Blog Category: Child ADHD Treatment

If you’re a parent who believes in taking a proactive approach to your child’s education, then you’ve probably realised by now that comparing your young one to the school’s resident whiz kid(s) is ill-advised. There is truth then, in this kernel of wisdom: “Every child is a unique gift from God”.

Understanding how your child takes in information, assimilates it, learns, is perhaps the first step to making their education a better experience for them. When parents start getting a grasp of what their child’s preferred way of learning is, they can start taking steps to work with that style of learning, instead of foisting the next flavour of the month upon their child. Individual learning styles don’t necessarily dovetail with the school’s pedagogy – but that’s OK. This just means that you’re blessed with more opportunities to help your child grow up with the values and convictions you hold dear.

Conventional wisdom tells us that people generally fall into one of three categories – visual, auditory, or kinesthetic learning. But before you pigeonhole your child into one of those convenient boxes, it is worth noting that while a child may have a dominant learning style, a combination of all the styles is required to learn about the wonderful, wider world that they’re growing up in. Once you have figured out their style, you can then begin to take steps to ensure that they have ample opportunities in the classroom and at home to take advantage of that particular style.

However, there are some children who constantly struggle when they are subject to the traditional classroom setting. Despite your efforts to supervise and coach them, they might continue to face persistent difficulties with reading and writing skills, as well as attention and behavioural regulation in terms of their academic performance.

A child with learning difficulties is affected in different ways, with the impact ranging from mild to moderate or even severe, with symptoms surfacing when the time comes for them to learn literacy and numeracy skills in the classroom. Children with learning difficulties are at risk of developing low self-esteem, which in particular is a consequence of the condition going undiagnosed and/or untreated. Imagine a dewy-eyed child who, with all the innocence of  youth, proudly strives and strains to do well at school – yet never reaping a jot of acknowledgement. Imagine (or remember) what it feels like to have the purity of childlike endeavour constantly rebuffed by the shame of underperformance. To have effort always met with negativity is tough for even the most motivated child, which may lead to the development of a poor self-concept that ends up causing further social-emotional issues in future.

All children, learning difficulties or not, need love and support for them to cultivate a strong sense of self-worth, build confidence and develop resilience. In seeking ways to help your child who has a learning difficulty, bear in mind that your role as a parent is not to “cure” the difficulty, but to arm your child with the social and emotional tools they will need to work through challenges and develop strategies for compensating with their difficulties. In the long run, your child will emerge stronger and more resilient.

Even though everyone’s been a kid before, I know that the new and bewildering responsibilities of parenthood can sometimes make us forget what we, as children, wanted to have for ourselves. I’ve outlined some tips which can be invaluable to our efforts to support a child with a learning difficulty.

1. Knowledge is power – learn everything you possibly can about your child’s learning difficulties and needs.

Doing your own research and keeping abreast of the new developments in evidence-based learning and behavioural interventions not only helps your child, it helps to foster a sense of solidarity with your child. The more you know about your child’s needs, the better you are equipped to help your child. Start with your child’s teachers and consult with professionals (e.g. educational psychologists, school psychologists, or child clinical psychologists) who are best positioned to work together with you and your child in this journey. Collaborating with your child’s school teachers and fostering a good relationship with them helps in the overall understanding of your child’s needs – this facilitates consistency between home and school, which is particularly essential for children with challenging behaviour.

2. Be an advocate for your child by raising awareness.

While society has made great strides towards the goal of inclusivity, awareness of special education needs and learning disabilities is still limited (but growing). Embrace your role as a proactive parent, taking responsibility not only for your child’s welfare but also contributing to the child who does not have a dedicated guardian in their life. Yes, your journey will be fraught with challenges and frustrations, but always remember to remain calm and to persevere. We often don’t realise just how much children internalise behaviour and views that they perceive in their parents. As a parent, you are entrusted with the very delicate task of moulding a young mind. Your healthy optimism, perseverance, and sense of humour doesn’t just benefit you – it positively influences your child to be a self-advocate, which is a very important goal for a parent in these circumstances.

Some parents choose to hide their children’s learning difficulties in secrecy, for fear of stigma or unjust treatment by others. They might honestly feel that they’re serving the best interests of their child. On the contrary – it is this very lack of understanding and awareness from family and friends that causes the misattribution of a child’s developmental needs to ‘laziness’ or ‘poor parenting’ or ‘mischief’. By shining a light on the condition, you help others develop empathy and come to be more supportive of your child. Within the family, siblings might feel that there is more attention and preferential treatment towards the brother/sister with learning difficulties, despite being aware of their condition. Hence, it is also important for parents to reassure all their children equally that they are loved, to provide support to their work, and to include them all in routines for the child with learning difficulties.

3. Focus on your child’s strengths, not just weaknesses.

No one is defined by disability or need. And no one is perfect either. As you embrace your child’s flaws, celebrate their strengths in the same breath. As with all other human beings, a child with learning difficulties too will come into their own personality, interests, strengths and weaknesses. Focus on the gifts and talents which your child is blessed with, and help them to nurture their areas of strengths such as in activities they excel in.

4. Praise effort rather than outcome.

Children with learning difficulties may not always excel academically, and if they do, they likely have put in a lot more effort than their peers to have achieved a similar good grade. Acknowledge the effort made, which deserves recognition – no matter if the child has gotten the answer right or wrong. Your child is demonstrating courage when they try out new approaches to assignments and study strategies, and if you want them to learn from mistakes and be receptive to feedback, credit and praise must be given where due. It will take time for new practices and interventions to work and for new skills to be acquired, so bear in mind to focus on the long term goals, and to break larger tasks down into smaller, more manageable milestones which can be spaced out over time.

Everyone’s definition of success is different, but the aspirations you have for your child probably extend well beyond the fulfilment of good grades. Working with parents, it has been my experience that most, if not all, express the desire for their child to lead an independent life, in which they are capable of providing for themselves, and above all else, to be happy. This being the case, then success in life definitely isn’t based on just academic success, but rather on things like having a sense of self-worth, the willingness to ask for and accept help, the ability to bounce back in the face of adversity and the emotional depth to form healthy relationships – values and qualities that are not quantifiable like the metric of exam grades.

5. Keep your child motivated.

As school is most likely a source of frustration for your child who puts in much more effort than in proportion to the reward of good performance, it is important to find something in school that brings your child enjoyment, that they are motivated to pursue without much prompting. Sometimes, to taste the fruit of serendipity, one must eschew his comfort zone. This may involve having your child participate in a CCA of their choice, attend camps or other school-related activities, and encouraging your child to have good relationships with peers and teachers. It can be difficult to motivate your child to learn, and to invest time in subjects which already make them feel inferior and bad at. You will probably meet less resistance if you start from your child’s level of ability, carefully choosing lesson topics that already are of interest to them. Give them some measure of autonomy to choose how they study or complete homework – building in breaks and breaking down challenging tasks into smaller chunks gives them ownership in the crafting of their own timetable, helping to keep them motivated to follow through with their plan.

Finding a role model who has flourished in spite of their learning difficulties can show your child that success is attainable, and that it is their own choice not to allow their current difficulties to define them. Celebrity, athlete, friend, neighbour or pastor, the only requirement to those role model shoes is that your child feels comfortable talking to them.

6. Encourage healthy lifestyle habits.

Stress may manifest differently in children than in adults. While some signs may be more overt, such as trouble sleeping, agitation, acting out, or meltdowns, others may retreat inwards – shutting down, spacing out, withdrawing and isolating. Even as adults ourselves, we may lack the prescience to recognise that our internal systems are under stress, let alone children who have not yet matured into such skills. Hence, it is your responsibility to be vigilant of signs of stress in your precious one.

Your child’s eating, sleeping and exercise habits are also vital to their overall learning ability.  With a healthy routine which incorporates a balanced diet, quality sleep and sufficient physical activity, children will be better able to focus and concentrate.

Other than the physical, paying attention to your child’s emotional needs is also important. When they are faced with the frustrating challenges presented by their learning difficulties, allow them to express their feelings in a safe space. Validate them by acknowledging that the cause of their gripe is an issue, but be careful not to coddle them into poor self-restraint. Be ready to listen when they are ready to talk, and be a grounding, reassuring presence which helps their mind integrate with their body, and re-orient into a sense of calm.

Above all, remember to take care of yourself! The uniquely sacrificial dint of parenthood sometimes diverts needed attention from our own needs. If you are to project an empathetic sense of warmth, you will first need to cultivate self-compassion, and allow yourself the space to tend to your own needs. The quality of support you are able to provide to your child is dramatically affected by your own levels of stress and exhaustion. Parenting is a full time job, but don’t let yourself burn out emotionally.

In order to do this, you need to be mindful of your own limitations. You are the best gauge of when to rouse the oarsmen to right your ship. If you have a supportive spouse, or friend, or family member, take heart. Lastly, there is great benefit in the solidarity of support groups, which serve as useful support and also reminders that you are not alone in your unfolding journey!

Are children being over-medicated for mental health issues? We spoke to DR ADRIAN LOH, Senior Consultant Psychiatrist at Promises Healthcare, who explained how doctors balance the use of drugs like or ODC or ADHD medication for kids with a duty of care in diagnostics and treatment.

Dr Loh’s general observation around healthcare in Singapore is that both parents and doctors remain cautious in the use of medication in children and adolescents being treated for mental health issues.

Yet, while it’s appropriate to exercise due diligence before starting medication – especially in view of possible side effects – there is a flip side when they’re withheld without good reason.

“This may be due to insufficient understanding of the medication,” says Dr Loh. “There may be unfounded fear of ‘addiction’ or concerns about costs of treatment, for example, or it could be because of the persistent underlying social and cultural stigma around mental illness.”

What to take into account when considering medication

The decision to use medication, he says, should be a carefully considered one, taking into account a few key areas.

1. In making a diagnosis, a good practitioner should also identify relevant factors that influence a child’s mental health condition, including their age and education level, the presence of other medical conditions, underlying temperament and personality traits, family and interpersonal relationships, as well as socio-cultural norms.
2. There should be an assessment of the severity of the child’s symptoms and the level of distress caused to the child – and in some cases, to those around him.
3. The practitioner should be able to confidently assess the impact of the condition across different areas of the child’s life.

For parents, stress around children’s mental health can be significant. For many of us, the tendency is to observe a child for signs of mental distress, but then wait to act. When we finally cannot intervene to help anymore as the child becomes a teen and even more inaccessible, we then realise it’s time to get professional help from therapists and psychiatrists.

From there, it can be an extended journey, according to Dr Loh. A patient may need months of therapy to unpack and get to the root of their fears, mood swings or erratic behaviour. Depending on the considerations mentioned earlier, the doctor will consider the use of medication to try to alleviate some of their symptoms at a suitable juncture.

“For example, a child could be diagnosed with mild ADHD (Attention Deficit Hyperactivity Disorder), but if there is a significant impact on their friendships or their ability to cope with schoolwork, and if other attempts at helping, such as classroom management, have been unsuccessful, it may be timely to introduce the use of ADHD medication for kids.”

Patient and parent responses

Dr Loh also notes that not all medication is going to “work” the way we want it to. Every patient responds to therapeutic drugs in a different way. “Some drugs that are used to treat mental health conditions may not have the intended effect and the doctor may then have to cycle through several different types to land on the right one. This can be distressing for the patient as well as parents, who can feel that the child is ‘over-medicated’.”

It’s a conundrum that requires patience from all involved, as not trying medication altogether may cause more harm, he says.

“Another illustrative case is with OCD (Obsessive-Compulsive Disorder). This is a condition that local and international studies have shown to be often characterised by a prolonged duration of untreated illness, extending even past a decade for some individuals. In many of the young people I’ve treated, my personal experience is that it would have been beneficial for them to have been started on medication much earlier in the course of their illness.”

At the same time, there are some instances where antidepressants may not be the most helpful solution. “Inappropriate use of medication is another valid concern,” says Dr Loh. “One example would be to ignore the underlying factors contributing to a child’s depressive symptoms. These could include unresolved grief after a death in the family, or feelings of helplessness or guilt about parents’ marital conflicts. In these situations, it’s wise not to offer antidepressants as a cure-all. Instead, offer counselling or other forms of therapies alongside the judicious use of medication to help the child in a holistic manner.”

In instances where parents describe “over-medication”, Dr Loh says that it could be possible that some children may have been offered medication without considering other alternatives. “When experiences of this kind are shared with other parents, it can lead to a perception that medication is overused.” He adds that if medication at a particular dose has been tried for a certain period and doesn’t result in an improvement of symptoms, this too can lead to an unwarranted generalisation that medication is ineffective.

Final word

It’s about taking the time to come to the right solution – because making or sticking to an inaccurate diagnosis can lead to the inappropriate use of medication. “If a teenager has symptoms of what we call hypomania (a less dramatic state of elevated mood) and those symptoms are missed and they are treated only with antidepressants, it can lead to a poor treatment response or even a worsening of what eventually can turn out to be a bipolar disorder.”

Mental health hangs in a delicate balance for both children and adults. It needs much more attention than we tend to give it, says Dr Loh – it’s all too easy to ignore the symptoms of unease and distress and block them with screen distractions. If you have concerns, he suggests speaking to a therapist as a key part of your self-care regimen.

About the doctor

Dr Loh is an experienced psychiatrist with a subspecialty focus in child and adolescent Psychiatry. He has a special interest in Obsessive-Compulsive Disorder and anxiety disorders, expertise in military and aviation psychiatry and a strong appreciation for the cross-cultural aspects of mental wellbeing.

This article was first published on the Expat Living Website on 30th March 2023 and written by Anna Murphy.

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.

(Click on the link for a version with English subtitles. Remember to click on the ‘Settings’ button to reveal the English subtitle selection. https://www.mewatch.sg/en/series/en-ullae-s2/ep9/958092)

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”.

Parenting is an incredible journey filled with growth and transformation for both children and caregivers. As children progress through various developmental stages, it’s natural to witness changes in their behaviour and abilities. However, some challenges may arise, leaving parents concerned and seeking support. In such situations, psychological testing emerges as a valuable resource, offering parents insights into their child’s development and paving the way for tailored assistance.

In the article, “Psychological testing for children: What it is and what to expect,” written by Honeykid’s Esther Chung, we embark on a journey of understanding the significance of psychological testing and how it can positively impact children and families. Expert insights from Educational and clinical psychologists, Tan Su-Lynn and S. C. Anbarasu respectively, will illuminate the purpose and process of psychological testing. As caregivers, being well-informed about this process will empower us to provide the best support and nurture the full potential of our beloved children. So, let’s delve into the warmth and professionalism of psychological testing to embrace its benefits fully.

Follow this link to read the full article: https://honeykidsasia.com/psychological-testing-for-children/