Mental Health Issues in Kids Are Worrying. Here Are the Warning Signs

From school stress, relationships issues to family problems and bullying, there has been a rise in the number of stressed-out children and youth in Singapore, according to experts. Increasingly, these children are turning towards 24-hour hotlines and email befriending services for support—and we are looking at children as young as five years old.

Stress when not handled adequately and properly can lead to anxiety, depression or suicidal behaviour.

In 2016, Samaritans of Singapore (SOS), a suicide prevention agency, received about 1,900 calls from those aged five to 19 in 2016–an increase of 70 per cent compared to 2012, as told to Channel NewsAsia.

Mental illness is extremely real and it’s more than just being stressed. This increasingly worrying trend in Singapore sees 1 in 6 people in Singapore suffering from some form of it, with depression, alcohol abuse and OCD (obsessive compulsive disorders) the most common, according to SingHealth HealthXchange.  

However, like other illnesses, mental illness also have cures and patients can recover and bounce back. Knowing what constitutes mental illness and accepting that it is something that needs to be addressed together as a community is the first step.

theAsianparent spoke to Dr Julian Hong, a doctor of DTAP Clinic Group and the alternate director of Resilience Collective. 

Dr Hong shares his insights on mental illnesses; he identifies common warning signs of mental illnesses in children that parents can look out for, and why a parent’s role is important on empowerment and recovery. 

The 5 Different Categories of Mental Illnesses

Firstly, it is important to understand that mental illnesses affect one’s mood, thinking and behaviour. 

There are 5 categories of mental illnesses:

• Mood disorders (Depression, Bipolar)
• Anxiety disorders (OCD, Generalised Anxiety)
• Eating Disorders
• Dementia (Alzheimer’s)
• Psychotic Disorders (Schizophrenia)

Common Mental Illness Child Warning Signs 

1 in 10 children worldwide experience mental health concerns, however less than 33% of them seek help.

• For children under 15 years old in Singapore, common mental illnesses include: 
  • Autism Spectrum Disorder (ASD)
  • Attention deficit, hyperactivity disorder (ADHD)
  • Anxiety
  • Depression

A 2010 study in Singapore found that mental illnesses accounted for the largest group of DALYs (33%), for children under the age of 15.

*One Disability adjusted life years (DALYs) is a term used to calculate disease burden and is also known as the loss of 1 year of “healthy life”.

• As for young people in the age group of 15 to 34 years old, common mental illnesses observed include: 
  • Anxiety
  • Depression
  • Schizophrenia

Do you know mental illness child warning signs? | Image: File photo

Mental Illness Child Warning Signs And Risks: What Parents Should Take Note 

As caregivers to their children, mums and dads play an important role. Their daily interactions with their child allows them to sense when something is not right (i.e. parental instinct).

Here are the major conditions and some of the early symptoms of mental illnesses in children:

• Autism Spectrum Disorder (ASD)

There is a tendency for the warning signs of ASD to occur in the first 2 years of a child’s life and often affects the social development of children. The warning signs may be present a little, or a lot.

They affect the child’s interaction and communication with the world around them which includes:

1. Minimal eye contact
2. Little to no smiling
3. Playing with other people or share enjoyment
4. Making noises to get your attention

*This is a non exhaustive list of symptoms.

At 18 months when your child undergoes routine vaccinations, your doctor would take the opportunity to assess your child’s development. And in the process, any concerns of ASD would also be identified. 

However, if you suspect that your child has a developmental concern, it is advised to seek medical attention early.

• Attention deficit, hyperactivity disorder (ADHD)

There are 3 main components of ADHD: inattention, hyperactivity and impulsivity.

A child may have one or all of these components of ADHD and they include behaviours such as:

• Being overly fidgety and squirmy
• Impulsivity to interrupt others
• Being unable to wait for their turn 
• Difficulties in controlling their emotions (which often results in huge tantrums and mood swings)

Other signs of inattention starts to surface when the child is made to perform a task—usually at school. He/she tends to daydream, is unable to focus and eventually does not complete the task. Sometimes teachers notice these behaviours and reports them to parents.

Again if you suspect any degree of ADHD, or face difficulties in parenting your child, please seek early medical attention with a child psychologist, paediatrician or your family doctor.

• Anxiety

Mental Illness Child Warning Signs: When a child is having an anxiety attack, they say “my stomach hurts.” (Image: File photo)

Anxiety in children can present itself as phobias or excessive extreme fears, to anything that can range from loud noises, animals, water to visiting certain places like schools and hospitals.

The child responds to these stimuli through crying, throwing tantrums, clinging, avoidance and sometimes even psychosomatic symptoms such as stomach pains or headaches.

There are many good tips out there to handle your child’s anxiety that the Child Mind Institute suggests. You can adopt these practical steps in your day to day interactions with your child to support him/her through his/her anxieties.

However, if these anxieties start to feel out of control, seeking medical help early can alleviate this parental child stress and better equip you to better handle your child’s fears and anxieties.

• Depression

Depression is more than the occasional feeling of sadness experienced by a child but something that is persistent (present consistently more than 2 weeks) and affects the daily activity and functioning of the child.

Your child may experience all or a combination of these symptoms:

• Changes in appetite or sleep (excessive or too little)
• Feelings of sadness
• Hopelessness
• Suicidal thoughts
• Not enjoying activities that child used to enjoy
• Difficulty in concentrating
• Lethargy and tiredness
• Irritability and edginess. 

The concern behind depression is the deliberate self harm and suicidal ideation which is an important area that needs to be addressed. (more on that below)

• Schizophrenia

Childhood Schizophrenia is the same as adult Schizophrenia which requires lifelong treatment.

While it may be difficult to notice the signs and symptoms, they include developmental delays when compared to a child’s peers. General signs and symptoms include: 

• Poor self care bathing, dressing
• Problems performing in school
• Shows excessive delusions and suspicions of others around
• Difficulty controlling emotions (too much or lack of)
• Strange behaviour, ideas or speech

Spotting these signs and symptoms though, does not mean that your child has Schizophrenia.

It could be pointed towards other mental health issues. And you are advised to seek medical care early for your child.

Why Depression Matters And How Parents Should Deal With A Suicidal Child

Depression is indeed a major concern because if left untreated, it can transition into adulthood. 

According to SOS, suicide is the leading cause of death for Singapore’s millennials aged 10 to 29. In 2017, there were 2.5 times more suicide deaths as compared to road traffic accident deaths. And in that same year, 361 precious lives were lost to suicide alone.  

A 2018 study done in Singapore showed that deliberate self harm occurred in 23% or nearly 1 in 4 adolescents who sought psychiatric help at a local hospital.

The risk factors that were associated with this deliberate self harm included the female gender with 5 times more likely, concomitant depressive disorders at 2.5 times more likely and alcohol use at 3.5 times.

Parents, children and screen time: 

Recently there has been a revolting practice called the Momo challenge, where suicide instructions were embedded in innocent children’s videos on Youtube, as reported on CNN.

Planting thoughts of self harm into an innocent child’s mind is repulsive and it is extremely important for you to take note of your child’s screen time and even curate what he or she watches on the internet.

There is no substitute for sitting down with your child and watching the programmes with him or her and using those moments to parent the right values across.

“Trust your parental instincts”

Unless a youth is aware that he or she has a mental health condition, most of the time concerned parents would bring him/her to see a doctor or counsellor, which begins the process.

It is important to trust your parental instincts and in your daily interactions with your child, if you sense that something is amiss especially with some of these warning signs. Every suicidal thought must be taken seriously.

You will find the relevant hotlines at the end of the article.

Warning Signs (adapted from SOS Singapore): 

• Talk and Speech
  · “My family will be better off without me”
  · “My life is meaningless anyway”
  · “If you don’t love me, I’ll kill myself”
• Actions
  · Giving away treasured possessions and saying goodbye
  · Researching suicide methods
  · Writing suicide notes (including emails/diaries/blogs)
• Mood
  · Emotional outbursts m(anger, sadness, irritability, recklessness)
  · Loss of interest
  · Anxiousness or feelings of shame

Parental support is important. Stay with your loved one and listen attentively to let them know that you are very concerned. Let him/her person speak about his/her suicidal thoughts, it does not increase their risk of committing suicide.

How can parents and children with mental illnesses be empowered to bounce back?

• Educate

It is important to know the signs of mental health issues in your children. Learn to ask for help where you can. When in doubt, do your online searches, ask questions, ask the experts and find out everything you need to know.

• Empower

This leads you on to the next step of being equipped and empowered once you feel confident on caring for your child. Work with your trusted medical team and your family members and know that you are not alone.

• Encourage

Receive encouragement from those who have gone through the same journey and are going through the same journey of being a caregiver to someone with mental health issues. Exchange tips on best practices.

Prevention Is The Best Cure: Where to seek help? 

• For concerns of depression and suicide:

For immediate help: Call 999 or the Samaritans of Singapore (SOS) at 1800-221-4444 (Both operates 24/7). Stay on the phone with them until someone comes to you.

Alternatively, head down to the Accident & Emergency (A&E) Department of the nearest hospital to have someone attend to you.

For non-urgent cases: IMH has a community health assessment team (CHAT) for mental health assessment at Scape Hub Orchard.

Make an online appointment here: https://www.chat.mentalhealth.sg/get-help/make-chat-referral/

• For concerns of substance and alcohol dependence

National addiction management service: https://www.nams.sg/ or call them at 67326837

• Getting help as caregiver of a child with mental health concerns

You can reach out to Caregivers Alliance, a charity for caregivers by caregivers to support them through this journey of caregiving to a loved one with mental health challenges. Check out  https://www.cal.org.sg.

All responses are contributed by Dr Julian Hong, a doctor of DTAP Clinic Group and the alternate director of Resilience Collective. 

Source: CNA, MOH Healthhub, SingHealth HealthXchange