Parenting is an incredible journey filled with growth and transformation for both children and caregivers. As children progress through various developmental stages, it’s natural to witness changes in their behaviour and abilities. However, some challenges may arise, leaving parents concerned and seeking support. In such situations, psychological testing emerges as a valuable resource, offering parents insights into their child’s development and paving the way for tailored assistance.
In the article, “Psychological testing for children: What it is and what to expect,” written by Honeykid’s Esther Chung, we embark on a journey of understanding the significance of psychological testing and how it can positively impact children and families. Expert insights from Educational and clinical psychologists, Tan Su-Lynn and S. C. Anbarasu respectively, will illuminate the purpose and process of psychological testing. As caregivers, being well-informed about this process will empower us to provide the best support and nurture the full potential of our beloved children. So, let’s delve into the warmth and professionalism of psychological testing to embrace its benefits fully.
Are children being over-medicated for mental health issues? We spoke to DR ADRIAN LOH, Senior Consultant Psychiatrist at Promises Healthcare, who explained how doctors balance the use of drugs like or ODC or ADHD medication for kids with a duty of care in diagnostics and treatment.
Dr Loh’s general observation around healthcare in Singapore is that both parents and doctors remain cautious in the use of medication in children and adolescents being treated for mental health issues.
Yet, while it’s appropriate to exercise due diligence before starting medication – especially in view of possible side effects – there is a flip side when they’re withheld without good reason.
“This may be due to insufficient understanding of the medication,” says Dr Loh. “There may be unfounded fear of ‘addiction’ or concerns about costs of treatment, for example, or it could be because of the persistent underlying social and cultural stigma around mental illness.”
What to take into account when considering medication
The decision to use medication, he says, should be a carefully considered one, taking into account a few key areas.
In making a diagnosis, a good practitioner should also identify relevant factors that influence a child’s mental health condition, including their age and education level, the presence of other medical conditions, underlying temperament and personality traits, family and interpersonal relationships, as well as socio-cultural norms.
There should be an assessment of the severity of the child’s symptoms and the level of distress caused to the child – and in some cases, to those around him.
The practitioner should be able to confidently assess the impact of the condition across different areas of the child’s life.
For parents, stress around children’s mental health can be significant. For many of us, the tendency is to observe a child for signs of mental distress, but then wait to act. When we finally cannot intervene to help anymore as the child becomes a teen and even more inaccessible, we then realise it’s time to get professional help from therapists and psychiatrists.
From there, it can be an extended journey, according to Dr Loh. A patient may need months of therapy to unpack and get to the root of their fears, mood swings or erratic behaviour. Depending on the considerations mentioned earlier, the doctor will consider the use of medication to try to alleviate some of their symptoms at a suitable juncture.
“For example, a child could be diagnosed with mild ADHD (Attention Deficit Hyperactivity Disorder), but if there is a significant impact on their friendships or their ability to cope with schoolwork, and if other attempts at helping, such as classroom management, have been unsuccessful, it may be timely to introduce the use of ADHD medication for kids.”
Patient and parent responses
Dr Loh also notes that not all medication is going to “work” the way we want it to. Every patient responds to therapeutic drugs in a different way. “Some drugs that are used to treat mental health conditions may not have the intended effect and the doctor may then have to cycle through several different types to land on the right one. This can be distressing for the patient as well as parents, who can feel that the child is ‘over-medicated’.”
It’s a conundrum that requires patience from all involved, as not trying medication altogether may cause more harm, he says.
“Another illustrative case is with OCD (Obsessive-Compulsive Disorder). This is a condition that local and international studies have shown to be often characterised by a prolonged duration of untreated illness, extending even past a decade for some individuals. In many of the young people I’ve treated, my personal experience is that it would have been beneficial for them to have been started on medication much earlier in the course of their illness.”
At the same time, there are some instances where antidepressants may not be the most helpful solution. “Inappropriate use of medication is another valid concern,” says Dr Loh. “One example would be to ignore the underlying factors contributing to a child’s depressive symptoms. These could include unresolved grief after a death in the family, or feelings of helplessness or guilt about parents’ marital conflicts. In these situations, it’s wise not to offer antidepressants as a cure-all. Instead, offer counselling or other forms of therapies alongside the judicious use of medication to help the child in a holistic manner.”
In instances where parents describe “over-medication”, Dr Loh says that it could be possible that some children may have been offered medication without considering other alternatives. “When experiences of this kind are shared with other parents, it can lead to a perception that medication is overused.” He adds that if medication at a particular dose has been tried for a certain period and doesn’t result in an improvement of symptoms, this too can lead to an unwarranted generalisation that medication is ineffective.
Final word
It’s about taking the time to come to the right solution – because making or sticking to an inaccurate diagnosis can lead to the inappropriate use of medication. “If a teenager has symptoms of what we call hypomania (a less dramatic state of elevated mood) and those symptoms are missed and they are treated only with antidepressants, it can lead to a poor treatment response or even a worsening of what eventually can turn out to be a bipolar disorder.”
Mental health hangs in a delicate balance for both children and adults. It needs much more attention than we tend to give it, says Dr Loh – it’s all too easy to ignore the symptoms of unease and distress and block them with screen distractions. If you have concerns, he suggests speaking to a therapist as a key part of your self-care regimen.
About the doctor
Dr Loh is an experienced psychiatrist with a subspecialty focus in child and adolescent Psychiatry. He has a special interest in Obsessive-Compulsive Disorder and anxiety disorders, expertise in military and aviation psychiatry and a strong appreciation for the cross-cultural aspects of mental wellbeing.
This article was first published on the Expat Living Website on 30th March 2023 and written by Anna Murphy.
Raising a child is demanding – their emotions and personality trait can change frequently. As a parent, how can you tell if your child’s behaviour is part of growing up or a cause for concern?
Child psychologists at Promises, Tan Su-Lynn and SC Anbarasu speak to the editorial team at ANZA about psychological tests for children and adolescents which help parents better understand the strengths and challenges their child has in areas of cognitive, behavioural, learning and socio-emotional functioning.
Learn more about the types of tests and what goes into one.
As parents, we all want the best for our children. We naturally see the good in them and marvel at their every new development and discovery. However, raising a child can be demanding. Even under the greatest circumstances, their emotions and personality traits can change frequently, and it can be difficult to pinpoint when certain behaviours are typical or might need special attention.
Just like us, children experience a huge range of emotions (some more adorable than others!). They can be sad, anxious, aggressive or irritable. They can be restless, reclusive or downright grumpy. In most cases, these feelings are perfectly healthy, but how can you tell if your child’s mannerisms are a part of growing up or a cause for concern?
Promises Healthcare, Psychiatric & Psychological clinic can help to put your mind at ease with their psychological tests for children and adolescents. Carried out by their expert team of senior child and educational psychologists, these evaluations can help parents to better understand the strengths and challenges their child may have in areas of cognitive, behavioural, learning and socio-emotional functioning.
Tan Su-Lynn, Senior Educational Psychologist at Promises
Why take a psychological test?
While the idea of psychological tests for children might sound daunting, they can be essential in helping parents to make educated choices and implement strategies to ensure a child is getting the right support. “Intelligence – sometimes referred to as the Intelligence Quotient (IQ) – includes cognitive functioning, intellectual ability, aptitude, thinking skills, and general ability,” explains Senior Clinical Psychologist at Promises, S C Anbarasu. “Based on the type of assessments used, trained psychologists can obtain a more in-depth understanding of a child’s challenges. Some potential issues that can be detected include emotional or behavioural problems, or delayed learning with writing, spelling, maths or reading. Testing also helps to identify the presence of autism, ADHD or dyslexia.”
Says Tan Su-Lynn, Senior Educational Psychologist at Promises, “When a child is observed to have difficulties with their learning or behaviour in school or at home, this may suggest the possibility of a learning or behavioural disorder. Severity of the difficulties should also be taken into consideration, such as whether they impact their social, home and/or school functioning. Psychological testing can obtain a profile of a child’s strengths and areas that require support.
Reasons for a psychological test can include:
Learning difficulties or delays (for example, difficulties with spelling, writing, reading)
Emotional or behavioural problems in the classroom or home
Admission to special educational programmes
Increased understanding of a child’s learning style
Concerns regarding possible attentional difficulties
Underachievement
Giftedness
Senior Clinical Psychologist at Promises, S C Anbarasu
What are the tests and how do they work?
Depending on your concerns and your child’s needs, there are two types of psychological tests for children available at Promises to ascertain a child’s profile. “The IQ test measures a range of cognitive abilities and provides a score that is intended to serve as a measure of the child’s intellectual abilities, overall thinking, reasoning skills and potential,” explains Su-Lynn. “Our Academic Testing assesses areas in language, reading, writing, mathematical skills, comprehension and fluency.”
After an initial consultation period, both assessments take place in stages. As each one lasts approximately 6-12 hours, sessions are spaced out to reduce fatigue and distraction. There are no scary school exam style set-ups here: each test involves fun problems, puzzles and questions. “Generally, most children enjoy the testing sessions as it’s an engaging process,” says Anba. “To make sessions as stress-free as possible, we have regular breaks so they can play with their favourite toys. Tasks that involve using hands to construct or fingers to point at pictures appear to appeal the most. Parents are welcome to join their child throughout for support.”
Once completed, a feedback session is arranged to discuss the outcome and provide parents with the opportunity to ask questions. Parents also receive a comprehensive written report with recommendations for home and school settings. Continues Anba, “With psychological tests for children, we can address potential issues early and hopefully prevent the child from feeling demoralised, stressed and anxious in the future.”
When parents and teachers work holistically with Promises, everyone receives a better understanding of the child’s behaviour and game-changing solutions to bring them a brighter and happier future.
While most of us may be familiar with the term ADHD or Attention-Deficit Hyperactivity Disorder, we may be unfamiliar with the challenges and struggles a child diagnosed with ADHD goes through.
Our senior psychologists from the Child and Adolescent team, S. C. Anbarasu and Tan Su-Lynn, spoke to the editorial team at HoneyKids Asia to shed more light on ADHD, how it affects kids, what are the early symptoms, and how parents can support a child with a diagnosis.
Written by Dr B. Malavika, Psychological & Educational Therapist
Have you met Michael recently? He’s the bright, young, dynamic person at our office… I always thought of him as the person who’s the life of the party, and he genuinely seems to care for his colleagues… Aah, yes, the same person who unfortunately missed out a promotion this year… I heard his boss say that he definitely had the potential, but it wasn’t showing up in his work. He would initiate tasks with enthusiasm but would lose interest quickly; turned up late for meetings, or even forgot about them, and frequently misplaced important files as his table was often cluttered.
Does this seem familiar? Do you recognise similar signs in yourself or someone else you know? These issues might be due to something known as Executive functioning deficits or disorder (EFD). Though symptoms start in early childhood, the challenges might have been seen as the individual’s behaviour problems and not as a syndrome. Even as adults, many of those with EFD aren’t aware they have it — they just know that even everyday tasks can be challenging.
What is EFD?
Executive functions are the set of higher-order mental skills that allow us to analyse, plan, organise, make suitable decisions, manage time, focus attention and execute the plan. No matter how smart or talented one is, not much will get done well without these key capabilities. The human brain comprises of two systems: the automatic and the executive. While the automatic system guides 80 to 90% of our activities every single day, the executive system guides the remaining 10 to 20% and requires purposeful, regulatory effort.1
What causes EFD?
Experts don’t know exactly what causes this and a 2008 study found that differences in these skills are “almost entirely genetic in origin due to differences in brain chemicals” 2
People who have executive functioning deficits might have problems with many of these functions:
starting, organising, planning, or completing tasks on deadline.
multitasking
listening or paying attention
remembering tasks or details
problem-solving
time management
decision making
controlling emotions or impulses
prioritising
But it is important to note that EFD is not associated with low IQ.
Almost everyone has some symptoms similar to EFD at some point in their lives but It isn’t EFD if the difficulties being faced are recent or occurred only occasionally or intermittently in the past. If you’re curious to know if you do have EFD, you could take the test given below.
Even if you’re not sure if EFD is indeed the cause of the problems experienced, or, if you do not want to give it a label, you could still use the tips/ strategies given below to enhance your general skills and productivity at work.
One surprising way found to improve executive function in adults is aerobic exercise. Many research journals have published that regular aerobic exercise in older adults can boost the executive functions that typically deteriorate with age, including the ability to pay focused attention, to switch among tasks, and to hold multiple items in working memory.3
If you think that the feeling of the constant deluge at the office is largely the result of so many things clamouring for attention at once, a tool like Stephen Covey’s Quadrants can be used. Each quadrant (Q) has a different property and is designed to help prioritise tasks and responsibilities. These are:
Q 1 – Urgent and important
Q 2 – Not urgent but important
Q 3 – Urgent but not important
Q 4 – Not urgent and not important
Another useful technique is the Pomodoro technique of time management developed by Francesco Cirillo in the late 1980s. It uses a timer to break down work into 25-minute intervals, separated by 5-minute breaks. This method not only helps you remove distractions and enhance focus on your task, but it also factors in time to take a short breather.
Those who are tech-savvy can find these as smartphone apps. Other technology tools that can help are File-sharing software like Dropbox to keep notes handy, digital sticky notes or reminders, and password manager software to keep track of passwords. Those who are not comfortable with technology can compensate for working memory deficits by making information external — using cards, signs, symbols, sticky notes, lists, journals, clocks and timers.4
Other simple workable strategies are:
Break large tasks into smaller individual tasks and put them into a linear order or flow chart. This helps provide clarity and allows you to monitor your progress
Keep a routine
Know yourself and get your best work done according to your own biorhythms
Give it a positive twist – make the activity a ‘want to do’ instead of ‘should do’.
Games can help to improve executive function skills. Games like Checkers, Monopoly, and Clue use planning, sustained attention, response inhibition, working memory and metacognition. Games like Zelda and SimCity help with problem-solving and goal-directed persistence. Managing fantasy sports teams also use executive skills like task initiation and time management while having fun.4
Positive emotions reduce the impact of stressful events on the self and help build resilience. They make us more flexible, allowing us to be more open to options of problem-solving. Studies show that people feel and do their best when they have at least three times as many positive emotions as negative emotions.5 It is, therefore, most important that you periodically reward yourself when you have met the goals you have set. Equally important is positive self-talk which is a powerful tool for increasing your self-confidence and strengthening your resolve to make these healthy new habits a part of your personal and working life.
When to seek help?
Diagnosis of EFD can be difficult because certain symptoms are similar to those caused by other conditions, such as ADHD, LD, depression, anxiety, mood disorders or OCD. If any of the symptoms listed above continually disrupt your life, talk to a mental health professional. There is a variety of strategies recommended by experts to help strengthen the areas of weakness that EFD creates. Treatment options could be medications and therapy such as occupational or speech therapy, Cognitive behavioural therapy (CBT).
Vasantham (Mediacorp’s Tamil & Hindi TV Channel) studios reached out to Promises Healthcare’s Senior Clinical Psychologist, S C Anbarasu, in the name of bringing greater mental health awareness to the Indian community in Singapore.
In En Ullae S2 episode 9, we are introduced to an exuberant boy, who upon closer inspection is revealed to suffer from Attention Deficit Hyperactivity Disorder (ADHD). Is he beset by developmental issues, or is there a more benign explanation? Senior Clinical Psychologist S.C. Anbarasu opens the episode with a parsimonious explanation of ADHD – simply, people with ADHD are distinguished by a lack of ability to pay attention, and appear to have vast amounts of energy, hence, ‘hyperactivity’.
In a dramatisation, the boy’s mother wears an expression of bemused exasperation – the problems began even before his birth. Prolonged labour (which occurs after 18 – 24 hours), and a possible Caesarean section heralded the coming of a “problem child”. Anusha Venkat then recalls how, at the age of 2 or 3, she came to the realisation that her son’s inability to focus was far more prevalent than what she observed in other children. Even a couple of seconds of concentration seemed to be a hard ask. He couldn’t remain placated long enough to complete any task. At the childcare, teachers baulked at how he pinged from corner to corner of the room.
Anusha reveals how a serendipitous discovery that Carnatic music could calm him down enough to remain in one spot for more than 10 minutes. A breakthrough! Anbarasu explains that while a child suffering from ADHD can disrupt classroom proceedings, it is pointless to use force to discipline them. ADHD can make someone feel like they are “constrained within a container” if they are impelled to do a task in which they have no interest. Instead, they expend their energy reserves by indulging in some other activity – like running around and being a little menace. For parents who are unaware of ADHD as a mental health condition, seeing their child act out can be scary. In fact, Seelan (the boy protagonist) went undiagnosed at age 3 – doctors merely offered that most children are, well, rambunctious tots at that age. It takes a diligent parent to make a reasoned conclusion that their child may suffer from ADHD. Seelan was given assorted tasks to complete, with his attention span closely watched, even who he liked or disliked in class was logged.
However, Anbarasu recommends that care must be taken to conduct a diagnosis per the Diagnostic Statistical Manual (DSM-5). First, the test must be conducted on children below the age of 12. While school-going children come with a larger raft of observable behaviours due to differences in environment (home, school, etc), Anbarasu admits that is is not easy to chalk up roughhousing or rowdiness to ADHD when those are developmentally appropriate behaviours for a child. Apparently, six or seven are ages when an accurate diagnosis is reached easiest.
Aside from Carnatic music, Seelan’s attention span was helped by repetitive menial tasks like peeling potatoes, chopping ladies’ fingers and carrots. Anbarasu acknowledges that dealing with ADHD in children is a time-consuming task because they aren’t able to complete tasks as quickly as their peers. He calls on parents to pick up the slack – strategising holistic ways to help their child, both at home and in school. It’s a collaborative effort between teachers and parents to then carry out an agreed-upon strategy.
All is not doom and gloom, however. Seelan is observed to play with Lego building blocks for hours on end, despite not performing in the classroom. Anbarasu calls this ‘hyper-focus’. It is a state of mind wherein the mind eliminates noise that potentially distracts them from the task at hand, a sort of “perk” if you will. We are cautioned that encroaching upon this state of hyper-focus can exacerbate emotional issues and precipitate anger. People with ADHD are victim to ‘emotional dysregulation’, which may manifest from frustration in perceived inability to complete tasks satisfactorily. Seelan was unable to appreciate the benefits of delayed gratification, getting restless and upset if things didn’t go his way. Anbarasu explains that this results from emotional dysregulation as well.
At some point, Seelan faces potential expulsion from his class due to the complaints of other children’s parents. Especially in Singapore, where grades are paramount, a poor academic performance which results from an inability to work with a child’s ADHD can be distressing to parents. The teeth-gnashing frustration can make parents feel helpless, and Anbarasu suggests that these situations call for a consultation with a professional therapist who will elucidate the behavioural issues at hand. This gives parents more information to plan future steps. Parents of children with ADHD also attract stinging criticism from other parents. They might feel inadequate in their roles as nurturers and mentors. Anusha has accepted this to be a part of life, chortling as she muses that “you can’t change people”. Whatever the case, it isn’t fair to fault parents for a child’s ADHD. Or the child. Anbarasu clarifies that ADHD is a neuro-developmental disorder – in other words, that’s just how the cookie crumbles. Blame should not be apportioned. Anusha recalls how Seelan used to behave like an attention hog – in its absence, tantrums would be the order of the day. According to Anusha, dealing with instances of emotional dysregulation like this is challenging, especially if you have to deal with the needs of your child while observing social propriety.
Every child’s circumstances are different, so Anbarasu recommends that care be taken to evaluate if danger is imminent. Shouting for a little is perfectly OK. Deal with them after they have thrown their fits because anger is not conducive to receptiveness to advice. Anbarasu is careful to eschew the notion of a “cure” for ADHD. Rather, he says that it is “treatable”. Whether with medication or psychotherapy, or a combination of the two.
Children with ‘combined-type’ ADHD are challenged in a triune of areas – attention, hyperactivity and impulsivity. For these cases, neuropharmacological support is required, to aid concentration and retention of information in class. If the ADHD is not as pronounced, therapy alone could manage the condition. For parents who are especially harrowed by their child’s condition, they should know that there is ample evidence in favour of managing ADHD through the concurrent administration of medication and therapy. On top of psychiatric interventions, there are support groups inside and outside the classroom for parents who are overly stressed.
The episode closes with the narrator speaking over clips of Seelan looking positively cherubic. The viewer is called on to spare the snide remarks, replacing them with positivity, understanding, and “plenty of support”.
We use cookies to ensure that we give you the best experience on our website. If you continue to use this site we will assume that you are happy with it.Ok
Tan Su-Lynn, Senior Educational Psychologist at Promises
