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The art of taking the case of a child with Autism Spectrum Disorder

Townsend Letter for Doctors and Patients, May, 2007 by Judyth Reichenberg-Ullman, Robert Ullman

Homeopathic case-taking is the name for the initial patient interview--or intake, as it is called in allopathic (non-homeopathic medical) circles. It is very different from the first appointment with a conventional medical doctor for a number of reasons. We homeopaths consider this interaction to be a very special, in-depth experience. When we take a case, we have no standard laundry list of questions to ask, which is quite different from a routine medical review of systems. We do have the patient fill out a medical history form ahead of time (or ask parents to fill it out for their child). But this process is mostly to jog the memory about anything that must be communicated and to provide any details that we may not, for some reason, elicit during the case-taking. Some of you may be surprised to know that we don't actually read the forms ahead of time, because we do not wish to prejudice ourselves beforehand. We do keep the completed forms in front of us and consult them during the case-taking to make sure that we have covered everything of importance, according to the parent, about the child. This brings us to the important individual aspects of this interaction:

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* Open-mindedness: A homeopath makes every effort to approach each child as unique, fresh, never-before-encountered. Samuel Hahnemann, the founder of homeopathy, emphasized the importance of lack of prejudice. No matter how many children we have seen before with a similar diagnosis, history, appearance, mannerisms, or behaviors, we need to keep ourselves free of assumptions. Case-takings are filled with surprising moments in which we observe, hear, and witness things we have never before experienced. The state of "not knowing" or "no mind" that is referred to in Zen is very apropos for a homeopath. There may be a temptation to say to ourselves, "Oh, that child reminds me of ______." However, absolutely any medicine in the homeopathic material medica may be needed.

* Taking, receiving, and catching the case: Case-taking has evolved considerably in sophistication since we first started learning homeopathy in the late seventies. We were taught to ask consistent laundry lists of questions, regardless of the patient or complaint. In fact, no one ever actually taught us how to take a child's case. We learned that on our own through trial-and-error and lots of experience. When we are with children now during the first interview, we try to be more spontaneous and present. Dr. Divya Chhabra of Mumbai, India calls the process "case receiving." Catching, a phrase that occurred to us over the past few days, has more of an active connotation, even one of pursuit. This approach can be necessary with some children, depending on temperament. The initial interview has a give-and-take quality. Listening intently, observing, remaining present, yet actively following clues, patterns, repetitive words, and gestures--whatever is unusual about the child.

* Following the energy of the case: Each case has a thread that runs through the child's case, life, behavior, and mode of dealing with the world. That energy will be expressed in everything that child says or does, in one form or another. Although it is extremely helpful if the child is verbal, the energy transcends words and is generally expressed in gestures, hand, or body language, or by other nonverbal means of communication.

* Strange, rare, and peculiar symptoms: These are perhaps the three most important words in taking a homeopathic case. They refer to anything that makes a child unusual or unique. It may be a physical, mental, or emotional symptom; a recurrent gesture; perseveration; or behavior. It can be anything that makes the child different from every other child with Autism Spectrum Disorder (ASD). The more unusual the symptom, the better the likelihood that a homeopath can find a medicine for him or her. You can imagine that, with over 2000 possible medicines to choose from, a homeopath needs to be able to distinguish one medicine from all the others, in order to prescribe for that child.

The case of Angie, which we document in our book on Asperger Syndrome (AS) (see www.drugfreeasperger.com), offers an excellent case point for strange, rare, and peculiar symptoms. Diagnosed with AS and Attention Deficit Hyperactivity Disorder (ADHD), Angie had been medicated unsuccessfully with a variety of psychiatric drugs. It is common for children with AS to exhibit socially inappropriate behaviors, but Angie's were over the top; she gave whomever happened to be in her vicinity the finger while yelling the F-word over a hundred times a day! Certainly this degree of profanity was odd, but the most unusual aspects of Angie's case were her continual spitting all over the floor and at those around her, her tendency to bark like a dog, to lick people's feet and arms, and to apologize profusely and immediately after engaging in these strange behaviors. It was this combination of very peculiar symptoms that made the prescription of Lyssin (made from rabies) obvious and highly successful.

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The art of taking the case of a child with Autism Spectrum Disorder

Townsend Letter for Doctors and Patients, May, 2007 by Judyth Reichenberg-Ullman, Robert Ullman

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