Child and Adolescent Psychiatric Conditions

Attention Deficit Hyperactivity Disorder (ADHD)

It is estimated that in every classroom of 40 students, one to two children may be suffering from ADHD. When left undetected and untreated, the child or teen with ADHD will have difficulties with his concentration, ability to focus and will not be able to follow the lessons in class or the teacher’s instructions. He will display hyperactive behaviour and will be disruptive in class. Most importantly, he will not be able to do perform to his full potential in school and in examinations. Many times he will be punished by his parents and teachers for his behaviour and will be ignored by his peers as he cannot follow the rules when playing. All these result in frustation for the child who may go on to develop futher difficult conduct and oppositional behaviours.

If your child has ADHD, he or she may display the following symptoms:

Inattention

• • Fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
  • Has difficulty sustaining attention in tasks or play activities
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
  • Has difficulty organizing tasks and activities
  • Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  • Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)
  • Easily distracted by extraneous stimuli
  • Forgetful in daily activities

Hyperactivity

• • Fidgets with hands or feet or squirms in seat
  • Leaves seat in classroom or in other situations in which remaining seated is expected
  • Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
  • Has difficulty playing or engaging in leisure activities quietly
  • Is often “on the go” or often acts as if “driven by a motor”
  • Talks excessively

Impulsivity

• Blurts out answers before questions have been completed
• Difficulty awaiting turn
• Interrupts or intrudes on others (e.g., butts into conversations or games)

Management and Treatment

In children, the first line of treatment is therapy with behavioural modifications. Medications may be recommended by the child psychiatrist to enable the child to cope with the ADHD symptoms. This will help prevent the child with ADHD from being labelled as a “naughty” or “lazy” child by his teachers and parents. Punitive actions from adults and ostracization from peers due to their impulsive behaviours are factors leading to alienation of ADHD children and worsening of their behaviour.

Anxiety Disorders

Anxiety and stress are common and normal feelings that your child or a teen may experience. However, if the stress or anxiety becomes overwhelming and is affecting his or her academic performance and other aspects of life, he may be suffering from an Anxiety Disorder and it may have be best that he or she sees a professional like a psychiatrist for help.

Some tell tale signs that your child may need help:

• A deterioration in his or her academic performance and results. In more severe cases, he or she may have school refusal.
• Difficulty falling asleep due or staying awake worrying about things.
• Frequent anger outbursts and irritability.
• Frequent physical complaints (eg. nausea, stomach ache, headaches, etc) with no medical cause.

Common Anixety Disorders include:

Generalized Anxiety Disorder (GAD). Children and teens with this disorder have excessive, free floating anduncontrollable worries about daily life events. They have negative appraisals about things and have a tendency to catastrophise. Things that they worry about include failing exams, a loved one dying and sometimes natural disasters.

Panic Disorder. This is a disorder characterised by repeated panic attacks which are intense periods of fear or apprehension usually lasting ten minutes to an hour. During the attacks, the child or teen may have accelerated heart rate, sweating, trembling, sensations of shortness of breath, chest pain or discomfort, nausea or stomach distress, feeling dizzy, unsteady, lightheaded, or faint, numbness or tingling sensations and chills or hot flashes. They may think that they are” going to die” or “going crazy”. Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting and uncomfortable experiences of a person’s life and may take days to initially recover from.

Obsessive Compulsive Disorder (OCD). Children and teens with OCD have obsessions, or repetitive intrusive ugly thoughts that make them anxious, and/or they engage in compulsions (repetitive behaviors or mental acts) in an attempt to reduce the feeling of anxiety. Some compulsions may include repeated hand-washing, checking, tapping, or mental routines (such as counting backwards from 20). An example of an intrusive thought is “The door knob is contaminated and I will get an infection and die from touching it”.

Post Traumatic Stress Disorder (PTSD). PTSD is a disorder that develop after being involved, witnessing, or hearing about a frightening traumatic event. Symptoms include upsetting vivid memories, nightmares, flashbacks of the event, and avoidance of place or things that would remind the sufferer of the traumatic event.

Separation Anxiety Disorder. These children have excessive anxiety about being separated from an important attachment figure, such as a parent. They may cling or cry when a parent leaves the home, or refuse to go to school or bed without a parent being present.

Specific Phobias. Phobias are persistent, excessive and unreasonable fears of an object or situation and is beyond voluntary control. Some common phobias for children and teens include fear of certain animals, heights, and injections.

Social Anxiety Disorder. These children and teens have an intense fear of social and/or performance situations, and excessive concern about social embarrassment or humiliation. They may avoid social activities like going to parties, performing in recitals, speaking to adults, and may even have school refusal.

Treatment of Anxiety Disorders

Anxiety Disorders can be treated with medications and/or therapy. Medications used in the treatment of depression have been found to also be useful and effective with Anxiety Disorders. In cases of mild Anxiety Disorder, referral to a psychologist for therapy alone may be effective in helping the child or teen cope with his or her symptoms. Common therapy used in Anxiety Disorders include Cognitive Behavioural therapy which addresses the negative thoughts, Eye Movement and Desensitisation and Reprocessing (EMDR) for PTSD and Hypnosis / Hypnotherapy to help with relaxation and ego strengthening.

Depression in Children and Teens

Children can become depressed and depression has been diagnosed in children of all ages, but appears to incease significantly throught adolescence. Some studies have shown that by age 18, prevalence rates of depression can be as high as 20% with girls being more likely to be depressed than boys.

Younger children with depression may present with lack interest in activities they previously enjoyed, being overly critical of themselves and having feelings of hopelessness about the future. Difficulties at school may arise from a decrease in ability to concentrate during classes. Depressed children tend to lack energy, have problems sleeping and may be irritable and angry. They may have somatic or physical complaints such as giddiness, stomach aches, nausea or headaches. They can have suicidal ideations which may even progress to suicide attempts. The symptoms becomes more “adult-like” as the child progresses through to adolescence with adolescents presenting with more sleep and appetite disturbances, suicidal ideations and suicide attempts.

The symptoms of depression are:

• depressed mood nearly every day
• loss of interest or pleasure in most activities
• significant weight loss or weight gain
• poor sleep or over sleeping
• agitation / irritability / restlessness or feeling slowed down
• feeling tired easily or loss of energy
• feeling worthless or having excessive guilt
• poor concentration, difficulty thinking or forgetfulness
• suicidal thoughts, plans or attempts

Treatment of Depression

Depression is a medical / psychiatric illness and like other medical conditions, it cannot be simply willed away. Early and proper treatment will result in the best outcome for your child and prevent consequences such as academic failure and in severe cases, suicide. When you bring your child to the psychiatrist, he will recommend a holistic approach to the management of depression which may include medication, referral for therapy and social interventions that best suits your child’s needs. Do not hesitate to ask questions or to provide inputs as your participation and support is vital to your child’s road to recovery and wellness.

Myths and Concerns about Seeing a Child Psychiatrist

Despite the difficulties that your child is facing, you may have some misgivings and struggle about bringing him or her to psychiatrist. Here are some commonly encountered fears and concerns that parents may have.

1. Let’s wait and see. The problem will go away!

Mental or psychiatric illnesses are like any other medical illnesses. Without treatment, your child’s condition can potentially worsen. Studies have shown that early treatment, sometimes even at a subsyndromal stage where the illness have not become full blown, will bring about the best outcome.

2. People will think my child is crazy if he/she sees a psychiatrist.

Today in Singapore, children see psychiatrists for many reasons. From simple stress and adjustment difficulties to serious psychiatric illnesses. Seeing a psychiatrist does not mean that your child will be stigmatise. Many parents seek the help of psychiatrists to advise them on how to manage their children’s behaviour, how best to cope with the symptoms their children may have and how to improve the life of their children. It is also reassuring to know that your child’s condition is confidential and privacy is ensured at all times.

3. My child will be given medication and he/she will be addicted to it.

While medication treatment can be an important part of treatment for psychiatric conditions, many child and adolescent psychological conditions do not need medication. Only after careful evaluation and discussion with the parents and child, would the psychiatrist start any medication for your child if needed. Indeed, medication is only one aspect of the holistic treatment your child will be provided when seeing a psychiatrist. Our doctor also provides psychological therapy such as cognitive behavioural therapy, EMDR, hypnosis / hypnotherapy, etc to aid your child in his or her problems.

If you follow the medication regimen provided for your child by the doctor, there is no risk of addiction.

4. Seeing a psychiatrist will ruin the future of my child.

Your child’s condition will be kept strictly confidential. Current literature has shown that early interventions provides the best outcome fo many psychological conditions. If left untreated, your child’s mental condition may deteriorate and worsen resulting in longterm consequences for his or her future.