Case Study Learning Disability Child

Debbie Kennedy accepts her 10-year-old son can be difficult to handle on occasion.

He’s autistic and has been diagnosed with attention deficit hyperactivity disorder.

There are times when he gets frustrated, angry and stressed. Equally, she says, he can be calmed down quickly with simple interventions.

“He’s very intelligent,” says Kennedy.”He could tell you anything about any car. He loves Top Gear . . . when he does act out, I can control him with one hand or distract him.”

But she says the past past two years have been marked by a sharp deterioration in his behaviour. She puts much of this down to what she says was the overuse of seclusion at school to control his behaviour.

In all, she estimates he was placed in a seclusion or “time-out” room on more than 30 occasions over a two-year period.

While in most cases she was told they were for short periods of time, she maintains that on a several occasions he was placed there for up to two hours at a time.

“In order to help a vulnerable child like Dylan manage his emotions and control his behaviour, he needs support, guidance and explanation,” she says.

“If he’s isolated from others, without guidance or support, I can’t see how that helps. In fact, it’s a more frightening experience – especially for a child with disabilities.”

Benincasa Special School in Blackrock, Co Dublin, said that while it was not in a position to comment on Dylan’s individual case, the school had always acted “properly and in accordance with good practice at all times”.

In line with its policies, seclusion was only ever used as a measure of last resort and where a child was disruptive to the point of posing an imminent danger to themselves or others.

Kennedy, however, feels the school was too quick to seclude her son and says he regularly came home in tears after being placed in the room, or isolated from the wider class.

“He would spend hours crying, saying how much he wanted to die and felt he wasn’t good enough.”

She also feels he was placed in the room on foot of relatively minor incidents, like throwing a pencil against a blackboard or refusing to do work.

School records, however, show there were occasions when he kicked or punched staff. On one occasion, he is said to have raised a chair in the air, before it was taken from him.

The seclusion room – based on photographs taken by Dylan’s mother – is a small bare room with no furniture.

Peephole

There is a window with metal bars on the outside. The door has no handle on the inside and there is a peephole for staff.

The school said a staff member was present outside the seclusion room, monitoring the student, at all times.

“The seclusion room is designed with regards to the health and safety of the student in question. The room does not contain certain furniture as such items are often considered safety hazards to both the student or staff members,” it said.

Kennedy ended up withdrawing permission for her son to be placed in the room. Afterwards, she says she would receive phone calls from 9.10am onwards asking her to collect him.

He ended up being taught at home by his mother for long periods and resumed school on a limited basis.

She is careful to say Dylan enjoyed several successful years at his special school prior to this and many staff went out of their way to help and support him. “I couldn’t speak highly enough of them.”

But she feels the use of seclusion has left a damaging legacy which Dylan is still coming to terms with.

“He needs therapy after all that’s happened. We can be out having fun and he’ll mention what happened to him,” she says.

“He is the most caring and affectionate boy. He’s clever and funny and has a huge obsession with cars. I wouldn’t change him for anything.”

PRELIMINARY INFORMATION:

NAME: Master S.V.
Sex – Male
Date of birth: 04-06-1991
Religion/caste: Jain – Kutchi
School: I.H. Bhatia English Medium School.
Standard: II
Father:  38 years
Mother:  35 years – Housewife
Siblings: 1 brother, 11 years old

CHIEF COMPLAINT

Intellect:  A known case of  Dyslexia. He writes the opposite – mirror image like. e.g.: F for 7, b for d.  Difficulty in reading and writing.  Speaks one thing and writes another. He has been  receiving remedial training at M.S.S.

EDUCATIONAL ASSESSMENT REPORT SUMMARY:-

Master S.V. shows deficits in area of position in space.  He has difficulties in sustenance of attention for a required amount of time, as well as attending to finer details.  He lacks efficient strategies for learning.  His auditory analysis and synthesis are weak and phonetic associations are poor.  His cognitive abilities are not age appropriate. All these lead to his academic performance being below average.

Diagnosis: DYSLEXIA

ASSOCIATED COMPLAINTS:

Since birth: Coryza 2, thick blakish crusts + from the nose. < COW 2
Occassional. Epistaxis
H/O Recurrent Acute Otitis Media (AOM)

PAST HISTORY

– 3 attacks of Hepatitis ’94, ’95 , Jan., 2000
– History of Accidental consumption of caustic soda solution in December 94
– Reccurent Heat boils.

Family History:

Paternal Gr. Father – Died 3 years back – Cancer
Paternal Aunt – H/O Koch’s ,
Paternal Gr. Mother – Diabetes M.

BIRTH HISTORY:

FTND (Full Term Normal Delivery)
Antenatal – Nil.  Post Natal – Nil
Mothers’s mental state during pregnancy – Normal
CIAB – No other significant abnormalities

MILESTONES:

Head holding -?
Dentition – 7 months
Walking  – 9 months
Talking   – 1½ years single words, no double syllables Mama, Papa etc., Delayed.
Vaccination:  Fully immunized up to age

PATIENT AS A PERSON:

Appearance:  plump child, chubby.
Appetite – (N) G:  Curd 2
Perspiration – profuse Gen. 22 Odor  (++) offensive
Stools – (N) – Occ. 2 – 4/d
Urine  (N) Nocturnal enuresis  ½ -3 months sleep: light.

Dreams:
Sleep: Occ.  Startles in sleep, Occ. Talks in sleep
Thermal:  Sun  < – Epistaxis – more frequent in summer
Needs the fan in summer but slow in winter. Likes to Cover himself and occasionally needs woolen sweater in winter.

Examination:

Rhinorrhea +
Chest – Clear
Moles +
White spots on nails

LIFE SPACE:

Master S is an 8 year old child from a middle class Kutchi Jain family.  He was accompanied by his mother.  Since the last 3 months they were living as a nuclear family – mother, father and 2 sons.  Earlier they were staying in a joint family with paternal grand father, paternal grand mother, 1 paternal uncle, his wife and daughter.  The paternal uncle is the father’s younger brother.  There were a lot of conflicts in the family after paternal uncle’s marriage.  Till then things were fine.  These conflicts between family members were about financial issues and household chores.  His father runs a ‘Kirana’ store (grocery shop).  Paternal uncle is in service.  The mother assists at the shop as it is at close to their house.  Mother said that the quarrels in house affected her children very much.  She explained that S always had a typical frown on his face, which has reduced now since they have separated.  She said that the children would always be very concerned about her. “What if they do something to my mother?” He carried a fear that paternal uncle’s family would harm her mother especially in the father’s absence.  He didn’t take her with him when going out and left them alone.  S never liked to spend time with his paternal uncle or paternal aunt. Recently a cousin sister was born. His mother said that the patient went to his teacher and told her that he doesn’t have any cousin sister and he will never go close to her.  His mother explained that she never encourages such ideas and this was his own thinking.  The dreams that he described also showed a lot of resentment towards parental uncle and his family.  He was attached to paternal grandfather.  He always used to spend time with him when his mother went to the shop.  After paternal garnd father’s death, the patient used to remember him all the time. He remained in a depressed mood and always said that he wanted to go to him.

Mother also said that the elder brother takes care of the patient.  Last year when the mother was sick, they managed all the work.  The patient is also quite independent.  He does all his work on his own.  He enjoys staying at maternal garnd father’s place.  Since there are a lot of people around, he mixes with other children there and is playful.  He is extremely impulsive.  Recently he chopped off his eyebrows with a scissor.  He goes into the tank to hide there. He plays a lot of pranks with other children in school. HE is quite a restless, impulsive child.  Has no fears, and when questioned about this he said that parents beat him if he doesn’t study.  Mother reported that patient gets along extremely well with his father.

In the interview when mother was talking about the family conflicts, the patient started crying and had to be sent out to play.  Later he was observed to be playing on the slide.

The supervisor reported that child went to his cabin was standing there for some time and then lay down on the examination table.  He described the child as `BINDAS’ (ready to take risks). We see here a lot of discrepancy in the picture that mother gave and the observation made by others.  But she was probably better able to appreciate to the problems and psychological pressure of this child.  She said that the elder brother doesn’t allow the patient to play with him and so he generally plays with children younger than his age.

HOMOEOPATHIC UNDERSTANDING: –

Here we have explained the dynamic interaction between the child and his environment The child is extremely sensitive to the conflicts in the family, which have affected him very badly. There has been an insecure feeling. He has a lot of resentment for the uncle and his family, which he harbors all the time : ‘He has a frown on his face‘. He settles down somewhat after the separation into a nuclear family set up.

Also there was the state of grief after the loss of paternal garnd father, whom he was very attached to. His resentment towards his uncle is reflected in his dreams and the way he discusses his cousin sister. His behavior during the interview in terms of weeping further reflects tendency to harbor emotions. Though mother has shown sensitivity towards the child’s educational problem, there was a slightly mistaken perception regarding the emotional impact that he had from certain key events and other social inputs e.g., his relationship with peers, brothers perception of his problems and their interactions etc. Corrections of these, would go a long way in the further progress of the child. Currently, it was all being compounded by behavioral problems. He is an extremely restless and impulsive child. It is out of control. The way he hides in the water tank, clips off his eye brows etc. demonstrates this.

From the above understanding the following totality emerged:

R.S   –       <Grief

–Brooding

–Hatred

–Weepy

–Restless

–Impulsive

–Insecurity

–Perspiration- profuse

–Perspiration- offensive

PDF         Speech delayed

< Summer, hot weather
< COw

The prominent remedies which came up were Causticum and Natrum Mur.

Causticum covers the sadness part with weepiness and impulsiveness. But it does not cover the features of deep hatred and resentment. Based on this understanding Natrum Mur was selected as the remedy.

With an analysis pointing to moderate susceptibility, we started with Natrum Mur 200 1 PHS

The dominant miasm was understood in the Tubercular zone based on his restless, impulsive behaviour and suppurative tendencies. However some of his dispositional traits like attachments, brooding tendency and physical appearance, delayed speech show Sycotic traits.

MOTOR PATTERNS

·Impulsiveness, Restlessness
·Writing, Reading difficulties
·Writes in mirror images eg. “b” for “d”
·Deficits in area of position in space.
·Delayed speech.

SENSORY PATTERNS

·Weak auditory analysis and synthesis.

·Poor phonemic associations.

·Visual process deficits.

SENSITIVITY

·Sadness.

·Brooding.

·Resentful.

·Weepy.

·Hatred.

EGO – SUPER EGO

·Poor self esteems.

·Nervousness.

·Insecurity.

Remedy: NATRUM MUR

DISCUSSION:

MULTIDISCIPLINARY PLANNING AND PROGRAMMING:-

Master S. has been studying in a school which has a provision for remedial education. He had already been assessed and had received remedial education at another institute which co-ordinated with his school. His behaviour has not shown any improvement.

The psychologist then referred him to our institute for the purpose of Homoeopathic management and schooling.

S was taken up by our miltidisciplinary panel and it was decided that he would need a proper structured programme with coordinated care as he had not responded in a normal school with remedial back up. So he would need to be admitted in a special school for children with learning disabilities.

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