Dr. Sameer Vermani pls help - my son 4 yr old

Dear Sameer Vermani,

I am writing to in the context of my son Shivam who turned 4 years in November 2010. I’d be grateful if you could pls review his case and suggest an appropriate remedy. While his physical development is by and large commensurate with age, he has behaviour and learning issues. He developed well till the age of around 2.5 - 3 years and his actions and behaviour were by and large age-appropriate but deteriorated subsequently. Currently his chief problems are:

- does not respond to name and comes around only if there is something of his interest (typically something to eat)
- does not take interest in the classroom and does not mix with peer group although is happy being in their company (he gets excited if a child comes home and will play with his toys somewhat more if he sees other children playing with his toys).Does not look at the people or kids around. He recognizes his parents, but does not call them by saying papa or mamma.
- does not speak appropriately and mostly uses grunts such as eeeee, aaaaa, uuuuu etc. to express a need (although was able to speak two words at a time to express his needs previously & was able to say No for the things not required i.e. till around 3 years of age such as car mein jayenge, mum piyega, nahi khayega, idli khayega, nind aayee hai. etc.)
- does not answer any questions (previously i.e. till around 3 years took interest and would respond correctly when asked the color of his clothes or those of another person sitting next to him, but does not do so now.)
- Till the age of 2.5-3 years used to respond correctly when asked to touch the various body-parts such as nose, head, ears etc. but does not respond so now. Simply does not show any interest in this activity now and looks askance or pretends to have not listened when asked now.
- does not sit still and has poor attention span (previously i.e. till around 3 years of age used to take keen interest in listening to short stories or rhymes and would also repeat some parts of them. Also previously was able to solve simple puzzles and build a cube/block using 6 independent toy planks)
- avoids eye contact (was better previously, though we must admit we didn’t notice this aspect much previously)
- will hold our hand and pull us in the direction of the object desired and take us to the same but not point towards the object or say its name (previously used to either say the name or point to the object; although on this aspect he was always more keen to obtain the desired object himself than ask us for it)
- was previously almost obsessed with animal pictures and their corresponding names and sounds but now takes no interest in the same. Previously he used to point to a particular animal picture and say aloud its name such as “horse hai yeh” and try to mimick the sound it makes. However, has no such interest now and stares in another direction or blankly when we point to an animal picture and ask its name or the sound it makes.
- the words he now uses are typically not relevant to the situation and is a mere repetition of a phrase uttered by us in another situation such as during a story telling session. Previously was able to use words appropriately such as “mum piyega” to express the need to drink water
- rubs his private parts and would lie on the stomach with his hand on the private part. This had previously happened around the age of 2.4 years when started going to the playschool, but subsequently stopped when we discouraged him from doing so by removing his hand. Has reappeared in the last five to six months (i.e. at around 3.5 years)
- likes to be in a play-area with swings and slides and will happily sit in a swing for a long time but will take little interest in other creative activity such as playing with other children or imaginary play
- previously i.e. till around 3 years of age was interested in games such as hide and seek, running, listening to rhymes, story-telling etc. but now has no such interests now
- likes to sit in a car and be driven around and keeps looking outside and enjoys being in busy markets or malls.
- likes to eat food and is interested in a whole variety especially fruits but will eat a few bites and drop it only to pick it up sometime later and eat again. Likes to keep eating something every few minutes.
- Is not toilet trained still despite our repeated attempts. During day time he avoids toilet on bed or sofa or car.
- Gazes from the corner of his eyes and throws tantrums on small things

Physical and Mental Characteristics

- Has a fear of heights. Will easily climb or descend stairs but when he realizes the height by looking down will immediately get conscious of the same.
- Sweats more than usual in the upper body. But also catches a cold very quickly. So in the winters we have to make him sleep with woolen jersey or sweater but by midnight have to change his clothes as they are sometimes damp with sweat. Then by around early morning say around 4 am, he may start coughing if by mistake we have forgotten to put back the sweater.
- Till around the age of 2.5 years, used to cry when strangers would come to our house. However, this gradually subsided when he became more familiar with the guests.
- Likes swings and merry go rounds but threw up once when we were coming downhill on a circular route.
- Occasionally flaps his hands when running
- Is a good looking child and was often called the Murphy baby for his resemblance to the child used in the advertisement for the Murhpy radios.
- will run into a busy street oblivious of the approaching vehicles and the dangers they pose though this has improved in the last 3-4 months.
- Was always a bit hyper and was mortally afraid of getting injections.
- Is a light sleeper and gets up easily on small noises and light.
- Does not allow his nails or hair to be cut easily and has to be held by another person while he howls when his nails are cut.
- Prefers to sleep in the dark and his sleep is disturbed as soon as it is sunrise after which he tosses and turns and does not sleep soundly. He requires thick curtains in the room to help him sleep.
- He was extremely clingy with his mother and used to get anxious even if she was away for a minute. His sleep was very poor from day one of birth and was never more than 10-12 hours even during the first few days after birth. It was difficult to put him to sleep and he would sleep only while breastfeeding. He was breastfed till 1.5 years of age.
- He is extremely fond of water and likes to play with it. However, he does not like formal baths especially if water is poured over his head or on his face. His reaction is extreme as he gets visibly terrified and screams and his body shakes as he tries to wriggle free when his hair is shampooed or water poured on his face.
- Shivam is better managed in a routine such as waking up early but likes to visit new places. Likes constant excitement is almost always on the go.
- Likes the cooler climate but cannot tolerate extreme heat or cold and also catches cold quickly.
- Previously used to be obsessed with the fan. He’d shriek with delight when the fan whirred at a fast speed and would repeatedly point to it. His fascination with the moving fan was much from around 1.5 to 2.5 years of age and he’d point it out to anyone who came home.
- Occasionally walked tip-toe for some time 1.5 – 2 years of age, but not always. Was slightly reluctant to wear shoes and even now prefers shoes which are soft and have some open structure such as Crocs
- No epileptic issues – EEG shows multifocal epileptoform discharges but the neurologist advised that these are normal in hyperactive children. The EEG was performed under sedation given his hyperactivity.
- He was tested for metabolic screening using the urine organic test, which was negative i.e. no abnormalities were noted.
- The latest stool test (performed in Dec 2010) shows no worms or any other abnormalities.
- Has a reasonably good memory e.g. of shops and what he bought there so if taken to a market he’d go back to a particular shop and stand in front of the specific counter where he was previously taken and provided something to eat of his interest.
- Almost excessive focus on eatables and likes to eat something every few minutes
- Likes attention, likes music but also gets irritated if music is played for much longer. Previously would get stuck onto a particular music record and insist on listening to it 20-25 times but does not have any such fascination now.
- Is startled easily. Previously the sudden pressure cooker whistle and food processor whirring would terrify him and he’d cling to either his mother or father but this has now subsided and he’s ok now with these sounds.
- We’re not sure of his dreams as he does not communicate appropriately but of-late he gets up sometimes in the middle of the night and sits up.
- Shivam likes to eat things of all tastes, but does not like to mix them. He likes stimulating foods or tastes. For example, he likes to lick a lemon, but will separately ask for salt or sugar. Overall he likes salty and pungent food. Avoids trying new things to eat except fruits but if his mother is eating the same thing mostly he comes to eat that.
- Shivam cant tolerate hunger and cries if his food is delayed.
- His motions are normal and 3-4 times a day
- Is extremely fond of Coloring using a pen, pencil or color. Will hold a pen and start coloring on almost anything including paper or walls. But is unable to distinguish between something which has a coloring impact such as a pen and something which has no coloring impact such as a unsharpened pencil. Will pick up almost anything even a mobile phone and start to “color”. But from last 3-4 months he has started putting crayons in his mouth, so we avoid giving crayons to him. Now a days he is fond of swing. He is on the swing for most of the day.
- There were times when he would giggle for no apparent reason. He started covering of ears around 3 years of age, when exposed to noises such as an airplane passing overhead but this has now reduced to a large extent.
- He can understand the tone we are taking in and can respond to it very well.

General history from birth till date
He was not able to sleep well from the first night he was born, we tried hard to make him sleep. He tried to sleep while having feed, so his sleep was in small parts and to make him sleep we swung him up –n –down. He was able to listen to songs or lullabies for s long time.
Was admitted to a playschool at around 2 years 4 months. Did not attend very regularly and used to go only for 2-3 hours each day. This was very difficult initially as he was clingy and would not let the mother go but slowly adjusted to being alone in the school. During his play school he picked up things that were being taught in school and used to recite these when he came back occasionally, but not when asked.
Even his teacher told us that he didn’t answer their questions when asked but answered when she asked other kids. However, was hyperactive and did not sit still and the teachers had to almost force him to sit on the chair. Subsequently they had to appoint a maid to sit in the chair and hold him for the duration of the school. Has had a few chest and stomach infections and each time they were treated with antibiotics. While we were not very keen on the allopathic medicines, but his infections would not subside on their own even after waiting for several days and he had to be administered the antibiotics or other modern medicines after which he would get better. His first antibiotic dosage was around 6-8 months of age when he contracted a stomach infection around the time of teething.

As a young infant Shivam was affectionate, answered correctly when asked questions, liked the attention provided, and was developing normally till the time he was sent to play-school. We’re not sure if something happened at school which led to this deterioration. However, within 4 to 5 months of being in the playschool, which included almost 2 months of summer vacations, his teacher called us and advised that we should show him to a child psychologist given his fascination with the fan and his general poor attention to what was being taught in the class. So we’re not sure if we missed any abnormality in his growth which the teacher instead caught. As Shivam is our first child, we could not calibrate his growth to any other child to know the differences.

He liked the train and squealed with delight when we bought him a new train with the bells and whistles. When we took him on a vacation when he was 3 years old he was very happy on seeing the sea and kept saying “itna sara mum” ie (so much water).

Birth: November 2006

Delivery Method: Normal Delivery

Full term, born on the due date

Cried just after birth

Weight at Birth: 2.4 kgs

Height at Birth: 34 inches

Milestones such as teething, sitting, turning the head, crawling, walking, talking achieved on time

Vaccinations: All given as recommended. Including oral polio, muscle polio, HIB, MMR, etc.

Prior Consultations: We consulted a reputed homeopath in Delhi who advised that this is likely the result of vaccinations and will subside over time. However, we’re not sure as to the root-cause as Shivam’s deterioration was not sudden but slightly gradual. The homeopath had recommended the following which have not yielded much results,
Asram Europa, Tarantula Hispanica, Hyoscamus Niger, Baryl Carb

Current Therapies:
He is undergoing sensory integration therapy 2 days a week. This is to reduce his sensitivity to touch. He is also undergoing applied behaviour analysis therapy 3 days a week. We have also recently started speech therapy 2 days a week. However, while these have resulted in some improvement, the progress is slow and erratic.
[message edited by shivamdad on Wed, 16 Mar 2011 04:53:44 GMT]