Podcast: Cut the child some slack if they're struggling

Podcast: EP30

At a special clinic at Fudan University's Children's Hospital, psychologists who specialize in "learning challenges" work with boys and girls struggling with mental and emotional issues, rather than turning "slackers into straight-A students."

"A significant part of what we're doing here is to help the family grow," said Dr Zhu Daqian, head of the psychological department.

Since the opening of the clinic in 2020, it has assisted more than 1,500 students in identifying the root cause of their difficulties. Two-thirds of them suffer from neurodevelopmental disorders (NDDs), while others struggle with mental issues.

In the second part of her interview with Shanghai Daily, Dr Zhu talks more about the prognosis and treatment, how online learning affects patients, and what parents can do if they think their children may have emotional problems.

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Q: What are the common treatments?

A: It depends on the kind of disorder. Treatment for attention-deficit hyperactivity disorder (ADHD), which is a kind of NDD, is comprehensive. It includes medication, parent training, behavior therapy and certain kinds of training in school. Based on their conditions, we choose one or a mixture of treatments.

Q: What does the medication mainly target?

A: Medication is mainly for children with ADHD. These kids have trouble concentrating for a long time or have difficulties with self-control, due to the imbalance of neurotransmitters that help to focus. If the condition is moderate to severe, medication is required, which can help balance the level of the molecules.

Q: How can therapy help?

A: We have this set of training materials for organizational skills for kids with ADHD. It is an effective way to improve their executive ability in daily life.

We teach children some skills. For instance, how to record homework, how to tidy up their study appliances in a planned way, how to arrange study time so they will be able to have a sense of time. When their organizational skills improve, they are able to review certain subjects or finish assigned tasks.

Q: How long does therapy last?

A: For structured training like this, it usually lasts 13 weeks. And we ask the educators to join us in the training. First, our therapists will show kids, as well as their parents and psychological counselors in schools, a certain skill.

The counselors then help the kids review it during a week, and the head teachers will watch and keep a record if the kids are able to use the skill, such as marking down their homework and tidying up their appliances.

At the end of the week, the kids receive some rewards from their parents based on their records. So altogether, 13 skills for 13 weeks.

Ti Gong

Q: What can we expect after 13 weeks of training?

A: They will do things in a much more systematic way, have a better sense of time and manage themselves better. This way, studying won't be a big problem. They must repeatedly use all the skills, and someone has to remind them to use the skills and reward them accordingly. That's why we need to involve both parents and teachers in the whole process. They are there to remind, monitor and reward. It's also a new skill for parents and teachers.

After the kids improve their organizational skills, there could be other problems like emotional impulse, issues of emotional control or social skills. They will then be admitted into other training groups.

Q: So this therapy is a long-term process ...

A: Yes. But it is also possible that the kid has been doing pretty well all the time. Then, after treatment, all he/she needs is regular clinical follow-up. A large part of what we are doing here is to accompany the family to grow.

Q: Do you remember any instances when you had to accompany a family for a very long time? How are they doing now?

A: This family came to me when the child was in primary school, and is now about to go to high school. The child had ADHD, and we confirmed it. The family came to us very early, so they didn't get to attend those structured training groups but had one-on-one therapy. The parents were quite good at digesting and the kid had a strong willpower to improve the situation.

And also, the teachers understood the situation, and instead of chastising, they gave a lot of encouragement, so the kid, full of confidence, was doing very well, even in primary school.

However, the child's condition is between moderate and severe, so the mother comes to visit us regularly to renew the prescription and tell us about the child's current status.

Now entering puberty, the child seems to be getting impulsive. There is now more conflicts between parents and the child, and even some fights in school. So we have to make some adjustments and learn to show more respect to the child.

Q: Since the COVID-19 pandemic, schools have switched online. How did it affect your patients?

A: Some children have responded positively. For those with autism spectrum disorder (ASD), they feel emotionally disturbed and physically unwell upon entering an unfamiliar environment. They also have trouble developing social contacts. Online lessons keep them away from these troubles, and they are more responsive in their studies.

But for most children with NDDs, especially those with ADHD, a lack of a structured environment for study is harmful. It's hard for them to distinguish home from school, and they think it's okay to play video games and watch cartoons at home.

Q: How does one deal with these situations?

A: There isn't much to do, actually. It is very demanding for a parent to supervise a child like a teacher does. It is getting even tougher now that parents need to go to work. Under such circumstances, we started prescribing medicines for those with ADHD who normally do not need medications.

Q: Is it possible to prevent "learning difficulties?"

A: It's impossible for those with congenital problems, such as NDDs. Even for well-developed children, there will always be some difficulties in studying. What matters is how to deal with the problems and not to let them become a disturbance.

Q: Any suggestions for parents to help relieve their children's emotional stress in daily life?

A: If parents have noticed that the kids are depressed or nervous, or having trouble with their studies, cut them some slack in their studies. Take a break, let the child relax a bit.

Spend more time playing with them. It'll be great if there could be a fixed playing time of 20-30 minutes, when parents can put chores, work and studies behind them and just play with the child wholeheartedly. Maybe they will discover something's happening with their children while playing.

"Learning Difficulties" Clinic

Opening: Every Thursday, 1:30pm, 20 patients only

Reservations: Through the hospital's WeChat

Address: Zone C, 3/F, Outpatient Building, 399 Wanyuan Road