So if you feel anxious, depressed, stressed, or even suicidal? What can you do? Too many people suffer in silence and don’t seek help! Come join a conversation about mental health issues! Our experienced panel will consist of mental health professionals from various disciplines, a Senior Consultant Psychiatrist, Senior Clinical Psychologist from Promises Healthcare Clinic, and an Assistant Head of a Family Service Centre! The panel will be moderated by Casework Manager of SG Accident Help Jevon Ng, an advocate for mental health and wellbeing. Our panel members all have a lived experience of mental health and will be answering questions from the audience.audience participation is encouraged. Please click the link below to join the webinar: https://us02web.zoom.us/j/83397902082Date: Saturday, May 16 2020Time: 4:30 pm – 6:30 pmEvent Categories: Raise Awareness Organizer@Migrant workers Singapore Support by SGcare Physiotherapy Clinic
Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Clinical Psychologist, S C Anbarasu, in the name of bringing greater mental health awareness to the Indian community in Singapore.
In En Ullae S2 episode 9, we are introduced to an exuberant boy, who upon closer inspection is revealed to suffer from Attention Deficit Hyperactivity Disorder (ADHD). Is he beset by developmental issues, or is there a more benign explanation? Senior Clinical Psychologist S.C. Anbarasu opens the episode with a parsimonious explanation of ADHD – simply, people with ADHD are distinguished by a lack of ability to pay attention, and appear to have vast amounts of energy, hence, ‘hyperactivity’.
In a dramatisation, the boy’s mother wears an expression of bemused exasperation – the problems began even before his birth. Prolonged labour (which occurs after 18 – 24 hours), and a possible Caesarean section heralded the coming of a “problem child”. Anusha Venkat then recalls how, at the age of 2 or 3, she came to the realisation that her son’s inability to focus was far more prevalent than what she observed in other children. Even a couple of seconds of concentration seemed to be a hard ask. He couldn’t remain placated long enough to complete any task. At the childcare, teachers baulked at how he pinged from corner to corner of the room.
Anusha reveals how a serendipitous discovery that Carnatic music could calm him down enough to remain in one spot for more than 10 minutes. A breakthrough! Anbarasu explains that while a child suffering from ADHD can disrupt classroom proceedings, it is pointless to use force to discipline them. ADHD can make someone feel like they are “constrained within a container” if they are impelled to do a task in which they have no interest. Instead, they expend their energy reserves by indulging in some other activity – like running around and being a little menace. For parents who are unaware of ADHD as a mental health condition, seeing their child act out can be scary. In fact, Seelan (the boy protagonist) went undiagnosed at age 3 – doctors merely offered that most children are, well, rambunctious tots at that age. It takes a diligent parent to make a reasoned conclusion that their child may suffer from ADHD. Seelan was given assorted tasks to complete, with his attention span closely watched, even who he liked or disliked in class was logged.
However, Anbarasu recommends that care must be taken to conduct a diagnosis per the Diagnostic Statistical Manual (DSM-5). First, the test must be conducted on children below the age of 12. While school-going children come with a larger raft of observable behaviours due to differences in environment (home, school, etc), Anbarasu admits that is is not easy to chalk up roughhousing or rowdiness to ADHD when those are developmentally appropriate behaviours for a child. Apparently, six or seven are ages when an accurate diagnosis is reached easiest.
Aside from Carnatic music, Seelan’s attention span was helped by repetitive menial tasks like peeling potatoes, chopping ladies’ fingers and carrots. Anbarasu acknowledges that dealing with ADHD in children is a time-consuming task because they aren’t able to complete tasks as quickly as their peers. He calls on parents to pick up the slack – strategising holistic ways to help their child, both at home and in school. It’s a collaborative effort between teachers and parents to then carry out an agreed-upon strategy.
All is not doom and gloom, however. Seelan is observed to play with Lego building blocks for hours on end, despite not performing in the classroom. Anbarasu calls this ‘hyper-focus’. It is a state of mind wherein the mind eliminates noise that potentially distracts them from the task at hand, a sort of “perk” if you will. We are cautioned that encroaching upon this state of hyper-focus can exacerbate emotional issues and precipitate anger. People with ADHD are victim to ‘emotional dysregulation’, which may manifest from frustration in perceived inability to complete tasks satisfactorily. Seelan was unable to appreciate the benefits of delayed gratification, getting restless and upset if things didn’t go his way. Anbarasu explains that this results from emotional dysregulation as well.
At some point, Seelan faces potential expulsion from his class due to the complaints of other children’s parents. Especially in Singapore, where grades are paramount, a poor academic performance which results from an inability to work with a child’s ADHD can be distressing to parents. The teeth-gnashing frustration can make parents feel helpless, and Anbarasu suggests that these situations call for a consultation with a professional therapist who will elucidate the behavioural issues at hand. This gives parents more information to plan future steps. Parents of children with ADHD also attract stinging criticism from other parents. They might feel inadequate in their roles as nurturers and mentors. Anusha has accepted this to be a part of life, chortling as she muses that “you can’t change people”. Whatever the case, it isn’t fair to fault parents for a child’s ADHD. Or the child. Anbarasu clarifies that ADHD is a neuro-developmental disorder – in other words, that’s just how the cookie crumbles. Blame should not be apportioned. Anusha recalls how Seelan used to behave like an attention hog – in its absence, tantrums would be the order of the day. According to Anusha, dealing with instances of emotional dysregulation like this is challenging, especially if you have to deal with the needs of your child while observing social propriety.
Every child’s circumstances are different, so Anbarasu recommends that care be taken to evaluate if danger is imminent. Shouting for a little is perfectly OK. Deal with them after they have thrown their fits because anger is not conducive to receptiveness to advice. Anbarasu is careful to eschew the notion of a “cure” for ADHD. Rather, he says that it is “treatable”. Whether with medication or psychotherapy, or a combination of the two.
Children with ‘combined-type’ ADHD are challenged in a triune of areas – attention, hyperactivity and impulsivity. For these cases, neuropharmacological support is required, to aid concentration and retention of information in class. If the ADHD is not as pronounced, therapy alone could manage the condition. For parents who are especially harrowed by their child’s condition, they should know that there is ample evidence in favour of managing ADHD through the concurrent administration of medication and therapy. On top of psychiatric interventions, there are support groups inside and outside the classroom for parents who are overly stressed.
The episode closes with the narrator speaking over clips of Seelan looking positively cherubic. The viewer is called on to spare the snide remarks, replacing them with positivity, understanding, and “plenty of support”.
All children have fears. Most simply complain about their worries and move on. However, there are some whose fears get more intense over time instead of naturally fading away.
The World Health Organization (WHO) officially classified the novel coronavirus, also known as COVID-19, as a pandemic on March 11, 2020. Children’s responses to such stressful events are unique and varied. Children who are privy to information from a variety of sources can be disappointed, confused, angry, or sad. Some children may be irritable or clingy, while some may regress, and demand more attention, or have difficulty with eating, sleep or self-care.
Amidst the COVID-19 outbreak, it is a given that everyday life will change, and will continue to change for most people. Children may have difficulties adjusting to their routines (e.g., schools and child care closures, home confinement and social distancing), which may interfere with their sense of structure, predictability, and security.
To help your child cope with his/her anxiety around the current COVID-19 situation, the following recommendations can be considered:
Validating your child’s feelings is important.
For example, if someone in the family is unwell, acknowledging and validating your child’s concerns, in addition to reassuring them that the affected family member has the best available medical care to manage the illness, is helpful. When you talk to your child or teen, it’s also important to use words and examples that are developmentally appropriate for their maturity.
It is important to help your child maintain a sense of structure if they are needed to be away from school.
Take a break from social media and the news. Use this time to play with your kids and build an even better parent-child relationship. When it’s safe for them to return to school, be patient while helping them return to their routine so that they can gradually readjust to their normal, everyday activities.
Be a source of stability for your children.
Children are more likely to be intolerant of uncertainties. This means that children tend to view uncertainties as harmful or overwhelming. As such, they may react with fear and avoid preparing for the unknown. It would be helpful if parents focus on the current facts about the situation instead of predicting. Predicting and guessing can become a problem at times, as this may cause anxiety to escalate. If you don’t have an answer to your child’s questions, don’t feel like you’re obliged to play the all-knowing parent. Say you don’t know but you’ll try to find out. While teens and young adults are old enough to understand the risks that COVID-19 bring, be careful when talking to others when in the presence of preschool kids as they may potentially scare themselves with misguided misinterpretations.
Children learn better from modeling behaviour.
Demonstrating how to cough or sneeze into a tissue and discarding it properly, trying to keep your hands from touching your face, and washing your hands regularly can foster good basic hygiene. When you see your kids practicing good hygiene praise them for it.
In stressful times, when children feel helpless, there’s a tendency to blame others.
If they are seen to blame a certain group of people, for example those who have recently travelled, listen to them and address such concerns in your conversation. Importantly, do ensure that you do not reinforce negative stereotypes in your own conversations or behaviours.
Foster a home environment that allows your children to express their feelings.
In some families, when one child in the family has a severe mental illness, the other children can sometimes feel left out. Parents need to bear in mind that this can be a hard time for all children in the family; hence, it’s important to let all siblings have the latitude to express their feelings and feel like they can retreat to safe spaces in your home environment.
Children are capable of picking up on their parents’ emotional energy.
In dealing with the situation, it’s also important that you acknowledge and manage your own anxieties so as not to amplify your child’s fears. This is even more important for parents of children who are generally anxious or have significant worries about something.
This current situation of COVID-19 is challenging and new to most of us. As there is no template to rely on to approach this crisis, we’re in the dark about how long this situation will last or when we will be able to return to life as we knew it. Nevertheless, parents and others can help children navigate these uncertain moments by equipping them with the right resources and instilling resilience in them.
Senior Clinical Psychologist and child psychologist S C Anbarasu was featured on Yellow Pages Singapore’s ‘Ask A Doctor series’, which decided to engage him to answer some questions about children’s mental health issues because of increasing awareness about the effects of Singapore’s education system on their mental well-being.
He answers questions on how to recognise stress in children, Singapore’s education system, child suicide rates here, recommendations on this pressing issue, and more.