Thursday, 22 November 2012

Helping a child break her silence

By Eveline Gan, TODAY, 21 Nov 2012

Unlike most grade-conscious parents, Madam Angela Yap pays relatively less attention to her eight-year-old's academic grades. Instead, at each parent-teacher meeting, the 41-year-old stay-at-home mum is more concerned about how her daughter, Carmen Tow, has fared in her oral communication skills.

Diagnosed with selective mutism last year, Carmen went through her pre-school, kindergarten and Primary 1 years without uttering a single word, even though she was capable of normal speech at home. She would also clam up in front of friends and relatives - something which used to frustrate and irritate her mother.

Said Mdm Yap: "It was hard for me to understand why she behaved like that. At home, she is always noisy and would boss her little sister around, but in school, she was in a world of her own. I was always yelling at her because I thought she was being rude or defiant."

The Anderson Primary student has, however, made tremendous improvement after 13 weeks of therapy conducted by nurses from the Institute of Mental Health (IMH).

"I was so relieved when her condition was finally identified, and glad that help was readily available," Mdm Yap said. "Now, when the teacher asks her a question, she is able to whisper feedback to her and that is a huge achievement."

Carmen, who has just graduated from Primary 2, showed further progress recently, when she was able to read aloud in class.


Carmen is a success story of the Response, Early Assessment and Intervention in Community Mental Health (REACH) programme, which helps children and adolescents aged six to 19 years studying in primary and secondary schools and junior colleges.

Launched in 2007, it is led by the IMH in collaboration with the Ministry of Education and various voluntary welfare organisations. School counsellors are trained by the REACH team to identify and manage at-risk cases, with more complex cases being referred to REACH for assessment.

Associate Professor Daniel Fung, Chairman Medical Board and Programme Director of REACH, said it has been effective in picking up cases that would otherwise have slipped through the cracks.

"Our aim is to pick up at-risk behaviours or early-stage mental health conditions as early as possible before they lead to more serious problems in the long run. For instance, while anxiety is not a life-threatening condition, it would certainly affect the child's school work and everyday life when it becomes chronic," said Assoc Prof Fung.

In the past five years, some 18,159 calls have been made to the REACH helpline by school counsellors to seek advice on managing their cases.

Of the 1,571 cases referred by the schools to REACH, 662 were subsequently seen by doctors at the IMH and the National University Hospital.

Primary school students like Carmen make up 70 per cent of the cases picked up by REACH. About half of the cases seen were for attention deficit-hyperactivity disorder. The rest were for anxiety, depression and learning disorders.

Other serious mental health disorders like psychosis have also been picked up, noted Assoc Prof Fung.

Innova Primary counsellor Paulina Chng, who has undergone training by REACH, felt that identifying and providing support to children with mental health issues early helps them to cope better in school.

For Carmen, support from the school and timely intervention made her less withdrawn, said Mdm Yap. She also roped in help from Carmen's classmates by sharing her condition with their parents.

The REACH programme has been rolled out to all mainstream schools. The IMH plans to bring it to all 20 Special Education Schools by next year.

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