 04.26.2008 |
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Aspergers Syndrome Recovery With Homeopathy Case Note: The patient was referred by Norman (A local physician who I tutor in homeopathy.) Apparently the parents had been trying many things, mostly homeopathy since the boy was 4 years old. They had given up since they had seen no changes in the boy. Norman kept encouraging them to come. After one year, they finally agreed and made an appointment. he parents brought the boy in to the waiting room. I introduced myself and explained that I’d prefer to see Thomas by himself initially. Then after a time, I’d excuse Thomas to the waiting room while inviting the parents in. I prefer to see how the child interacts by himself. In addition, this method sometimes encourages patient to speak more freely. The downside is that I don’t get to see how the family interacts together as much. In this case, after introducing myself and inviting Thomas in, he began a tantrum in the waiting room. He refused to come in and began yelling and screaming at the parents. I then retreated into my office and allowed the parents to address it. After five minutes of screaming and insisting he’d not come in, he calmed down. Eventually he opened the door to my office and entered. He had a frown on his face initially. But eventually he opened up a little and was quite charming. He never actually interacted with me in a free way, but was reticent to offer much spontaneously – certainly not unusual for this type of case. Below is the edited transcript of the case, along with follow-ups CC: ASPERGERS SYNDROME S: Thomas:
I excuse the boy out to the waiting room and invite the parents in. I respectfully ask the boy to do a drawing for me, which he refuses. The parents comments are merged into one, with them both taking equal part in the interview. Parents Interview: What is important? He has incredible mood swings. All too often he is unhappy, sad, not joyful. Upset about things, gets upset really fast about small things. Spends too much time being miserable. Absolutely refusing to cheer up. He is also defying authority incredibly. Incredibly hard headed, he closes off into this anger defiance, unhappiness. Very unhappy in school. He just goes through the motions in school. Teacher wrote in he is just making the motions. All seems to be burdens, he doesn’t enjoy most of his day. It basically seems like prison for him, sits there and waits for the day to be over. In the previous school, lots of disciplinary problems. Belligerent, talking back, trouble, etc. New school, has much more guidelines, and he does much better with them. At the same time he has those incredible highs, happy as a clam. Especially with friends, but whenever something happens, the smallest thing, he swings back into this anger. It might be connected with the season, last summer doing very well. He was very anxious around his birthday , doesn’t like being on the spot. Overwhelmed by too many people. He gets anxious about birthdays. He can complicate things for himself, sees the problems of things, rather then the joys of them. Before birthday, was worried about all the presents. He makes a mountain out of a mole hill. Wants to make himself unhappy, to find things he doesn’t like and blow up. Seeing the glass very empty. It can change 5 times during a day, no pattern to it. Not wanting to go to school is the clearest. It is all over the place, one never knows. You need to read him somehow, constantly. We don’t know what to expect. You wake him up in the morning and he may scream or smile. He can say I don’t’ want to wake up, or will want to cuddle. If you say it is cold, he should have a coat, he blows up, and doesn’t want to go to school. There is a little thing that blows him up. Somehow a small thing triggers this reaction. It can be the toast that is too dark. Almost like looking for or waiting for things that will make him upset. More? He comes from school, says boring horrible, then he will get excited. There is a strange dichotomy, he says it was horrible, then goes on to recount something he is proud of. It seems there are events in school, that he is proud of, having interest in. The other night he started to dance. He doesn’t like dance at school, but he danced really well at home to this renaissance music. He is an outside child, loves to play outside. He runs around with his friends and they have a fabulous time. But during school, hates recess, no one that he can connect with, they all play sports. He can’t relate to that. Doesn’t like basketball or football. He wants to play imaginary games or physical games, but not sports. It is hard to fathom, but he has a desire to be happy and have a good time, but at the same time something that doesn’t want him to do that in specific situations. I remember bringing him to school, and he was complaining, etc. Then his face brightened and he remembered an activity about school. Then he is happy to go, and as he leaves you tell him to take a jacket, or something insignificant. Then everything is overshadowed and forgotten, he is miserable. That tiny little thing is ruining his entire life, that thing he doesn’t want to do, It is strange. Strange? This willingness to cloud one’s joy with those things. This desire to find something that will make him unhappy. But it is also his explosions, he is a volcano. Explode? Screaming, sometimes throws things on the floor. He can lash out. He insults us, calls us names, stupid, etc. The tantrums are so strong, like a tornado, like a volcano. Often I can’t keep my calm. More? A friend was nagging him about a toy, and he pushed this other kid, he sent him flying through the air, the boy landed on his face. He will hit children, and sometimes even with sticks. His brother Frederic is very big. Yet he said he is afraid of Thomas, he doesn’t know what he’ll do next. Thomas has bitten Frederic. Frederic will tease him, and he will fly into a rage and bites him, or takes a shovel and tries to hit him with the shovel. At times it is very aggressive. But, last summer taking care of a 2 year old in the summer. He loved her, he had a nice time with her. Cared about her, a fabulous relationship for the whole summer. He happily did whatever they told him to do with their child. Now doesn’t seem to enjoy playing with her. Harming himself in any way? No, but he threatened that he wants to commit suicide, that life is not good. More? He was in a darkened closet, and said I want to commit suicide, don’t want to live, I don’t’ like life. Another thing, he will explode if something is not going the way he wants it to. This kind of “I’m no good”, “I’m a failure.” Then the other extreme, where he can sit down for 3 hours, wants to build something, imagine something and he does it. He does it exactly right. Without being distracted, extremely focused! It happens very seldom, can be so focused. Coming up with amazing designs and solutions, quite remarkable. He is becoming a little Da Vinci. Imagining how things can work, this is way of playing. With his friends, they can spend 7 hours in the garage and make an electric airplane with a motor. A couple of days ago, he initiated these new ideas. He is often the leader, even though his friends or 4 or 5 years older. There are lots of kids that really like him, want to be around him. Except at school, he is a different kid there. He was playing a part in a Xmas play. He’d do things wrong, or be wooden, he’d go against others. He couldn’t’ do it, yet two days ago, at night he was dancing to music quite remarkably. It came out of him, no pressure to do it, he wasn’t on the spot, it was a type of play. So again this type of dichotomy. When that little window opens and he can let himself go, it is beautiful. He also has many other sides, one very peculiar. He goes to the bathroom, the favorite one upstairs. Then no one is allowed to be on that entire floor - he screams at everybody. He needs to be alone by himself to go to the bathroom. Or today he was hearing Hotter Potter, and I couldn’t’ be checking my emails in the same room.. Like he has to create this world for himself. He talks to himself when playing, and doesn’t want anyone around when he is playing, go away he shouts. Like with the LEGOS, like creating those worlds for himself. It is a roller coaster, in cycles. More? If something happens to me, or I get hurt. He suffers the pain, he is crushed, lots of empathy. He tends to feel the pain more then I do. But he also has a pretty high resistance to pain, things don’t hurt him. Example? He was hurt yesterday, and it didn’t bother him. Or he’ll challenge his brother to give him torture, come and torture me. (demonstrates giving “Indian rug burn”) He says to his brother - do it more,more, see, it doesn’t hurt. He will also be late for the dinner, doesn’t want the food, or will leave early. He just doesn’t want to eat it. Almost every evening there is a huge thing about the dinner. Another odd thing. Whenever he is around something that is electronic, he acts weirdly, film, game boy, electronic device, he reacts weird. Weird? He gets totally hooked on it, but not .. almost as if somewhat magnetized by it, obsessive quality about it. If watches a movie, it is a little scary, he gets red cheeks, He gets so involved in it. He gets very fidgety, pillows are all over, always moved. Oh that is the other thing, he moves, always moves. He can’t sit still ever. He also always wants physical contact. Climbs on you, always always. The other human’s body is a playground. It is endearing, but when he steps on your body, it can be hurtful. He is unable to comply to your requests to be more respectful. TV? It takes time for him to come out of it. He seems to be somewhere else, can’t switch it off and enter the normal world again. We pay when having him watch a movie, because we have an hour of quiet time, then afterwards he is strange. The movies, he comes out of them, like a limp rag. He is just staring vacantly, if you touch him lightly afterwards, it is like hitting him with a hammer. He is more irritable afterwards. He listens to those books on tapes. Not interested in TV or computer. But likes someone telling a story. But if reading a book to him, it is different. After the tapes, he can’t sleep, he is magnetized. Because not coming from a living human person, it is something electronic. If I read him the book, likes to listen, always wants one more chapter. There is an excitement about it, but not that weirdness, not that disquiet. A physical disquiet happens when the book is read from a tape. More about Bathroom reaction? It is going to stool, he announces it. He’ll go and lock the door, he’ll stay for ½ an hour. He used to have to be stark naked to go to the bathroom. Now he can do it dressed, but no one can be around. There has to be drama, always drama. This is a highly eccentric child, yet we feel those mood swings and depressions goes beyond quirkiness and idiosyncrasy. Physical Illnesses? He complained of lower back pain. The lower back muscle was very stiff. He couldn’t sit on the floor. He tends to slouch over. For several weeks, was really in pain. It was sitting on the floor that he complained of. Appetite? Eats a lot, up until 4 o’clock. Doesn’t like to eat in the evening. Likes sweets, fruits, salad, but doesn’t like hot meals. But loves salads and fruits and sandwiches. Salads? Yes, he really loves salads. Hot meals? Doesn’t like it, whereas he eats sandwiches with delight. He likes apples and banana’s, yogurt. Doesn’t really like meat, or fish or shrimp, they gross him out. But does like dairy, dairy products. Averse? Meat, sandwich meats, with the exception of Salami. He doesn’t like it because it is cooked, or because a formal dinner. But the idea of having to eat with so many people, he doesn’t like that either. Also dislikes cooked peppers. But likes them raw. He eats a lot up until the evening. He eats quite a bit, yet not chunky foods. Temperatures? He loves the warmth, conducts his business in front of the fire. He likes the warmth. Will sit on the heating vents. But when outside, never seems to be cold. Clothing? We try to dress him more, but he takes the jackets off. He says I want to be medium, He doesn’t want to stand out. Sensitive? Very sensitive to sound, it makes him upset, if too loud. Sounds? That distract him from falling asleep. If he hears just the faintest noise, can’t go to sleep. He is also very overwhelmed by having a lot of people there. He needs a specific light amount in the room, not too dark, but not too light. Touch? He loves touching people. But so wary of strangers, he wouldn’t like it if a stranger tried to touch him. Wouldn’t want anything to do strangers. Fears? When we said we are going to the desert, he said I’m not going, because of the scorpions there. Also complained to the teacher about the scorpions. He is a bit of a daredevil, likes swings. But not things outrageously dangerous, normal boy behavior. Sleep? He has nightmares, quite often, but he never talks about them. Once dreamed the house was flooded, and water everywhere. Then he could jump from the top of stairs and swim in my room. I can hear him , he talks in his sleep. He wants me to stay in his bed until he falls asleep, also his cats, who he loves, always with him. He goes to sleep at 8, doesn’t want to wake on school days. On the weekends he gets up by himself. When it is an obligation, he doesn’t want to comply. Structure, or coercion, needing to do something superimposed from somewhere else, creates a problem. Most peculiar? Father: wants to make himself miserable. Mother: It is the intensity, miserable or happy. Either absolutely happy, or absolutely miserable. Alternating? Often anger alternating with mania. Or futility, or boredom. The switches can be very rapid. The intensity of this unhappiness is real. It is an intense change. When happier, he is very giving, open, light. One never knows which will happen. It is unpredictable. He doesn’t like extraordinary events. We rented out the basement to a foreigner, takes him a long time to open up. Doesn’t like anything out of the ordinary. He is a creature of habit. Maybe a fear of having to deal with strangers. He is afraid of joining a new group, other children’s group for instance. Being afraid to be with strangers. Nervous habits? Jerky motions with his feet, as he is falling asleep. He has sensitivity to tee shirts, socks, seams, tags, etc. Clothes have to feel just right, if clothes don’t feel right, has to put something else on. Takes him a long time to get dressed, for things to feel right. Doesn’t wear wool sweaters. Likes clothing loose Nervous habits? For a long long time, he was sucking his thumb while twirling his hair .Since very young, he’d twirl his hair, and then pull it. He had a bald spot on the back of his head. Even now at night, he will suck his thumb and he is twirling his hair. He couldn’t do it the other way around. Only does it at night. Anything about Thomas that is over the top -- extreme? He had a faze where he always pulled down his pants, obsessed with his genitals. Went on for a lot of time. Nothing he likes more then shocking people. Like Austin Powers, reciting lines out of Austin Powers. He likes penis and humping jokes. He really wallows in it. He used to take a bath with his brother, he used to pulled Frederic’s penis. Once he attacked an adult’s crotch. Grabbed him right in the crotch!. He was in preschool, pulling down his pants. He does play with his penis in the bathtub all the time. He had a faze where he was grabbing people between the legs. Now it is about shocking them with words. His mood is better in summer then the winter. I believe it is the light, better in the light days, not cloudy. I’m teaching him recorder right now, he is very fast, but frustrated. He is fabulous, draws and paints, if not perfect. Whenever he feels it is not perfect, gets very frustrated about it. He has a teeny lisp, certain words can’t pronounce. Had it more before. Puts his tongue at the wrong spot for certain sounds. Today was grumbling, then was laughing for a half minute, then upset again.
Alternating? Can go from extreme concentration to boredom. Extreme
happiness to boredom. When focused on some project, or Legos for 2 hours.
He comes up refreshed, his batteries are loaded, not as fidgety. He says he
needs to refuel. It is mental focus that then calms him down. This was coming to the end of the interview. I then asked the parents, how would we know that Thomas is getting better. What would be some benchmarks that would help us to assess whether or not homeopathy was really helping. I’ve found over time, that it can be difficult to make definitive assessments. Using a list of benchmarks has been very helpful for me to make better assessments. The list below is what they elaborated: Benchmarks:
A: After taking the case, I thought this could be an arachnid, specifically Androc. It looked like an arachnid to me because of the following themes in the case:
After a little research through Reference works and Macrep, Androctonus confirmed well. I don’t know how to differentiate between Buthus (our other scorpion) and Androctonus. But Androc has the love of salads, mood swings (Buthus too), sensitive to noise (as all arachnids), & dancing (arachnids). In addition, it was striking to me how the parents reiterated his fear of strangers. In addition, Androc has the rubrics:
These rubrics seem to suggest a defensive attitude, someone who needs to be on guard. This boy is quite defensive and perhaps his aversion to strangers is an expression of this. I also liked the rubric:
As it seems to reflect his rather dark moods. In addition, there are many alternating symptoms listed in the repertory as well as several other good confirmatory rubrics. The patient also singled out scorpions himself as well (and snakes, but the themes suggest an arachnid). I see this fairly often, that a patient will state the Rx, either by being averse, identifying with it, or dreaming of it. Of course, we can easily be mislead by these compelling images. Therefore we have to balance the archetypical images of the patient with good symptoms from provings, or clinical experience. So I thought Androc would be a good first prescription. P: 1. Androc 1M (Hahn) dry split dose, given in two separate envelopes. To be taken on clean palate approximately 12 hours apart (started 2/6/04) Friday, April 04, 2003 CC: ASPERGERS SYNDROME S: Thomas:
Mother: How is he? I don’t know, maybe a month ago, he had a phase of being nice, it was quite amazing. At first, we couldn’t believe how nice he was being. We thought, is this our child? But it is not so much different now. So now it is only a little bit better, not as bad as February when we brought him. School, he likes a little more, but because he has discovered a kids trading game. But not in general. He also said he doesn’t like the world. I then inquired about some of the benchmarks we’d made at the initial history: Benchmarks: 1 Angry explosions – minimum once per day, more often multiple explosions He had several good weeks, about a month ago, there was improvement – ~ 2 or 3 weeks worth. 2 He hates school – that is daily for years now. With the cards, talks more about friend, and looks forwards to going, and still complains that the teacher doesn’t care about his work. 3 Getting up every morning kicking and screaming about going to school – every morning. You know he actually gets up, not friendly, but getting up, and doing the carpool with neighbors, but now doing it, didn’t do it before. That is an improvement. 4 Very defiant, obstinate in general Same 5 Averse, intolerant of Strangers Once we had a stranger, and he seemed fine. But once he were going to have some friends over and had a huge scene. 6 Privacy around stool – no one can be on the second floor when he is using the bathroom. Will scream and yell. A little bit better, we don’t have to evacuate the floor now. 7 Restlessness, constant fidgetiness Still the same. 8 Always avoids dinner with family, either leaves after a bite, is late, or won’t come. Same, will not budge, something it seems that some foods he doesn’t like. 9 Temper tantrums from being a perfectionist That is actually gone, the frustration, I haven’t seen him that way, but it wasn’t so bad before homeopathy though. 10 Getting into fights often Same 11 Daily Alternating moods – rapid, intense mood swings – It is not so extreme, but overall not happy, more negative and almost pouty He has been able to get homework done lately. That is something he never would do before. That may be a change. You called a while back saying he was sick, tell me more? Maybe a week after the Rx. I gave him the spare dose you gave me. Then the fever and ear infection went away in one day. He commonly can bounce these things off, so hard to say whether the medicine helped or not. He is still depressed. Depression is the same? I think it is connected to these mood swings, when he really feels bad, it is a deep depression, but maybe not lasting as long. It seems the same, maybe not occurring as often, but still here. A change? Not sure. Does he seem to get violent without remorse? yes, when I catch him hitting his brother, he won’t apologize, or says I don’t care. Empathetic? Yeah, with little people, with me, father, or his cat. But not with Frederic, because then afraid his brother will hurt his feelings, or put him on the spot. Or that Frederic would embarrass him. How is he at connecting with people? With the family and friends, yes, but further then that, no. He says quite often, that he doesn’t like life, the world, wants to jump off the bridge, usually when he gets admonished. When someone tells him he shouldn’t have done this or that, he feels extremely bad about himself. If he has an idea of building something or playing something. or getting all his books together, does it on a whim. If his interests can’t be fulfilled, then it explodes into a huge drama. Does he complain much? Yes he is a complainer. A: I thought it a bit strange that the improvement petered, but it may be that the correct Rx is Buthus, or some other arachnid. It is hard to tell at this assessment, but I believed Androc was at least close, that his Rx was either Androc, or Buthus. So I gave him 10M dry in the office. That way I could make a more definitive assessment at the next follow-up. I thought if the next follow-up was not more encouraging, I’d consider shifting to Buthus. P: 1. Androc 10M (Helios) single dose dry in office 2. Call should there be any problems Thursday, June 05, 2003 CC: ASPERGERS SYNDROME S: What is happening? From when we first came until now, he is getting much better. But it is not so easy to tell why (the parents started him with a school counselor at roughly the same time as the beginning of homeopathic treatment – I was not told about this until this visit). 1 Angry explosions – minimum once per day, more often multiple explosions He just today got a rejection letter [for a program he wanted to get into] and he cried very hard. I actually gave him the Rx, and he was willing to come [to this appointment], it calmed him down. 2 He hates school – that is daily for years now. He is enjoying it a little bit, he connects more to others. He opens up a bit. 3 Getting up every morning kicking and screaming about going to school – every morning. That has been going quite well. In general, it has been fine for the last month, it is improved. 4 Very defiant, obstinate in general That has improved too. 5 Averse, intolerant of Strangers Haven’t had many strangers come so don’t know 6 Privacy around stool – no one can be on the second floor when he is using the bathroom. Will scream and yell. It is a little bit better, but still there 7 Restlessness, constant fidgetiness Maybe a little less 8 Always avoids dinner with family, either leaves after a bite, is late, or won’t come. Finishing still not better. No changes here. 9 Temper tantrums from being a perfectionist That I haven’t noticed at all. He did extremely well in baseball, but couldn’t hit the ball for more then a month, just lately he is able to. But he still went, even though he couldn’t do it. He was still going, and looking forwards to the game irregardless. 10 Getting into fights often I think he is a little bit calmer. 11 Daily Alternating moods – rapid, intense mood swings – It is better, seems more steady. A: The response was looking good, so I made a follow-up appointment for September and let him ride on the previous dose of 10M until then. P: 1 Wait and Watch Friday, September 19, 2003 CC: ASPERGERS SYNDROME S: Thomas:
I have often noticed that children who have little to no awareness of their problems, are unreliable for assessment purposes. So I sometimes have to defer to the parents about their children to get a clear assessment. So after a little more chatting, I excused the boy to the waiting room to talk with his father. Father: My sense is that the homeopathic medicine has helped, for sure. We have done a few other things too though. We’ve installed full spectrum lights. Been trying to be more accommodating for him. Then summer came, which helps him a lot generally. The thing which worries us is what happens when the winter comes. That is big concern, a bit of a worry for us. Much has changed since the sun came out. He doesn’t complain about going to school. He seems to be enjoying more things in general, not as standoff-ish as he used to be. There are still things that make him very unhappy, he was singing in a big show, and he didn’t’ get accepted for a performance, for example. He is auditioning to another show. The idea of not wanting to have anything to do with anybody else, is not as strong. Was very unhappy, because his best friend was in a class without him, but has adjusted to it. Everything is a little bit less. He has some health problems, back aches - great back aches. He has this contraption, a kind of belt (from the osteopath). Eating with us, doesn’t run away as he did. Becoming a little less neurotic. We were here in dead of Winter when we first came to see you, it started back then, the changes. We had a psychological evaluation, they said maybe Asperger’s syndrome, maybe this maybe that. Tell me more about back problems he is having? Over summer fine, exercising a lot. Now has to abide by someone else’s order, when insecure, or bored, or unwilling, he slumps, slouches. His muscles right and left of the spine, hard as a rock. He will complain about it quite a bit. One episode was interesting, he didn’t get in class with best friend, cried for 3 hours. Was saying how terrible things were, and didn’t want to go to school, he had a huge huge melt down. Saying he won’t go to school. Then somehow calmed himself down, and now in school and doing fine. I hope he goes through the winter with out major depression. Overall? We are very happy with treatment. We had previously tried many treatments with no success, many homeopaths as well. Your are the first one that has really helped him. Benchmarks: 1 Angry explosions – minimum once per day, more often multiple explosions Much less frequent. It is also much less heart felt, now more childlike. 2 He hates school – that is daily for years now. Most importantly has friends in school now - never had that before. 3 Getting up every morning kicking and screaming about going to school – every morning. No problem – that was every day. 4 Very defiant, obstinate in general That is definitely much better 5 Averse, intolerant of Strangers Don’t know 6 Privacy around stool – no one can be on the second floor when he is using the bathroom. Will scream and yell. He is fine, doesn’t scream about that anymore. 7 Restlessness, constant fidgetiness He is calmer then before. He can sit it out and work on his recorder - this is new. He can sit it out now while playing and practicing. 8 Always avoids dinner with family, either leaves after a bite, is late, or won’t come. He is eating dinner with us every night. He used to just run away, didn’t want to eat with us. 9 Temper tantrums from being a perfectionist I think it has improved, because I’ve never seen him upset over perfectionism anymore, and he did before. 10 Getting into fights often Much less fights, again, much less. 11 Daily Alternating moods – rapid, intense mood swings – We still has that, still happening. He can lock onto a theme, some times obsessively. Better or worse? It is better, but still there. 12 Twirling hair He has stopped that 13 Shocking speech, lewd, or inappropriate He still does it, but not as a weapon anymore. Not to shock people, does it humorously 14 Sensitive to Noise Not sure if changed 15 Electronic Media – “magnetized” by books on tape, TV, Movie Still has, I’m not sure if there are any changes here. A: Still progressing. Parents are concerned about his back pain. They are also concerned that he may do poorly in the winter. P: 1. Watch & Wait Monday, October 06, 2003 Case Note: Spoke to Thomas’s mother today. She mentioned that a long time friend of the family recently spoke with Thomas for several hours. Afterwards she came up and said, “what have you done with him, he is totally changed!” Another thing is that now the boy wants to be on stage, he is auditioning for plays, something he wasn’t doing before, huge for him. He still has a tendency to shift moods, but is able to get himself out of them better. Now he has long stretches of good days, and when the moods come, they are shorter lasting. She mentioned he was complaining quite a bit about his back pain also. A: The prognosis is good, but his back pain is clearly not shifting. In addition, they’ve brought him to osteopathic treatment, yet he continues to complain, so a good opportunity to test the Rx and see if it will clear the back pain. P: 1 Androc 10M 2 doses dry, to be taken 12 hours apart (mother picked up and dispensed 10/17) Thursday, November 20, 2003 CC: ASPERGERS SYNDROME S: Thomas:
Mother? He is doing well. From school, we have a parent teacher conference. He is doing much better then last year. What is much better? He goes to school, seems to enjoy some things. In contrast to past? Much better, no homework last year, he wouldn’t do it. We just gave up on it, didn’t even try. Now he is in a Shakespeare production. Has his lines, and is doing fine. He really loves it. I see him up on stage, don’t even recognize him. He has been doing that and also started cello lessons. He is a bit overstretched with activities. He is okay, with few exceptions. Concern about the winter? He has a hard time getting out of bed, only since season has changed. Mood? He doesn’t want to go outside, ugly and grey. Nothing to do when the weather is so bad. Benchmarks: 1 Angry explosions – minimum once per day, more often multiple explosions No, that happens sometimes, maybe once per week. 2 He hates school – that is daily for years now. Doing better. 3 Getting up every morning kicking and screaming about going to school – every morning. He has a really set rhythm for himself, if sleeps too long, it disturbs his rhythm, then upset. It is better. It was fine prior to a week ago (beginning of Portland rain, misty, and cloudy weather). 4 Very defiant, obstinate in general That is better 5 Averse, intolerant of Strangers We have a young women that is living with us, no objection at all, actually likes her. She is a stranger. My sister is visiting too, doing fine 6 Privacy around stool – no one can be on the second floor when he is using the bathroom. Will scream and yell. He still has the privacy, will lock the door. But doesn’t scream if we are on the same floor. 7 Restlessness, constant fidgetiness He still has that tendency. But now has phases where he can be still, a game or a book, or a project. It has improved. 8 Always avoids dinner with family, either leaves after a bite, is late, or won’t come. Still has part of that, food is not important. He likes to run by his own schedule. 9 Temper tantrums from being a perfectionist He has that now with the Cello, he has a very good ear. If he can’t get it perfect he screams. Overall it has changed though. With the homework assignment he couldn’t deal with imperfect home work assignment. But it got better. We tried a couple of years ago with the violin, but a disaster. He has gotten more at ease, he is much more loose in general. 10 Getting into fights often Now he is not, not happening anymore, much better 11 Daily Alternating moods – rapid, intense mood swings – It is no longer the rapid switches, now predictable. Like if goes to bed late, next day, in a horrible state. Before it was random outbursts. He still has bad moods. But usually because not enough sleep. 12 Twirling hair That stopped 13 Shocking speech, lewd, or inappropriate He doesn’t do that to shock now, now more to be funny, doesn’t use it to shock someone. 14 Sensitive to Noise Not sure 15 Back Pain I think it has gotten better since the last dose, he hasn’t been complaining. Beginning of school year he has been complaining. Now not complaining. 16 Electronic Media – “magnetized” by books on tape, TV, Movie He still has that, can’t stop, same with video games. Overall about the same. He is participating in family outings, like watching his brother perform etc. It is a lot better for the whole family. His brother no longer feels threatened. Really everything has improved. He is a different kid. Sometimes I pinch myself, saying to myself “will this stay this way?” A: Excellent progress. Given the parents are concerned about him having difficulty during the winter I think an LM is a good idea. P: 1. Androc LM3 QD begun November 20th 2/09/04 Case Note: discussion with parents, several things getting a bit worse. I told them to stop the LM until I see them in a few weeks for the next follow-up 2/23/2004 CC: ASPERGERS SYNDROME S: You were worried about him doing poorly in winter? It is much much better then last year. Back pain? He still has that, sometimes complaining, but not as often. He is biting his tongue, until it bleeds, as a nervous tic. He cracks knuckles, which is a new one. We had a big fight at home, and he was very sad for two weeks. He also had a phase where he didn’t’ get what he wanted and then would get himself into some deep depressions. Benchmarks: 1 Angry explosions – minimum once per day, more often multiple explosions For a long time it has been better, but lately, it has been coming back a little. 2 He hates school – that is daily for years now. I think he actually likes it now. He used to be the sullen one, now the class clown. I saw him at school recently, and he is not so much interacting. Still not the initiator at school. 3 Getting up every morning kicking and screaming about going to school – every morning. No, not a problem at all now. very seldom doesn’t want to get up. Mostly gets up before us now. 4 Very defiant, obstinate in general Now more able to say yes, but has his no’s too 5 Averse, intolerant of Strangers He seems to tolerating them better. 6 Privacy around stool – no one can be on the second floor when he is using the bathroom. Will scream and yell. That has totally disappeared. 7 Restlessness, constant fidgetiness It is much lower, still very physical, but no, not all over the place. 8 Always avoids dinner with family, either leaves after a bite, is late, or won’t come. He is finicky about dinner. He definitely likes sweet. Has it improved? yes 9 Temper tantrums from being a perfectionist Yesterday he still had that, got upset over something he was working on. He can get tremendously frustrated with cello. In October, he was really doing well. Now more of a problem if it is not perfect. Tremendously hard on himself, and doesn’t believe when teacher give positive feedback. Lately doesn’t want to go to his karate, because too high pressure on himself. Particularly he does poorly with larger groups. He also concentrates very hard. He has a hard time with coordination. He is not a coordinated kid in general. 10 Getting into fights often That is better. What is really amazing is he isn’t hitting back if he gets hurt during play. He’ll actually come in instead of hitting or starting a fight.. That aggressiveness is gone, still gets somewhat aggressive, but not like that anymore. 11 Daily Alternating moods – rapid, intense mood swings – Lately has been putting himself into these deep depressions. Not like it used to be 3 or 4 times a day. If he doesn’t get something, he is quite manipulative. Those one second to the next mood swings 12 Twirling hair Maybe 2 months ago, he started doing that again, a little bald spot again. When he does it, it is out of his control, like nervous tension 13 Sensitive to Noise I don’t think it is a problem anymore. 14 Electronic Media – “magnetized” by books on tape, TV, Movie He is not listening to them anymore (books on tape). We thought he’d be addicted, but he is not over doing it. Recently, he played a computer game for a whole day, and was alright, not a zombie afterwards. Does he seem to get magnetized like he used to? Not anymore. A: Wonderful response to the Rx. Patient is doing well on all fronts. He is perhaps slipping back a bit, but it is also his more difficult time of the year, so perhaps that is contributing a bit. I advised the parents to let me know if there are any problems, but that I expect he will probably continue to do well on his own without any more Rx. They are to call if he has any further problems Monday, March 01, 2004 Case Note: His back has been hurting. His behavior seems worse as well. A: perhaps a bit of a regression after all. P: 1 10M single dose dry (Added at request of George Guess on 7/5/04) Friday, June 25, 2004 CC:
Mother: We got him up this morning, he said he refuses to see that doctor, refuses. How is he? I think he is doing okay, with his up and downs. The school called in a meeting with Special Ed teacher, psychologist, they are still concerned that he is tremendously hard on himself. He had a test, did almost perfect, but so upset, that he didn’t do good enough. He does this constantly @ school, puts himself down. He doesn’t want to do it. He think he can not do it. Teachers think it is a real problem, and we think it is so much better then last year. They think he is very intelligent, and it is somehow unlocked. They are worried about his problems with transitions. He has learned how to articulate his needs, to make his feelings know. Yesterday had a huge belly ache, I made him a hot water bottle and gave the Rx, and it went away. That is another thing, he has a very good ear, but he won’t believe in it. Won’t acknowledge it. Changed? It is much better, he goes to school, Overall experience is definitely much better. Perfectionism? If he can’t get something right in practice, he will still stomp off and scream, but now can get him back. He is still tremendously frustrated with himself. He seems more personable? Yes, seems like doing better. He is very cuddly right now, needs a lot of physical comfort, sitting on our laps, needs a tremendous amount of that. An unfortunate thing, but his teacher will be my old teacher, and he was awful, so trying to change that. Concerns? That he will be okay over there. Being in sun? no problems. When in school, could never take his sweater off. It was like an armor for him, even when the weather was warmer. He’d even be sweating, but would’nt take it off. A: The point is doing well in general. His presence was better in the office, more calm, more approachable. All symtom's are improved except she is clear that is perfectionistic tendencies are improved, yet they are clearly still an issue. The best case scenario would be to use Q potencies daily. However that is not practical given their 6 months travel to Switzerland. So I recommended using the 10M, and I’ll purchase and send a 50M for them to have for any issues that arise while in Switzerland should they arise and 10M doesn’t act. Tracking:
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