https://www.straitstimes.com/singapore/parenting-education/anxiety-is-the-invisible-disorder-among-kids-i-was-suffering-every-day-in-school
2023-11-12
SINGAPORE – When Hannah was in lower primary school, she began feeling anxious all the time. She was overwhelmed by the marked change to her usual routine as well as the new environment and classmates.
While her peers eventually adjusted and adapted, every day was a struggle for her.
“I did not understand what I was experiencing. I did not have many friends and I was depressed at a young age,” says Hannah, now 22, who did not want to reveal her full name.
Secondary school was even more stressful because of the presentations she had to do. She resorted to self-harming to obtain medical leave and avoid showing up for them.
Near the end of Secondary 2, she mustered up the courage to tell her mother, who took her to see a psychologist in private practice. She was diagnosed with social anxiety.
“I felt relieved because my parents could understand how I was really feeling,” she says. “Before that, I felt like they didn’t think that it was serious if I experienced anxiety. It was taken lightly when, in fact, I was suffering every day in school and it affected my mental health.”
While she informed her school about her condition, she felt like “nothing much was done” as some teachers were not understanding when she missed presentations because of anxiety.
Hannah’s story is more common than one might think.
Singaporean youth miss 24 days of school a year on average because of depression and anxiety symptoms, a recently released survey of parents conducted by Duke-NUS Medical School and the Institute of Mental Health (IMH) found.
Their school performance dropped by an estimated 63 per cent compared with how they were expected to do if they had no symptoms of anxiety and depression.
Researchers polled 991 parents about their children, who totalled 1,515 and were aged four to 21, between April and June 2022. The survey found that 13 per cent of young people had symptoms of anxiety while 12 per cent had symptoms of depression, based on their parents’ responses.
In total, 16.2 per cent of youth had symptoms consistent with at least one condition. However, only 15 per cent of this group had a medical diagnosis and two-thirds had an unplanned visit to an emergency department.
The parents in the study reported that they spent an average of $10,250 on medical care because of their children’s mental health condition.
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At a national level, the direct healthcare cost for these conditions among youth is estimated to be $1.2 billion, the researchers say.
“The real effects of untreated mental health conditions among youth will extend well into adulthood, when they are less able to obtain rewarding and high-paying jobs due to poor school performance and other challenges resulting from their illness,” says Professor Eric Finkelstein, a health economist from Duke-NUS’ Health Services & Systems Research and a senior author of the study.
A similar survey by the same researchers among Singaporean adults during the same period revealed that depression and anxiety could be costing Singapore as much as 2.9 per cent of its gross domestic product or nearly $16 billion.
About one in five adults have such symptoms.
What is anxiety disorder?
Everyone has moments of anxiety, such as before a high-stakes examination, for instance.
But children with anxiety disorders have frequent worries that may seem out of proportion to the actual situation and they may avoid situations or activities because they fear it, says Assistant Professor Sharon Sung from the Health Services and Systems Research Programme at Duke-NUS.
Some of the common physical symptoms include headaches, stomachaches, giddiness, a racing heart, muscle tension and/or shortness of breath.
Anxiety often occurs together with depression and there may be overlapping symptoms such as social withdrawal, over-thinking, high levels of self-criticism, fatigue and sleep disturbances.
“It can sometimes be hard for parents or caregivers to tell what is driving these behaviours,” says Prof Sung, who is also a supervising clinical psychologist in the Department of Psychological Medicine at KK Women’s and Children’s Hospital.
She says that most research on this topic has documented higher rates of anxiety disorders among girls versus boys. A 2021 population study of youth in Singapore found the highest rates of anxiety among teens aged 14 to 16, she adds.
However, Associate Professor Daniel Fung, a senior consultant and chief executive of IMH, says the Duke-NUS and IMH study was based on parental responses.
Parents were not likely to report internalising symptoms such as sadness, which are more common in females.
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Males, on the other hand, tend to have externalising emotions such as anger and behavioural changes. The study also did not set out to answer questions about age group differences, he adds.
Well-intentioned parents may inadvertently reinforce their children’s anxiety when they tell them there is nothing to be afraid of.
“This makes children less likely to share their fears. If every time children say they are scared and the parent invalidates those feelings, they will often translate into physical symptoms like pain in the stomach, head or elsewhere,” Prof Fung says.
“Parents respond to physical ailments more seriously, so children with anxiety start doing that. Anxiety as a symptom may then be missed.”
Anxiety disorders are more pronounced and do not go away no matter how parents try to help, Prof Fung says, adding that the pandemic could have had an impact on the results of the study.
“One misconception about fears and worries is that if we avoid these fears, we will no longer have them. This is a fallacy as fears will grow through avoidance. Facing fears needs acknowledgement that they exist.”
A little help makes a huge difference
Managing anxiety disorders in children and youth is not always about getting the right medication or therapy.
In Hannah’s case, support from a teacher and classmates was crucial.
In 2018, she enrolled in Ngee Ann Polytechnic’s information technology (IT) course, but could not adjust to the new environment and took a 10-month leave of absence.
The following year, she wanted to explore her creative interests and enrolled in the polytechnic’s immersive media diploma programme. Her anxiety and depression flared up in her second semester and she deferred her studies for four months until the next academic year.
“The poly environment involves more social interactions and I was trying really hard to cover up my anxiety. It took up a lot of energy and left me feeling very tired. In the end, I could not handle it,” she says.
In 2020, Hannah resumed her studies in IT.
Ms Charis Tang, a senior manager at Ngee Ann Polytechnic’s School of InfoComm & Technology, swung into action when she found out about Hannah’s condition.
Hannah was allowed to do group projects as individual ones and some presentations on a one-to-one basis instead of in front of the class.
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During times when her condition worsened, Ms Tang made arrangements for her to attend physical classes via an online link.
Hannah’s classmates also readily took on responsibilities to help her once they learnt she had mental health challenges, Ms Tang adds.
Hannah, who was also diagnosed with autism spectrum disorder, a neurodevelopmental disorder, in late 2021, says: “Whenever I was feeling very down, Ms Charis encouraged me not to give up.”
She adds that her parents supported her wholeheartedly. She has an older sister who is 26.
Ms Tang, who also taught Hannah some modules, helped her look for a suitable internship in her final year with the help of SG Enable, the focal agency for disability and inclusion in Singapore.
“What truly surprised us was her resilience and determination. Despite the challenges she faced, Hannah refused to give up and put in exceptional effort in her work,” says Ms Tang, who has been with Ngee Ann Polytechnic for eight years.
Buoyed by their belief in her, Hannah persevered and graduated in the top 15 per cent of her cohort in May. She is now studying computer science in a local university.
“Every time I felt like giving up, I thought of Ms Charis’ kindness and the tutors and classmates who helped me along the way. I did not want to waste their efforts,” says Hannah.
What to do if your child has an anxiety disorder
Parents may find it hard to understand their child’s seemingly irrational fears.
“They may assume that anxiety is not a big deal or that the child will grow out of it,” says Prof Sung.
But if your child’s anxiety becomes severe and interferes with his or her life, it is time to seek treatment, she adds.
Parents may also try to help their children avoid stressors, but this could backfire and worsen their anxiety.
“When our children are anxious, it is natural to want to help them feel better. But if we allow them to avoid all stressful situations, we miss out on opportunities to teach them how to cope with anxiety.
“A better approach is to work with your child to gradually approach stressful situations, so he or she can learn how to manage them effectively,” Prof Sung suggests.
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Prof Fung says cognitive behaviour therapy (CBT) is the most important tool in managing anxiety and medication is seldom the first line of treatment.
In CBT, children learn about the origins of fears and worries, and how to recognise their body’s reactions. Older children will learn the difference between a feeling and a thought and how thoughts drive feelings, he adds.
“For example, if we think that something bad might happen, we will feel scared. Conversely, if we imagine a coping thought that good outcomes happen, the feelings will be more hopeful. This is practised in a series of behavioural experiments that we get the child with his or her parents to participate in.”
Prof Sung adds: “It is important for parents to understand that the goal of treatment is not to eliminate all anxiety, but to help equip young people with tools to manage life stressors effectively.”
Hannah says parents play an important role in helping their children manage their mental health conditions. They should avoid labels and instead make time to listen and communicate with their children without judgment.
Hannah, who has battled anxiety since primary school, tells other children and teenagers: “We should not give up hope because whenever we face challenges, we can learn ways to overcome these challenges and this will make us stronger and more resilient.”
Helplines
Mental well-being
Institute of Mental Health’s Mental Health Helpline: 6389-2222 (24 hours)
Samaritans of Singapore: 1800-221-4444 (24 hours) /1-767 (24 hours)
Singapore Association for Mental Health: 1800-283-7019
Silver Ribbon Singapore: 6386-1928
Tinkle Friend: 1800-274-4788
Chat, Centre of Excellence for Youth Mental Health: 6493-6500/1
Women’s Helpline (Aware): 1800-777-5555 (weekdays, 10am to 6pm)
Aware’s Sexual Assault Care Centre: 6779-0282 (weekdays, 10am to 6pm)
National Anti-Violence and Sexual Harassment Helpline: 1800-777-0000
Counselling
TOUCHline (Counselling): 1800-377-2252
TOUCH Care Line (for seniors, caregivers): 6804-6555
Care Corner Counselling Centre: 6353-1180
Counselling and Care Centre: 6536-6366
Online resources
mindline.sg
eC2.sg
www.tinklefriend.sg
www.chat.mentalhealth.sg
carey.carecorner.org.sg (for those aged 13 to 25)
limitless.sg/talk (for those aged 12 to 25)
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