Principles Of Child Psychiatry English Language Essay

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Conversely, when the mother is not present, even a nonthreatening but novel situation may be disturbing to some children; thus nursery school, as well as hospitalization, may evoke separation anxiety. A series of uncomfortable and slightly distressful episodes occur including the mother leaving the child with the stranger and shortly returning ( Schwartz 1983)

1 in 10 children aged 6-16 has mental health disorders: IMH expert

channel news asia

SINGAPORE : An estimated one out of 10 children aged between 6 and 16 years old has mental health disorders, said an expert from the Institute of Mental Health (IMH).

This was shared at the unveiling of a new one-stop facility for children with mental health and development issues on Monday.

Some 50,000 children in Singapore have mental health disorders, with 5,000 serious enough to need psychiatric care.

These children can now be treated at a one-stop facility at St Andrew's Community Hospital in Simei.

This is the result of a collaboration involving the IMH, KK Women's and Children's Hospital, and research agency A*STAR.

The new facility will bring together paediatrics, psychiatry and neuroscience expertise to one location.

Associate Professor Daniel Fung, director of IMH's Response, Early Intervention and Assessment in Community Health (REACH) Programme said the key is to provide accessible services to them in the community, because most rarely need to be seen by hospital services.

"This collaboration was set up really to work with all the different partners that deal with mental health across disciplines - paediatrics, psychiatry, neuroscience researchers - and across age groups, from preschool all the way to primary, secondary and junior college, and also across different sectors - health, education, social services," said Assoc Prof Fung.

Assoc Prof Fung stressed that parents too can play their part by moderating expectations and seeking help early for their children, especially for mild mental and mainly anxiety-related issues such as school refusal, separation anxiety and social anxiety.

The facility is also studying healthy infants in a key developmental research programme designed to find risk factors for cognitive problems.

Professor Michael Meaney, Senior Investigator & Associate Director of the Growth Development & Metabolism Programme, A*STAR said: "What we've done so far is to show that a lot of the functions of the brain - the emotional functions, the cognitive functions - we thought we could only access children who are 18 months of age or two years of age, we can actually study them in children as young as six months of age. 

"And what that means is that if you can look at variations, differences between kids at that early age, you might be able to understand how those differences would help predict who is going to require our services."

Prof Meaney said the mental health numbers in Singapore are similar to developed countries with modern cultural and economic demands - where families spend less time on their children.

The facility also sees school-age children referred by counsellors for language, emotional and behavioural issues.

Some serious disorders in children include schizophrenia and bi-polar disorders. -CNA/wk/ls

Sat, Jan 09, 2010

The Straits Times

Preschool pressures

Preschoolers below the age of six are not immune to stress and its effects.

Dr Ken Ung, a psychiatrist and senior consultant at Adam Road Medical Centre, said a common stressful situation for children below the age of six is when they start preschool.

Separation anxiety

Such stress typically stems from separation anxiety - this can happen when the child is separated from a loved one or caregiver to whom he or she has an emotional attachment.

Dr Ung, who has a special interest in child and adolescent psychiatry, psychotherapy and forensic psychiatry, said that children at that age are pre-wired to be attached to a caregiver for their survival. So when there is separation, they become anxious.

'It is a fairly universal ritual for many children to endure this stress when they start preschool,' he said. 'However, as their caregivers help them to see that the separation is transient, that nothing has happened to their relationship and that their caregivers continue to be present after the absence, the stress slowly reduces as the fear or threat associated with the separation recedes.'

Aside from separation anxiety, being in a new environment itself can be another stressor when starting preschool.

Dr Ung said that while some children adapt well to new situations, others are 'slow to warm up' and struggle to adapt initially.

Then, there are the children who are by nature 'difficult' and who do not take well to change. This group is expected to do the worst with the change of starting preschool and though most will eventually adapt, they may take a lot longer.

Activity overload

Meanwhile, overloading a young child, who is trying to adapt to a new situation, with extracurricular activities can take its toll too.

'At preschool, enrichment classes are useful to help parents discover which of the many interests they should help their children cultivate.

'However, it is important that children are not loaded with too many enrichment classes, nor should they be made to persist in an activity in which they have no interest or aptitude to pursue,' said Dr Douglas Kong, a consultant psychiatrist at Mount Elizabeth Hospital.

Enrolling a child in too many programmes can overload his or her ability to handle information, thus stressing the child, he said.

It is also imperative that the activities are appropriate for the child's level of physical and psychological development.

Parental expectations

Dr Ung noted that stress often occurs when there is a mismatch between a child's abilities and the demands placed on him by his parents or the environment.

Mrs Jeanette Buckley, 35, the managing director and principal of Hess Education Centre, said that one issue in Singapore is the speed with which parents want their child to start reading and writing.

'Parents try to get their children to rote-memorise words,' she said. 'We have had plenty of children come to us to be assessed. Sure, they can recognise words, but they're not necessarily reading.

'The minute they come to a word they don't know, they become stressed and can't sound it out. In addition, there are children who learn to read but do not comprehend words.'

Their stress, from such demands placed on them, can be exacerbated if they sense they are not meeting their parents' expectations or if their parents seem unhappy.

'Pushing them too hard, especially when they perceive there is displeasure and when they feel that they are letting their parents down, can spark insecurity and lower their self-esteem,' said Dr Ung.

Dr Kong added: 'A young child's self-esteem depends on his parents' love and approval. The child will always strive to please them.'

Other possible stressors include a child's home environment. Parental arguments, separation and divorce can create anxiety because there is concern over the possible absence of one of the parental figures.

Stress symptoms

While acknowledging that stress is inevitable, Dr Ung said too much stress is not healthy for the mental health of young children.

'Children are developing physically and psychologically,' he said. 'If they start to learn that the environment is dangerous and threatening, that is the mindset they may grow up with. This may lead to their becoming prone to anxiety and depression when they are older.'

Dr Kong said that learning can also be compromised when the child is stressed and anxious.

As young children may not have developed the ability to verbally express their thoughts and feelings yet, stress is often signalled by overt behavioural changes.

These include crying, irritability and an increase in the level and frequency of temper tantrums and sleep difficulty.

Miss Jessie Ooh, a psychologist at the University Children's Medical Institute at National University Hospital, said signs to look out for are the physical effects of stress such as stomachaches. She added that the picking up of new habits such as thumb-sucking can be another indicator that a child is stressed.

Dr Ung said: 'Most parents have an idea of the basic temperament of their child. Under stress, there will be marked changes in their behaviour and this would normally alert a parent.'

If the stress is chronic and behavioural changes are ongoing, parents should seek help for their child.

'The best prevention method is for parents to understand their children well - their strengths and weaknesses - and to provide a good match between them and their environment.'

Charmaine Khoo

I would appreciate it if mommies could share how they deal with their crying child in playgroup/nursery due to separation anxiety as my boy has been crying the past 2 days in his nursery class.


Posted on Sunday, July 15, 2007 - 12:38 pm:


It takes time for the child to settle down. I brought my daughter to playgroup and she was also crying for the first few sessions. It's coming to about 1.5 months and although she's settled down now, she still gets abit anxious 'some' times. What you can do is to talk to your boy about the activities/friends/teacher in the nursery class, sing some songs (sung in the nursery) to get him familiar and used to them.

I know it's not easy to see your child cry so much, i had thought of pulling out but... just wait a while more and see how it goes... my neighbour said her children went thru this phase at nursery/kindergarten/primary school! i guess all of us need some time to settle down in a new environment!

i made the mistake of walking out of the class, leaving my daughter to the teacher, without informing her... that's when she cried really hard. So now, i always say 'See you later' or 'i'll wait for you outside, you play with your friends and i'll come back to bring you home, ok?'... etc to let your child know that you will be back to bring him home.

hope this helps!

hi kit

my 3yr son just started to attend pre-n class in jul. both my hubby and i took turns to accompany him-sit in the class with him- for 2 hrs for 3 weeks!!! our hard work has been paid off, he goes off with a kiss and we pick him up 2hrs later daily.

separation anxiety is a tricky issue. there are 2 more of my son's classmates still having their maid hanging around-in the class-till today.

we curb our son's anxiety by assuring him that we are waiting for him outside his class. he will def see us the 1st thing he finishes his class-and we have to keep our promise and cannot be late. when he was distracted by the teacher with a drawing/painting activity, we will take the opportunity and tell him that we will wait outside. inform him when you leave-do not sneak away when he's not paying attention. this will only increase his insecurity.

posted on Friday, November 07, 2008 - 4:50 am:


I came to this forum cos I couldnt sleep.

My 3 year old son started a 2x/week nursery this week. 3 hours per session. I am still on maternity leave and am free to accompany him, but the school is very strict and wont allow me to go into the class with him. First day, I went inside, put schoolbag down with him, and sit a while until the teacher said I must leave. so I told him I wait outside, and he was fine.

today, the teacher wont let me into the class, so I had to drop him at the door. He started crying and the teacher had to drag him from me. My son was physically fighting her to get to me. I wanted to cry.

Later when I peeped into the classroom, he was walking to his seat, not crying. On and off during the class, he would start to ask for me and cry a bit, but stop when distracted.

When I picked him after school, he saw me and was about to cry and say he waited very long for me, but i distracted him and praised him and he didnt cry.

tonight, before going to sleep, I asked him if he liked his school, his teachers and his friends. He said Yes Yes Yes. but then when I asked him if he wanted to go to school tomorrow, he said no. And he kept telling me he didnt want to go to school. When I asked him why, he said he didnt like the teacher. When I asked him why not, he said he didnt like me to wait outside.


I am troubled that the teacher didnt let me stay, cos I think it would have helped in the transition.

I also find that the teachers are a bit strict, they raise their voices and I heard her tell another girl, why for no reason you cry, if you like to cry so much, you can stand in the corner and cry. I would have tried to pacify the girl if I were the teacher. Ask her why she cry. maybe someone step on her toe?

I dont know whether to insist that my son goes to school or to change schools

Posted on Sunday, January 04, 2009 - 12:54 am:

Hi Shanesky,

I can understand your situation. I started to put my son to a 2hr playgroup when he was 21mths old. For 2 terms and 5 days per week at he school, he has been very cranky and cry every day in the initial period. The teacher has to carry him everytime me or my maid send him there. At the 4th weeks or so , he will cry every time before going to school. I can't see what were they doing in the playgroup session. At that time, he still can't talk. I monitor for a period towards the 2nd term and I was confused too whether to change school.He has been crying once a while during the nite time for the whole of the 2 terms there but got better subsequently. After serious monitoring, I feel that my son is still small at his age and with the class size from 13 kid, mixing 18mths to 3+ years, to a total of 16 to 2 teacher. There was this grandma whose grand dau just join the PG and during the first 2 weeks, she accompanied her grand dua and she told me that my son was left crying unattended and she felt sad to see him struggling on the ground without attention. I presume the teachers are unable to attend to so many kids of such a small age. I decided to change him to another playgroup. I have put him to a 3X a week enrichment group with an initial 7 to 2 teacher ratio, he adapts well with initial crying for 1 to 2 weeks. I came to realise one thing, the teacher's attention to a kid is very important. With a terrible start, some kids may not like the environment. I have never heard him crying before going to school now whom he used to do that in his old PG school. It's a Blessing....


I am also quite troubled son is in playgroup, and he refuses to stay in the class without me. Had told him that I will be waiting for him etc...but he still cannot let go. Somemore almost half the class is crying, the teachers said not to tell the kids that u are leaving but to find chance to sneak off when they are engrossed in activity, since then my boy is never engrossed in his activity, even in his favourite song and dance and painting, he has to touch my body to ensure that I am around him all the time. The ratio is 15 to 2 teachers, but the class size is 16 now, teachers can't really give more than a min of attention to each child. My son can't talk well yet and sometimes he asked the teacher some questions, the teachers couldn't understand so just smiled or looked away...Then my boy will walk back to me, looking blur.

How? The teachers said they also need time to understand the child....But like what tanlt said, teacher's attention to a kid is v impt... A terrible start may turn him off future schooling....

Hi tanlt, which playgroup is ur son currently in?