A Case of ADHD

​This young 10 year girl was first diagnosed with ADHD and received medicine in 2008. At first they gave her Ritalin, then Motiron, then Concerta, but none of the drugs worked very well. After the Concerta she became very quiet and introverted and now for a year she has been on 25 mg Strattera.
She came off the Concerta in the autumn of 2011. Before she came off it she had no facial expression, no happiness or sorrow. When she came off it she slept 13/14 hours a day and she would not go to school. She only receives the medicine in order to be able to concentrate. When she started on the medicine she lost weight and lost her appetite. She was on a protein drink for a year. On Concerta and the other 2 types of medicine she had diarrhea and headache. She does not get that on Strattera.

Before the medicine she was unable to concentrate or sit down for long periods of time. She could not play games or become absorbed in anything. If S had a friend over, she might suddenly lash out at her friend or hit her in her head with a doll. (Here the girl becomes very uncomfortable and does not want her mum to elaborate on it, and says that she herself cannot remember such episodes.)
 We used to find it very difficult to get her to calm down and we spent ages to try to get her to fall asleep in the evenings.
(The mother never thought she would get pregnant.  Suddenly pregnant at 41. Very emotional during the pregnancy and had a lot of mood swings. The mother is not aware of family history of diseases. I asked if either she or her husband have had any venereal diseases. She has not, but was unaware if husband has had any and not comfortable about asking.)
Bronchial asthma at 18 months. She received medicine for that. The asthma stopped again when she started kinder garden at the age of 3. Sometimes S is very provocative and enjoys provoking her mother so that the mother becomes angry and upset.
Food poisoning on a few occasions.  Was admitted to hospital in 2006 or 2007 with what they then found to be Yersinia.
Great problem getting her to sleep.
Taking a lot of trouble regarding her looks. If she looks good the other kids cannot tease her.
She never undertakes anything before she is able to do it properly.
S wakes up with a headache that is worse on eating breakfast. She cannot describe the pain. (She has recently received braces for her teeth from her dentist. She has to wear them at night and they are increasingly tightened and the headaches have started since the onset of using the braces.)
S cannot listen to anybody who talks for a long period of time. She finds it very difficult in the classroom if the teacher has to explain anything in detail. She has to fiddle with something in her hands.
Troubled or restless when about to relax.
Very disturbed if she has to plan anything when about to sleep. If she is looking forward to a birthday party the next day for instance, then she cannot settle. She needs a lot of time to prepare herself for an engagement. She can become frustrated, sad and angry if she is actually looking forward to something.
Anticipatory anxiety. Expectations. A lot of expectations of herself.  She has to fulfill other’s expectations of her.
 
Repertorization
Mind, concentration difficult
Mind, concentration difficult- children in
Mind, spoken to; being-aversion
Mind, restlessness – children in
Mind, restlessness – sleep before
Mind, ailments from – anticipation
Mind, anxiety – anticipation; from – engagement; an
Mind, striking – children in
Generals, food and drinks – warm food – desire
Generals – heat- lack of vital heat
 
 
START
The remedies that came up on repertorization were : gelsemium, argentum-nitricum and medorrhinum.
According to Kent (1988, p728) medorrhinum has a “fear of sensation,” and a “great difficulty stating her symptoms.”
Med also has a “changeable state of mind- one moment sad the next mirthful” (ibid).
Medorrhinum has of course the fear of the dark, but as importantly according to Kent (1988, p.229) they also have “nausea after eating,” and “agonizing pains in the stomach.”  Kent elaborates that “Children of a sycotic father are especially subject to attacks of vomiting, diarrhea and emaciation” and they look pale (ibid). Furthermore in medorrhinum there is a tendency to asthma in children of sycotic parents.
Prescription: Med 1m evening and med 30c the following morning was prescribed and sent by post on 5.11.12
 
Follow up 30.11. 2012
Much more lively. She has laughed a lot more.
Had a headache.  Massive headache 8 days after taking the remedy. It was an old familiar headache and it lasted for 4 days.
No change in appetite. Still prefers warm food and white bread. Has also eaten a lot of soft boiled eggs and rye bread.
During the last months she was invited to two birthdays and she was not restless or anxious beforehand.
Diarrhoea just after taking the remedy. It squirted out in the night.
Perscription:  She is still improving so no prescription is necessary.
 
Follow up 23.2.2013
I am fine.  Sleep is fine. She does not have to take anything to sleep anymore. In some ways it seems like she is more rested in less time. Still less mood swings. She is much more stable in herself.  She still needs us to be in the room with her when going to sleep during school days. Falls asleep at 22.30. Sleeps until 8 in the morning.
The last month it has become difficult for me to concentrate. It was better.  But not so worried about things anymore. And I do not want to be special in this way anymore. It does not matter anymore.
She can accept a “no” from her mother now.
Still prefers warm food. Appetite is good, but very difficult to find something I like. Has become better at remembering practical stuff.
Prescription:  Med 1m evening and med 30c the following morning.
 
Follow up 5.4.2013
Stomach ache on Saturday. She has a very sensitive stomach. Perhaps she swallowed too much water in the swimming pool. Nausea in the morning. Ice cold hands and feet. Became sad. Forehead warm to the touch. Wanted a hot water bottle on the stomach and on her feet. Very chilly in her body.
I have not suffered from headaches.  I have been able to recall things I had not been able to remember before. This has been a very nice experience and I have decided that I want to come off the medicine. We have discussed it with the psychiatrist and I have stopped the medicine today.  I sleep well now and I am happier. My appetite was a bit better before I got ill.  My balance is not so good. When I cycle I can only indicate with my right hand not with my left hand.
I am not tired during the day anymore. I am not angry. The happy girl has appeared in me. No mood swings.  I still have a problem with time. Time is my enemy. But despite of that my restlessness is better.  More outspoken. I am secure sitting here talking to you. Not so stressed and the tension in my neck has gone. Things are going reasonably well at school. Concentration is increased.
The majority of evenings she falls asleep on her own now. Mum or dad sits with her approximately once or twice a week now.
Prescription: As she is still improving so no prescription is necessary, but watching symptoms closely as the conventional drugs stop working. Medorrhinum to give in case of a relapse.
 
Follow up 3.5.13
Going well.  My stomach is better. No diarrhea. A little nausea, but just on eating breakfast now. I feel more now. I can be very happy, but also sad now. But generally more happy.
She is more aware when the restlessness appears now. When it comes she goes into the garden and jumps on the trampoline. That makes her feel better. We have been to a parental meeting and the teachers say she is doing better. She is engaged in the classes now. She has, however, become a bit more teasing. This was how she used to be before the medication. Beforehand it was worse though. The teachers said if it did not get worse than this, then they would be able to cope with it. The teachers were surprised that she can suddenly sit quietly, absorbed in solving difficult equations.
One day last week she played with Lego for 4 hours nonstop with her dad. That has never happened before. The last couple of weeks S has been able to concentrate for more than an hour on several occasions. It is easier for S to get out of the house in the morning and go to school. Suddenly, wants to cycle to school by herself.  Sleeps now every evening on her own.  Appetite a lot better. Has put on 4.5 kilos
Prescription: : She is still improving so no prescription is necessary.
 
Conclusion
The case is still ongoing, but from being on medication, and despite of that, not being able to concentrate, having a lot of anxiety, and not thriving, S is gradually growing up and becoming able to live her life, sensing both herself and life around her as well as becoming aware of her own needs and limitations. While this is happening her concentration and sleep are improving.
 
Reference: https://hpathy.com/clinical-cases/case-adhd/
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