Exam Season - A parent's concern

1. Can you illustrate on how badly stress at school can affect children if left untreated?

A secondary 4 student in an elite school came to see me for low mood. He has been feeling that he cannot cope with his schoolwork and constantly feel pressurized as his classmates appear to cope better than him. He feels lousy about himself and that he is useless. He also started having suicidal thoughts. Despite having worked hard, he was very anxious prior to his school examinations as he was worried he would not do well and his results would be poor. He was also very fearful and catastrophized about the 'O' levels exams. 

2. What could happen to a child if they become too overwhelmed by anxieties? Some cases state self-mutilation and even suicide?

When a child becomes too stressed and anxious, they can develop aberrant behaviors. These can include tantrums and complaints of physical discomfort like stomachache in younger children. Teenagers may have deliberate self harm. They may become depressed and have suicidal behaviors. 

3. What are some of the ways I can help my children cope with academic pressure and exams today?

Focus on the process and not results. 

The most important factor in helping children cope with academic pressure is in shifting the focus and attention away from results to the process of working hard. This does not only emphasize the right value of hard work and perseverance but will also lessen anxiety as the child knows that as long as he worked hard, he has done well, rather than having to get good results in the examinations which can sometimes be dependent on factors such as luck. 

Stress management. 

Help the child learn about stress management. This can be achieve through proper rest and sleep, regular exercise, and having hobbies and time to play. A happy and stress free child will be more effective and passionate about learning. 

Sharing your experience. 

Children learn by modeling after their parents and mentors. Share anecdotes and stories about yourself and your experiences of how you dealt with your stress and academic hurdles. These stories will help the child know that he is not alone in facing these pressures and that he can overcome them. 

Maintaining long term goals and outlook. 

Explore with your child what his goals in life are and set long term targets. Understand that there are many ways to achieve these goals and many paths will lead them to where they will like to be in the future. When he realizes these, failing an exam or getting not so good grades will not be as daunting given the larger long term picture. 

2018 - Changes Ahead

Dear Readers,

Thank you for following this blog and emailing me with suggestions from time to time. This blog was meant to help compliment my clinic website, Psychiatrist Singapore. When I started out, I was writing my website with HTML and refused to use content management systems. However, with mobile access being the main way we use the internet these days and the need for fluid layout, my amateurish abilities in HTML no longer cut it and I had to move to CMS.

With my website now created with Wordpress, there seems no reason for me to not host my Blog on my main website. I will slowly migrate most of my articles to the new blog. Nevertheless, I find it a waste to shut down this blog and will use it to blog about my personal reflections of my life and my work. I will also leave most of the questions I have been asked over the years here as most of them pertain to parenting and child issues (understandably, lots of anxious parents out there in Singapore) but may not be entirely relevant to my work.

See you around :)

Adult ADHD in Women

With the improvement in understanding of Adult ADHD, we have today managed to also improve on our diagnostics of ADHD. This means that more are aware and can be helped.

While many will assume that only working female or working mothers need help with the poor concentration and attention deficits inherent to ADHD, non-working women or homemakers are vulnerable too! Whereas working adults may have the structure of their workplace, the routine of work and their superiors supervising them and keeping things in check, women and mothers at home have to keep their own schedules. Being a homemaker is a full time job requiring one to keep to schedules (picking children to and fro school and activities), deal with finances (marketing and paying bills) and multiple other work in between (cleaning, cooking, laundry, etc).And often without help!. In an individual with ADHD who has difficulties keeping a routine, tends to procrastinate or simply gets distracted easily, life as a homemaker can be chaos.

Even if one does not wish to seek treatment for ADHD, many a times, understanding what the underlying problem is and knowing one's weakness and limitations, help to put away the unnecessary sense of guilt and worthlessness, and decreases the possibility of other consequences of ADHD.

This article,on USA Today, explores why ADHD diagnosis is on the rise in America.

Question of the Week: Telltale Signs of Autism?

What is Autism? 

 Autism or Autistic Spectrum Disorder as it is formally known, is a neurodevelopmental disorder arising in childhood characterised by abnormal social communication and interaction and restricted, repetitive or stereotyped behaviour, interests. and activities.

What causes Autism? 

 The causes of Autism is unknown and are likely multifactorial in nature. Research suggests that there is a genetic component but the exact genes involved remain unknown. In recent years, childhood immunisations have been blamed for causing Autism but this myth has been largely debunked.

What are the early warning signs of Autism? 

 Babies or toddlers with Autism may manifest early signs such as poor eye contact when fed or smiled at, not waving goodbye or using gestures to communicate, not responding to a familiar voice or when his or her name is called. They may have delays in speech developement. They can also adhere more ridgidly to routines and may show perculiar and fixations to certain activities, often repeating them incessantly.

 How is Autism diagnosed? 

 Autism is diagnosed by specialists like developmental paediatrician, neurologists, psychiatrists or clinical psychologists. Careful history taking from the parents and obeserving the behaviour of the child will help the specialists come to a diagnosis. At times, autism scales can be used to assist in this process.

 What to do if you are worried? 

 If worried, it is best to bring your child to a specialist.

Social Media Addiction Q and A Part 2

Are there any trends in the way social media addiction occurs or presents itself?
The underlying behavioral addiction symptoms and profile of patients remains the same but the apps or websites addicted to changes with time and fad. Social media addiction is now more associated to the use of smartphones than the personal computer.

What health problems can social media addiction cause? 
The main harm is the disruption to one's life and routine causing social difficulties. For e.g., a student may stop going to school. If one tends to spend most time on social media and stop tending to his or her food intake, neglect regular exercising and sleep, this can lead to general ill health.

Many people might not even be aware they are addicted to social media. What are the signs that individuals and family members can look out for? 
Loved ones often have the unenviable position of determining if the usage of social media is indeed excessive. I have seen cases where parents overreact to normal usage and at other times being unaware that their children have lapsed into addiction. If loved ones notice that the patient is spending more and more time on social media, is neglecting their studies or work, tends to be sleepy in the morning as they are using social media excessively at night or become irritable or aggressive when pointed out that they are overusing, they can seek help with professionals to determine if the patients have an addiction problem.

What are some tips on overcoming the addiction? 
We cannot avoid the use of social media as it is a great resource and it will be important for parents and school to educate on responsible usage. Prevention is always superior to cure. Putting away ones' devices from time to time and having digital detox is useful. Always remember to designate areas and time of the day when devices like your smart phone should be put away. This includes at the dinner table and at bedtime. Continue to prioritize ones' friends and loved ones and having time with them in the real world than to just communicate via social media. Lastly, have real life hobbies and exercise regularly to have a good balance.

Should internet addiction as a whole be formally recognised as a disorder, why, and what difference it would make to treatment and tackling the addiction? 
Yes as it is the main type of behavioral addiction together with other forms of internet addiction at the moment. This will help bring awareness to afflicted individuals and loved one, allow for specialized services and programmes to be set up and allow for better outcomes for the patients.

Social Media Addiction Q and A. Part 1

Are such  social media addiction cases on the rise in comparison to previous years? If so, what is the increase?
The numbers have been quite similar in the past two to three years. It became more of an issue since smart phone usage proliferated.

Do you think this is an issue that is set to grow bigger?
Before it was mainly Facebook, but now there is Instagram, Snapchat etc. Internet and social media addiction have been a problem in the past decade since Facebook. The app used may change but the underlying harmful and addictive use of social media apps remains fundamentally the same.

Which sites are patients addicted to? What type of symptoms do patients with this form of addiction present with?
Most patients are addicted to a number of websites and apps. These may include common social media platforms, photo sharing apps, music / karaoke apps, internet gaming with social elements and online forums. They tend to spend excessive amounts of time on social media. This leads to harm and disruption in their life, such as missing school or not fulfilling their daily responsibilities. They later need to spent more and more time on social media in order to get the same tkick as before. Eventually, social media may become the centre of their life and they are perpetually preoccupied with using it or thinking constantly of going on it all the time. When denied usage, they may feel very uncomfortable or even become agitated.

What is the typical profile of the patients you see? Any university students?
 Many are teens to young adults. Both male and female. Almost always school going. There are university students as well.

Do the patients present with any co-occurring addiction or other medical conditions?
They usually present with co-morbid insomnia, depression and anxiety disorders.

What causes social media addiction?
Causes are unknown. They may be related to genetic predisposition to behavioral addiction. Patients may have derive pleasure and excitement from having likes, followers or positive comments from their posts and this lead to reinforcement of the behavior of excessive usage. In fact, it appears that individuals with little "real life" social networks tend to more easily fall prey to social media addictions. In cases with insomnia, they may find social media a means of dealing with their sleeplessness, having no one to talk to in the wee hours. Many with anxiety disorders and depression resort to using social media as a means to reach the outside world when they are withdrawn at home. The thrills and excitement they derive from social media and internet gaming may be the only stimulation they derive from life leading to excessive usage and addiction.

Question of the Week (31st August 2016)

From your expert perspective, at what age is it deemed OK for parents to leave their child at home alone?

It is difficult to define a specific age as children vary in their development and maturity. Pre-schoolers and those under 10 years of age must not be allowed to stay alone at home. Beyond ten, it becomes controversial. In the legislation of some foreign jurisdiction, children up to 15 years old are not allowed to stay at home. As each child is different, it will be best for parents to understand their child's temperament, maturity level and his or her propensity towards being impulsive to determine if their child can be safely left alone at home. 

If a child has to be left alone for any period of time, what tips do you recommend to parents in order for them to keep their child safe?

Firstly, never take safety for granted. Look into safety features such as locking the window grilles. Also, make sure that you are contactable so that the child can reach you immediately if he becomes frightened or has any needs. Having a good relationship with your neighbours will be important as they can sometimes keep a look out for you and the child can also approach them should any emergencies or needs arise.