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.

Post Natal Depression, Q and A. Part 2

Q3: Often, men (dads) seemed to be neglected in the equation of achieving parenting (psycho-emotional) wellness. Why is that so – is it true that they are less susceptible to post-natal and parenting blues?

Post-natal blues by definition pertains only to mums. However, while less likely than mums, dads are vulnerable to parenting blues or even depression. In general, due to societal expectations, the responsibility of child care and parenting still falls on mums. We have tax relief to help working mothers and much longer maternity leave and this is testament that mothers are expected and more likely to sacrifice their careers to care for their child. 

In most circumstances, it is natural that the child forms a much stronger attachment to mums than dads because of the child birth process and breast feeding. As such, the stress and responsibilities that falls on a father is much less. However, societal expectations are shifting. These days, the demands for a dad's involvement in child care and parenting is increasing and we are seeing more fathers who are finding it stressful and having difficulties balancing work and child care, and consequently getting blue.

Q4: Lastly, what can parents do to alleviate fears and anxiety? Is the attitudinal approach the best way to prevent it? Any tips?

As a society, we may want to be more cognizant of the difficulties new parents may face, particularly in this age of small nuclear family with little or no support from extended family. Much has been done to alleviate the financial aspects, as well as to provide longer maternity and paternity leave.I believe as a society we can still do more to educate and support parents. 

Other than attitudinal change, maintaining healthy family dynamics and a strong couplehood will improve support to the parent, allow them to talk about their fears and anxiety and prevent feelings of isolation. Mum and Dad must continue to spend time with each other and go "pak tor". Improving parental relationship will help with improving the care of the child and there is no need to feel guilty for leaving the child behind. Mum and Dad must also have their alone time so that they can have time of the stress of care and continue with their hobbies and meeting up with peers. The other spouse must recognise the need for alone time and not begrudge the other party but instead take turns to do so while the other cares for the child. Commonsensically, parents do need to sleep well, eat healthily, exercise and manage the stress from their career in order to keep these fears and anxiety at bay.

If the blues, anxiety and fears are serious, in that they affect the parent's ability to care for the child or to work, he or she should seek professional help and treatment Postnatal depression and Anxiety disorders can be effectively treated with medications and therapy. Denial of the conditions and leaving them alone can have dire consequences.

Post Natal Depression, Q and A. Part 1

Q1: Why do parents suffer from parenting fears, post-natal or parenting blues?

As with most psychological conditions, exact causes are not known. However, we can understand the reasons from biological, psychological and social cultural factors. Some individuals may be genetically vulnerable to having these conditions and there may be a family history. 

After pregnancy, there is also a fluctuation in female hormones which results in a risk of post natal; blues and even depression in mothers.

 Psychologically, parents may not be prepared for the stress of a new child. There may be a discrepancy between their expectations and reality and only realise that caring for a newborn may not be as easy as it seems, leading to feelings of incompetency, fear and low mood. If the newborn has a difficult temperament, parents may have an even harder time to cope resulting in further stress. 

Socio-culturally, especially in present days of having one to two children and every child is precious, there can be a lot of pressure from spouse, in-laws and grandparents to be overly protective to the child and to give the child the best. Conversely, lack of support and marital dysfunction can also lead to fears and blues.

Q2: Stress and anxiety from caring for infant is often identified as the culprit for post-natal depression. To what extent is this true? How can parents adjust expectations and would that help to alleviate post-natal depression?

Stress and anxiety are definitely symptoms which may indicate that there is an increase in the possibility that the mother may be or will be having post-natal depression. It is more pertinent to address the psychosocial issues that are causing these stress and anxiety. 

It is sometimes not only  the parents, but also those around them and even media portrayal that leads to difficult expectations. For example, many mothers have the stress of having to breastfeed there newborn perfectly and feel guilty when they are unable to due to physical reasons. The intense guilt then leads to depression. 

It will be helpful if would be parents are exposed to and educated about the potential difficulties that they may face. Most parents will give their best when caring for their child, and there is no need for perfection or comparison with others. Support and reassurance from spouse and family members are equally important.

Question of the Week (13 August 2016)

Question: Please share your opinion on the psychological benefits that spending in the outdoors can give to - babies, toddler, children and the family.

For children, even at an infant stage, playing is the main way of which they learn social interactions and other skills necessary for normal development. Outdoor activities are an important aspect of play. Outdoor activities allow for the possibility of playing in a large group and enhances the child's social skills and ability to work in a team. Ability to work and to get along with others is a crucial predictor or success in the future. Playing together also enhances the relationships of the family.

Outdoor activities also helps by allowing the child to use the whole of his body during play and this trains coordination, balance and spatial sense. Acquiring these skills and becoming physically stronger and healthier from sports and outdoor activities help a child feel more confident and increases his overall sense of wellbeing.

Getting sunshine outdoors is beneficial too. Getting adequate sunshine helps to regulate the circadian rhythm of our body and allows for better sleep at night and wakefulness in the day. Sunshine is also a natural antidepressant and brings about a positive mindset. Just be sure to drink adequate amount of water and put on your sunblock!

Bipolar Disorder FAQs Part 3

8. What new treatments/ medications are currently available for this group of patients, and how do the medications work to help patients alleviate symptoms? I read a new study which say that antidepressants may in fact, worsen episodes of mania in this group of patients. See link. What is your take on this?

The main stay of treatment for Bipolar Disorder are mood stabilisers which include medications such as Lithium, Sodium Valproate and Lamotrigine. Antipsychotic medications have been shown to have mood stabilising properties as well and are often used in Bipolar Treatment. Antidepressants can be used in the depressive phase of the Bipolar illness but must be used with caution as they may trigger a manic episode. Many a times, multiple medications may be needed to stabilise the high and low episodes that a Bipolar patient encounters. After the mood has been stabilised and the patient is well, he and his loved ones should be educated about the illness process and prevention strategies. Therapy such as social rhythm therapy, a type of behavioral therapy used to treat the disruption in circadian rhythms that is related to bipolar disorder, is beneficial.

9. What are the chances of a remission with treatment? Possible for patients to lead a normal and fulfilling life?

Although we still do not have a cure, Bipolar Disorder is a very treatable illness. Chances of remission is remarkably high at 80% with treatment and most patients return to where they are in their lives before the mood episodes. Most patients with Bipolar Disorder will require long term treatment and it is important for them to remain on treatment when the illness goes into remission as those who are compliant to their treatment are much less likely to experience a relapse.

10.  Can someone having  manic episodes manifest aggressive or unusual behaviours that may warrant hospital admission?

Patients can become aggressive and even physically violent during episodes of mania. They may pick fights over small day to day issues with their family members and this can escalate to physical altercations needing police intervention and admission to a hospital to keep the patient safe. Some patients develop grandiose delusions thinking they are important people and may become paranoid that others want to harm them. They can become aggressive and violent towards the perceived perpetrators. There have been instances where patients think they have special power,

Bipolar Disorder FAQs Part 2

 4. Some women experience mood swings, for instance, during certain times of their menstrual cycle. When are "mood swings" not considered normal, and may warrant medical attention?

 Many women may notice that they have dysphoric or irritable mood before and during their period, These mood changes are often described as mood swings. These mood swings are generally unrelated to Bipolar Disorder as there is no swing into a manic state. However, if the individual experiences irritability, tension or low mood severe enough to interfere with work, social relationships and activities, they may be suffering from Premenstrual Dysphoric Disorder (PMDD).

 5. A local 2010 Singapore Mental Health Study found that the average time taken for bipolar disorder sufferers to seek help was 9 years. - Why do you think they take so long to seek professional help?

When the symptoms of Bipolar disorder is mild, it can be hard to detect. Most of the time, the afflicted individual may not have insight into their symptoms. In fact, many enjoy their "new found" confidence and inflated self esteem. Family members may think that the individual is just stressed out or being difficult instead of recognising the symptoms as due to Bipolar Disorder. The strong stigma that remains associated with psychological conditions also prevents individuals and there loved ones from seeking help with professionals until the condition becomes severe.

6. Based on your experience working with these patients, what usually prompts patients to seek medical attention for their symptoms?

Many seek help during their depressive phase, when they feel lousy about themselves. and through careful history taking with the patient and their loved ones, a history of previous manic episodes can be obtained. Many patients may be admitted by their loved ones to the hospital when they display unusual behaviours or become aggressive during their manic episodes.

7. How common is it for bipolar disorder to go undetected, or dismissed as something not serious? Why is that so?

 Although there are no available data, Bipolar Disorder is one of the most likely diagnosis to go undetected. Unlike many medical condition where lab tests or objective testing is available in making a diagnosis, the diagnosis of Bipolar Disorder can only be based on the history provided by the patient and his loved ones and observations made by the psychiatrist during the consult. In milder case of Bipolar Disorder where the individuals present with issues such as irritability, restlessness, insomnia, and excessive alcohol consumption. For someone who does not know the individual intimately, the mood changes may be assumed to be normal. Even loved ones may sometimes find it hard to decide if the individual's mood is unusually high or he is an exuberant person to begin with. They may see the change as a change in his personality rather than him having a mental illness.

Bipolar Disorder FAQs Part 1

1. At what age does bipolar disorder typically surface, and why?

 It typically surfaces during early adulthood, usually in the 20s. This is attributed to the natural history of the illness and the real reason is not known.

2. What are symptoms of bipolar disorder, and how are they different from depression? (I understand that bipolar patients experience periods of low moods too, so how to differentiate between the two?) 

Patients with Bipolar suffers from episodes of mania or hypomania and depression. The depressive episodes of Bipolar Disorder are indistinguishable from clinical depression. As such patients who have depressive episodes are first diagnosed with clinical depression and the diagnosis will be revised should an episode of mania or hypomania surface. The symptoms of mania are elevated mood, increased energy, increased self esteem, decreased need for sleep, pressure to keep talking or unusual talkativeness, racing thoughts, distractibility, excessive involvement in harmful activities. The symptoms should last for at least one week. In Hypomania, the symptoms are milder and the duration may be shorter.

3. How quickly can a bipolar patient's mood swing from one extreme to another? What are the triggers for the mood changes? 

 Most bipolar disorder consists of mood episodes, depressive or manic, that typically last weeks to months if not treated. A typical example will be one month of mania followed by three months of depression and the rest of the year is normal mood. However, there are patients who suffer rapid cycling bipolar disorder who cycle four times of more a year. Whilst some patients are thought to cycle even more frequently than that, ie. days to even within a day, this remains controversial. Stresses in life, like work stress or family conflict, can sometimes trigger an episode. Sometimes a period of poor sleep, due to exams or work commitments can also lead to episodes.

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!