“ Importance Of Homoeopathic Rubrics & ISAA Scale In the Management O f Autism Spectrum Disorder”

Background: Autism Spectrum Disorder (ASD) is a complex developmental disability that affects communication, social skills, and behaviour. Conventional treatments have limited effectiveness for the core symptoms of ASD. Homoeopathy, on the other hand, uses detailed rubrics for Repertorization that can help guide individualized treatment. Aims: -Evaluating the role of Rubrics & ISAA scale in enhancing the management of ASD. Methodology: The study involved 120 children, between the ages of 2 to 12 years, who were clinically diagnosed with ASD. Detailed case-taking was conducted, which included physical generals, mental generals, particulars, and constitution. Prominent rubrics related to behaviour, communication, cognition, and sensation were identified and applied in repertorization for remedy differentiation. The outcomes included quantitative autism assessment scores using Assessment / diagnostic tool ISAA and qualitative feedback from parents and therapists at baseline and 12 months post-treatment. Results: The study showed marked improvements in the main behavioural, emotional, and sensory areas after individualized homoeopathic treatment guided by rubric selection. Statistically significant differences were seen in autism scores pre-and post-treatment (p<0.05). Conclusion: The study illustrates the essential role of in-depth rubric analysis in successful homoeopathic prescribing for autism spectrum disorder. The results showed positive outcomes when treatments were optimized through correlation of the characteristic symptoms and key rubrics.


INTRODUCTION:
Autism is a neuropsychiatric childhood disorder characterized by severe and pervasive impairment in several areas of development such as social interaction skills, communication skills and/or presence of stereotype behaviour, interest and activities.The onset is usually within the first years of life (1,2) .Specific autistic characteristics usually appear before the age of 3 years, and some children on the spectrum may have limited nonverbal and verbal communication by the age of 18-24 months (3) .PREVALENCE: The prevalence of autism spectrum disorder (ASD) and, specifically, is reported to have been increasing over time (4,5) .The estimated prevalence of Autism in India is around 1 in 68 children (6,7) .Boys are more commonly affected by Autism than girls, with a male-to-female ratio of approximately 3:1 (4,8) (9,10) ETIOLOGIC AND GENETICS: ASD is recognized as a complex disorder influenced by genetic, environmental, and possibly immunological factors.Studies have identified numerous genetic variations associated with ASD, highlighting the heterogeneous nature of its genetic architecture (8) Environmental factors such as prenatal exposures and maternal health during pregnancy have also been implicated in the development of ASD (11,12) EPIDEMIOLOGY: The World Health Organization (WHO) estimates the international prevalence of ASD at 0.76%; however, this only accounts for approximately 16% of the global child population (5) .As there was no Indian scale to diagnose or measure autism, the National Institute for Mentally Handicapped (NIMH) developed the Indian Scale for Assessment of Autism (ISAA) for diagnosing and measuring the severity of autism in 2009 (13)(14)(15) .
The Indian Scale for Assessment of Autism (ISAA) was jointly developed by the National Trust, Ministry of Health and Family Welfare, and Ministry of Social Justice and Empowerment of the Government of India (16,17) .Norms of ISAA for Diagnosis of Autism <70 normal, 70-106 mild autism, 107-153 moderate, 153 above severe autism (17,18) MATERIALS AND METHODS: Primary source: all cases were collected different periphery O.P.D of Bharati Vidyapeeth Homoeopathic medical college, cases were recorded according to neurologic case format, including detailed personal history, past history, medical history, family history and all necessary investigation.Total Duration of study was 12 months with 162 Sample Size, out of which 42 cases were drop out, so the total number of sample size is 120 for the study.Two group were made, Group A (constitutional) and Group B (clinical) computerized randomization, Isaa tool was used for the study.Comparison between Treatment Groups (Clinical vs. Constitutional):

Hypotheses tested:
Ho: There is no significant difference between the two treatment groups clinical and constitutional as far as the Total score of autism before treatment is concerned.

GENERALS ENERGY -excess of energy
Against H1: There is a significant difference between the two treatment groups as far as the Total score of autism before treatment is concerned.
Similarly, Ho1: There is no significant difference between the two treatment groups clinical and constitutional as far as the Total score of autism in the middle of the treatment is concerned.
Against H11: There is a significant difference between the two treatment groups as far as the Total score of autism in the middle of the treatment is concerned.Before treatment, the mean rank of the clinical group was observed to be 57.22 and that of the constitutional group was 63.89.Here the test statistic Mann-Whitney U statistic: 1599.5 with a pvalue of 0.294.Here, p-value >0.05 is statistically non-significant.We cannot reject Ho and conclude that there is no significant difference between the two groups as far as the total score of autism is concerned before the treatment.
In mid of the treatment, the mean rank of the clinical group was observed to be 71.23 and that of the constitutional group was 49.41.Here is the test statistic Mann-Whitney U statistic: 1145 with a p-value of 0.001.Here, p-value < 0.05 is statistically significant.
We can reject Ho and conclude that there is a significant difference between the two groups as far as the total score of autism is concerned in the middle of the treatment.
After treatment, the mean rank of the clinical group was observed to be 83.43 and that of the constitutional group was 36.80.Here the test statistic Mann-Whitney U statistic: 401 with a p-value < 0.001 highly statistically significant.
We can reject Ho and conclude that there is a significant difference between the clinical and constitutional groups as far as the total score of autism is concerned after the treatment.Figure 6: Boxplot of the group-wise total score of autism before, middle, and after the treatment.
Table 6(a) gives the descriptive statistics of descriptive statistics of Total score of autism before the middle and after the treatment and Figure 5 shows the distribution of the total score of autism for the clinical and constitutional groups before, in the middle, and after treatment.
Before treatment, for the clinical group of patients, the mean±sd of the total score of autism was 121.74±18.03and the median (IQR) was 123 (22.5).For a constitutional group, the mean±Sd of the total score of autism was 125.95±13.15and the median (IQR) was 128 (21).
During the treatment, for the clinical group of patients, the mean±sd of the total score of autism was 114.36±21.51and the median (IQR)was 106(34.5).for a constitutional group of patients, the mean autism score was 102.14±9.17 and the median (IQR) was 102 (15).
For the constitutional group, the median autism score was significantly lower than the median autism score for the clinical group.
After treatment, for the clinical group of patients, the mean±sd of the total score of autism was 109.18±21.87 and the median (IQR) was 104(26.5).for a constitutional group of patients, the mean autism score was 102.14±9.17 and the median (IQR) was 102 (15).For the constitutional group, the median autism score was significantly lower than the median autism score for the clinical group.
Figure 6 shows the treatment groupwise boxplot of the total autism score before, middle, and after treatment.The boxplot shows that the range of autism scores for the constitutional group was significantly lower than that of the clinical group.The results from the Friedman test as indicated by the table show that there is a highly significant difference in total autism scores across different time points within groups since the p-value is less than 0.01.This suggests that treatment has had a statistically significant effect on total autism scores.we can reject the null hypothesis and conclude that there is a significant difference in total autism scores across at least one of the time points within groups.This indicates that the treatment had an impact on improving or altering total autism scores among participants.
Figure 7: the mean rank of total score of autism at three points of time for clinical and constitutional groups.
Figure 7 shows the mean rank of the autism score at three points in time for clinical and constitutional groups.
For the clinical group, the mean rank of the autism score was 2.63 which reduced to 1.86 in the middle of the treatment and further significantly reduced to 1.51 after treatment.For the constitutional group, the mean rank of the autism score was 3.00 which reduced to 1.98 in the middle of the treatment and further significantly reduced to 1.02 after treatment.
RESULT: For both clinical and constitutional treatment groups, there is a significant difference between average autism scores in the Middle and after treatment.The test statistic value for the clinical group was 0.352 with a p-value <0.001 highly significant and for the constitutional group, the test statistic value was 1.983 with a highly significant p-value <0.001.
Group 2-12 years of age.ii.Both the sexes.iii.Mild and Moderate form of Autism.iv.Patients ready to sign consent form.Exclusion Criteria: i. Case < 2 years & > 12 years of age.ii.Cases of Mental retardation, Cerebral palsy, Down syndrome, Rett's syndrome,

Figure 1 :
Figure 1: Pie diagram representing Age-wise distribution of patients

Figure 2 :
Figure 2: Distribution of patients according to Gender

Figure 3 :
Figure 3: Distribution of patients according to treatment group.

Figure 4 (
Figure 4(a): Remedy-wise Distribution of patients in a constitutional group

Figure 4 (
Figure 4(b): Remedy -wise Distribution of patients in clinical group

Table 1 :
Distribution of patients according to age

Table 2 :
Gender-wise distribution of patients

Table 2 and
Figure 2show the Distribution of patients according to Gender.33.33% of patients were girls and 66.67% of patients were boys under study.

Table 3 :
Distribution of Patients according to treatment group.

Table 3 and
Figure 3 show the Distribution of patients according to treatment group.50.83% of the patients were treated with a clinical treatment group where Homoeopathic Medicines with Rubrics were applied.49.17% of the patients were treated with Constitutional Homoeopathic medicines.

Table 4 :
Remedy-wise distribution of patients.

Table 4
shows the remedy-wise distribution of patients.Figure4(a) shows the remedy-wise distribution of patients in a Clinical group.The top three medicines prescribed in the clinical group were Tarentula cubensis, Arnica Montana, and Zincum Metallicum.Tarentula cubensis was given to 14.2% of patients in the clinical group.Arnica Montana was given to 9.2% of the patients and Zincum Metallicum was given to 8.3% of the patients in a clinical group.Figure4(b) shows the remedy-wise distribution of patients in a Constitutional group.The top three medicines prescribed in constitutional were Calcarea Carbonica, Syphilinum, and Hyoscyamus Niger.Calcarea Carbonica was prescribed to 6.7% of the patients.Syphilinum was given to 5% of the patients and Hyoscyamus Niger was given to 3.3% of the patients.Figure4bshows the remedy-wise distribution of patients.

Table 6 :
Mann -Whitney test of Total score autism score before, middle, and after the treatment for Treatment Groups Clinical and Constitutional.

Table 6 (
a): Descriptive statistics of Total score of autism before middle and after the treatment.

Table 7 :
Friedman's test and Descriptive statistics of the total autism score before, middle, and