By --- Vivyan Chee heads Flourishing Minds at Singapore Children’s Society, a child and adolescent mental health service. Lin Xiaoling heads the research and advocacy department at Singapore Children’s Society.
https://www.straitstimes.com/opinion/will-you-recognise-the-signs-if-your-10-year-old-is-troubled
“Last time I went for counselling because of my self-harm... when I came back, (my parents) were pretty upset and scolded me.”
These were the words of a 12-year-old child sharing his experience with Tinkle Friend, a national toll-free helpline and chatline for primary school children in Singapore who need a listening ear.
Singapore Children’s Society has been running the Tinkle Friend service for 40 years. A study we did found that children struggle with mental health challenges too, and need help.
Mental well-being is in the spotlight with the parliamentary motion debate on advancing mental health earlier in February.
While we welcome the discussions, we believe that more attention should be paid to the needs of young children and ways to improve parents’ mental health literacy.
In particular, significant mental health problems can and do occur among children in middle childhood (seven to 12 years old), and these can have lasting effects.
In 2021, Tinkle Friend engaged in more than 4,200 chats with children. About 9 per cent were linked to mental health.
We analysed close to 60 anonymous and randomly selected chats concerning mental health on our Tinkle Friend platform in 2023 to understand children’s experiences with mental health and what happened when they tried to seek help.
In our study, the three main sources of children’s poor mental health were family, school and peers.
For some children, their family environment was rejecting rather than comforting. They cited parents who made harsh remarks or unfair comparisons with their siblings or peers.
Others faced conflicts with teachers. Some experienced issues with navigating peer relationships and bullying. The stress the children experienced also carried over from one context into another.
Downplaying a child’s struggles
Despite much discussion on mental well-being in recent years, many adults found it hard to acknowledge that young children experienced such challenges.
Perhaps children themselves self-censor.
Our study found that children with mental health concerns were often reluctant to seek help from the adults in their lives. They feared being judged. They did not want to burden others. Sometimes, they simply did not trust the adults around them.
“(My parents) will say, ‘Don’t be crazy, therapist is for those emotionally hurt people’, and they’ll think I’m (an) attention seeker,” said another 12-year-old.
Even children who did seek help found their concerns dismissed – by parents, teachers and school counsellors – which worsened their distress.
Some parents were outrightly hostile when their children tried to discuss their troubles.
One child told us: “(My mum) said in the olden days, no one helped her, and that I was very weak to ask for help.”
Some parents even went to the extent of actively blocking their children’s access to mental health services.
These chats show that mental health challenges can emerge during a child’s early years, but are often overlooked.
Parents are responsible for creating safe spaces and ensuring children can get the help they need. Sadly, they tend to either miss or misread signs of mental health distress.
Parents are understandably not as attuned to the needs of our children as we should be. In our eagerness to help our children overcome challenging situations, we may unintentionally downplay their struggles and emotional realities.
We grew up under different influences and sometimes forget that we should not use our own childhood experiences as a reference point nor project our own beliefs, feelings or solutions onto our children.
In some cases, the fact that we are emotionally invested in our children can cloud our judgment – to the extent that we are unable to view their mental health struggles objectively, especially if doing so calls our parenting skills into question.
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Signs to watch for
A common misconception is that our children are doing fine if they have not been medically diagnosed with a mental health condition. But it is important to understand that mental well-being exists on a continuum.
A child whose condition does not meet the threshold for medical intervention can still be languishing and requires support to regain his ability to thrive.
A child’s state of mental health can also fluctuate over time. He may be doing well but slip into periods of lows.
With younger children, our focus should be on recognising the subtle signs of the impact that mental health issues have on their daily lives, to address their immediate needs and stem any escalation of the situation.
Children typically lack the skills to articulate their feelings and experiences clearly, one key reason why parents must keep an eye out for common signs of mental distress.
In such instances, a child may return to earlier developmental behaviours, such as bed-wetting, thumb-sucking or excessive clinginess.
And while tantrums are a normal part of development, they are signals of underlying issues if these become more frequent or intense.
Complaints of chronic stomach aches, headaches or generally feeling unwell without a clear medical cause can also be indicators of psychological stress.
Sudden changes in eating or sleeping habits, like becoming picky about food or frequently waking up at night, can also be a sign.
Drastic changes in how a child plays, such as becoming more aggressive or withdrawn in his play or losing interest in activities he previously enjoyed, may signal emotional difficulties too.
Parents must be attentive to unusual changes in behaviours because children may resort to hiding or disguising their true feelings and thoughts in order to cope with difficult emotions or situations.
This is especially so with growing awareness of social norms with age, and an attendant pressure to appear “normal” or fit in with peers.
Children also learn from the adults around them. If they observe people masking their emotions and avoiding discussions about mental health, they may adopt similar behaviours and feel ashamed of their feelings.
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What parents can do
The surest way for children to get needed help is by educating their parents and caregivers about mental health.
This also works to reduce the stigma surrounding mental health, creating a more supportive and open environment for children to express their feelings.
Mental health literacy involves understanding the crucial role we play in our children’s lives and the impact of our own behaviours on their well-being. It also entails learning how to effectively communicate with them about mental health.
One strategy that parents can quickly adopt is to be more mindful about the “three pillars of health” – sleep, eat and exercise.
Together, their impact on a child’s mental health is significant and multidimensional.
Sleep: Think of sleep as the charger for a child’s brain. Without enough sleep, his brain can’t function at its best. Sleep is essential for recharging his mental energy, mood and cognitive abilities.
Eat: Imagine food as the building blocks for a child’s body and mind. Healthy eating habits construct a healthy and resilient body and brain, setting a solid foundation for mental well-being and growth.
Exercise: Picture exercise as an elevator for mood and energy. Physical activity, including unstructured play, elevates a child’s overall mental well-being to a higher, happier level. It’s like pressing the “up” button on his emotional state.
If, despite maintaining good sleep, diet and exercise routines, a child continues to exhibit signs of mental distress that significantly impact his everyday functioning, or suffers from severe mood swings, is anxious and withdrawn and struggles with studies, these are clear signals additional interventions are required.
Family as the cornerstone of children’s well-being
In this, we also need a shift towards a family-centric approach, to consider the family as a whole unit and recognise its influence on a child’s mental health.
When we focus interventions solely on the child, the subliminal message is that children are problems to be “fixed”.
However, research consistently shows that involving the entire family in a child’s therapeutic process leads to more effective outcomes.
This approach requires us to actively involve family members in treatment planning, decision-making and interventions.
It prioritises understanding family dynamics, relationships and communication patterns to address the needs of both the child and the family system.
Such an approach not only empowers families to support their children more effectively, but also strengthens family bonds and a child’s resilience in the face of adversities.
Childhood is a critical period for the brain’s development. Addressing a child’s mental distress early can prevent severe mental health issues in the longer term.
By doing this, we can also equip our children with coping mechanisms that will benefit them throughout life.
Vivyan Chee heads Flourishing Minds at Singapore Children’s Society, a child and adolescent mental health service. Lin Xiaoling heads the research and advocacy department at Singapore Children’s Society.
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