A Case Report on Ayurvedic Management of Attention Deficit Hyperactivity Disorder [ADHD] in Children

Akshay Gurav; Jennifer D’souza

A Case Report on Ayurvedic Management of Attention Deficit Hyperactivity Disorder [ADHD] in Children

Gurav A.^1*, D’souza J.²

DOI:

^1* Akshay Gurav, Assistant Professor, Dept. of Kaumarabhritya, Government Ayurveda Medical College & Teaching Hospital, Shivamogga, Karnataka, India.

² Jennifer D’souza, Final Year UG Student, Government Ayurveda Medical College & Teaching Hospital, Shivamogga, Karnataka, India.

Attention Deficit Hyperactivity Disorder - ADHD is the most common neurobehavioral disorder of childhood. It interferes with social, academic and occupational functioning and it is characterized by in-attention, hyperactivity and impulsivity. In Ayurveda, disorders related to psychiatric and behavioral disturbances are discussed under the chapter of Unmada. So, according to the sign and symptoms it can be co-related with Unmada. The present case was carried out in Kaumarabhritya OPD & IPD of Government Ayurveda Medical College & Teaching Hospital, Shivamogga, and Karnataka with an aim to assess the efficacy of Ayurvedic treatment protocol in the management of ADHD in children. Ayurvedic treatment like Kosthashodhana, Basti, Shirodhara and Nasya were followed and assessment was done before and after treatment and during follow ups. The given treatment was found to be effective in management of ADHD.

Keywords: ADHD, Unmada, Behavioral Disorder, Ayurvedic Management, Case Report

Corresponding Author	How to Cite this Article	To Browse
Akshay Gurav, Assistant Professor, Dept. of Kaumarabhritya, Government Ayurveda Medical College & Teaching Hospital, Shivamogga, Karnataka, India. Email:	Akshay Gurav, Jennifer D’souza, A Case Report on Ayurvedic Management of Attention Deficit Hyperactivity Disorder [ADHD] in Children. J Ayu Int Med Sci. 2022;7(5):166-170. Available From https://jaims.in/jaims/article/view/1914

Introduction

ADHD is a neurobehavioral disorder of childhood. Its prevalence in India was estimated at 1.3 per 1000. The American academy of pediatrics recommends evaluating any child between 4-18 years of age for ADHD, if he or she presents with academic or behavioral problems with symptoms of inattention, hyperactivity and impulsivity. It interferes with social, academic and occupational functioning. Its onset will be upto 12 years of age. Although the symptoms of ADHD begin in childhood, it can continue through adolescence and adulthood.^[1] Mothers of children with ADHD are more likely to experience birth complications such as toxemia, prolonged labor and complicated delivery. Maternal drug use, smoking and alcohol during pregnancy, lead or mercury exposure are commonly linked to attentional difficulties associated with the development of ADHD.^[2]

In Ayurveda, there is no direct correlation for ADHD, but according to its signs & symptoms it can nearly be corelated with Unmada. According to Acharya Charaka, the causative factors for Unmada are, intake of incompatible, contaminated and unclean foods, possession by spirits like Gods, mental trauma due to recurrent exposure to fear or exhilaration. By these causes the Dosha gets vitiated in the person possessing low level of Sattva Guna and in turn vitiate the mind, which is the seat of intellect. Common features of Unmada are, intellectual confusion, unsteadiness of mind, impatience, restlessness, incoherent speech, feeling of emptiness in mind, anxiety. Ayurvedic line of treatment has key role in managing Neurobehavioral disorders like ADHD etc., Hence, present case was an attempt to manage the ADHD disorder using Ayurvedic line of treatment.

Case Study

A 7-year-old female child with the complaints of hyperactivity, irritability in attentiveness, and lack of concentration, low memory power and delayed speech had approached our hospital. As per the information by her parents, the child was apparently normal till 3 years of age. Gradually they noticed the behavioral disturbances in their child. She was not able to concentrate on any things in particular for more time. She developed irritability behavior, inattentive and slow learning.

She had low memory power that she can’t even recognize their parents. Then she developed anxiety and fear towards people and the crowd where she became socially inactive. She also had the problem in her speech. Patient had taken treatment for this but no changes observed in her behavior. So, they approached our hospital for further management.

Birth History: Pre-term delivery with caesarean section [previous LSCS]. No history of Birth Asphyxia.

Developmental History: Gross motor & fine motor development were normal as per the chronological age but there was delayed with Language and Social development.

Family History: Non-Consanguineous marriage. Elder sister has no any problem.

Personal History

Diet - Mixed Appetite

Bowel - Clear (once daily)

Urine - Normal

Sleep - Sound

General Examination, Anthropometry and Vitals

General condition - Fair, Lean, Hyperactive and in-attentive.

Height - 110 cm

Weight - 17 kg

HC - 50 cm

CC - 56 cm

MAC - 13.5 cm

HR - 102 bpm

RR - 26 rpm

Temperature - Afebrile

Systemic Examination: Examination of Cardiovascular system, Respiratory system, Per abdomen shows no deformity. Gait was normal. Muscle tone and texture was normal.

Central Nervous Examination

Patient was conscious, inattentive, easily gets distracted, poor eye contact,

not obeying the commands and irritable, can’t speak even two words, unable to identify persons, body parts, numbers, colors, low memory power, not able to write.

Ashta Sthana Pareeksha

Nadi - Vata-Pittaja

Mala - Prakruta (once daily, normal consistency, satisfactory)

Mutra - Prakruta (4-6 times a day / 1-2 times at night)

Jihwa - Aliptha (not coated)

Shabda - Aspashta (unable to speak)

Sparsha - Sheetha (Cold)

Drik - Prakrutha (normal)

Akriti - Leena (lean)

Treatment Plan

DOA – DOD	Panchakarma Given	Shamana Aushadi	Observation (After 15 days of discharge)
1st sitting 30/08/2021 TO 08/08/2021	1st and 2nd day Krimimudga Rasa 1-0-1 A/F Udhwarthana with Kola Kulatta Chuna + Godhuma Churna f/b Nadi Sweda 3rd day Sadhyo Virechana with Gandarvahastadi Taila - 10ml with warm milk for 1 day 4th to 10th day Shirodhara with Dashamoola Kwatha. Sarvangaabyanga with Ksheerabala Taila f/b Nadisweda Matrabasti with Ksheerabalataila - 20ml	Saraswatarista with gold 10 drops -0-0 with milk on E/s Syp Memorin = 5ml-0-0 Smriti granules = 0-0-1tsf with milk bed time Asyapratisrana with Trikatu, Yastimadhu, Vacha Churna, twice daily	Mild decrease in hyperactivity. Slight increase in concentration. Able to spell few words.
2nd Sitting 29/09/2021 TO 06/10/2021	1st day Udhwarthana with Kola Kulatta + Godhumachurna f/b Nadi Sweda Trikatu Churna ½ tsf TID 2nd to 8th day Sarvangaabyanga with Ksheerabalataila f/b Nadi Sweda Takradhara with Brahmi, Yashtimadu, Vacha, Rasna, Ashwaganda Churna Matrabasti with Ksheerabala Taila - 20 ml	Brahmi Vati Swarna Yukta 1-0-0 with milk E/s Brahmi Ghrita = 5ml-0-5ml Asyapratisarana with Trikatu, Yastimadhu, Vacha Churna, twice daily	Able to spell more words than last admission Able to concentrate on particular thing for more time Social activeness increased. Able to follow some instructions given by parents.

3rd sitting 15/11/2021 TO 23/11/21	1st day Udhwartana with Kola Kulatta Churna + Godhuma Churna f/b Nadi Sweda 2nd day to 8th day Shirodhara with Brahmi Taila Sarvanga Abyanga with Mahanarayana Taila Matra Basti with Mahanaryana Taila	Brahmi Vati Swarna Yukta 1-0-0 with milk E/s · Brahmi Ghrita 5ml-0-5ml Syp Mentrich 0-0-5ml	Irritability was decreased. Fear towards stranger decreased. Able to spell more words than earlier
4th sitting 21/03/2022 TO 29/03/2022	1st day Udhwartana with Kola Kulatta Churna + Godhuma Churna f/b Nadi Sweda 2nd day Sadhyo Virechana with Trivrut Leha - 15gms with milk on E/S 3rd to 9th day Shirodhara with Ksheerabala Taila Sarvanga Abyanga with Ksheerabala Taila Matra Basti with Kalyanaka Ghrita - 20 ml	Smriti Sagara Rasa 1-0-1 Brahmi Ghrita 5ml-0-5ml Pratimarsha Nasya with Anu Taila 2/2 ------0-----2/2	Able to spell more words. Able to recognize the parents Concentration and memory is increased than the earlier.
5th Sitting 22/04/22 TO 29/04/22	1st to 7th day Shirodhara with Brahmi Taila Sarvanga Abyanga with Ksheerabala Taila f/b Nadisweda Matra Basti with Mahakalyanaka Ghrita - 20 ml	Smriti Sagara Rasa 1-0-1 Brahmi Ghrita 5ml-0-5ml Pratimarsha Nasya with Anu Taila 2/2 ------0-----2/2 Asyapratisarana with Trikatu, Yastimadhu and Vacha Churna.	Concentration on particular thing has been increased a lot. Able to recognize her family members and friends. Hyperactivity decreased She is able to attend the school Obeys the commands and does the assigned work properly. Able to spell her name and their family members. Able to recognize the body parts. Socially friendly behavior and friendship developed.
6th sitting 03/05/2022 TO 11/05/2022	1st & 2nd day Udhwartana with Kola Kulatta Churna + Godhuma Churna f/b Nadi Sweda 3rd to 9th day Sarvanga Abyanga with Mahanarayana Taila f/b Nadi Sweda Matra Basti with Brahmi Taila 20ml Shiro Pichu with Brahmi Taila	Saraswataarista with gold, 10 drops with milk E/s Brahmi Ghrita 5ml-0-5ml Brahmi, Vacha, Ashwagandha Chruna 0-0-1/2 spoon with honey at bed time	Follow up advised after 15 days

Samprapti Ghataka

Dosha - Vata- Pitta Pradhana

Dooshya - Rasa, Manas

Agni - Vishamagni

Udbhavasthana - Pakwashaya

Adhisthana - Shiras

Vyakthasthana - Sarvashareera

Srotas - Manovahasrotas

Srotodushti - Sanga and Vimargagamana

Rogamarga - Abyantara

Rogaswabhava - Chirakari

Sadya Asadyata - Krichra Sadhya

Diagnosis: Attention Deficit Hyperactivity Disorder (Vata-Pittaja Unmada)

Discussion

ADHD is associated with Pitta and Vata Dosha and even in this case we observed predominant of Vata and Pitta. So, plan of treatment was mainly to bring Vata-Pitta into normalcy. As ADHD is a neurobehavioral disorder, drugs were used which is having the Medya properties.

In the first admission we advised the Sadhyo Virechana with Gandarvahastadi Taila with milk for the purpose of Koshta Shodhana as well as it helps in further treatment by appropriate absorption of medicine. As she is 7 years old, the classical Virechana is contraindicated so, we planned for Sadhyo Virechana. Then in each sitting we had planned for the Sarvanga Abyanga, Nadi Sweda, Kashayadhara / Takradhara / Tailadhara, Matrabasti.

Probable mode of action of the treatment are as follows:

Udwarthana

In each sitting for 1^st day along with Deepana Pachana drugs we conducted Udwartha for Avaranahara action.

Shirodhara

As Shira is considered to be Uttamanga in Ayurveda which controls the functions of body, we planned for Shirodhara. When Dhara falls over forehead and

head, in a continues oscillatory manner it activates the local cells. With this the drugs used here like Dashamoola, Yastimadhu, Vacha, Brahmi are Vata Pitta Hara and possess Sheetavirya which gives cooling effect to head, helping in reducing the hyperactivity and the Medya property in them increases the concentration and memory power. Shirodhara only acts as the Sthanika Chikitsa which helps in acute cases. So, for the further development in the condition, we added Matra Basti with this simultaneously.

Matra Basti

According to Acharya Charaka, Basti is considered as Ardha Chikitsa which is the prime treatment for Vata.^[3] Rajoguna which is predominant in ADHD is controlled by Vata. So, if Vata is controlled then Rajo Guna also gets controlled. Basti acts on whole body through gut brain axis and acts on brain which helps in reducing the stress, anxiety and depression.

Initially we advised Matra Basti with Tailas like Ksheerabala Taila and Mahanarayana Taila, as the Taila helps in controlling the Vata which in turn controls the hyperactivity which is the primary complaint in ADHD. Later on in the further sittings we advised Mahakalyanaka Ghrita, as Ghritha controls the Pitta and also this Ghrita helps in increasing the cognitive power. When Vata Pitta got controlled, we used Brahmi Taila which is having Medya property.

Shamana Aushadi

After purificatory measures, the morbid Doshas from the body will be eliminated. After that by giving the Shaman Aushadi containing gold which possess the Medya properties will act on the brain cells and helps in increasing the concentration and memory power. So, we advised Brahmi Vati Swarna Yukta, Brahmi Ghrita, Saraswataarista with gold, Smriti granules etc.

Asyapratisaran

Speech is also matter of concern in ADHD and even in this case child was having the problem with speech, so we also planned Asyapratisarana with Teekshna, Ushna and Medhya drugs which helped a lot more in her speaking abilities.

Nasya: Nasa is the Dwara of Shiras. So, we advised the Pratimarsha Nasya with Anu Taila which increased her mental ability.

Conclusion

According to Ayurveda, ADHD can be nearly co-related to Unmada based on the sign and symptoms. Approach to Doshas involved, symptoms and Chikitsa are explained in the same. On this basis the case was diagnosed as Vata-Pittaja Unmada and accordingly treatment has been planned. Treatment included Deepana, Pachana, Shirodhara, Matra Basti followed by Shaman Aushadi with Medya drugs, Asyapratisarana and Pratimarsha Nasya along with speech therapy. As ADHD is Yapya Vyadhi an attempt was made to increase the quality of life to child as well as for the family and it gave the satisfactory results for which even the parents are also happy.

Reference

1. Paul Vinod K, Bagga Arvind. Ghai Essential Pediatrics. New Delhi: CBS Publishers and distributors; 9th edition. Pg 56.

2. Kleigmn Robert, Stanton Bonita, Jenson Hal B,Behrman Richard. Nelson textbook of Pediatrics. New Delhi: Elsevier publishers; 20th edition. pg 200.

3. Tripathi Brahmanand. Charaka Samhita. Varanasi: Chaukamba Publications; edition 2012. pg 1169

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-05-07	2022-05-09	2022-05-16	2022-05-23	2022-05-29
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	16%

Case Report

ADHD

Journal of Ayurveda and Integrated Medical Sciences