Q: What are the most common psychiatric problems faced by children and adolescents here?
In the community, anxiety-related disorders are the most prevalent.
The Institute of Mental Health's Child Guidance Clinic sees 2,200 to 3,000 patients aged between six and 19 each year.
And in the clinic, the most common conditions are attention deficit hyperactivity disorder (ADHD) - a neuro-developmental disorder of self-control where the child has serious difficulties with inattention, impulsivity and hyperactivity; stress-related problems and autism spectrum disorders - a range of developmental disorders characterised by difficulties in socialisation and communication, and a restricted or repetitive pattern of behaviours and interest.
Q: What are your current research interests?
My recent work involves a trial of fatty acids supplementation and social skills training for children and adolescents with disruptive behaviour disorders. Other trials have demonstrated benefits of fish oil in a variety of psychiatric disorders, and this study is the first of its kind in Singapore. We are still compiling the results.
Q: And you're also exploring new media in helping troubled kids?
We're midway through recruitment for a neurofeedback trial which involves improving the attention spans of children with ADHD through gameplay. Their brain activity will be monitored through sensors attached to a machine, which allows them to use the electrical impulses to control their actions in a video game.
Q: Singapore recently hosted the third Asia Pacific Research Ethics Conference, where hot topics included research with vulnerable populations. Why was the meeting important?
It was a platform for regulators, policymakers, institutional review boards, investigators, scientists and other clinical research professionals from around the world to share their knowledge and exchange ideas and best practices in human research subject protection.
As Singapore becomes more developed and does more research, the ethics of research needs to keep up.
From a scientific viewpoint, there are many questions that can be asked, but they may not necessarily be harmless to the participants involved. I mean, is it right to harm one person to save 10?
I am particularly concerned about children and adolescents in research.
Q: The National University Health System has also just launched the Paediatrics Ethics and Advocacy Centre (Peace) programme to study, advise doctors and educate the public on ethical issues related to children's medical care. What does that mean for Singapore?
It's great, and it's timely, because children are not really the masters of their own fate.
Q: Why is this age group particularly vulnerable?
There is much less research on children, about half the number of trials done on adults. Yet we tend to give them the same treatments, including medications, as though they are just small adults.
But even getting children to participate in trials is very hard.
Q: What are some of the difficulties in getting young participants for trials?
First, their parents have to agree; many don't want their children to be "guinea pigs". Children may also be unsure whether to say yes because of the stigma involved.
It's important to respect the child's best interests, and to judge what is an acceptable risk. So it's difficult to get kids on board, and a lot of research studies suffer. If we approach 10 parents and their children, only three will say yes.
Q: Do you think paying participants would help?
Well there's a fine line between inducement and compensation. Looking at 23 studies at the Institute of Mental Health, we found that the rate of recruitment was not really dependent on compensation.
Q: As a consultant psychiatrist with five children yourself, do you have any tips for parents?
Well, you want your children to grow up as independent and responsible individuals, and your job as a parent is to get them there.
Parenting should be age-appropriate - when your children are young, nurture and care for them.
When they're older, give them responsibilities so they can become more independent.
Don't over-parent or overprotect your child - give him space to grow. Children have an innate ability to deal with and cope with stress, let them learn from their mistakes.
This article was published on April 6 in The Straits Times.
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