Mast M.6 yrs old male Muslim patient was brought with the complaints of poor eye contact, no response to name, involved in self, not aware of his environment, no emotional response, recognises family members but does not show affection, no effect if parents are not there at home.
He indicates his need by gestures. Speech is only babbling and crying. He constantly puts fingers in mouth. He has repeated behaviour like flapping, head banging, knocks head on the wall, slaps himself, strikes objects on the table or wall, pulls hair and there is constant handling of genitals.
He is very restless, always wandering here and there and cannot sit at one place. He is obstinate about biscuits, milk. If he is restricted from doing any activity or if he does not get what he wants, he shows his anger by screaming, pulling others hair, bangs head on wall, slaps himself. Sometimes he gets up frightened from sleep and cries a lot for hours. Then his father has to carry him outside which sometimes helps.
He does not indicate urine and stool and he is dependent on parents for his activities of daily living like eating, bathing, dressing and toilet washing, etc. Physically he is very lean thin child. He has associated problem of constipation. He does not pass stool for many days (about 1 wk) and mother has to give him enema for this. Whenever he passes stool even with suppository or enema, he is shrieking 3 before stool, cries, restless, runs all over the room. Stool is very hard like stone and large, difficult to pass. Parents cannot see his distress and they are more worried about this constipation problem. Recently he had 3 episodes of convulsions in 2 months.
Family history of elder sister autism, cousin sister down’s syndrome,
On psychological testing he falls into mild to moderate degree of autism and moderate mental retardation. CARS-36.5, ATEC-86, SQ-36. He was advised to go for BERA (for hearing) and EEG —which could not be done after repeated trial as he did not sleep during the test.
If we study this case, from causative perspective, genetic is the strong base. Other strong triggering factors may be-treatment taken by mother during pregnancy, jaundice in child (viral infection with high bilirubin level-12.5mg).
This child was put in special school, with homeopathic treatment.
AFTER ONE YEAR OF TREATMENT
The most distressing constipation is relieved. He passes stool daily without any problem and stools are normal. His convulsions are controlled and very occasional. His eye contact has improved. He responds to calls and looks in that direction. His hyperactivity, obstinacy and monomaniac behaviour like head banging and handling genitals is much controlled. His night terrors are almost absent. In Speech there is not much improvement but he understands commands and follows sometimes.
Follow up CARS – 35 ATEC-70. Still treatment is going on. As treatment has started late in this case and there is mod autism, the child will take long time to improve but there are limitations due to associated moderate mental retardation.