Children with Issues

An exchange of Whatsapp messages with my siblings today took an interesting turn. My second sis, a university lecturer, was sharing that one of the Pre-U students she was supervising for some MOE research programme did not turn up as scheduled. She waited for 35 minutes at Jurong Point in vain and was understandably livid. Our conversation about this particular incident soon turned into a discussion, at points heated, about the limitations of our very academics-focused education system and how we seem to be pumping in vast resources into education and yet, still wind up producing young people who are emotionally fragile, have shoddy work attitudes and are not intellectually curious even if they are straight-As students. My second sis pointed out that she has seen several of her students suffer from a host of mental conditions such as depression and anxiety. Some of them have even attempted suicide before.   

As a psychologist-in-training, I sometimes find it disconcerting that my very employability depends on people being unwell. And it is unfortunate, but true, that psychological and other support services are in dire need these recent few years because children are increasingly presenting with more and more complex issues and 'conditions', whether it is developmental delays or disabilities and/or mental health issues. What is happening to our children?

In my opinion, there are two obvious reasons for this apparent increase in 'children with issues.' One is greater awareness and information as parents these days become more savvy and knowledgeable about child development issues, and as public education campaigns on various disabilities and/or mental health conditions gain momentum. Take the example of Autism Spectrum Disorder (ASD). Years ago, children with ASD may have just been labelled 'weird' or 'naughty'. Compare these labels with all the diagnostic labels available today: High-functioning Autism, Asperger's Syndrome, Autistic Spectrum Disorder, etc. Indeed, the very controversy surrounding the upcoming DSM-V centres on the idea that these different labels may all be clinical manifestations of the same underlying disorder.

But I digress. What I mean is, as parents today--whose general level of education and literacy may be much higher than their parents'--gain more information on these various 'child issues', they may be more inclined to step forward to get their child diagnosed with something. And in this group of very concerned parents, some may be overzealous in doggedly pursuing a diagnosis and eventually do wind up getting one from the practitioner out of persistence. (I had one mother, for example, who insisted that her child was autistic and needed to get into a certain autism-specific programme. I, of course, declined comment on this matter since it was out of my professional expertise.) From this angle, the responsibility thus falls onto the professionals in the field to make sure that our kids aren't being over- or even misdiagnosed, especially in face of pressure from parents who might not actually know better. 

There could also be a genuine increase in 'children with issues,' or rather, make that children with 'multiple issues'. I have chalked up a few years of experience in the field of psychological services now, and what I am seeing increasingly are children who are hard to place neatly into any diagnostic category. They have comorbid conditions, or simply have a bit of everything, whether it was delay in some areas of functioning and/or behavioural difficulties, or mental health issues. I have had students come in with mild features of ASD. It means they do have some traits, but not quite enough to qualify for a diagnosis. Their behavioural issues, however, may be no less challenging than kids who actually do have a clinical diagnosis. I have had mildly intellectually disabled students who go on to develop some serious mental health conditions such as schizophreniform disorder. On the average to higher end of the IQ scale, I have seen some supposedly really smart kids do poorly on literacy tests and who cannot read or write at all. On the more extreme end, I have heard of cases from fellow psychologists and/or psychologist trainees of young kids engaging in serious self-harm behaviours. And yes, caseload seems to be ever-increasing, and there always doesn't seem to be enough psychologists to go around. (That might very well explain why more and more universities are opening postgraduate masters/doctoral programmes to train more psychologists, but again, I digress.) In short, more kids seem to be coming into our referral systems with more complex profiles and issues.

If there is a 'genuine increase in children with (multiple) issues,' what then might be the reasons?

We might blame it on our education system, and how it tends to develop the academic side of our children, but fails to consider the importance of lifeskills or life values. But having done professional work in both Singapore and Australia, I am beginning to think there could be bigger reasons than the ills of our education systems alone. I may be oversimplifying things a little (or a lot!), but even with whole-school or even whole-system programmes in place to address the mental wellness of children and youth, youths in Australia still seem to be presenting with the same 'mental fragility' and same complex issues (sometimes even more complex), compared to youths in Singapore. Some may argue that the whole-school and whole-system approaches to promoting mental wellness in Australia may be more of a response to existing problems created by an education system that before that, very much focused on academics. And since it is only in the recent years that these programmes have been implemented, the effectiveness of these programmes may not yet be visible. As for Singapore, we may not have even thought of responding in a systemic way yet.

We might blame it on the family. Parents, especially, often take the fall for many things, including not providing children with enough guidance at home so that they learn how to be resilient, how to treat others right, and how to work hard without burning themselves out. As a parent myself, I know sometimes it really is not easy to teach a child all these things. Let us not forget too that these parents themselves are also products of the same education system that supposedly created all these problems. Think about the mindsets that would have been cultivated from when they were young, and how they might have carried these mindsets to adulthood, and now to parenthood. Modern-day parents also have many other priorities besides their children, such as work and further education (I am guilty as charged). Of course, there is no excuse for neglecting your child, absolutely not. It is categorically speaking the responsibility of parents to provide guidance to their children in areas like character and lifeskill development, regardless of whether the teachers in school provide that. And especially if schools do not provide that.

Finally, we might blame it on society, or modern-day society, with all its technological innovation and 'unhealthy' distractions such as violent television, social media, social networking, etc. Imagine: back in the stone-age, bullying was very much a physical, in-your-face affair. Now, you can bully someone by leaving nasty remarks on that person's Facebook page, tweet about it and even send an email to 10,000 other classmates on your email list. All quite easily done by hiding behind a computer screen and with several swift strokes across the keyboard. Yes, I am talking about the recent phenomenon of cyber-bullying. The dangers of cyber-bullying are real--young people with their full lives ahead of them have died by their own hand because of it. Indeed, in this day and age, violent television is no longer limited to slasher movies or gory computer games. It now also includes homemade videos of kids beating up other kids, or threatening to beat up other kids, uploaded onto sites like YouTube, or easily shared through high-tech video-sharing software programmes.

Our education system, family, society... The list goes on.

What or who do I blame it on? Well, just like the children these days may present with a bit of 'everything,' I think we can blame our children's current state of affairs on, well, a bit of everything. Modern-day environments may be 'unhealthy', education systems may be short-sighted, and family systems may be dysfunctional.  And all these interact, reinforce, complement one another in such complex ways that create, exacerbate or maintain our children's current sad state of affairs.

But who created these problems? Man (as in human) did. WE created these problems for ourselves and for our children. Ironically, we are actors responding to, as well as very much perpetrators of, an increasingly fast-paced, complex and pressurising world with lots of information, sometimes too much.

Hmm. What a lot to chew on.

Now, too much information for me as well after typing this lengthy blog post. To bed, to bed. :)