by Ian R. Luepker, ND, DHANP
Though most infants, even newborns, are communicating and interacting socially long before they can use language, parents eagerly await their toddler’s first words--a milestone that usually occurs around the child’s first birthday.
But for Simon, the time for this milestone came and went in silence.
Simon missed other milestones, too. “Everything was late,” Hannah, Simon’s mother told me. “He crawled late, walked at 22 months, no babble…”
Pediatricians, friends, and family may reassure worried parents of a child like Simon that he is simply a “late-bloomer” or that “boys talk later than girls.” But sometimes, there is an underlying root issue that helps to explain the delay.
The words don't flow
The list of possible explanations for a speech-language delay is long--autism spectrum disorder or another developmental disability; auditory sensitivities; auditory processing difficulties; deafness; a history of repeated ear infections; a short frenulum (membrane attaching the tongue to the floor of mouth) that literally “tongue-ties,” and, in Simon’s case, apraxia of speech (also known as verbal apraxia, verbal dyspraxia, or childhood apraxia of speech).
“Praxis” is the ability of the brain to conceive, organize, and, ultimately, carry out a sequence of motor movements. So a child with apraxia of speech has difficulty sequencing the motor movements needed for volitional speech.*
Imagine living in a world where you can understand what people say perfectly well (receptive language) but you are unable to respond (expressive language). A child with apraxia of speech may know exactly what she wants to say, but somewhere between this thought and its volitional expression, the necessary coordination of a complex sequence of motor movements involving her tongue, lips, throat, and breath does not come together quite right. The words don’t flow. Children with verbal apraxia may have difficulty imitating sounds, answering questions, or producing words on demand. They may have trouble getting the words out in the desired order or may be inconsistent with pronunciation.
In addition to verbal apraxia, six-year-old Simon struggled with a sensory processing disorder and a tic disorder. If verbal apraxia and sensory processing disorders are not addressed, life for children like Simon only becomes more difficult; their self-esteem suffers and frustration builds as they repeatedly fail to negotiate their verbal and sensory-rich landscapes. Though 20% of all children may experience a transient tic disorder that can spontaneously resolve without treatment, Simon’s tic disorder was considered chronic due to its duration and intensity. Conventional medical practitioners frequently prescribe clonidine (Catapres®) and guanfacine (Tenex®), or anti-psychotics such as haloperidol (Haldol®) to suppress tics. These drugs carry considerable risk of unwanted side-effects. Hannah sought homeopathic help for Simon's verbal apraxia, sensory processing, and tic disorders in hopes of getting relief with a safe, holistic approach without having to resort to such conventional medications.
He will wrap you around his finger!
“Simon was my third pregnancy and it was a stressful time," Hannah explained. "We were in the process of moving and Simon’s grandfather was dying of cancer. When Simon was born, I didn’t have much milk. He also had trouble breastfeeding because he was sucking from his throat rather than his mouth.” Simon’s inability to coordinate the motor movements necessary to suckle was an early sign of dyspraxia.
“Now, at age 6, he is in a regular classroom. Several therapies have helped, but there is still something odd about him. He can come across as typical, but the more you talk with him, the more you realize his speech is different. For example, he will commonly misuse or omit words and skip pronouns. He’ll say ‘Do you play basketball with me? Do you play? Do you play?’
“If you ask him a question somewhat out of context, he often responds with a nonsequitur, something completely unrelated to the question. Sometimes he will use sentences he is familiar with, but they are out of context.
“He has some sensory issues--he 'stims' [short for 'stimming' or self-stimulating] by taking his fingers and pressing firmly down on his head while grinding his teeth. He tends to do it more when he is tired, having a bad day, or stressed. He will clap his hands quickly, and he’s a hand-flapper, too. He likes to be squeezed and enjoys deep pressure. Swimming under water provides this pressure for him. He loves it! He likes electric sounds, and will bring them close to his ear. He has a very high pain threshold.
“Simon has a tic--he will scrunch his eyes together. It sort of looks like a twitch.
“In general, he does better with family and people familiar to him. When we have guests over, it disrupts his environment and is stressful for him. Recently, he has become really moody. His frustration threshold is low and he goes between crying hysterically and laughing very quickly.
“In general, Simon is very endearing. Happy, funny, lovely! He will wrap you around his finger. He will walk around the classroom, by himself, smiling. He gets away with stuff because he is so endearing!”
Hannah told me that Simon’s tastes tended toward sweets, fish, salty foods, pickles, and eggs.
In considering Simon’s case, what stood out the most was his unusual use of language. He would answer questions with irrelevant answers and omit or misplace words when speaking. Also, he was very slow learning to talk.
Simon’s unique sensory profile could be described as simultaneously hypo-responsive (i.e., under-responsive to stimuli) and sensory craving. His love of deep pressure, tendency to seek out electric motor sounds, and affinity for being squeezed are examples of a craving for stimuli. Simon’s habit of pressing his fingertips firmly down on the crown of his head while grinding his teeth apparently satisfied some unmet sensory need. On the other hand, his high pain threshold was indicative of a hypo-responsiveness. Not surprisingly, children like Simon who are hypo-responsive to stimuli often crave it.
While at school, Simon would walk around the classroom by himself, smiling and happy--yet withdrawn, verbally, from the world around him. This struck me as an interesting juxtaposition: a happy loner, walled off from social interaction by his difficulties with communication. Simon's recent episodes of alternating quickly between laughter and tears made sense to me, as children struggling to express themselves verbally may have difficulty with emotional self-regulation.
Just a dash of nutmeg
In analyzing Simon’s case, I sought a remedy that would address his difficulties with language and communication, his sensory issues, and his changeable moods.
I first considered Alumina (a homeopathic remedy prepared from aluminum) because its indications were similar to some of Simon’s idiosyncratic uses of language and alternating moods. But Alumina is a very well-known and well-proven remedy, so I am not likely to prescribe it when a case is missing some essential Alumina indications. Simon’s case lacked a history of constipation, which I would expect to be present (and often central) in an Alumina case. I also considered homeopathic Opium because its indications corresponded with Simon's high pain threshold and Simon’s withdrawal into an inner world. However, it conspicuously failed to cover his communicative quirks, and, in my experience, I expect to see more fright and violence (often manifested in dreams of war) in those needing homeopathic Opium. Finally, I briefly considered Plumbum (a homeopathic remedy made from lead) as a possible choice for Simon. Like Alumina and Opium,Plumbum is considered a neurological remedy. Yet because its indications didn’t cover his language difficulties, I didn’t feel this remedy matched Simon's totality of symptoms as well as Nux moschata.
Made from nutmeg, Nux moschata seemed to thread the most characteristic aspects of Simon’s case together, and I excitedly delved into the materia medica ofNux moschata to ensure that the other components of Simon’s case were represented. Allen’s Encyclopedia describes these proving symptoms of Nux moschata: “unusually happy, but could not talk and had no desire to talk. Ideas were somewhat confused with great incoherency on attempting to express her idea.” Nux moschata also matched Simon’s sensory issues, including his desire for pressure, hypo-responsiveness to stimuli, and teeth grinding. Additionally, it covered his changeable mood--“an alternation between laughter and tears, a sudden change from grave to gay, lively to serene.”
I gave Simon a single dry dose of Nux moschata 200c.
No more flapping
Six weeks later, Simon's mother contacted me with a glowing follow-up report: his sensory issues had improved by at least 50%! She told me that his “sensory stim” of placing pressure on his head while grinding his teeth had lessened. Even more encouraging, however, was the news that his speech had become clearer and more understandable. In fact, Simon’s teachers were commenting that they understood him much better now. Hannah exclaimed: “This is huge! He seems more mature. It has really been amazing…this remedy is helping him a lot!”
One of the most striking changes in Simon came just two days after his first dose of Nux moschata. Hannah said that he came home from school and started to eat his snack as usual. He finished his snack, started flapping his hands, then looked at his hands, and stopped flapping! “He hasn’t flapped his hands since!”
Four months after the initial dose of Nux moschata, Hannah told me that his tendency to answer questions irrelevantly had decreased more than 80%!
One year into Simon’s homeopathic care, the gap continued to narrow between other children and Simon. During a meeting with his teachers and therapist, Hannah learned that Simon was continuing to develop friendships with other children.
Now, nearly two years have passed, and Simon continues to make progress in all areas. Hannah recently told me that she feels homeopathy has helped Simon “find equilibrium.” It has eased his sensory needs (e.g., for deep pressure) and helped him with his stims and tics. “He has more control over his stims. In general, he comes across as more age-appropriate,” Hannah tells me. He is playing soccer and basketball, and he's one of the fastest swimmers on his swim team!
One of the indications that Simon needs another dose of Nux moschata is when his facial twitch/tic returns. Amazingly, his tics will disappear within 48 hours of a re-dose of the remedy! Since beginning his homeopathic treatment two years ago, Simon has needed seven doses of Nux moschata (beginning with the 200c potency and later increasing to 1M), and each time his vital force responds robustly with cognitive, communicative, and sensory integrative gains.
Recognizing that many hands have been involved in Simon’s progress, I asked Hannah what other interventions, in addition to classical homeopathy, have been most helpful for her son. "First and foremost," she responded, “patience!” Simon also benefited greatly from a skilled speech therapist trained in the PROMPT method. Far from a “cook-book” approach, this therapy looks at each individual to determine how to develop the most normalized and flexible motor control, cognitive skills, and social interactions. Chiropractors, cranial-sacral therapists, and occupational therapists trained in sensory integration have also benefited Simon considerably. In addition, fish oils, carnitine (an amino acid), and supplemental iron for an iron deficiency have made a difference.
The beauty of self-expression
Simon has made enormous progress over the last two years, thanks to Hannah’s diligence in finding non-invasive therapies for Simon. She especially credits homeopathy with greatly reducing or eliminating his tics, hand flapping, and other repetitive behaviors and improving his sensory processing. Most importantly, homeopathic treatment has dramatically helped him integrate the innumerable processes bridging thought to speech.
Simon's inner nature remains--he’s a happy, loving, and endearing child. What has changed is his ability to express that beautiful inner nature with words!
* Simon's verbal dyspraxia is in contrast with "global dyspraxia," in which a child has difficulties executing a broader range of fine and gross motor movements. With these children, developmental milestones such as rolling over, crawling, and turning the head will be delayed or missed.
Find Out More
For more information about Childhood Apraxia of Speech (CAS) and dyspraxia, Simon's mother Hannah recommends The Late Talker by Dr. Marilyn Agin and Lisa Geng, and Developmental Dyspraxia by Madeline Portwood.