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Children & Youth Bullying: How to Spot and Address it

Children & Youth Bullying: How to Spot and Address it

By Tan Su-Lynn, Educational Psychologist

Bullying can be manifested in many forms, and children and youth can be involved in many ways in it. However, with 1 in 4 children in Singapore reporting that they have experienced bullying a few times a month, bullying might be closer to home than you think. 

Bullying is done with the intent to hurt and is repeated or persistent. Often, the target of bullying finds it difficult to stop it or stand up for himself / herself. This is different from peer conflicts or quarrels which typically involve incidents where children mutually hurt each other. As parents and caregivers, how do we support our children as they navigate the complexities of relationship-building, and what are some warning signs that indicate that they are involved in bullying? 

 

Broadly, there are three different types of bullying

  • Relational: When hurtful actions are made with the intention to shame a person and damage the forming of healthy relationships and friendships. This can take the form of leaving someone out of a group, teasing, name-calling, expressing negative thoughts or feelings about a person, and even intimidating them to do things against their will.

 

  • Physical: When harm has been inflicted on a person or their belongings. This can take the form of hitting, punching, kicking, inappropriate touching and persistent damaging or stealing of belongings.

 

  • Cyber-bullying: Occurs on the internet, through mobile phones, computers, video-game systems and other forms of technology. Both relational and physical bullying can occur on this platform. For example, digital technology can be used to gossip and spread rumours or hostile messages, or game accounts can be hacked and items stolen. 

 

How do I identify if my child is involved in bullying?

Recognising these warning signs is the first step in stemming bullying. 

Warning signs of being a target of bullying:

Your child…

  • has unexplainable cuts, bruises, scratches or other injuries
  • comes home with lost, torn, damaged, or destroyed clothing, books, stationeries or other belongings 
  • is unusually hungry after returning from school
Physical Signs
  • seems fearful of going to school, walking to and from school, riding the school bus, or taking part in organized activities with peers, and often finds or makes up excuses (e.g. faking illness) as to why he/she cannot go to school
  • has declining grades, lost interest in school work or suddenly begins to do poorly in school
School-related signs
  • experiences a loss of appetite, or has changes in eating habits like skipping meals or binge eating
  • reports sleeping difficulty (e.g. trouble falling and staying asleep, frequent bad dreams, etc)
  • complains frequently of headaches, stomachaches or other physical ailments
Health signs
  • suddenly stops talking about friends and has few, if any, friends, with whom he or she spends time with during recess or after school
  • is withdrawn and stammers
  • continually ‘loses’ money or starts stealing
  • appears anxious, sad, moody, teary, or depressed when he or she comes home and suffers from low self-esteem 
  • self-harms or talks about suicide
  • becomes aggressive and unreasonable
  • refuses to talk about what is wrong
  • begins to target siblings
Emotional and Behavioural signs

 

Warning signs of engaging in bullying:

Your child…

  • gets into verbal or physical fights
  • suddenly possesses unexplained extra money or new belongings
  • often reacts aggressively towards others
  • has friends who bully others
  • may be excessively worried about their popularity and reputation
  • can be competitive
  • has received many disciplinary warnings and actions 
  • refuses to accept responsibility for their actions 
  • blames others for their problems
  • experiences anxiety or depression
  • has difficulty regulating his/her emotions and behaviour
What should I do if I think my child is involved in bullying?

It is important to talk with children who show signs of being bullied or bullying others. The safety and mental health of our children should remain an utmost concern. It’s painful to think of your child receiving or inflicting harm on other kids, but bullying is a serious issue for both the targeted and the aggressor. According to research, a vast majority of bullies have also been the targets of bullying, and less than 1% of primary school children are “true bullies” – those who were not bullied by their peers.

Bear these three C’s in mind when relating with your child: Communicate, Consult and Connect

  • Communicate
    If you hear from a teacher or another parent that your child involved in a bullying situation, the first thing you should do is talk to your child about the situation. Be direct about the issue, but make it clear that you are open to hearing your child’s side of the story. Stay calm and say something like, “Your teacher called to tell me that you were involved in some bullying. I’m really concerned about this, and we need to talk about it. Please tell me what happened.”Avoid prejudging the situation and reacting based on emotions. It can be tempting to immediately blame the other party, criticise parenting, or condemn the school system, but it is also worth taking time to look inward and reflect on whether your own actions may be influencing your child’s. Some children may be modelling their interpersonal style based on the behaviour they have observed. If so, it is important to start fostering a positive home environment, where members of the family treat one another with kindness and respect, creating a safe space for children to share their worries and failures.

 

  • Consult
    Talking through the situation with your child can help you understand why the bullying is happening, and what steps need to be taken in order to stop it. For example, you may find that your child has incredibly low self-esteem and bullying helped him/her feel powerful and able to control something. He/she might prefer being known as ‘the worst kid in school’ and interacting with other children in the process, rather than not being noticed at all and having no friends. Or perhaps your child might accept being the target of bullying with the mistaken belief that such behaviours are acceptable between friends. Some children may not be able to articulate their feelings. This is especially true of children who are struggling with anxietytrauma, or another mental health issue. If you are having trouble, consider consulting a child psychologist or psychiatrist who has a lot of experience evaluating kids’ behaviours. Your child might need a therapist’s help to work through underlying issues, investigate the root of the problem and guide you and your child in tackling the specific challenges that your child faces in his/her social interactions. 

 

  • Connect
    Ultimately, it is about building a close and lasting connection with your child. Connecting with your child about his/her day-to-day life will put you in a better position to recognise signs of bullying and trouble. Start with asking your child a few open-ended questions on a daily basis. For example, ask him/her to share about one really great thing that happened that day, and one not-so-great thing. It can be tough to get started, but children who are regularly encouraged to share details of their lives with their parents tend to be more comfortable with continuing to do so when they are in their adolescence. Listening to your child in a supportive, non-judgmental way helps them feel connected to your presence and love in their lives, and makes them more receptive to opening up to you about their problems as well as accepting the advice that you give to them. It is always better to handle challenging issues like bullying together so that your child will be able to walk out of the shadow of the bullying with confidence and courage.

 


Reference

1 https://bullyfree.sg/wp-content/uploads/2018/12/The-Straits-Times_Bullying-in-schools-stable-and-managed.pdf, https://mothership.sg/2019/12/bullying-singapore-pisa-2018/

2 https://www.theguardian.com/education/2008/aug/29/bullying.schools2 

Tips on Parenting Practices that promote Good Mental Health in Children & Youth

Tips on Parenting Practices that promote Good Mental Health in Children & Youth

Author: Dr Mark Toh, Consultant Clinical Psychologist

The 2nd Singapore Mental Health Study (SMHS) which began in 2016 (reported in December 2018) was initiated by the Institute of Mental Health (IMH) in collaboration with the Ministry of Health (MOH) and Nanyang Technological University (NTU). The study focused only on those 18 years old and above. The findings show that 13.9% or 1 in 7 Singaporeans have experienced a mood (major or bipolar depression), anxiety (obsessive compulsive disorder and generalised anxiety disorder) or alcohol use disorder (alcohol abuse and alcohol dependence) in their lifetime. These are the top 3 mental disorders in Singapore among the conditions assessed in the study. The study also reported that more than three-quarters of those with a mental disorder in their lifetime did not seek professional help. In the first SMHS study in 2010, the lifetime prevalence rate of mental disorders in the Singapore population was 12% or 1 in 8 persons. 

 

In a 2012 publication on Depression by the Ministry of Health, it was reported that depression affects between 2.5% to 18% of youth*. Depression among youths in Singapore is considered common. But it is a serious mental health symptom because of it what it reflects of children’s experiences in their environment. In particular, it is a serious reflection of what they may experience in the family or relational environment. If not adequately treated, the depressed child is likely to bring their depression into adulthood. This means that the emotionally wounded or damaged child is likely to carry their wounds forward as adults. This is a likely scenario because it is estimated that an initial episode of depression increases the likelihood of a second episode by 50%. A second major episode of depression increases the likelihood of a 3rd episode of depression by 75%. A third major episode of depression increases the likelihood of a 4th episode by 100%. Not surprisingly, depression has been found to affect brain structures and functioning. It is this recurrent tendency of depression that the suicide risk often increases over time within the same individual with a history of depression.

 

The risk of depression in childhood needs to be a major consideration for all those concerned with the development of children. Depression among children is a serious health problem because it can impair the emotional development of the child. It can seriously affect identity formation which is foundational to how the emerging adolescent learns to relate to themselves, to others and to the world at large. Later as adults, depression can impair psycho-social as well as occupational functioning. Depression is associated with significant morbidity and mortality. Also, depression can be triggered by, or lead to, other mental health conditions such as substance abuse, anxiety, schizophrenia or personality disorders.

 

Signs to watch for in children who may be depressed:

  • Continuous feelings of sadness and hopelessness
  • Irritability or anger
  • Social withdrawal
  • Increased sensitivity to rejection
  • Changes in appetite — either increased or decreased
  • Changes in sleep — sleeplessness or excessive sleep
  • Vocal outbursts or crying
  • Difficulty concentrating
  • Fatigue and low energy
  • Physical complaints such as stomachaches, headaches that do not respond to treatment
  • Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests
  • Feelings of worthlessness or guilt
  • Impaired thinking or concentration
  • Thoughts of death or suicide

 

Not all depressed children display these symptoms. They are more likely to display different symptoms at different times at different settings. When depression is significant, there are often noticeable changes in social activities, loss of interest in school and poor academic performance, or a change in appearance.

 

The young child is most vulnerable to depression due to the quality of relationships with his or her caregivers. This vulnerability increases when the family environment is also accompanied by marital conflict, abuse, violence, illness and/or low socioeconomic status. However, it is in the quality of relationships with caregivers that is crucial because of what it can offer as a buffer or protection from other external events or causes. Therefore, the mental health of children begins with thoughtful parents who genuinely understand and care about their child’s emotional needs and development.

Parenting Practices that promote Good Mental Health in Children:

1. Love your child unconditionally

  • A genuine attitude to decide in the best interests of your child, and not in the parent’s convenience. Children thrive under certain physical and emotional conditions. The long-term view is needed. Parenting must understand the healthy outcome effective parenting can produce. This helps to plan to optimise the emotional development of the child. Loving well in the best interests of the child provides the best head start towards orienting the child to relate to themselves and others in a healthy way. Children’s need to establish a healthy identity, to uncover and stretch their potential, and learn to self-actualise will require parents to stretch their own emotional ‘ceiling.’ This means parents who desire to raise emotionally healthy children have to face their own insecurities so as not to impose them on their own children. Parenting with the best interests of the child will often be at the inconvenience of parents especially if parents do not appreciate the value of nurturing relationships which children thrive on.
  • Loving your child well answers the deep longing for the child to later ask, “Am I worthwhile?” The need for children to recognise their own personal importance, value and worth prepares them to find that their later life will amount to significance. The child at risk of depression commonly struggle with this sense of self regard. Loving the child unconditionally is not based on the social or academic performance that society may hold out for children. Instead, mistakes are accepted as a natural part of their learning. If the parents placed their importance on their children only in reaching their own ambitions, or social or academic accomplishments, these indicate conditional expectations for them to find approval or acceptance. The will view their worth based on what they do instead of who they are. 

 

2. Ensure safe and secure physical and emotional surroundings

  • Secure attachment, which is offering an ongoing, consistent, soothing, accepting presence to the infant is the important beginning in the parent-child relationship that helps the infant to learn to feel safe and secure in the world. This is a foundational need for positive mental health in infants and children and later adulthood. Emotional safety from the secure bond offered by a secure parent helps young children to trust the caregiver and to experience their world as safe and predictable. Through this quality of care, a child is encouraged to first accept themselves as as lovable, as important. It also prepares them next to want to explore their world as they mature physically. This means parents who wish the best for their children have to prepare them to become independent over time.
  • Punitive, harsh or neglectful parents, especially when physical punishment is employed, leads to children questioning their worth or value and increases the risk for later depression. Parents who frequently employ shame, threats, insults or convey other derogatory messages to their children tend to raise a child who view themselves as defective. This is particularly damaging to children. Indeed, the DSM-V lists the sense of hopelessness or worthlessness as a common symptom of depression. Children can be raised to view themselves as defective, and that their life as meaningless.
  • Promoting a safe emotional environment emphasises listening and empathy as skills, and being age-appropriate supportive as an attitude. Being emotionally present and listening well will foster the child’s wish to share their experiences. It builds on the bond already started from providing a secure attachment. It encourages children to view the parent and other people as a safe resource they can count on later if needed. It answers the important question that children ask, “Is it OK to be me?” This also fosters familiarity with emotional intimacy that better prepare children for friendships and significant relationships later. Familiarity with close and supportive relationships also mean that the child is less likely to isolate themselves socially when they face problems later on. It is a wise parent who value interactional activities with their young children early on rather than let them become overly attached to computer games and the internet to amuse themselves. Excessive computer use at the detriment of other activities has been linked to increased loneliness, poor social development and depression. 

 

3. Nurture Self-confidence and High Self-esteem

  • Self-confidence is most easily found when children grow up feeling loved unconditionally.
  • The foundation provided when the child feels loved should be supported by the child’s search for mastery in the world when they are ready to explore. Starting with simple activities, their need for autonomy and mastery over their environment allows them to gain confidence over the tasks they wish to take on. It is important for parents to support this rather than to over-protect them from exploration. Parents who are over-protective of their children and anxious about possible mishaps will find it difficult to foster the autonomy and independence their children need. To build their self-confidence and nurture high self-esteem, parents should be ready to praise their children’s exploratory efforts, be honest with them about their own mistakes, participate in the children’s  activities, encourage them in activities where their interests match their ambitions and allow them to be tested by the tasks they take on.
  • The child’s ability to overcome, which allows them to be exposed to the frustrations and disappointments along the way, is something they have to face as well. Children should be encouraged to enjoy the process in the process of becoming. Learning to face their own frustrations, disappointments and failures will also serve to build self-confidence. Avoiding frustrations or disappointments or learning through determined effort and even failure tends to undermine self-confidence. The opportunities for children to grow through tasks and responsibilities is the beginning from which they can discover and establish their personal power and resilience.
  • Looking for ways to nurture your child’s self-confidence and develop high esteem answers the child need to know “Can I do it?” It requires that parents focus on building strength or resilience through the children’s autonomy –their learning to exercise control over their environment– rather than emphasize ease or comfort through avoidance.

 

4. Promote opportunities to Play with other children and self

  • Play is an integral part of emotional development of children. It is the primary means in which children learn to explore, to discover themselves in their world, and socially to cooperate, take turns and help in friendships. Studies have even suggested that inadequate play time for preschool children lead to more disruptive behaviour. Besides social interactions, play allows for the development of emotional awareness and fosters empathy where children learn about their own emotions as well as the emotions of others. Play also allows children to enjoy the process of becoming one self. This is important in a goal-oriented world that emphasises only winning or success or grades. Indeed they can discover the truth that frustrations and disappointments are often the price we all pay to achieve success. In so doing, play allows children to learn how to emotionally regulate their feelings when they are presented with opportunities to learn to express thoughts, feeling and behaviours in socially appropriate ways.
  • Play is an important part of the child’s need to learn and experiment. Participation in play individually or in a group is an integral part of this learning process. Parents who are open to social interactions offer their children important advantages because they can facilitate their children’s emotional regulation and social learning when they play with their children on a regular basis. Children are more likely to enjoy other people contact when they already enjoy warm relationships with and have fun with their parents. TV or computer use should be monitored so that children are encouraged to engage more in active learning through participation. Computer games designers have made it easier for children, especially children who are neglected or are alone a lot, to be addicted to computer games. Excessive computer use has been found to be linked to depression in children.
  • Play offers the opportunity to address the questions that children ask, “Am I OK and is it good to be me?

 

5. Provide appropriate guidance and discipline

  • While children need to explore, develop new skills and become more independent and responsible, they also need to learn that certain behaviours are not acceptable. They need to be offered guidance and discipline that is fair and consistent from the family unit. They tend to take these social rules to their school and eventually to the workplace. Expectations may be expressed firmly but they need to be kind and realistic. Again, children learn best within encouraging and nurturing relationships. Parents need to be aware of their own maturity and growth and emotional status as they seek to help their children develop self-control, self-discipline or become kind. Their children cannot be expected to growth in those areas which parents have not grown themselves.
  • Explain “why” the child is being disciplined and the consequences of their actions. Criticism should be focused on the behaviour and not the person. Threats, nagging and the use of threats should be avoided. The power that the parent wields should emphasise guidance and instruction in the best interests of the child that allow for children to learn from their mistakes. Those parents who practice excessive domination or coercion should understand that it is not helpful in the long run if children are forced to accept a place of surrender in order for them to survive in the relationship. They need to be encouraged to exercise their own power when appropriate. What has been described as authoritarian parenting, characterised by high demands with poor feedback or nurturance has also been found associated with a higher incidence of depression in children. This is in sharp contrast to authoritative parenting which is characterised by high demands accompanied by responsiveness to the child’s emotional needs. This approach is found to produce children who are responsible, they can regulate themselves, they can make good decisions on their own, and they are respectful to others and to rules.

 

Parenting is primarily a personal and emotional project in raising one’s children. It is foundationally an emotional process to secure the child before a young child eventually matures to believe in themselves. This is crucial before they begin to actively learn to navigate themselves in an increasingly complex world. It is widely understood as a parent’s most important life task since the emotional outcome show up in emotionally healthy or unhealthy individuals even before adulthood beckons. There is an emotional ‘birthing’ process where the Self of a child arrives at a healthy place in their identity formation. Or the opposite will happen. Quality parenting in this ‘birthing’ process create the foundation in which the next generation of children find the basis for their own survival, happiness and fulfilment. As such, parents learning to parent with optimal outcomes will do well to emotionally mature and be healthy themselves so that their children have the best chance to establish themselves in a healthy place in preparation to thrive in life. 

—-

References:

Institute of Mental Health, Latest nationwide study shows 1 in 7 people in Singapore has experienced a mental disorder in their lifetime, 2018. https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf

The Ministry of Health, Depression: MOH Clinical Practice Guidelines, 2011.

Woo BSC, Chang WC, Fung DSS, Koh JBK, Leong JSF, Kee CHY, et al. Development and validation of a depression scale for Asian adolescents. J Adolesc. 2004 Dec; 27(6):677-89.

Woo BSC, Ng TP, Fung DSS, Chan YH, Lee YP, Koh JBK, et al. Emotional and behavioral problems in Singaporean children based on parent, teacher and child reports. Singapore Med J. 2007 Dec; 48(12):1100-6. 

Auteurs, thespians, and emotions. Except it’s all truly heartfelt. Psychodrama!

Auteurs, thespians, and emotions. Except it’s all truly heartfelt. Psychodrama!

Written by an anonymous contributor

I am a self-confessed introvert. And I’m also an addict.

I was recently cajoled into attending a Psychodrama session. I’d heard things about it – years earlier, my then significant other lauded the raw emotional exploration her sessions afforded her. I encouraged her, it was good for her. Personally though, I found the idea of a group session’s ability to evoke genuine emotion alien. It was the antithesis of who I was.

I had never enjoyed group sessions. I hated them. The introvert in me screamed (silently) in indignation at being forced into a room with my peers, lorded over by therapists who would extol the heaven-sent power of vulnerability, hanging it over the heads of us sullen detainees. They would espouse connectedness with others, openness. To me, these were just unattainable states of being that I could never actualise. The years wore on, and I plodded along, entwined with my precious, thorny, addictions. Prison, pricey rehabs abroad. I took care to never bring my real self along to the banal group therapies – I merely presented them with an alter-ego. Faking it to get along. Or “faking it to make it”, in the parlance of addicts like myself who would say or do anything to achieve a discharge.

I was living an entirely unremarkable life, losing friends and embarrassing myself.

Then, I experienced a seismic shift in circumstances. To represent it as merely ‘mandated’ would be to deny gravity to what had happened. I had run afoul of the law again, and paid my penance with a 9 month long “drug rehab”. I got out, and three months later I was a year clean. Still, I wasn’t happy. I had done no soul searching, nor had I even begun to scratch the surface of my addiction, always lurking in the shadows. Of course, a large part of my reticence towards accepting sincere nudges in the direction of help could be attributed to personal and moral failings. But why was I the person that I was? That’s when I decided to attend a psychodrama workshop at the urgings of my boss, a sweet girl whose genuine concern had initially confounded me. Why did I acquiesce? To understand myself, I guess. So, I went in with an open mind.

Psychodrama is about exploring internal conflicts, by acting out emotions and interpersonal interactions. I wasn’t inclined to be the center of attention just yet, so I left other enthusiastic participants to play the protagonists. The director, a bubbly personality whose sharp wit was tempered by insightful, genuine empathy, herded a roomful of clueless attendees with a deft hand, schooling us in psychodrama’s basic concepts. I made myself small in the corner and watched as our director doubled volunteers, acting out scenes from their lives, giving voice to their unconscious. Revelatory perspicacity was the order of these moments. I watched as they were mirrored, experiencing themselves from the outside, drawing from a nonjudgmental pool of collective consciousness. I watched as roles reversed – mothers became their daughters, and wives their husbands. All of them seemed edified, comforted, even. Misty eyes and rivulet strewn faces, sighing into closures when none previously seemed possible. There was a woman pained by a frightful trauma, her repressed malefaction she seemed so sure she had committed driving her to seek expiation from whom had ceased to be able to give her any. From the outside looking in, I was sure her wound was self-inflicted – we all knew this, but one’s own guilt is deeply personal, often insidious. As her situation percolated in my mind, so did my own guilt. I hadn’t wept when I learned of my father’s and sister’s departures, I hadn’t wept at their funerals, I hadn’t wept at their memorials. I hadn’t needed to, because I had my addiction. Now, without the pernicious warmth of substances, these losses became some therapeutic cynosure of a starting point. I had begun to understand myself, through others. The cynic in me finally realised why, across addiction recovery literature, syllabuses are almost invariably characterised by the motif of benefits accrued by group therapy. I think it owes something to the collective experience of humanity, that no matter your guilt or your shame, there are people out there who have lived congruent experiences. It may seem cloying and mawkish for me to say that no-one is truly alone, but it’s true.

You just have to look in the right places.

 

 

Helping Your Kids Survive And Thrive With Home Based Learning

Helping Your Kids Survive And Thrive With Home Based Learning

Written By: Tan Su-Lynn, Educational Psychologist

In the midst of this current COVID-19 crisis, there is so much uncertainty for parents and children, which translates to overwhelming stress about family members’ health and safety, as well as an upheaval of school and work routines.

With no external help from grandparents, or the essential childcare centres to mind the kids of dual- income parents, no part-time helper to clean the house, and with the panic that ensues with each announcement from the government about the tightening of circuit breaker measures, it can feel like the end of the world. Foreboding desire to tear your hair out and scream in exasperation. And to top it off, parents now find themselves playing the role of “teacher” in supporting and facilitating their child’s Home Based Learning endeavours.

Yes, I hear you.

Singapore has just heard from its Prime Minister, who has decreed that current circuit-breaker measures will extend beyond the initial 4th May deadline, which is now 1st June, which adds the novelty (if you are so inclined to be a paragon of good cheer) of an additional month of government sanctioned acronyms that must be helping ministers and bureaucrats find their feet too!

Families in Singapore and the rest of the world are experiencing increased stress and anxiety right now. So, amidst this chaos, here are some tips for you to help your child cope with HBL, which will hopefully help in restoring some order in this otherwise chaotic household atmosphere..

As we all practice social distancing, it also provides an opportunity to slow down and pause, and to find our own footing in learning new ways to live. Children continue to grow and develop as they encounter new life experiences, including coping with this inescapable global pandemic, so it is important to continue fostering positive relationships and strengthening emotional connections with our children.

  1. Work out a daily routine with reward system

Research suggests that children benefit from schedules and engaging in productive activities, so plan activities that will create structure and fun memories. Set aside specific times for doing online lessons, doing homework, and reading or visiting virtual museums. To keep your child engaged and motivated, consider breaking up the day into smaller manageable blocks, taking care to cater to the short attention spans of your kids.

Visuals are especially great for reminding younger children what to do and how to do it, and these visuals can be simply hand-drawn and paired with keywords and then stuck on the wall. For some children who have completed their online lessons and are getting restless and fidgety, you may want to give them a to-do list of activities that they can complete independently, empowering them.

Guiding your child in setting goals and scheduling tasks are part of valuable life skills of time management and task organisation. Once their tasks are completed satisfactorily, they can be rewarded. Hence, if you would like your child to be more independent, polite, helpful, then rewarding them for their good behaviour in which these traits are displayed will be a good starting place for you.

For example, you can explore the effectiveness of “if/then” statements such as, “if you finish this piece of homework, then you can play 15 minutes of computer games with your brother”, or the use of a token system like “each time you can stay seated for 15 minutes, you get a token, and after you get 5 tokens, you can exchange them for something of your choice”.  Tokens are  reinforcers that the child earns which are exchanged for a larger reward based on their achievements. This system also helps in gaining instructional control, as well as acquiring self-monitoring skills and delayed gratification. Just as with any behavioural reinforcement strategies, the token system can be adjusted over time as your child’s skills develop and can be utilised less frequently. It is up to your parenting style and the temperament of your children to devise token systems that keep them engaged.

  1. Recognise and praise efforts

Change is difficult for everyone, including for your child. If they are able to conduct themselves in an appreciable manner  in certain scenarios in which they were previously unable to, this in itself is an accomplishment worth celebrating! Remember to give credit for their displays of maturity – praise them, show affection, or give a little treat. Children and adolescents learn very quickly by receiving direct feedback from adults. By reinforcing appropriate and desirable behaviour, the more likely your children will repeat this behaviour and overtime will coalesce into a good habit.

While it is part of being a parent to have to say “NO” to some of your children’s inappropriate requests or behaviours, it is important to ensure that you  mindfully maintain a balance of more positive than negative interactions with your children. Try to focus as much as you can on the good things that your child is doing. After all, having more positives throughout the day helps in those moments when you have to say “NO”. Be deliberate and consistent in praising and rewarding them, and to follow through with providing the reward as soon as your child demonstrates the desired behaviour. In working out the goals with your child, it will be reasonable to start by picking 1 to 3 behaviours or skills to focus on for reward and praise throughout the day. Items used as rewards have to be of value to the child and should not be easily accessible unless earned – this would keep your child motivated in completing the tasks and meeting the goals.

  1. Manage screen time

In this circuit breaker period, having extra screen time will not hurt, especially to reach out and to stay socially connected with friends. However, do set expectations with your child that the change in rules is a time-limited exception and regular limits will be put back in place when this circuit breaker is lifted.

While flexibility is important during this period, by no means should you allow unlimited screen time. Work out with your child on managing screen time. In the local mainstream schools, your child can be expected to be using technology to support HBL consisting of about 2-3 hours of online learning every day. With your child already spending time on online learning, work out with them on an agreement to take short breaks in between their online lessons and reduce their recreational screen time. This can be replaced by partaking in creative projects such as painting or baking, or using recycled materials to make toys or playing board games with the entire family. This also means that parents should also monitor their own digital device usage. Make use of this time to nurture new healthy habits for yourself and your children.

Now that the government mandated circuit breaker has been extended, you shouldn’t worry about having to keep the children entertained.  Yes, it is inevitable that they will whine and complain about boredom, but remember that boredom can be harnessed. It is through boredom that  allows them to create their own meaning and purpose, to be resourceful and to get to know themselves better. When young minds are free from distraction and constant torrents of information, they discover ways to create and find their own fun, or to further explore something that they are already interested in. This could be writing a book, staging a performance, drawing and painting, and the list goes on with endless possibilities!

  1. Encourage emotional expression and validate your child’s feelings

Children need to be secure about accessing their emotions rather than fearing them. To do this, they need to cultivate essential skills of being aware of their emotions and dealing with their experiences and concerns in manageable doses.

Being able to express our emotions allows others to understand how we feel, helps us to manage our own stress, worries, disappointments and sadness, and prevents us from spiralling into negative and maladaptive ways of coping. Holding in or denying our emotions  sometimes unconsciously results in angry outbursts or aggressive behaviour. One way to teach children about expressing and managing their emotions is by using books or through videos, and even modelling for them in the sense that adults are role models for their children, who ‘model’ the behaviour of their parents through observing and imitating.

For older children and adolescents, perhaps the most painful part of this COVID-19 crisis and HBL is the loss of important school experiences such as school or national competitions which they have trained very hard for, or performances which they have put in hours of rehearsals into, and the daily interactions with friends.  Give them a safe space to share their feelings and listen without judgement and without giving advice or reassurance. Some will be worried about missing out on activities expected to help them with school admissions, and these feelings of worry and stress are indeed valid. So again, allow them to acknowledge and share their feelings, and then express confidence in their ability to rebound.

  1. Practice empathy

With all the changes happening around us, it is indeed a challenging time for yourself and for your children. Start by having empathy for yourself as you navigate through uncharted waters in this battle against COVID-19 and its impact on routines and lifestyles. Yes, it is messy and chaotic, and it is OK to be not OK with any of this.

Children learn by watching the behaviours and reactions of the adults around them, so use this as a critical opportunity to prepare them to deal with uncertainties in life. Other than using books or TV shows to help children learn about empathy, you could also talk about how doctors and nurses are working to care for others with COVID-19 and to elicit their thoughts and feelings as they imagine what the healthcare workers are experiencing. Another example would be imagining what their teachers are experiencing with WFH (working from home) and HBL. By teaching and practicing empathy, your children will grow up being more compassionate and altruistic with the genuine intention to help others without expecting anything in return.

For children with special needs, it is likely that they would have had access to regular therapy services or remediation support either provided by external agencies or are school-based.  It would be beneficial to maintain collaboration with the therapists to see if there are workable options that can be carried out at home so that your child’s learning is not impeded. It’s indeed a challenging time for everyone, and more so for children with special needs and their parents/caregivers. With big changes happening, it can get really overwhelming especially for a child with special needs. Remember that these behaviours are not personal but are the manifestation of a skill deficit which occur to meet a need. Professionals can help to support you through this. Reach out to a professional here. You are not alone.

For children with anxiety or mood-related concerns, this circuit breaker period will likely exacerbate their mood swings, emotion dysregulation, and problems with attention and focus. This is the time to be even more patient and supportive of your child. For younger children, you may notice some behaviours or physical complaints, for example, having tummy aches, headaches or nausea, which are somatic manifestations of underlying anxiety or worry.  If you or your child feels overwhelmed, do reach out to a professional here that is in tune with your needs.

 

Helping The Elderly During This COVID-19 Circuit Breaker Season

Helping The Elderly During This COVID-19 Circuit Breaker Season

Dr Rajesh Jacob (Senior Consultant Psychiatrist @ Promises Healthcare) was interviewed by Tamil Murasu on 19th April about his views on ways we can help the elderly during this COVID 19 Circuit Breaker season.

Here’s an English translation of that interview:

1.What kind of mental issues that the elderly can experience during a pandemic like COVID 2019

Physical distancing during this public health crisis is essential in preventing the spread of the virus, but it can come at a high cost to seniors’ mental health and well-being, resulting in loneliness, anxiety, depression, and cognitive problems. Self-isolation will disproportionately affect elderly individuals whose only social contact is out of the home, such as at daycare venues, community centres, and places of worship. Those who do not have close family or friends, and rely on the support of voluntary services or social care, could be placed at additional risk, along with those who are already lonely, isolated, or secluded. It’s hard to escape news updates about coronavirus disease (COVID-19). The constant headlines and media reporting may make some people anxious. In particular, older adults, people with chronic health conditions, and caregivers are likely to be at higher risk for increased stress and anxiety, since they face a higher risk of illness if they contract the virus. Fear and worry about your own health and the health of your loved ones can result in changes in sleeping or eating habits, difficulty sleeping or concentrating, worsening of chronic health problems and increased use of alcohol or tobacco.

2) What are the potential do’s and don’ts that the elderly have to observe during this period of time? (e.g. spreading unverified COVID-19 news via whatsapp)

Maintaining seniors’ connection to their healthcare providers using the telephone or video telehealth platforms is critical and “may be the most important thing we do as mental health professionals.These include greater use of computers or tablets to stay connected to family, loved ones, and friends through video chats and playing online games.Seeing each other’s faces, hearing their voices, and sharing the experience that we’re going through can be therapeutic for everybody.Mindfulness-based interventions and relaxation techniques could also be helpful.There are many computer-based applications for these mindfulness exercises that the elderly folks can try out.

For seniors who are not tech savvy , and have difficulty using smart phones and the internet, just calling their relatives or friends through the phone would be immensely helpful for their mental health and reducing anxiety and fears.

Seniors who are comfortable and confident in using the internet can also sign up to govt websites such as www.gov.sg to obtain correct factual information. Due to widespread internet access, numerous fake messages and videos can be potentially circulated through whatsapp causing increased unnecessary fear and anxiety. This can be avoided by restricting too much exposure to online news and messages and probably watching the news on TV once a day for those who are more prone to anxiety.

GO ON A NEWS DIET

Stay informed, know what’s going on but don’t get locked into endlessly watching “breaking news” on the 24-hour news channels.

3) How can family members in the household assist to ease their worries, concerns and fears?

Children and grandchildren of the elderly who are living alone can also help by being in regular online contact and also calling them on their phones and giving them verified factual information of the COVID outbreak . For family members living in the same household, it is good to regularly update the elderly people about correct factual information about the epidemic. It is also important for the family members to keep the elderly engaged in other activities such as reading, playing indoor board games, chess, and other activities. It is also important for the elderly to avoid going out  as they are more vulnerable and family members can help by providing groceries and other household essentials to them.

4) What kind of meaningful activities can the elderly engage at home during this period?

In addition to picking up the telephone, other  options that may help seniors stay mentally engaged include practicing hobbies or activities such as knitting, crossword puzzles, “or whatever else works for them. Whatever helps them cope and keeps them occupied during self-quarantine should be encouraged. If there is a positive aspect to the COVID-19 pandemic, it’s that it has forced people to slow down and connect with each other.You may not be able to control the virus, but you can help control your emotional reaction to it.Take breaks from watching, reading, or listening to news stories, including on social media. Hearing about the pandemic over and over can be upsetting.Take care of your body. Take deep breaths, stretch, or meditate. Here’s a free guide on how to meditate from Mindful magazine.

Eat healthy, well-balanced meals.

Relax by doing activities you enjoy. Try crossword or jigsaw puzzles, , cook healthy meals and freeze some for later, and seek out TV shows to watch that give you pleasure. Explore your library’s online offerings.

For those who are not tech-savvy , it would be useful to learn the basics of using the internet and also learning to use online tools such as Facebook or zoom, so that they can get in touch virtually with friends and relatives if they are living alone.

5) How can the community play its part to care for the elderly who have little family/external support and live alone?

It is important for neighbours living in the same floor to look out for the vulnerable elderly living next to them. It is at times of crisis like this, do people need to get more empathetic and concerned about their fellow human beings. Neighbours can check on their well being on atleast twice a day basis, help them to get their groceries and also check on their physical health and get medical help if required.

There are also community agencies run by the government  as well as NGO’s  who have volunteers who can provide additional support to the elderly living along or with poor family support.

There are organisations which can provide meals delivered to their houses which will avoid the elderly leaving their houses unnecessarily .

6) Taking care of elderly patients especially those with conditions like dementia can be challenging for care givers. How can care givers ease their tensions, worries and stress while taking care of the elderly at home ?

For patients with Alzheimer disease or other cognitive problems, maintaining routine is important. Any change in routine can lead to agitation and behavioural issues in these patients. Share simple facts about what is going on and give clear information about how to reduce risk of infection in  older people with cognitive impairment. Repeat the information whenever necessary. Instructions need to be communicated in a clear, concise, respectful and patient way. It may also be helpful for information to be displayed in writing or pictures. It will be also useful for caregivers of patients with dementia to take turns in looking after them to reduce the risk of caregiver stress and caregiver burnout. It will also be useful for caregivers to join online groups where they can share their concerns and other relevant information with similar caregivers looking after people with dementia.