Alex*, a five-year-old boy, has been on his mother’s nerves. Although most three-year-olds can dress themselves, Alex is still unable to dress himself sometimes. When outdoors, he does not walk, but chooses to jump, skip, or run instead. He likes to keep his hands occupied by tearing paper into tiny pieces. At school, he would be punished by his teachers at least three times a week. On one occasion, he would urinate on his friend’s foot, on another, he would pretend to fall and accuse another student of having pushed him. Although he understands all his lessons well, he is generally disruptive in class due to his inability to sit still for more than five minutes. Alex has a disorder known as Attention Deficit Hyperactive Disorder (ADHD).
*the child’s name has been changed in order to protect his privacy
What is ADHD?
In 1844, Dr Heinrich Hoffman, a German general practitioner who founded a mental hospital, wrote poems in a book he designed as a present for his then three-year-old son. Symptoms of attention deficiency and hyperactivity were portrayed in “The Story of Fidgety Philip”:
Let me see if Philip can
Be a little gentleman
Let me see if he is able
To sit still for once at table
Thus Papa bade Phil behave
And Mamma looked very grave
But fidgety Phil
He won’t sit still
Additional symptoms of inattention were depicted in “The Story of Johnny Look-in-the-Air” which described how Johnny lost things and was easily distracted by external stimuli. ADHD was described then the same way the Institute of Mental Health’s (IMH) website describes it today. Watch the video in the link to understand how frustrating it can be for parents. Its symptoms are characterised by three main areas; namely inattention, impulsivity and hyperactivity. It is not caused by low intelligence. In fact many of them have very good thinking and reasoning abilities.
In his book “Attention Difference Disorder”, Dr. Kenny Handelman, attempts to convince his readers that what is known as Attention Deficit Disorder (ADD) – with ADHD as the hyperactive variety – is not necessarily a deficit. It is just that people with ADD/ADHD can focus better on areas that they like. So, is it a mental or a developmental issue? Dr. Handelman explains that ADD/ADHD is a brain-based disorder, a medical condition which can be corrected with the use of medications. Approximately eighty percent of cases are hereditary – although it may not be obviously exhibited in either parent. The remaining twenty percent can be attributed to maternal smoking or alcohol consumption during pregnancy, prematurity of birth, head injuries, lead poisoning between birth to the age of three, or chemotherapy.
ADHD in Singapore
There are no national statistics on how many children in Singapore have ADD/ADHD, but the Child Guidance Clinic (CGC) of IMH alone handles 800 cases of newly diagnosed ADD/ADHD in children and adolescents between the ages of six and nineteen since it started operating eight years ago.
The CGC runs a program called REACH (Response, Early intervention and Assessment in Community mental Health). Its conception went through years of formulation as chronicled below:
- 1968: Child and adolescent psychiatry is introduced at Woodbridge Hospital
- 1970: MOH establishes the Child Guidance Clinic (CGC)
- 1980: Modern technology is employed in observation rooms
- 1982: 18-bed unit is opened for older children and adolescents with disturbed emotional states and behaviours
- 1993: The Department of Child and Adolescent Psychiatry is formed
- 1998: Parent support groups for ADHD are formed
- 2004: CGC at NUH; the Children’s One-Stop Psycho-Educational Services (COPAS) Programme – to address the learning difficulties of children – is set up
- 2005: The in-patient unit is revamped to monitor patients in graded levels
- 2007: The National Mental Health Blueprint is formulated
- 2011: The REACH program is inaugurated
The REACH team works closely with school counsellors, general practitioners and social workers of voluntary welfare organisations such as Singapore Children’s Society, Beyond Social Services, MCYS Community Services Society and Touch Community Services (Youth Service Group). The team helps these organisations to broaden their scope of care given to students with emotional, social and behavioural issues and disorders within the community.
The complimentary assessments, when necessary, are conducted in the child’s school or at the related voluntary welfare organisation after consent from the child’s parents is obtained. Depending on the result of the assessment, the child may be referred to the relevant medical institution closest to their area of residence. (IMH for North and Central, NUH for West and KKH for East)
In the first four years since 2007, the majority of the 12,714 calls to REACH were for ADHD and emotional disorders such as anxiety and depression. These are serious issues. According to Dr. Handelman, untreated ADD/ADHD risks academic underachievement and therefore underemployment, accidents and injuries, substance abuse, impulsive sexual behaviour, criminality, social isolation and dangerous inattentive driving. Since August 2011, the REACH program covers all government schools, from primary schools up to junior colleges.
Self-Screen Your Child
There is an easy and free way for you to rule out any developmental issue for your young child aged 5 years and below. It is regrettable that a local version of such a website is not available, but this service by an American non-profit organisation works just fine. Click here and submit the date of birth of your child and they will send you an age-appropriate online questionnaire. You will receive the results by e-mail within two weeks.
When Alex’s parents noted the different behaviours of Alex and his younger brother, they consulted a child psychologist who advised them to attend SignPost. It is a community-level education program for parents of children with developmental needs led by KK Women’s and Children’s Hospital’s Department of Child Development. Upon completing the program, Alex’s mother commented that there were some easy methods taught which she started using at home. For example, she considers her kitchen, where all the cooking and baking takes place, not to be a place for rowdy boys. In the past, she used her pleasant motherly tone to warn him, but to no avail. Then she resorted to yelling and threatening, but that did not work favourably either. After the program, she asked him to write down the house rules and paste it on the kitchen door himself. Not only did it work for him, he also became the guardian of the kitchen and now reminds his brother that the kitchen is out of bounds!