difficulty waiting his or her turn
18	Interrupts or intrudes on others
19	Argues with adults
20	Loses temper
21	Actively defies or refuses to comply with adult’s requests or rules
22	Deliberately annoys people
23	Blames other for his or her mistakes or misbehaviour
24	Is touchy or easily annoyed by others
25	Is angry or resentful
26	Is spiteful or vindictive
27	Bullies, threatens  or intimidate others
28	Initiate physical fights
29	Lies to obtain goods for favours or to avoid obligations
30	Is truant from school without permission
31	Is physically cruel to people
32	Has stolen items of nontrivial value
33	Deliberately destroys others property
34	Has used weapon that causes severe harm
35	Is physically cruel to animals.
36	Has deliberately sets fire to cause damage
37	Has broken into someone else’s house or business
38	Has stayed out at night without permission
39	As runaway from home overnight
40	Has forced someone into sexual activity
41	Is fearful, anxious, worried
42	Is afraid to try new things for fear of making mistakes
43	Feels worthless or inferior
44	Blames self for problems, feels guilty
45	Feels lonely, unwanted, unloved(complaints that no one loves him or her)
46	Is sad, unhappy or depressed
47	Is self conscious or easily embarrassed
total	score

 Academic performance:

Sr no	performance	Problematic	Average	Above average
1	Reading
2	Mathematics
3	Written expression

Class room behaviour:

Sr No	Behaviour	Problematic	Average	Above average
1	Relations with peers
2	Following directions/rules
3	Disrupting class
4	Assignment completion
5	Organisational skills

Basing on this widely elaborative scale, we can find out what is the severity of condition and progression of condition during the treatment. 

Why ADHD most often misdiagnosed:

Most of the children are often readily diagnosed with ADHD due to sleep troubles, careless mistakes, fidgeting or forgetfulness. However some of the conditions are often misdiagnosed as ADHD as it mirrors some of the symptoms.

Some of the conditions mistakenly diagnosed as ADHD are, bipolar disorder, mood disorders, some of behavioural problems, Autism, low blood sugar levels, sensory process disorders, sleep disorders, hearing  problems.

Bipolar disorders are tends to develop later after age 18, when ADHD develops early after 6 yrs age. ADHD is chronic problem, while bipolar is episodic and remain dormant for periods between outbursts. ADHD children are tends to be unnerved by overstimulation, while bipolar children are typically respond to disciplinary action and conflicts with authority figures. Depression, irritation and memory loss is commonly associated with bipolar disorder but ADHD children do not experience despair as a symptom.

Moods with someone with ADHD approach suddenly and can dissipate quickly, but in bipolar it will goes longer for hours and days. Lack of attention and easily distracted nature are common for ADHD where as in bipolar mood disorders it is a pathological condition.

Children with Autism spectrum disorders are often overexcited by stimulating environments and may struggle with social interactions. The behaviour of autistic children may mimic the hyperactivity and social developmental issues common in ADHD.

Something as benign as low blood sugar levels also mimics the symptoms of ADHD. Children with low blood sugar levels or hypoglycaemia show aggression, hyperactivity, inability to sit still and inability to concentrate.

Sensory processing disorder can produce symptoms similar to ADHD like, under or over sensitive to touch, movement, body position, sound, taste, smell and may be accident prone or have difficulty in paying attention, especially if they feel overwhelmed.

Children with ADHD, tend to difficulty in calming down and falling asleep. However, some sleep disorders shows some symptoms of ADHD because of lack of sleep. Lack of sleep causes difficulty in concentrating, communicating and following instructions and creates decrease in short term memory.

It may be difficult to diagnose hearing problems in young children who do not know how to fully express themselves. Children with hearing problem have hard time to pay attention because of inability to hear properly. Missing details and underdeveloped communication and difficulty in social situations mimics as lack of focus and concentration often mistaken as ADHD symptoms.

However kids are kids after all. They are easily get distracted, bored and doesn’t want to concentrate if they are not interested in the particular activity. Even though they are normal, sometimes teachers and parents compares with peers and mistaken as ADHD children. But every child is unique in their activities, interests and behaviour and they may be low or high in the behaviour compared to other peers which often mistaken as ADHD symptoms. 

Treatment for ADHD:

Treatment of ADHD is aimed to reduce the symptoms of disorder and improving the functioning. Treatment includes medication, psychotherapy, education and training or a combination of both medication and psychotherapy.

Medications include counterintuitive to treat hyperactivity with stimulants which activates brain circuits to support attention and focussed behaviour. But long term usage of these stimulants leads to various side effects like, loss of appetite and insomnia.

Behaviour therapy main aim to improve their behaviour and it involves practical assistance, such as help to organise the tasks and completing the homework like that. Behavioural therapy also teaches the child how to monitor his or her behaviour. Therapist can teach the children social skills, such as how to wait for their turn, share toy, ask for help or respond to teasing. Learning to read facial expression and tone of the voice in others, and how to respond appropriately.

Homeopathy and ADHD:

Homeopathy is scientific system of medicine which acts on the person as a whole not on the disease. Individualistic and constitutional treatment, enable to take complete history of the child including mother’s pregnancy history and take totality of the symptoms of the child in mental, emotional and physical plane. Basing on the symptom totality, correct homeopathic medication is drawn and treats the child. Homeopathy helps to reduce the symptoms of ADHD without any side effects and helps to improve their quality of life. Homeopathy definitely helps to cure the ADHD cases, unless we can treat the person with correct and appropriate medications. Side effects other system of medications also be treated with homeopathic medication.

Homeopathic remedies indicated in ADHD are, LACH, LYCO, RUTA, BELL, CHAM, THUJA, SULPH, OPIUM, SEPIA, STRAM, PHOS, CALC-C, RHUS TOX, NAT-M, CHIN, CARCINOSIUM, NUX-M, PLAT, MEDO, ARN, BAR-C, PULS, STAPH, ALUM, PHOS-AC.

RUBRICS which help in ADHD cases:

GENERAL-ENERGY EXCESS OF,

MIND- ABSENTMINDED

MIND- ABSORBED

MIND- ANSWERING, hastily

MIND- BROODING

MIND- CLIMBING, desire to

MIND- CONCENTRATION, difficult.

MIND- CONFUSION OF MIND

MIND- FORGETFUL

MIND- GESTURES makes

MIND- IMPATIENCE

MIND- LOQUACITY

MIND- MISTAKES, making calculating

MIND- MISTAKES, Differentiating objects

MIND- MISTAKES, Making reading

MIND- MISTAKES, Making writing, omitting

MIND- QUESTIONS, speaks continually in answer, without waiting for,

MIND- RESTLESSNESS

MIND- RUNNING, desire for,

MIND- SENSITIVE, external impressions to all

Indicated remedies for ADHD:

BARYTA CARB: dwarfish mentally and physically. Inattentive and lack of concentration in class. Constant need of physical as well as emotional support. Weakness of memory seems to forget everything and doesn’t like change, shy and pick or bites his nails to show his shyness. Delay in achieving motor skills, clumsy. Prone to recurrent infections, great sensitive to cold weather. Absent minded, absorbed, aversion to play and always clings to mother.  Frightened easily. Laughing immoderately.

CALC CARB: indicated for sluggish children, slow at school, slow at games, clumsy in action. Sluggishness in their attitude, also feels happy constipated. Slow in speech, frequently reflects long before answering. Habit of constantly putting fingers in mouth. Frightened easily at trifles. Weak in geometry, makes mistakes in simple calculations. Biting nails. Can not bear to be looked at. Head sweats profusely while sleeping. Difficult and delayed dentition.

CAPSICUM: ailments from change of residence, school. Extreme  sensitive ad touchy children. Sluggish, placid and lazy, due to which the child hates any form of physical exercise. Strong fear of reproach.  Children who feel unloved and uncared. Child hates anything unexpected than the daily routine. Tendency to catch cold easily.

CHAMOMILLA: excessive temper tantrums and conduct disorders in children of mother who abused to drugs, coffee or tobacco. Irritability and peevish. Cannot bear to be touched. Restless, move from person to person, fidgety, extremely dissatisfied. They want to be carried and petted. The child cannot enjoy music, sensitive to music. Child tends to put fingers in mouth all the time. Capricious appetite and marked thirst.

CINA: cross, irritable, ill humoured, cannot bear anything coming near, does not want to be touched. Desires many things but rejects when offered. Temper tantrums and attention seeking behaviour. Restless, cannot lie for five minutes, moves constantly. Cannot sits in one place. Cannot resist touching anything on table. Not pleased or satisfied with anything. Mischievous. Biting nails. Behavioural problems in children. Constant desire to pick his nose until it bleeds.

HELLEBORUS: indicated for those who feel stupid, that they cannot cope with life challenges. They are sluggish, dull, unresponsive. Have difficulty in memorising and articulating thoughts. They have tendency to despair, strong aversion to making any effort, yet are easily angered.

LACHESIS: indicated for those loquacious, agitated, hyperactive and restless. Moody with emotions. Conduct disorders characterised by violent anger, biting, jealousy and rudeness. Always loves to interfere in others conversations. Children who are born with feelings of hostility towards world, their mothers also have similar feelings during pregnancy. Complaints worst after or during sleep. Left sided complaints.

LYCOPODIUM: aversion to company, playing outdoors, prefers to be in safe secure zones. Causeless crying. Lazy children, tendency to procrastinate any work or duty given to him or her. Terrible hand writing, weak in mathematics, especially in calculations. Helpful in dyslexic children, who makes mistakes in reading, speaking and writing the words. Restless, stamping their feet when sitting. Tendency to bite or put everything in mouth.

However, these are some indicated remedies but the careful observation, complete case history and reportorisation will give a constitutional remedy indicated for child is the correct medication to help in treating the ADHD children.