Application of a web-based cognitive-behavioural therapy programme for the treatment of selective mutism in Singapore: a case series study

<p><b>INTRODUCTION</b>Selective mutism (SM) is characterised by limited or a lack of speech in selected social settings. Recent reviews suggest that cognitive-behavioural therapy (CBT) is an effective and promising treatment approach for SM. However, there is still a lack of studies documenting the applicability of CBT for SM in diverse populations. The goal of the present study was to examine the use of a web-based CBT programme ('Meeky Mouse') among Singaporean children diagnosed with SM.</p><p><b>METHODS</b>Five children with SM (one boy and four girls aged 6-11 years) participated in the 14-week 'Meeky Mouse' programme, in addition to being prescribed with an unchanged dosage of fluoxetine 10-20 mg daily. The progress made by the children throughout the course of the programme was documented by the therapist.</p><p><b>RESULTS</b>Post treatment, four out of the five children demonstrated improvements in the frequency of speech during therapy sessions at home, in school and at other social situations.</p><p><b>CONCLUSION</b>Findings from the present study provide support for the use of a web-based CBT programme in improving speech and decreasing the severity of SM among affected children.</p>

Sleep disturbances in Singaporean children with attention deficit hyperactivity disorder

<p><b>INTRODUCTION</b>Many studies have reported various levels of association between sleep disorders and attention deficit hyperactivity disorder (ADHD). This study aims to investigate sleep disturbances in children with ADHD prior to treatment and during treatment.</p><p><b>MATERIALS AND METHODS</b>This study recruited 114 child and adolescent patients diagnosed with ADHD and 60 normal patients. Sleep disturbances are assessed using the parent-rated Child Behaviour Checklist (CBCL) questionnaire. In addition, chart reviews and semi-structured clinical interviews were conducted for 54 patients with ADHD who had been seen at the clinic since 2002 to examine the sleep disturbances they experienced during treatment over a 4-year period.</p><p><b>RESULTS</b>Compared to the normal subjects, parents of children with ADHD reported that their children slept less. The summation score of the sleep items on the CBCL was also significantly higher in the ADHD group. Girls with ADHD also had more "trouble sleeping". When children with ADHD received treatment with medications, they experienced sleep-related side effects. Out of the 54 children with ADHD, 18.5% experienced sleep disturbance related to medication, with 13.0% reporting daytime somnolence and 5.5% reporting insomnia.</p><p><b>CONCLUSION</b>Our study showed that there was an increased frequency of sleep disturbances in children with ADHD prior to treatment with medications. The children in our study appeared to sleep less. A significant proportion also experienced sleep disturbance during treatment with medication, of which daytime somnolence and insomnia were the most commonly reported problems. Future research in this area is needed to further examine the range of sleep disorders in ADHD children locally.</p>

Effects of CBT on children with disruptive behaviour disorders: findings from a Singapore study

Objective: The study examines the effectiveness of a CBT treatment programme over and above that of Treatment As Usual (TAU), with children who were referred to an outpatient child psychiatric clinic for disruptive behaviour disorders in Singapore. Methods: One hundred and three children aged 8 to 12 (mean±SD=10.22±1.31) who participated in the study were assigned to either the CBT+TAU (n= 51) or TAU group (n=52). Children in both the CBT+TAU and TAU groups received a standard and typical service offered to children at the outpatient child psychiatric clinic. In addition, children in the CBT+TAU group attended the CBT treatment programme that consisted of nine 1.5 hour weekly sessions. Results: Findings from ANCOVA indicated that children in the CBT+TAU treatment group showed significantly lower levels of aggression and significantly lower levels of parental stress at posttreatment and at 3-month follow-up in comparison to the TAU group. Conclusions: Findings from the present study provided some evidence of the effects of CBT in reducing aggressive behaviour and parental stress among children with disruptive behaviour disorders. Interpretation of the findings, recommendations for future research, and implications of the present study were presented.