High Fever Manifestation During Acute Infections Coincides with Improvement in Autism Spectrum Disorder (ASD) While Under Classical Homeopathy, A Case Report

Introduction

Autism Spectrum Disorder (ASD) is one of the most frequently occurring neurodevelopmental conditions in children.¹ It is estimated that around 2 million children suffer from ASD in India, with every 1 in 65 children being affected.² Repetitive and restrictive behaviour patterns, together with impairment in social interaction and communication, are the hallmarks of ASD.³ Boys are four times more likely than girls to have the disorder, and comorbidities such as depression, anxiety, epilepsy, attention deficit hyperactivity disorder (ADHD), intellectual disabilities, sleep disorders, and gastrointestinal issues are common.^4,5

Diagnosis of ASD is most frequently made in early childhood. Though many standardized screening and diagnostic tools are available today, M-CHAT (Modified Checklist for Autism in Toddlers), CARS (Childhood Autism Rating Scale), and DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) are the most widely used.^6,7 CARS (sensitivity 0.93 and specificity 0.49) is a 15-item assessment tool in which each item in the test is rated on a scale of 1–4, with higher scores indicating greater impairment. A total score of 15–29 indicates non-ASD, 30–36.5 indicates mild to moderate ASD, and 37–60 indicates severe ASD.⁸ CDDC (Communication DEALL Developmental Checklist) is used to assess developmental skills in children aged 0–6 years. It covers 8 domains (gross/fine motor, activities of daily living, receptive/expressive language, cognitive, social, and emotional skills) and has 36 questions per domain.⁹

ASD is typically a lifelong condition. However, symptom severity can decrease over time, and individuals may no longer meet the diagnostic criteria in certain instances. Communication and social interaction skills often improve with age. Hence, language development and average nonverbal Intelligence Quotient (IQ) are reliable predictors of a favourable prognosis.¹⁰

Recent studies suggest a potential correlation between autism spectrum disorder (ASD) and chronic neuroinflammation. This inflammatory state is believed to be driven by the activation of microglia, astroglia, and pro-inflammatory cytokines in specific brain regions of individuals with ASD.^11–13 Behavioural, occupational, and speech therapy are all used in the conventional management of ASD. However, these therapies might not be sufficient to manage neuroinflammation associated with ASD.¹²

There is growing evidence that parents of children with ASD frequently opt for complementary and alternative medicine (CAM).¹⁴ Homeopathy has been proven beneficial in children with ASD as evidenced by the study of Vaidyeswar and Rao, where a retrospective analysis of 60 cases indicated measurable improvements in speech, cognition, and behavior. The most notable shifts were observed in children aged 2–5, with progress recorded over a 3-to-4-year period alongside concurrent therapies, where children with ASD showed a significant reduction in hyperactivity, behavioural dysfunction, sensory impairment, and communication difficulty with homeopathic treatment.¹⁵ An open-label, single-arm study by Nair et al observed significant clinical reduction in ASD severity over a one-year period. By utilizing a personalized approach that addressed the unique mental and physical “totality” of each child, the study reported a significant improvement in social interaction and reciprocity, however the authors acknowledged the lack of a control group and assessment of investigative markers such as neurotransmitters.¹⁶

The “Continuum Theory” propounded by Vithoulkas et al, used as a conceptual framework for classical homeopathic treatment prognosis, posits that the existence of chronic inflammatory states implies inefficient acute inflammatory responses in an organism. Therefore, acute inflammatory defence in response to common infections may be absent or lack characteristic features, such as high fever.¹⁷ They further state that the return of acute illnesses with high fever (efficient acute inflammatory defence) during treatment for chronic disease is a positive prognostic sign.^17,18

We describe a case of ASD, intending to present an unconventional approach to its management and the observation of improved acute inflammatory defence (high fever during common infections) in the course of such an approach, as the ASD symptoms improved under classical homeopathic treatment. The CARS and CDDC were used to assess the outcome.

Case Description

The patient, a 2-year-9-month-old Indian boy, presented for homeopathic consultation in October 2015. The diagnosis of mild to moderate ASD was made for him in March 2015. He was given speech and language therapy, which was stopped six months into homeopathic treatment.

Presenting Complaints

On initial presentation for homeopathic consultation in October 2015, the patient had delayed speech, would make noises, and could speak only one or two words, without meaning. He did not respond to his name being called, made no eye contact, and did not play with other kids. There was a history of delayed milestones as he started sitting at eight months and walking at one and a half years of age. At around sixteen months of age, the patient’s mother started noticing significant changes where the child stopped responding to his name and stopped crying to indicate passing stool and urine.

Past Medical History

The patient had a history of repeated episodes of influenza with mild fever till about fifteen months of age, which were treated with antibiotics.

Birth History

The child was born by lower segment caesarean section (LSCS) at full term, as the mother had a previous LSCS. His birth weight was 3.4 kilograms (7.5 pounds).

Family History

There was a strong family medical history of tuberculosis on his mother’s side.

Investigations

On audiology and speech language evaluation performed at 2 years, 2 months, the child was found to use nonverbal modes of communication predominantly, and have poor attention, eye contact, and imitation skills. He was noted to have fair cognitive skills (Figure 1A).

Figure 1 (A) Summary Report of School of Audiology & Speech Language Pathology & CDDC evaluation of 16 March 2015. The highlighted section indicates the total CARS score of 33, categorized as mild to moderate ASD. (B) CDDC evaluation of 04 Jul 2017. (C) CDDC evaluation of 10 Aug 2018. Notes: The following typographical errors appear in the original reports and are noted here for clarity: “referrence” (reference), “observrations” (observations), “corelation” (correlation), “inconsistant” (inconsistent), “irrelelevant” (irrelevant), and “anamolies” (anomalies).

The Modified Checklist for ASD in Toddlers (M-CHAT) was administered, and the report indicated that the child showed a deficit in two critical items, namely verbal skills for any direct or indirect speech and attention deficit (eye contact, imitation, sitting to play), and CARS showed a score of 33, which indicates mild to moderate ASD.

CDDC assessment was as shown in Table 1.

Table 1 CDDC Assessments

Diagnosis

Autistic disorder (ICD-10: F84.0).¹⁹

Differential Diagnosis

ASD must be differentiated from other developmental disorders like Rett syndrome and other psychiatric conditions like selective mutism, intellectual disability, attention-deficit hyperactivity disorder (ADHD), and childhood schizophrenia.²⁰ Clinical screening tools confirmed the diagnosis in this case.

Homeopathic Consultation

On October 18, 2015, the patient presented with delayed speech, sudden shrieking, and autistic symptoms as listed above. The homeopathic symptoms of note were as follows: offensive-smelling stools, passed while standing; aversion to sweets and craving of bananas and chalk; tendency to be restless, obstinate, and mostly engrossed in own world; becoming angry at contradictions and fearing people; and continuously placing a collar/napkin in his mouth.

Classical homeopathy involves a tailored prescription of a single homeopathic remedy based on an in-depth evaluation of mental, emotional, and physical symptoms. The speech delay, along with obstinacy, restlessness, a history of delayed walking, peculiar stool symptoms, and aversion to sweets, indicated the homeopathic remedy Causticum hahnemanni.²¹

Prescription

Causticum 1M, one dose.

Follow-up and Outcome

This case was followed up for eight years, during which the patient received several remedies, a single remedy being chosen each time, based on symptom similarity. Improvement began within a few months of initiating the treatment with Causticum 1M, and subsequent remedies were prescribed according to evolution of symptom totality over time. The patient showed remarkable improvement in communication and cognitive skills, as appreciated on the CDDC (Figure 1B, C and Table 1) and CARS (Figure 2); these improvements are graphically represented in Figure 3. By age of ten years, the child showed no signs of ASD, and his IQ was assessed to be 102 (Figure 4A). It was noteworthy that his academic report for the year 2023–24 showed “A” grades in most of the scholastic and non-scholastic activities (Figure 4B). The detailed follow-up from 2015 to 2023 is given in Table 2.

Table 2 Follow-Up of the Case

Figure 2 (A) CARS Test Scores of 04 Jul 2017. The highlighted section indicates the total score of 22, interpreted as minimal autistic features. (B) CARS Test Scores of 10 Aug 2018. Notes: The following typographical errors appear in the original reports and are noted here for clarity: “inconsistant” (inconsistent), “referrence” (reference), “irrelelevant” (irrelevant), and “consistensy” (consistency).

Figure 3 (A) Graphical representation of CARS scores across time points. Orange represents the baseline score (2015), blue represents post–high fever assessment (2017), and purple represents the final assessment (2018). (B) Comparison of CDDC developmental domains between 2017 and 2018 assessments, demonstrating improvement across multiple developmental domains.

Figure 4 (A) Developmental tests assessment of 05 May 2023, demonstrating an IQ score of 102 within the average range (90–110). The highlighted section is intended to emphasize the child’s developmental synchrony and IQ. (B) School report card of 2024 demonstrating consistent academic performance across scholastic and co-scholastic domains. Red boxes highlight the grades for ease of identification. Notes: The following typographical errors appear in the original reports and are noted here for clarity: “pediatrcian’s” (pediatrician’s).

Discussion

Though the relationship between fever and ASD is multifaceted and complex, studies suggest that autistic children often exhibit a reduced frequency of fevers compared to their neurotypical peers. On the other hand, autistic children who do develop fever are in a very crucial stage where it is important to preserve their defence mechanism.²²

According to the Continuum theory of diseases mentioned above, this phenomenon is from the mutually exclusive nature of efficient acute inflammation and low-grade chronic inflammation.¹⁷ The likely explanation for this is that when the organism’s health is elevated as a whole, through treatment, the neuroinflammation may decrease, leading to the onset of acute infections with fever, something it was incapable of before, in the presence of chronic inflammation.

In the above case, prior to initiating homeopathic treatment, the patient experienced only mild febrile episodes that were managed with conventional medicine. Approximately five months after treatment began, the patient developed high-grade fever during acute infections, representing a change in the pattern of febrile response. This coincided with improvement in the Autistic features. Over the subsequent two years, acute infections were more frequently accompanied by high fever. The patient received homeopathic treatment during all acute infection episodes. As the immune system was further strengthened, infections and fever became less frequent, along with continual progress in developmental, mental, and behavioural domains (Figure 3B). Acute infections, when they did occur, were consistently accompanied by high fever, indicating a robust acute inflammatory defence. Therefore, it may be asserted that the course of events, in this case, was consistent with the Continuum Theory.

The Continuum Theory by Vithoulkas provides a valuable framework for understanding the connection between acute and chronic inflammatory states, which helps guide case prognosis and treatment decisions.¹⁷ The improvement in chronic inflammatory states, post mounting an efficient acute inflammatory response with fever, was observed in cases where classical homeopathy was applied.^23–25 Also, in a case-control study, it was verified that patients diagnosed with chronic inflammatory conditions who were under homeopathic treatment showed improvement in their condition once the ability to put up a high fever returned.¹⁸

The Modified Naranjo Criteria for Homeopathy (MONARCH) causality assessment provided a score of 11/13, suggesting a significant benefit from the treatment (Table 3). There is a rare possibility for ASD symptoms to resolve on their own in a short period without treatment,²⁶ which was unlikely because our case showed no improvement despite therapies.

Table 3 Modified Naranjo Criteria for Homeopathy (MONARCH) – for Causality Assessment

The limitation here was the inability to demonstrate whether the homeopathic remedies influenced the immune system in resolving chronic inflammation and mounting acute inflammation, as no immunological parameters were investigated. Also, this being a case report, the observed outcomes should be viewed as preliminary. While the results are encouraging, they necessitate further rigorous study to establish definitive efficacy.

Conclusion

This case report presents an eight-year follow-up of a 2 year 9 months old Indian boy diagnosed with mild to moderate ASD. The patient received individualized classical homeopathic treatment under which neurocognitive and psychological domains showed improvement. By age ten, his IQ came under the average range for his age, he could speak four languages, and he scored “A” grades in both scholastic and non-scholastic activities. The improvement became evident after common acute infections with high fever (did not occur previously in the patient) started to appear. This observation was consistent with the findings of the Continuum Theory proposed by Vithoulkas et al. By highlighting this observation in the case, we aim to contribute to understanding the relationship between chronic and acute inflammation in ASD and present a therapeutic intervention that intends to preserve the immune system’s functionality, thereby preventing the progression of chronic inflammatory states.

This ASD case improved in the neurocognitive and psychological domains under classical homeopathic treatment, as evidenced by the clinical observation scores. Such improvement was associated with the onset of the ability to raise high fevers during common infections, absent before. This observation was in accordance with the continuum theory, and larger scientific studies are essential to confirm this connection between fever (efficient acute inflammatory defence) and ASD (chronic inflammation).