Child Guidance Clinic @ Health Promotion Board

I arrived at the SGH early enough to have a quick bite at the Café. I was disappointed with the quality of food. The clinic was quite deserted when I arrived. The ECTA students were all looking excited to take on the day at the Clinic. By 8 am, we, together with some medical interns, were crammed into a small room. It was a special room in that there was a one-way mirror that allowed us to view the life-demo going on in the next room.

The medical team took us through Reactive Attachment Disorder (RAD), a psychophysiologic condition with marked disturbed and developmentally inappropriate social relatedness in most contexts that begins before five years of age and is associated with grossly pathological care. This pathological caregiving behaviour may consist of any form of neglect, abuse, mistreatment or abandonment.

Due to maltreatment by caregivers, RAD sufferers have difficulty forming healthy relationships with their caregivers, peers and families. In the treatment modality, the concept of `goodness of fit’ applies to caregiver and child.

Following the talk on RAD, a medical intern conducted a live-demo on a fresh case of school-refusal (unlike truancy, patient’s refusal to go to school is known to his family members.) It was a complex case and the intern took more than an hour to elicit useful information. A year-long school-refusal surprised Dr Fung. Children with such behaviour should have been brought in within two weeks, he lamented. Dr Fung is an advocate of multidisciplinary treatment. He mobilized the other medical team members to look into additional findings, such as co-morbidity and possible organic cause. His personal choice of action on such behaviour would be to send the patient back to school the next day or soonest possible. (Early Return.) This is a `flooding’ process whereby the patient is compelled to face the anxiety or whatever that is making him/her shun school immediately. However, there is also a place for graded exposure, he commented, so as to address anxiety or etiology excavation (such as learning difficulty).

We watched 3 live-demo by Dr Fung, out of which 2 were follow-up cases. He demonstrated the compassionate and caring side of a medical professional. I could see the therapeutic alliance he established and maintained through out all the sessions. He was also very effective as an instructor in that he briefed us on the case and gave a tentative prognosis on it in between sessions.

It was time well-spent for me indeed as I gained insights into children cases.