Master A.M., 6yrs 10 month old boy from a Muslim family, staying with his Grandmother, Parents, aunty, an elder brother and sister was brought to our clinic by his mother for behavioural problems and delayed speech in June 2010.
As reported by mother, he is known case of Borderline IQ (72). He is very restless, doesn’t sit in one place for long. Only sits for long time to watch T.V. but in that also, he is very fidgety. Outside he is always running here and there, will not stay with parents and it is difficult to control him. Nobody can control him except his mother. He has no sense of fear or danger. Does cycling very recklessly and fast without fear of falling. He is very restless during sleep and changes position frequently. He is stubborn and does not listen to anyone except his mother. Will never answer anybody even though he can. He always says ‘no’ for everything or any work given. He Throws Tantrums when his demands are not fulfilled and always he has demands when outside. He has delayed speech and pronunciation is not clear. He is taking speech therapy. There he sits with difficulty and is often distracted easily. He does not like to study. He is going to a normal school but not able to cope up as very restless and poor concentration. He cannot copy from board, cannot read and very slow at writing. He is independent in wearing clothes, eating and partially dependent for washing.
Associated complaints-he has multiple small round violaceous patches s on face, upper and lower extremities with lot of itching since 6 months. It is diagnosed as lichen planus and treatment is going on but it is not improving. Also his appetite is very poor. He is underweight and mother is worried about his height also. O/E—ht-108 cm, wt—16 kg.
He has history of convulsions (5-6 episodes) which started at 4 months of age. He was on medication with Valparin till 3 ½ yrs of age. No convulsion reported from 1yr of age. Low calcium and hypo parathyroid levels were reported as a cause for convulsions.
OBSTETRIC HISTORY AND BIRTH HISTORY
He is born to consanguineous parents (marriage in relation), both parents being first cousin. He is the third child, first two deliveries were forceps delivery and both are absolutely fine. Age of mother during conception was 30 yrs. Mental and physical health of mother during pregnancy was normal. There was no unusual stress or anxiety. No specific Cravings/Aversions.
Birth was full term, planned c-section delivery as it was breech presentation. He CIAB (cried immediately after birth). His Birth weight was 2.4kg. There were no problems immediately after birth. .Motor milestones were delayed like walking after 2 yrs. Speech monosyllables –after 3 ½ yr, full sentences 5 ½ yrs, still pronunciations are not clear. Speech therapy was started at 5 yrs.
He is obstinate by nature and will keep making demands. He shows aggressive behaviour towards both adults and children especially when prevented from doing something. He wants means wants and will throw tantrums, shout, run, hits, irritate till his demands are not fulfilled. Once his demands are fulfilled quickly he is fine. Nobody can handle him outside; he is slightly scared of his mother and father. He knows where his demands will be fulfilled only there he throws tantrums. If he wants to see T.V. and somebody else is watching he will shout so much that everybody will leave the remote. Likes to play outside, cricket football etc. but only wants to do batting. If he sees that other children are not cooperating then will leave the game. He likes cycling and does cycling so fast that others get scared and move away, but he is not bothered. No fears of dark, animals, being alone, etc. He always says no at first for any kind of work. Will never obey instructions. Never answer any questions. He troubles his sister very much because she does not beat or shout at him and pampers him a lot. At school initially he was calm, will listen to the teacher. No complaints from school till Sr kg. Now there are many complaints about his behaviour. He could not read or write without teacher’s personal assistance. He has no interest in reading, writing, etc.
He was reluctant to comply for instructions like answering questions, sitting on chair, physical examination. He was fidgety and restless. He was irritating mother, asking her to leave the cabin and go home. He missed letters while writing his name. Could name all the days of the week correctly. He seemed to have difficulty in drawing figures from memory and copying as well. He did not have fluent speech.
- 7/06/08 – IQ Assessment Estimated mental age based ON RAVEN and SEGUIN GODDARD FORM BOARD TEST Is 3.6 yrs and estimated IQ is 72 which is in the BORDERLINE RANGE
- BOHEMS TEST OF BASIC CONCEPT (BTBC) is of below average level of concept formation for his age. His attention and concentration skills are below average
- Oct-2010-REPORT BY DEVELOPMENTAL PAEDIATRICIAN— he present with delay in cognitive adaptive skills, higher order of language skill and fine motor skills. He also presents with signs and symptoms of ATTENTION DEFICIT HYPERACTIVE DISORDER.
- 26/7/2004 – Parathyroid ——–6.85pg/ml——-BELOW N
- 17/11.2007 parathyroid—– 16.3pg/ml——– (WNL)
- 16/10/2010—Thyroid level —-N
- Parathyroid ———–N
Follow up after 1 year
His restlessness is better 60 to 70 %. He can sit for studies, therapies, school and in the clinic. He completes the task given. He follows instructions most of the times. His obstinacy has reduced, but is a little moody at times. He is cooperative with us. He answers all questions, allows physical examination. He is now going to a special school. He copy from the board. His writing is improved and he can write from his memory. Can write an essay of 4 lines. Can identify images and write from his memory. He can write numbers up to 10. His speech is improved, can speak in sentences, though his pronunciation is still not very clear.
His appetite has improved and there is constant gain in his height and weight.
Skin complaints (lichen planus) is better and only few white discolouration can be seen.
Recent psychological report says—23/8/11– ADHD quotient is 83—which show below average possibility of ADHD. His behaviour in school has improved. He is compliant and follows instruction. His difficulty in remaining seated has improved. He copies from the board.
On 7/11—ht-117 cm wt –20 kg
Homeopathic Treatment is still going on.