Swine Influenza and You

What is Swine Influenza?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

Is it contagious?
Swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

What are the symptoms?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?
Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

For more details please visit http://www.cdc.gov/swineflu/swineflu_you.htm

Stress in children and adolescents

By

Dr Abang Bennett Taha

Specialist Psychiatrist (Child and Adolescent)

RIPAS Hospital, Bandar Seri Begawan

A Palestinian student looks out the window of a classroom. At school, factors that may cause stress include starting school, change of school, high expectations, bullying by peers or other schoolmates, and punishment by teachers. Pressure from studying is the most common cause of stress in children and adolescents. epa

In modern society stress is inevitable. Stress arises when an individual perceives that he cannot adequately cope with the demands being made of him or when his well-being is threatened.

The worst possible way to cope is to run away from it or avoid dealing with it. If an individual is constantly stressed, he will be in danger of developing long-term stress-related physical illness or more importantly it could trigger a mental breakdown.

This article will initially discuss stress in general and then specifically focus on stress in children and adolescents. We will then deal with approaches for both parents and teachers to help their children or students who are stressed.

Is stress bad?
The answer is both 'yes' and 'no.'

If we have no stress in our lives, we would probably be dead. With little or no stress, we would not be motivated to perform. As stress increases, our performance will also increase until it reaches an optimum level of functioning.

Further increase in stress after this optimum level will not, however, increase the performance but will plateau off until the stress level becomes distress.

At this point, further increase in stress level will cause the performance to decline. Stress is therefore both useful and bad depending on the intensity of the stress experienced.

What causes an individual to feel stress may not affect another. A lot depends on the personality, attitude and expectation of life. The challenge is for the individual to determine what level of stress he needs to function at his optimal level.

Can children and adolescents experience stress?
The adolescence period is the most stressful time in a young person's life. This is the time when children change or grow up into adults. They are going through puberty, meeting the changing expectations of others and coping with feelings that may be new to them. Children too cannot avoid stress. The sources of stress may be personal, from the home, and the school.

Personal sources
Personal sources include high hopes, unrealistic values, fear of failure and comparing himself to his siblings or other children.

Children and adolescents who have impaired intellectual ability, especially mild intellectual impairment, are vulnerable to experiencing stress when their disability is not recognised by their parents or teachers.

Home
At home, entry and exit events can be very stressful to both children and adolescents. The birth of a sibling is very stressful to a child or even an adolescent, which may lead to emotional or behavioral problems.

To a young child, the younger sibling is his rival. An adolescent may feel ashamed when his mother gives birth to a sibling.

Parental conflict, where there are lots of quarrel and violence at home, is the worst stressors that a child or adolescent can experience. Divorce by itself is harmless but becomes stressful when there is a fight for custody of the children or when the parent who has custody is neglecting the child.

A divorce may help young people recover from the 'trauma' of being caught in the dysfunctional family environment. An intact family with calm environment is the best environment for young people to nurture and this is what we should achieve.

Not being able to fulfil the demands of parents is another source of stress at home. Please remember that young people have their limits and each individual is different. Expecting all young people to respond to our demands in the same manner can lead to disaster.

School
At school, factors that may cause stress include starting school, change of school, high expectations, bullying by peers or other schoolmates, and punishment by teachers. Pressure from studying is the most common cause of stress in children and adolescents.

Teachers should be able to recognise the early signs of stress in young people. They and the school management should provide a suitable environment for young people to learn and nurture rather than expecting young people to 'digest' whatever has been taught, or at the other extreme, ignoring young people when they cannot learn as expected.

Young people with special needs can go into 'catastrophic reaction' if they are stressed in the mainstream environment. They should not be ignored but should instead be given the support throughout the time they are at school.

Young people with borderline problems (ie those who appear normal but just cannot learn as much as their peers) are the most stressed individuals in the school scene. They are usually labeled as lazy or their parents are considered to be paying no attention to their educational needs.

Reaction to stress in children and adolescents
This depends on the developmental stage of the child, ability to handle stress, duration and intensity of the stress and support that is given. In early childhood, they may feel unloved, becoming clingy and demonstrating a dependent behavior.

Children in the middle childhood stage may show fearfulness, defiant behaviour, complain of headaches and sleep problems or observed to have poor concentration at school.

Adolescents on the other hand will demonstrate it with anger, hysterical behavior, disappointment, low self esteem and loss of faith in adults. In extreme cases, adolescents may indulge in health risk behaviours such as deliberate self-harm, violence, substance use, risky sexual behaviour and unhealthy dietary behavior.

Before we discuss the approaches to handling stress, let us examine the following cases.

Case 1
Armah was actually the kind of daughter any parent would be proud of. She studied hard, was obedient and a devout Muslim. She had a few friends and spent all her free time looking after her younger siblings.

Her father had very high expectation of her, wanting her to excel in her 'O' Level examinations. Armah felt so pressured to do well in her examination that when the day arrived, her mind was a blank.

She had so wanted to make her parents proud. She was devastated when she failed the exam. Her father was angry, blaming her for not studying hard. She felt worthless and a disgrace to her family. Impulsively she took 20 Panadol tablets.

Case 2
Ali, a Primary I pupil, cries when he wakes up in the morning, complaining of stomach ache and refusing to go to school. This happens everyday, consecutively. The doctor who treated him could not find any physical causes for the problem.

Earlier, his mother had spent a lot of time forcing him to focus on his 'Spelling' subject as she was expecting him to score 100%.

He scored poorly and was admonished by his teacher. When he returned home, his mother also scolded him.

Case 3
A Form III girl was punished by her teacher in the presence of her classmates for not handing in her assignment according to the required format.

She had told her father to buy the materials from the shop earlier but he could not effort to buy them. The next day she was not her normal self and started to scream and going berserk when she was in the toilet.

The other students nearby attempted to calm her down but she was strong. One of the students who tried to help her also started to scream.

These three cases show the various types of reaction to stressful situation. All the situations depicted above happen in our real life and the experiences encountered by the children are perceived as stressful leading to maladaptive reactions.

Children and adolescents should enjoy studying rather than pressured to do so. Sometimes children have limit to their learning ability, therefore parents and teachers should have realistic expectations regarding their ability.

In case 3, it was the family's financial difficulties that caused the girl not adhering to the regulation.

In this situation simple financial help and the teacher's understanding of the girl's problems removed the maladaptive behaviour. We must always remember that social problems in our community are the reactions of young people to stressful situation that occur at home, at school or both.

How can we help stressful young people?
Keep talking to them: Everyone needs to be able to talk and listen to others. If it stops happening, problems and misunderstanding creep in. Keep the communication lines open.

Listen to them: Being able to listen is a key aspect of good communication.

Good listening means:
- showing you are attentive
- trying to understand what they are saying to you
- taking time to find out about their views and feelings without arguing with them
- not insisting on our views being heard all the time; listen to their views as well.

Put ourselves in their shoes

It will help if we can show that we do understand what it's like for them. It means showing them that we are sensitive to their problem. We have to try to look at the world through their eyes.

Be there and be available
It is important that young people know the door is always open for them to talk to us. They want to feel we are always interested in them. Sometimes, unfortunately, we are physically, but not emotionally present.

Be firm but consistent
Make sure our views and feelings are known and that we want them to respect our views. Be consistent as well. Do not keep changing your mind or making threats that you won't carry out. We must differentiate firmness from anger.

Remember young people are unique
Children have strengths and they all need to feel valued and good about themselves. When they feel they can achieve something, and that we recognise what they have done, it helps to build their self esteem.

What to do when the above approach is not helpful?
When the above approach is not helping young people or when the stress led to serious psychiatric complications it is important that the child or adolescent is referred to the mental health professionals.

Who are the mental health professionals who can help them? A child and adolescent psychiatrist or a clinical psychologist may be able to help.

A child and adolescent psychiatrist is a medical doctor who has further training in the diagnosis and treatment of mental health problems in young people.

They use both medicine and psychological techniques in helping these young people.

Clinical psychologist is not a medical doctor but they learn about both normal and abnormal human behavior. In addition they have further clinical training in the treatment of people with mental health problems using psychological techniques.

Sometimes we use antidepressant if young people become depress. For the very young psychological methods are best.

These include parents' management training, behavior modification, cognitive behavior therapy and workshop for teachers.

Source: Weekend, 18 April 2009

Understanding autism

By

Malai Haji Abdullah bin Malai Haji Othman

Senior Nursing Officer

Ministry of Health

There is no theory of the cause of autism which everyone has found convincing. There may be multiple causes. Thus we will review some of the proposed causes.

Most researchers are absolutely convinced that the cause is biological rather than psychological.

Bernard Rimland in his book, "Infantile Autism", cited the following evidence for a biological genesis and against the idea that parents cause their children to be autistic:

- Some clearly autistic children are born to parents who do not fit the autistic parent personality pattern.
- Parents who do fit the description of the supposedly pathogenic parent almost invariably have normal, non-autistic children.
- With very few exceptions, the siblings of autistic children are normal.
Autistic children are behaviourally unusual "from the moment of birth".
- There is a consistent ratio of three or four boys to one girl.
- Virtually all cases of twins reported in the literature have been identical, with both twins afflicted.
- Autism can occur or be closely simulated in children with known organic brain damage.
- The symptomatology is highly unique and specific.
- There is an absence of gradations of infantile autism which would create "blends" from normal to severely afflicted.

Points four and nine are not generally accepted now, perhaps because of the broadening of the condition's definition over time, and perhaps because of additional observation & data collection.

There is still controversy over neurological differences in the brains of autistic people and the rest of the population.

However, it does appear from evidence obtained through autopsies, MRI and PET scans that there are subtle cellular changes in the autistic brain.
The increased incidence of seizures (20-30 per cent develop seizures in adolescence) also points to neurological differences.

Some specific theories as to the cause of autistic symptoms:
- Yeast infections.
- Intolerance to specific food substances.
- Gluten intolerance ("leaky gut syndrome"), casein intolerance causing intestinal permeability and allowing improperly digested peptides to enter the bloodstream and cross the blood-brain barrier which may mimic neurotransmitters and result in the scrambling of sensory input. I've also heard "Leaky Gut Syndrome" described as lack of the beneficial bacteria that aids digestion, and that the resulting matter in the bloodstream invokes an unnecessary immune reaction.

Phenolsulphortransferase (PST) deficiency theory that some with autism are low on sulphate or an enzyme that uses this, called phenol-sulphotransferase-P. This means that they will be unable to get rid of amines and phenolic compounds once they no longer have any use for them. These then stay in their body and may cause adverse effects, even in the brain. Treatment is dietary as well as epsom salts baths.

A phrase you will sometimes hear is "theory of mind" or "the theory of mind hypothesis". This is not so much a supposed cause of autism as an assertion as to its nature. The basic idea of the hypothesis is that autistic people lack an awareness of other people's minds that typical people start developing at a relatively young age, that is, the autistic person doesn't so readily develop theories about what is going on in other people's minds. A corollary is that an autistic person's awareness of other people's minds is something that is developed intellectually through their own efforts.
Furthermore, adherents of this theory suppose that some or all the other typical characteristics of autism stem from this one main deficit. The hypothesis is explained in some books (some have "Theory of Mind" in the title, also Uta Frith has written on it and simple tests have been devised to test a person's awareness of other minds.

These are the frequently asked questions by members of the public with regards to autism and I will try to address some if not all of the questions.

What is Autism?
Autism is a life-long developmental disability that prevents individuals from properly understanding what they see, hear, and otherwise sense. This results in severe problems of social relationships, communication, and behaviour.

Individuals with autism have to painstakingly learn normal patterns of speech and communication, and appropriate ways to relate to people, objects, and events, in a similar manner to those who have had a stroke.

What are the characteristics of autism?
The degree of severity of characteristics differs from person to person, but usually includes the following:
Severe delays in language development
Language is slow to develop, if it develops at all. If it does develop, it usually includes peculiar speech patterns or the use of words without attachment to their normal meaning. Those who are able to use language effectively may still use unusual metaphors or speak in a formal and monotone voice.
Severe delays in understanding social relationships
The autistic child often avoids eye contact, resists being picked up, and seems to "tune out" the world around him. This results in a lack of cooperative play with peers, an impaired ability to develop friendships, and an inability to understand other people's feelings.
Inconsistent Patterns of sensory responses
The child who has autism at times may appear to be deaf and fail to respond to words or other sounds. At other times, the same child may be extremely distressed by an everyday noise such as a vacuum cleaner or a dog's barking. The child also may show an apparent insensitivity to pain and a lack of responsiveness to cold or heat, or may over-react to any of these.
Uneven patterns of intellectual functioning
The individual may have peak skills - scattered things done quite well in relation to overall functioning - such as drawing, music, computations in math, or memorisation of facts with no regard to importance or lack of it.
On the other hand, the majority of autistic persons have varying degrees of mental retardation, with only 20 per cent having average or above-average intelligence. This combination of intellectual variations makes autism especially perplexing.
Marked restriction of activity and interests
A person who has autism may perform repetitive body movements, such as hand flicking, twisting, spinning, or rocking. This individual may also display repetition by following the same route, the same order of dressing, or the same schedule every day. If changes occur in these routines, the preoccupied child or adult usually becomes very distressed.
Autistic children display unusual behaviour. A typical autistic child's behaviour is likely to include: no speech; non-speech vocalisations; delayed development of speech echolalia; delayed echolalia: repeating something heard at an earlier time; confusion between the pronouns "I" and "You"; lack of interaction with other children; lack of eye contact; lack of response to people; treating other people as if they were inanimate objects; when picked up, offering no "help" ("feels like lifting a sack of potatoes"); preoccupation with hands; flapping hands; spinning; balancing, such as standing on a fence; walking on tiptoes; extreme dislike of certain sounds; extreme dislike of touching certain textures; dislike of being touched; either extremely passive behaviour or extremely nervous, active behaviour; extreme dislike of certain foods; behaviour that is aggressive to others; lack of interest in toys; desire to follow set patterns of behaviour/interaction; desire to keep objects in a certain physical pattern; repetitive behaviour (perseveration); self-injurious behaviour; and "Islets of competence", areas where the child has normal or even advanced competence, such as drawing, music, arithmetic and memory.

There are other conditions which sometimes coincide with autism: synesthesia (an unexpected sensation arises when a particular sense modality is stimulated); and cerebellar abnormalities revealed by MRI scans raised levels of serotonin in the brain

What causes autism?
Autism is a brain disorder, present from birth, which affects the way the brain uses information. The cause of autism is still unknown. Some research suggests a physical problem affecting those parts of the brain that process language and information coming in from the senses. There may be some imbalance of certain chemicals in the brain. Genetic factors may sometimes be involved. Autism may indeed result from a combination of several "causes". No factors in the psychological environment of the child cause autism.

How common is autism?
Autism is one of the four major developmental disabilities. It occurs in one to two of every 1,000 births.

Who is affected with autism?
Autism is distributed throughout the world among all races, nationalities, and social classes. Four of every five people with autism are male.

What is the most common problem in autism?
Individuals with autism have extreme difficulty in learning language and social skills and in relating to people.

How does autism affect behaviour?
In addition to severe language and socialisation problems, people with autism often experience extreme hyperactivity or unusual passivity in relating to parents, family members, and other people.

How severe are behavioural problems in people with autism?
In autism, behavioural problems range from very severe to mild. Severe behavioural problems take the form of highly unusual, aggressive, and in some cases, even self-injurious behaviour. These behaviours may persist and be difficult to change.
In its milder form, autism resembles a learning disability. Usually, however, even people who are only mildly affected are substantially handicapped due to deficits in the areas of communication and socialisation.
Does autism occur in conjunction with other disabilities?
Autism can occur by itself or in association with other developmental disorders such as mental retardation, learning disabilities, and epilepsy.
Autism is best considered as a disability on a continuum from mild to severe. The number of handicaps and degree of mental retardation will determine the location on that continuum.
What is the difference between autism and mental retardation?
Most people with mental retardation show relatively even skill development, while individuals with autism typically show uneven skill development with deficits in certain areas - most frequently in their ability to communicate and relate to others - and distinct skills in other areas.
It is important to distinguish autism from mental retardation or other disorders since diagnostic confusion may result in referral to inappropriate and ineffective treatment techniques.

Can people with autism be helped?
Yes, autism is treatable. Studies show that all people who have autism can improve significantly with proper instruction. Many individuals with autism eventually become more responsive to others as they learn to understand the world around them.

How can persons with autism learn best?
Through specially trained teachers, using specially structured programmes that emphasise individual instruction, persons with autism can learn to function at home and in the community. Some can lead nearly normal lives.

What kinds of jobs can individuals with autism do?
In general, individuals with autism perform best at jobs which are structured and involve a degree of repetition. Some people who have autism are working as artists, piano tuners, painters, farm workers, office workers, computer operators, dishwashers, assembly line workers, or competent employees of sheltered workshops or other sheltered work settings.

What leisure activities do persons with autism enjoy?
Individuals who have autism often enjoy the same recreational activities as their non-handicapped peers. They usually like music, swimming, hiking, camping, working puzzles, and playing table games.

What services are available for people with autism in Brunei Darussalam?
The Child Development Centre (CDC) of Ministry of Health, The Special Education Unit of Ministry of Education as well as Pusat Bahagia of Ministry of Culture, Youth and Sports, there are also organisation such as KACA and Pusat Ehsan.
There are school classrooms, social skills training, job training, and life planning services for persons with autism in Brunei Darussalam for persons with autism provided by SMARTER Brunei.

What additional services are needed for children with autism in Brunei Darussalam?
Children with autism need: respite care; before- and after-school care; recreational programmes; and prevocational training.
What do people with autism need when they become adults?
Adults with autism need: vocational training; job opportunities; and recreational opportunities.

How can people who have autism learn meaningful job skills?
With the help of specially trained job coaches, people with autism can learn skills that will enable them to successfully work in competitive employment, supported employment, or in sheltered workshop programmes.

In what ways can persons with autism have relative independence in living?
They can learn skills to live as independently as possible through specifically designed programmes in appropriate centres and supervised home programmes.

What groups in Brunei Darussalam working to help people with autism?
Besides the CDC of Ministry of Health, the Special Education Unit of Ministry of Education as well as Pusat Bahagia of Ministry of Culture, Youth and Sports, there are also organisation such as KACA and Pusat Ehsan, while SMARTER Brunei, which is a family support group comprising parents, professionals, students, and others, focusses only on dealing with autism spectrum disorder and its existence is to raising the visibility of autism and broadening services for individuals who have autism.
The organisation furnishes support to parents, siblings, and professionals in the form of information and referral, autism spectrum disorder centre for early intervention programme, intermediatery intervention programme and also high functioning intervention centre, job coach services, public education, advocacy for adult centre and life planning services, and news and information to everyone.

Source: Weekend 4 April 2009