ADHD in Singapore

 

Attention Deficit Hyperactivity Disorder (ADHD) is a neuro-developmental disorder of self-control. As the name suggests, the symptoms of ADHD are characterised by serious and persistent difficulty in three areas, namely:

• Inattention
• Impulsivity
• Hyperactivity

It is quite normal for children to be active, inattentive and impulsive. However, children have difficulties in the above areas when these behaviours:

• are severe and persistent
• occur across more than one situation, for example, at home, school, the supermarket
• impair their performance at school and their relationships with others

Children who exhibit such behaviours may be suffering from ADHD. Another name for this is hyperkinetic disorder. ADHD is related to abnormalities in brain functioning and development. It is also associated with other factors that can affect brain functioning or development, such as genetic factors, injuries, toxins and infections. 

Signs and Symptoms

Children with ADHD exhibit a variety of symptoms. Accordingly to diagnostic criteria, the symptoms must have started before the age of seven and be evident for at least six months.

With inattention, the child:

• often fails to give close attention to details
• often has difficulty sustaining attention in tasks or play activities
• is often easily distracted by extraneous stimuli
• is often forgetful in daily activities
• often does not seem to listen when spoken to directly
• makes careless mistakes in schoolwork or other activities
• often does not follow instructions and fails to finish schoolwork, chores or duties
• often has difficulty organising tasks and activities
• often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
• often loses things necessary for tasks or activities (toys, school assignments, pencils or books)

With hyperactivity and impulsivity, the child:

• often fidgets or squirms in the seat
• often leaves his seat in the classroom or in other situations where remaining seated is expected
• often runs about or climbs excessively in situations where it is inappropriate
• often has difficulty playing or engaging in leisure activities quietly
• is often ‘on the go’ or often acts as if he is ‘driven by a motor’
• often talks excessively
• often blurts out answers before questions have been completed
• often has difficulty waiting turns
• often interrupts or intrudes on others

Treatment

There is no simple treatment. A multidisciplinary approach is most effective. This includes:

• Medication
• Medicine changes the brain chemistry so that the brain may function in a more orderly manner. As a child’s concentration improves and hyperactivity lessens, the child will find life more manageable and satisfying.

• Help with behaviour management and organisation skillsParents can help children structure and organise their life. Having a routine is essential. Parents may make use of concrete reminders, such as lists, schedules and alarm clocks to help break down homework activities into small steps. Use of small, frequent and constantly repeated incentives and feedback increase children’s awareness of what they are doing. Positive results are encouraged in this way.

• Training parents to elicit desired behaviourTraining parents helps them to elicit the desired behaviour they want in their children. As children with ADHD often feel they can do nothing right or well, helping children experience success by discovering what they are good at will foster their confidence and competence.

Where to Get Help for ADHD Diagnosis, Treatment and Support

 

(A) Subsidised Venues for Diagnosis & Treatment of ADHD/ADD (For Children)

 

Child Guidance Clinic (CGC)
Health Promotion Board Building
3 Second Hospital Ave #03-01
Singapore 168937
Tel: 6435-3878/9

The main government clinic in Singapore under the Institute of Mental Health that assesses and treats behavioural and developmental disorders in children and adolescents up to the age of 18 years. Students can pay a subsidized fee if there is a referral letter from school or polyclinic (Long queue expected)

                 

Child Development Unit (KK Women’s and Children’s Hospital)
Specialist Clinic M
Podium I, Children’s Tower
100 Bukit Timah Road
Singapore 229899
Tel: 6394 2211
Students can pay a subsidized fee if there is a referral letter from school or polyclinic
(Long queue expected)

 

The Children's Specialist Clinic (National University Hospital)
Clinic 'A'
Main Building Level 1
National University Hospital
5 Lower Kent Ridge Road
Singapore 119074
Tel: 6772 5502

 

James Cook University Psychology Clinic
JCU Singapore Psychology Clinic
JCU Singapore Campus Block D
600 Upper Thomson Road
Singapore 574421

Email: psychologyclinic@jcu.edu.sg
Website: www.jcu.edu.sg/Clinic_Intro.htm

This is a University Clinic where ADHD children and adults can get diagnosis and medical treatment. Low cost of $20 per consultation session (diagnosis tests will cost more). As this is a training clinic, patients are seen by psychiatric students under training.

(B) Support & Service Organisations

 

Student Care Services (SCS) – Educational Psychology Services (EPS)
The EPS serves students aged 5 to 18 years coming from families with less than $2000 monthly income. The EPS provides diagnostic and intervention programmes for students with learning difficulties, special behavioural / emotional / developmental issues, and special needs eg autism, dyslexia, attention deficit. They also provide support services for parents.

There are 3 centres:

SCS Clementi Centre
Blk 437 Clementi Ave 3 #01-98
Singapore 120437
Tel: 6778 6867

 

SCS Hougang Centre
Blk 463 Hougang Ave 10 #01-964
Singapore 530463
Tel: 6286 9905

SCS Yishun Centre
Blk 202 Yishun St 21 #01-89
Singapore 760202
Tel: 6759 6821

Email: epsenquiries@students.org.sg
Website: www.students.org.sg

Care Corner Educational Therapy Services (ETS) - Mr. Isaac Tan
Offers specialized services for children with special learning needs which covers ADHD, attention difficulties, dyslexia, reading difficulties, writing difficulties and slow learning.
Serves children from 5 to 13 years old. Services include consultation, specialist tuition and intervention programs to improve learning abilities conducted at its centre in Toa Payoh and at six primary schools. Subsidies are available to families needing financial assistance.

Care Corner Educational Therapy Service
Blk 149 Toa Payoh Lorong 1 #01-963
Singapore 310149
Tel: 6259 8683
Email: ets@carecorner.org.sg
Website: www.carecorner.org.sg/ets.html
Learning To Learn Centres (Kampung Senang Charity and Education Foundation)
The Learning To Learn Centre is run by Kampung Senang Charity and Education Foundation. The Centre helps children with learning challenges, including ADHD, Autism Spectrum, Dyslexia, developmental delays and children who do not respond well to traditional teaching methods, at affordable and subsidized rates.

They run 2 Centres :

 

Kovan MRT Centre
Blk 221 Hougang St 21 #01-90
Singapore 530221
Tel: 6487 3430 (Mr. Ong Chee Seng)

 

Tampines Centre
Blk 840 Tampines St 82 #01-113
Singapore 520840
Tel: 6788 2568

Email: email@kg-senang.org.sg
Website: www.kg-senang.org.sg

(C) Support Groups

 

Society for the Promotion of ADHD Research and Knowledge (SPARK)
1008 Toa Payoh North, #03-08
Singapore 318996
Email: Spark_Singapore@yahoogroups.com
Website: www.spark.org.sg

SPARK is an independent, voluntary welfare organization which promotes ADHD awareness and runs a support group for parents who have children with ADHD / ADD.

 

SPARK holds monthly Parent Support Group meetings and talks relating to ADHD, treatment methods and coping strategies. They are held on the first Saturday of every month, from 9am–12noon at the Child Guidance Clinic, 3rd floor of the Health Promotion Board Building, 3 Second Hospital Ave, Singapore 168937. 

 

ADHD Singapore Mailing Group
This is a mailing group which offers a forum for people to connect with others in the group to ask questions on ADD / ADHD related issues and to share learning. To join the mailing group, just send an empty email to:

Email: ADHD_Singapore-subscribe@yahoogroups.com
Website: http://groups.yahoo.com/group/ADHD_Singapore/

                   
Sources:
http://www.imh.com.sg/clinical/page.aspx?id=249
http://www.spark.org.sg/help.html

Does your child have Attention Deficit Hyperactivity Disorder (ADHD)?

Does your child have trouble paying attention, controlling impulsive behaviours (may act without thinking about what the result will be), or is overly active? If he does, does that mean he is suffering from ADHD?

Unfortunately, above characteristics are symptoms of ADHD. And that makes almost the entire population of children being classified as sufferers of ADHD at one point or another. An article published by the British Medical Journal, claims that attention-deficit hyperactivity disorder (ADHD) is being overdiagnosed. The writers argue that the definition of ADHD in doctors’ guidelines has broadened in recent years and this has contributed to a steep rise in diagnosis of and drug prescriptions for the disorder, which is unnecessary and possibly harmful for some individuals. The authors call for a more cautious diagnostic approach to help reduce the risk of overdiagnosis. This move is certainly welcomed. Well, before any changes is made to the diagnostic approach, let's take a look at what ADHD is and how a child is currently diagnosed.

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). Although ADHD can't be cured, it can be successfully managed and some symptoms may improve as the child ages.

ADHD has three subtypes:

• Predominantly hyperactive-impulsive
  • Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
  • Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.

• Predominantly inattentive
  • The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.
  • Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

• Combined hyperactive-impulsive and inattentive
  • Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
  • Most children have the combined type of ADHD.

Causes

Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.

Genes.
Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder. Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.
Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This NIMH research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.

Environmental factors.
Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children. In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD.

Brain injuries.
Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.

Sugar.
The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it.

Food additives.
Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an increase in activity. Research is under way to confirm the findings and to learn more about how food additives may affect hyperactivity.

Signs & Symptoms

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.

Children who have symptoms of inattention may:

• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable
• Have difficulty focusing attention on organizing and completing a task or learning something new
• Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
• Not seem to listen when spoken to
• Daydream, become easily confused, and move slowly
• Have difficulty processing information as quickly and accurately as others
• Struggle to follow instructions.

Children who have symptoms of hyperactivity may:

• Fidget and squirm in their seats
• Talk nonstop
• Dash around, touching or playing with anything and everything in sight
• Have trouble sitting still during dinner, school, and story time
• Be constantly in motion
• Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:

• Be very impatient
• Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
• Have difficulty waiting for things they want or waiting their turns in games
• Often interrupt conversations or others' activities.

Who Is At Risk?

ADHD is one of the most common childhood disorders and can continue through adolescence and into adulthood. The average age of onset is 7 years old.

Diagnosis

Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children, or seems constantly "out of control." Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently "spaces out" in the classroom or on the playground.
No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child's pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood mental disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.
Between them, the referring pediatrician and specialist will determine if a child:

• Is experiencing undetected seizures that could be associated with other medical conditions
• Has a middle ear infection that is causing hearing problems
• Has any undetected hearing or vision problems
• Has any medical problems that affect thinking and behavior
• Has any learning disabilities
• Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
• Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent's job loss.

A specialist will also check school and medical records for clues, to see if the child's home or school settings appear unusually stressful or disrupted, and gather information from the child's parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.
The specialist also will ask:

• Are the behaviors excessive and long-term, and do they affect all aspects of the child's life?
• Do they happen more often in this child compared with the child's peers?
• Are the behaviors a continuous problem or a response to a temporary situation?
• Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?

The specialist pays close attention to the child's behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations, and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.

Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.

Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:

• A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.

• Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.

• Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.

• Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.

• Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.

• Tourette syndrome. Very few children have this brain disorder, but among those who do, many also have ADHD. Some people with Tourette syndrome have nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others clear their throats, snort, or sniff frequently, or bark out words inappropriately. These behaviors can be controlled with medication.

ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses.

Recognizing ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.

Sources:
http://www.cdc.gov/ncbddd/ADHD/
http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
http://www.nhs.uk/news/2013/11November/Pages/Experts-argue-that-ADHD-is-overdiagnosed.aspx