Several times every month, someone calls me seeking a referral to a psychologist or psychiatrist for their child or a friend’s or relative’s child.

The presenting problems are usually school refusal, suicidal or self-harming behaviour and, on occasion, violent behaviour.

These are likely due to, or exacerbated by, an underlying depression, generalised anxiety, social anxiety, problematic internet gaming or a developmental disorder.

These issues preceded Covid-19 and the recent school incidents, and I know that mental health professionals like myself, as well as government agencies, are concerned.

While many children from the families we work with at the Ministry of Social and Family Development (MSF) experience a multitude of adverse childhood experiences like abuse, neglect, poverty and family criminality, many of the kids my friends call me about come from loving Christian families and hail from high-achieving schools.

True, some children are experiencing significant family conflict and questionable parenting; yet others have caring parents and seem to have led sheltered, non-eventful lives before the onset of their emotional problems. So, what happened?

Before going on, please let me point out that this phenomenon is happening in many developed countries around the world, so we should not play the blame game here.

Let us not fall prey to the fundamental attribution error by assuming it is simply a weakness in the child or the parent. Neither should we point our finger at our schools, because they are merely microcosms of society itself.

The aetiology of youth mental health problems is complex and multi-factorial. It is often a string of events or a confluence of factors that results in mental health issues for a particularly vulnerable child.

What can affect our child’s mental wellbeing?

1. Being immersed in a high-achieving environment

Societal pressure to succeed is reflected in the school environment.

In the US, children from high-achieving schools have been categorised as a high-risk group in terms of mental health, along with children from impoverished families.

US studies have found that children in high- achieving schools have higher rates of anxiety, depression and rule-breaking behaviours compared to the national average.

These children experience greater pressure from multiple sources, including self-oriented perfectionism which reduces their sense of autonomy, sense of motivation due to personal wishes, and satisfaction with achievements.

Perfectionism is a two-edged sword: It helps push one towards greater heights, but it also makes it very difficult for a child to handle failure. It can feel like all or nothing, do or die.

In addition, in high-achieving schools, social comparison, envy and perceived parental criticism have been found to be linked to students’ emotional maladjustment.

2. Existential questions

During last year’s Circuit Breaker, a 13-year-old girl I am supporting called me on the phone out of the blue, sobbing in anguish and repeatedly asking me: “What is the meaning of life?”

Kids caught in the never-ending cycle of schoolwork, tuition classes, exams and competitions will inevitably question: “Is this all I have to live for? Is there more to life?”

Beyond solving our immediate problems and achieving our goals, we all need a meaning for our existence.

As Christians, do we discuss the deeper questions of life with our kids?

3. Family relationships

Family attachments form the foundation of our safety and security from which we venture out to explore the world.

Family relationships are as much about marital relationships as they are about parent-child relationships.

Psalm 68:5 says, “He sets the lonely in families.” But what if we are lonely in our own families?

Many parents work long hours in high-pressure jobs. If they barely have enough time to sleep, how much time can they carve out to spend with their children?

Also, parents who are facing relationship issues (for instance, marital conflict, adultery or divorce) often lack emotional availability and are less responsive to their children’s needs.

Research has shown that exposure to marital conflict and divorce puts a child at risk for emotional and behavioural problems.

4. Parent-child communication problems

Many parents are not comfortable talking about feelings or tough topics with their children.

Most of our communication centres around studies (“How was your test?”), nutrition (“Did you have your breakfast?”), instructions (“Say hi to auntie”), facts (“There is home-based learning next week”) and warnings (“Better not do that or you will get into trouble”).

But if parent and child do not talk about what is happening in our lives, share feelings, resolve conflict or discuss thorny issues on a regular basis, how can we expect our children to turn to us when they face a serious problem or a crisis? How do we usually react when they tell us bad things?

5. Peers, social interactions and real/perceived rejection

Adolescence has never been more fraught with complex social challenges. Today’s teen has to cope with social comparison with peers, fickle friendships, and possibly bullying, shaming, isolation, loneliness, rejection and betrayal, often in full voyeuristic view of peers through social media.

When a young widow found grace in grief

Some kids, lacking the social communication skills to handle the complexities of teen relationships, escape into the world of Internet gaming. I have come across teens who, after one bad incident with peers or a series of innocuous exchanges, become self-conscious and experience social anxiety. They subsequently withdraw from real life and retreat to an online life instead, some skipping school for months.

6. Boy-Girl relationships

One of my sons previously received a call from a friend who was at the top of a block of flats, thinking of jumping after a break-up with his girlfriend. Thankfully, we were able to notify the boy’s parents and he is fine now.

At that age, a breakup feels like the end of the world. Teens may not understand that bad feelings do eventually go away and a future without their loved one is not as bleak as they think.

These first experiences of heartbreak, coupled with an under-developed frontal lobe, can cause teens to sometimes make impulsive, risky decisions without thinking fully about the consequences.

7. Technology

Research shows that problematic gaming in children is associated with low self-esteem, anxiety, depression, poor academic performance, lack of friends and poorer family relationships, among other variables.

Longitudinal studies have found that parent-child connectedness and positive perceptions of the family environment are protective against later problem gaming.

Escaping into gaming is an easy way for youth to distract or numb themselves against negative feelings. But what starts off as a way to self-regulate emotions may become addictive, setting off a vicious circle.

If a teen trying to avoid unhappy peer relations at school starts gaming late into the night, he is likely to experience sleep deprivation, exacerbating his already low mood. His sleep-wake cycle disrupted, he may find it harder to wake up and pay attention in school, leading him to fall behind academically and become more socially isolated.

This only provides greater impetus to keep escaping into gaming.

What can we do?

The best advice I can offer to parents in general is the following:

1. Strengthen your relationship with your child and hone parenting skills

This does not happen overnight; it requires effort, skills, time and patience.

Adopt evidence-based positive parenting practices. Let us arm ourselves with knowledge and skills on how to correct and shape our children’s behaviours without damaging their self-esteem or our relationship with them. We cannot rely on the ways on which we were raised, believing they might work now. Let us have the humility to learn new strategies and grow our parenting skills.

Show unconditional love. It is important that our kids know our love for them. They need to see, hear and feel that they are precious in our eyes and that we hold a positive view of them despite their misbehaviours, mistakes and misguided notions.

2. Strengthen your communication with your child

The channel of communication needs to be opened up during “peace time”, so that it is functioning when we need it most. How can we do this?

Preach less, listen more. Listen not just to what she is saying but to what she is not saying. Try to identify what she might be feeling. Reflect her feelings (“You feel hurt by your friend’s betrayal”) and empathise with her emotions (“That’s really tough”). Let us not minimise what she is going through just because we do not understand. (Do not say things like, “That is such a small matter, why should you feel bad?”)

Heartfelt and often humourous, family advocates share how to make families stronger on Salt&Light Family Night

Praise more, criticise less. Kids need to know we are pleased with them. Use descriptive praise by pointing out what we are pleased with, for instance, appropriate coping or help-seeking behaviour (“I am glad that you thought it through carefully and walked away from that situation, even though you were tempted to do otherwise. That really takes strength”) or (“I like it that you came to me to discuss this issue first”).

Praise effort rather than ability, performance or results. (“As long as you put in the effort to study and did your best, you should be proud of yourself. Let’s leave the final exam results in God’s hands.”)

Repair ruptures. Ruptures in our relationship with our children are inevitable, particularly when we discipline them, take away privileges for their own good, or when we lose our cool with them.

Rupture and repair must go together. Repairing a relationship may mean apologising if we behaved badly or explaining our actions once everyone has calmed down. Based on research, Gottman Institute recommends five positive interactions to off-set every negative one.

No more family holidays – how else can families bond?

When one of my sons was going through an oppositional phase, I had to work hard to ensure that every interaction did not end up as a scolding, but that we would have fun and funny interactions as well.

Be approachable. Children often do not turn first to parents with their problems because they are afraid of our response. We need wisdom as parents to sit calmly with our child, hear them out and not over-react. Easier said than done, I know.

Be authentic. Kids need to hear more than just our success stories; they want to hear about our authentic struggles, mistakes and self-doubt, how we overcame them, and how God saw us through our darkest moments.

But again, the general principle is more listening and less story-telling (bite-sized anecdotes unless they ask for more details).

3. Be invested in their spiritual walk

Have age-appropriate discussions about existential questions, and about our spiritual walk with God as well as their journey with the Lord.

Have discussions about the meaning of life; why there is suffering and evil in the world; why there is hypocrisy even in the Church; what a Christian worldview is; what it means to live out our faith, and so forth.

Teens are looking for something bigger than themselves and for a deeper meaning in life that transcends the grind of schoolwork and pressures of life.

As Christians, we are so blessed because we indeed have the answers. However, our teens have to explore, challenge and eventually find their own answers to personal and spiritual questions like, “Why did God allow this to happen to me or my friend?” and “Can I count on Him when things go wrong?”

As parents, we need to sit patiently with them in their pain, invite their views and not just give one-sided lectures.

4. Pray

Let us intercede for our children daily and pray with them as often as they allow us to.

Cover our schoolchildren with these prayers, urge parents and educators

I have spent countless nights interceding in tears for my children while they were growing up and navigating challenges of their own. I cling to our Father in heaven, who loves them more than we as parents ever could and knows what is best for them.

I cry out for their souls to be saved first and foremost – whatever it takes. So that the Holy Spirit who is the best Counsellor of all can speak into their lives. So that they can experience how deeply God loves them and has a plan for them, beyond their immediate failures, disappointments, or shortcomings.

5. Work on ourselves and our relationship with our spouse

Remember all the communication skills I mentioned earlier with regards to our kids? Let us use them with our spouse too.

Our kids learn a lot from us, especially if they witness us showing affection to our spouses, or see us model good conflict management. Attending courses on managing marital conflict can provide us with the right skills.

If you have serious personal, mental health or marital issues, please do seek professional help for yourself, bearing in mind that our kids are affected by us. We are all imperfect and broken in our own ways, and we owe it to them to work through our own issues.

The metaphor of “putting on your own oxygen mask before attending to your child” applies here.

6. Encourage a balanced and healthy lifestyle

Research has shown that sleep, exercise and nutrition strongly impact children’s physical, emotional and mental wellbeing. Where we can exercise authority, and appropriate to the age of our child, it is important to set limits, for example, to how much computer time they are allowed and what time they need to go to bed.

7. Monitor your child and seek help early

We can read up about the symptoms of depression or anxiety so that we can recognise early signs and seek help. For family and parenting issues, MSF will be scaling up FAM@FSC, which is currently being offered by Care Corner Singapore and Fei Yue Community Service.

Online resources for parents include CPH Online Counselling (for parenting, marital and divorce issues) and Mindline.sg, while SOS’s Care Text was set up recently for youth to text anonymously for help.

Some social service agencies offer counselling services for mild mental health issues in children. For children with more serious mental health issues, we can take them to see a psychiatrist or psychologist in government facilities such as the Child Guidance Clinic; in restructured hospitals with child and adolescent mental services (e.g. KK Women’s and Children’s Hospital or National University Hospital); or in private practice.

This article first appeared in the November 2021 issue of Methodist Message. Reproduced with permission.