My interview with Her World with regards to:

How to get along with your in-laws before and after the wedding

Read it here.

Methylphenidate (Stimulant Medication For ADHD): 4 Points to Note From a Recent Review

A recent systematic review of 185 randomised controlled trials of methylphenidate, "Benefits and harms of methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)", found that:

1) Methylphenidate can improve some of the core symptoms of ADHD – reducing hyperactivity and impulsivity, and helping children to concentrate. 

2) Methylphenidate can also help to improve the general behaviour and quality of life of children with ADHD.

3) There is no evidence to suggest that methylphenidate increase the risk of serious (life threatening) harms.

4) Methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite. 

It is important to discuss the potential benefits and risks of starting ADHD treatment for your child with his or her psychiatrist. Whilst this review did not provide any new insights to the treatment of ADHD, it consolidates what we already know in helping children who suffers from ADHD and its related consequences. Future studies will surely shed more light and strategies on ADHD treatment.

Speak to a psychiatrist today should you suspect that your child, or yourself, has ADHD.

Bipolar Disorder: Interview with Today Newspaper

I was recently interviewed with regards to Bipolar Disorder together with Dr Mok Yee Ming of IMH. You can read the article from this link.

Bipolar Disorder is a debilitating and chronic (long term) illness. Nevertheless, sufferers can lead a completely normal life with medications and treatment. Early treatment will give you the best outcome.

Question of the week (7 December 2015)

"I know I should take better care of myself but I am still young so I don't have to worry about my diet, sleeping habits, exercise, etc"

When we are young, we tend to live in denial of our mortality and as a result, we erroneously think that we can abuse our body with unhealthy diets, late nights, work stress and inadequate rest. Not only do we wear our bodies out earlier with these bad practices, we also risk them becoming habits of which will be very difficult to change even when we want to when older. 

Suggestions:

1) Never use your age as a reason as there can be no excuse to wreck your body. Your body and mind deserves to be respected.

2) The younger you are, the easier it is to form good habits, so start having healthy routines and habits as early as possible.

3) You can just do it. You will realise that living healthily (ie, adequate exercise, good sleep schedules, adequate rest and moderation in food and alcohol) is not hard to achieve at all and will help you feel both mentally positive and physically attractive.

ADHD in Children: FAQ Part 4

Some health magazines say that specific types of food (including additives) have been shown to cause or worsen ADHD symptoms. If this is true, what are some foods that parents should avoid in their child’s diet? 

Again this has never been proven. However, anecdotally, parents do notice that some children have increased hyperactive behaviour when given sweets and excessive sugar, what we call the sugar high. So avoiding sugar may be useful. It is important to remember that diet and removing additives cannot replace proper treatment. Otherwise the child continues to suffer the ADHD symptoms.

What are some ways that parents can help in managing their child’s ADHD symptoms? 

First and foremost, parents will need to be educated about that ADHD is not unlike any other medical problems and ADHD children are not lazy, naughty or being wilful. As such, what parents need to do is not be punitive but to approach the symptoms with patience and compassion and to assist the child with managing his or her symptoms.

Parents should consult their child's psychiatrist in learning about the specific approaches they can adopt. These will usually include setting up firm and consistent boundaries and routines for the child, rewarding and encouraging positive behaviour and meting out the appropriate consequences for bad behaviour. Adjustments to communication styles are important. Parents need to catch their child's attention before speaking to them rather than just yelling at them. Use as little words as possible as the ADHD child has poor attentional span and will not be able to follow long instructions.

What should parents do to avoid triggering or worsening their child’s ADHD symptoms? 

 The worst thing a parent can do is to avoid the issue altogether and not seek treatment. This deprives the child the chance to achieve his or her full potential and often leads to poor self-esteem, conduct problems and even substance abuses in adolescence. Whilst parents do not worsen ADHD symptoms per se, if they are punitive towards the child with ADHD, this can lead again to low self-esteem. If they react aggressively to the child when the child acts impulsively, the child will pick up the aggression. Whilst it is not easy, patience and calmness helps the parents deal with ADHD symptoms in their children much more effectively

ADHD in Children: FAQ Part 3

- What causes ADHD? 

The exact causes of ADHD are still not fully understood. However, it is likely to be due to a number of factors coming together. We know that ADHD can be inherited and that the genes controlling the chemicals or neurotransmitters in the brain are different in those with ADHD.

- What are common symptoms that parents can look for to identify that their child has ADHD? 

There are two main domains of symptoms; attention deficits and hyperactivity. The main symptom is difficulty in paying attention. A child with ADHD may have problems listening and following instructions, finishing tasks, is forgetful and easily loses his belongings. He distractible, tend to daydream and make careless mistakes. He will avoid activities that require sustained concentration or that might be boring. In the hyperactivity domain, he is restless and cannot sit still. He may run and climb on things constantly and when seated, may tend to squirm and fidget. The ADHD child is always on the go, will talk excessively and cannot play quietly.

- What are the most effective ways to treat patients between the ages of 3 and 10? 

Most of the time, we only start to diagnose ADHD for children who are 5 and above. This is because, unless very severe, inattention and hyperactivity can be quite common in children 3-5 and may improve naturally as they mature. ADHD can be treated with medications. Currently, two main types of medications are available, stimulants and norepinephrine uptake inhibitors. They help ADHD by increasing the level of neurotransmitters (chemical messengers) in the brain called dopamine and norepinephrine. Behavioural modifications and therapy are also useful treatments and are always given alongside medications.

- Many proponents of ‘food as medicine’ claim that ADHD symptoms can be controlled through a change in dietary habits – how much truth is there to this claim? 

There has not been any proof about these claims and studies done have consistently shown that dietary changes have no bearing on ADHD symptoms. The exception to this is fish oil which has shown to improve attention deficits symptoms and decrease hyperactivity in some cases.

Question of the week (19 November 2015)

"I have trouble falling asleep at night and as a result I feel tired in the mornings. This leaves me feeling sluggish and unproductive during the day. What can I do?"

Many do not realise that waking up well is as important as falling asleep to prevent insomnia. If you allow a lousy night of sleep to upset you the next morning such that you stay in bed, refuse to exercise and give yourself an excuse to be sluggish, a negative vicious cycle will be ensue, which results in the poor sleep perpetuating the next night. However, if you wake up well, exercise and be active upon waking, your brain will know it is the morning and it will signal to you when it is night and this results in a healthy circadian rhythm and better sleep.

Suggestions:

1) Improve your sleep quality by observing good sleep hygiene:

-Go to bed and get out of bed the same time all the time.  

-Have a soothing pre-sleep routine

-Avoid doing things in bed except sleep and sex to prevent feeling alert in bed all the time

-Avoid tossing and turning in bed for more than 15 minutes if you cannot fall asleep as you will get anxious. Go to another room and read a book and try to sleep again when tired.

2) Establish a good exercise schedule. Try and do so in the morning so as to wake the mind up and do not let one night of poor sleep stop you from exercising. The best way to stop that sluggish feeling is to stay active and activated by fun activities!

FAQ: Physical Punishment in Children

What age is deemed appropriate when it comes to disciplining a child (toddlers included)?

Discipline should start as early as 8 months. This can be a simple "no" for example when the baby plays with the remote control. However, the baby should also be praised if he obeys the instructions.

Are there any benefits to using physical punishment (caning or a smack on the bottom/Palm) on a child? What about parents who incorporate this punishment at an early age?

Whether physical punishment is appropriate boils down to the cultural  background and values of the family. Most western studies have shown that physical punishment is detrimental to the child. I would suggest minimising using physical punishments as parents may then only focus on punishment and not on teaching or educating the child. Nevertheless, physical punishment, when incorporated with consistency and non punitively, can be a quick and effective way of disciplining the child. 

What consequences might a child have if he is reprimanded or caned at an early age? 

If a child is fairly and appropriately reprimanded or even caned, and the reasons why these punishments meted out are carefully explained, I do not think that the child will have any consequence. However, if a parent metes out punishments, especially physical ones, as he or she is frustrated, this can lead the child to learn to react violently when distressed. If the physical punishments escalates inappropriately, it may become physical abuse and may scar the child permanently leading to long term psychological difficulties. 

Could this lead to a more disciplined child? Or might it have possible negative effects?

As mentioned above, it depends largely of the punishment is meted out appropriately. A parent must never can or hit the child out of frustration. The punishment must be predetermined and meted out consistently, and proportionate to the age of the child and the bad behavior. A good amount of teaching and education must follow suit. If so, the child understand why he is punished and learn from it leading to better discipline. 

At what age would physical punishment (caning or a smack on the bottom/palm) be deemed ok for a child? Why?

Physical punishment, if at all used, should only be used when the child can understand the correlation between his actions and consequences. This would be at the earliest 3-4 year old. 

What is the best way to properly discipline a child? 

A positive approach is often best. Therefore encouraging good behaviour with use of techniques such as star chart / reward chart will be desirable. Using methods such as time out when a child is throwing tantrum or misbehaving is also useful. 

Most importantly, it is most important to be consistent and firm in disciplining the child. Do not be punitive and do not shame the child. 

Fears in Children: 4 Questions Answered

Q: How should a parent help a child cope with his/her fear of the dark, bad dreams, clowns and strangers?

Generally mild fears and simple phobias can be ignored if they are not affecting the life of the child to a huge extent. They are usually a passing phase and the child will slowly get better as he matures. Parents should remain calm and not be frustrated with these. Most importantly, do not be punitive and start calling the child names, as this will cause further low self esteem.

Q: How can a parent help the child get over the fear?

If for some reasons, the child's fear and phobia is affecting his life, he can be gradually exposed to the feared object. Parents can start by telling positive stories of these feared objects. For eg. adventures in the dark or a friendly helpful clown. They can also share their own experiences with their fears when they were young. Subsequently they can increase the degree of exposure slowly. If serious, it is best to get professional guidance.

Q: Are there any "don'ts" when trying to help a child get over the fear?

i) Don't push the child, give him time.

ii) Don't criticise the child as this makes him more fearful.

iii) Don't bother with the fear or phobia, if it is not really affecting the child's life.

iv) Don't ignore working on your own anxiety and fears, as the child may have learnt it from the parents.

Q: What's the likelihood of the fear being brought over to the child's adulthood?

Most children have fears as they continue to have magical thinking and believe in their fantasies, for eg. monsters. However, as we grow older, we lose these magical thinking and the fears mostly go away as well.

Four Differences Between Depression and Burnout

The article, Four Differences Between Depression and Burnout, has been moved here.