Behavioural and Socio-emotional Disorders are often overlooked in developmental screening as there is a wide range of what appears normal in the preschool age. Au-tism spectrum disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) of preschool onset are the most commonly occurring disorders which may present to the primary care physician. There is a wide range of what is ‘normal’ in children’s behaviours and socio-emotional development which a primary care physician can expect to meet during each of the six well-child visits. Typical behaviours and learning at each developmental stage and what the physician can address at each of the ‘well-child’ visits will be reviewed. The screening to be conducted at each visit will follow on from ‘red flags’ described in the Singapore Child Health Booklet.

INTRODUCTIONSleep problems are common in all ages, but may be particularly acute in urban Singapore. This study aims to describe the sleep behaviour of, and to identify any sleep problems in, preschool children.

MATERIALS AND METHODSThis was a cross-sectional questionnaire survey of 372 children attending local childcare centers. The questionnaire was based on the Children's Sleep Habits Questionnaire (CSHQ), a validated parent-report sleep screening questionnaire that contains 54 items identifying sleep behaviours in children.

RESULTSA total of 372 (40.0%) children participated. The mean age was 4.1 (SD 1.3) years (range, 2 to 6 years). Average total sleep duration was 10.8 hours (SD 1.1) with average night-time sleep duration of 8.5 hours (SD 0.6) and average nap duration of 1.6 hours (SD 1.0). Co-sleeping was common; 80.9% of children shared a room with someone else. The most common sleep problems were in the domains of sleep resistance and morning behaviour; namely: requiring company to fall asleep (n = 272, 73.1%), being afraid to sleep alone (n = 228, 61.6%) and diffi culty in waking up (n = 165, 44.4%). Among parents, 84.1 % (n = 313) perceived that their child's sleep duration was adequate.

CONCLUSIONThe duration of sleep in the Singaporean preschool population sampled is signifi cantly lower than recommended values and that of previously described Caucasian populations. Parental perception of sleep adequacy deviates from current recommendations. Given the clear relation of sleep duration with cognitive functioning, learning, and physical growth, this sleep deprivation should be addressed with parental education and opportunistic screening of sleep in well-child follow-ups.

Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Habits ; Humans ; Male ; Prevalence ; Singapore ; Sleep ; Sleep Deprivation ; epidemiology ; Sleep Wake Disorders ; epidemiology ; Surveys and Questionnaires ; Urban Population

INTRODUCTIONThis study aimed to determine the sleep patterns and dysfunctions in children with learning problems in comparison against a local population-based sample.

MATERIALS AND METHODSParents of 200 children with learning problems and 372 parents of a local population-based sample of typically developing (TD) children were recruited to complete a questionnaire on their child's sleep patterns and sleep problems. The Children's Sleep Habits Questionnaire (CSHQ) is a validated parent-reported sleep screening questionnaire that contains 54 items identifying sleep behaviours in children.

RESULTSThe mean age of the sample was 4.2 years (SD: 1.4; range, 2 to 6 years). Sleep duration was similar between the 2 groups. The difference in mean CSHQ subscale scores between children with learning problems and TD children was significant for sleep-disordered breathing (1.3 vs 1.2,= 0.001). Among children with learning problems, 36.5% snored (vs 26.6% of TD children), 30.5% had noisy breathing (vs 18.8%), and 9.0% (vs 4.6%) experienced difficulty breathing 2 or more times a week. Children with learning problems woke up in a more irritable mood (= 0.01), had more difficulty in getting out of bed (<0.001), and took a longer time to be alert (<0.001). They exhibited fewer behaviours of daytime drowsiness (= 0.009). Among this group of children, 15.0% of parents reported that their child had a sleep problem compared to 9.0% in the TD group.

CONCLUSIONSleep breathing disorders and symptoms of morning sleepiness are more prevalent in children with learning problems. Symptoms of daytime lethargy are similar between the 2 groups. We suggest that a simple outpatient screening targeted at these problems be instituted in the initial workup of any child with learning difficulties.

Case-Control Studies ; Child ; Child, Preschool ; Comorbidity ; Female ; Humans ; Irritable Mood ; Learning Disorders ; epidemiology ; Male ; Prevalence ; Singapore ; epidemiology ; Sleep ; Sleep Apnea Syndromes ; epidemiology ; Sleep Hygiene ; Sleep Wake Disorders ; epidemiology ; Snoring ; epidemiology

INTRODUCTIONThis study aimed to describe the demographic, social, developmental and behavioural profile of children hospitalised for alleged child maltreatment syndrome (CMS).

METHODSThis study was a retrospective review of the consecutive inpatient records of children (0-16 years) admitted to the National University Hospital, Singapore, for alleged CMS over a three-year period. Descriptive data on the demographic characteristics, alleged maltreatment, medical and developmental histories, and family background of these children were collected and analysed. Chi-square statistics were used to test whether family factors were associated with the type of maltreatment and the presence of developmental disorders.

RESULTSA total of 89 children, who accounted for 90 admission cases, were studied. Physical abuse (70.0%) was the most common, followed by neglect (11.1%) and sexual abuse (7.8%). Child protection services had already been involved in 29.2% of the cases prior to the child's admission. Children who were victims of abuse were more likely to come from homes with a prior history of domestic violence (p = 0.028). Financial difficulty was found to be a risk factor for neglect (p = 0.005). Among the 89 children, 15.7% were found to have developmental disorders and 10.1% had mental health diagnoses. Children who had developmental disorders were more likely to have a parent with a mental health disorder (p = 0.002).

CONCLUSIONA sizeable proportion of the children admitted for alleged CMS had developmental or behavioural disorders. Clinicians have a role in ensuring that these children have appropriate follow-up plans. Children from high-risk families should be screened for maltreatment.

Adolescent ; Child ; Child Abuse ; statistics & numerical data ; Child, Abandoned ; statistics & numerical data ; Child, Institutionalized ; statistics & numerical data ; Child, Orphaned ; statistics & numerical data ; Child, Preschool ; Developmental Disabilities ; epidemiology ; etiology ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Inpatients ; statistics & numerical data ; Male ; Poverty ; Prevalence ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Attention Deficit Disorder with Hyperactivity ; diagnosis ; drug therapy ; therapy ; Caregivers ; Child ; Evidence-Based Medicine ; Humans ; Methylphenidate ; therapeutic use ; Parents ; Psychiatry ; methods ; standards ; Singapore ; Societies, Medical