Mental Health

The fight for attention

Voices bounce around the open, bustling mall in various volumes and tones. The garish-coloured signs of each store front are so loud, shouting products and services. Everywhere, everything in this city demands your attention.

Bodies blur past in every direction so quickly it’s impossible to focus on any single one. They’re being shunted between floors on shifting escalators, some shuffling around in groups, others ploughing past on purposeful solo missions. Loud colours and brash sounds are a dizzying rush that pierce the brain. In front of me, Jesse Sng rips his napkin into shreds and rolls them into tiny balls. They sit in a pile next to his forgotten coffee.

Jesse Sng was diagnosed with hyperactive sub-type ADHD. Photo: Madison Fiorenza.

For most, a shopping centre can seem bright and interesting and distracting. For people living with Attention Deficit Hyperactivity Disorder, like me, it can be a spiralling pit of overstimulation and sensory impact. High volumes and searing colours can make focusing on a single task or conversation impossible. With a brain that takes in everything, sensory shutdown can inhibit functioning and the ability to pay attention.

The wall of the cafe next to us blocks half of the mall from view. “I thought this would make less distractions,” he says. Despite this, we turn our heads in sync at a roar of laughter from the table behind us. From the outside, Sng is a normal, perhaps fidgety, 57-year-old man. His brain is a different story.

A year ago, Sng was diagnosed with ADHD. He was encouraged to go for an assessment by his daughter who, along with her three siblings, also has ADHD. Sng says he knew he was different from an early age. Despite this, he did not know enough about the disorder to pursue a diagnosis and spent most of the first 56 years of his life compensating for his neurodivergence. According to the UK National Health Service, ADHD is mostly diagnosed in children, where symptoms are easier to catch in classroom and home settings (NHS, n.d.). However, many educators and parents have a surface level knowledge of ADHD symptoms, and diagnoses can be missed if the student does not show a severe drop in grades. Sng says this holds true for older generations especially. “In the late 80’s, even 90’s, there was no such thing as ADHD in the minds of most people,”

“We were just left to figure things out on our own.”

ADHD is categorised into three sub-types: inattentive, hyperactive or a combination of the two. Infographic: Madison Fiorenza.

As ADHD gains more recognition worldwide, people in Singapore living with the disorder feel the awareness and attitudes towards it are not progressing fast enough. The meritocratic society defines success with a few narrow criterium: get into a good school, get good grades, get a good job. For neurodivergents, this seemingly straight path to success is riddled with obstacles, turns and setbacks. With brains that aren’t wired to sit quietly through hours of school and weeks of work, success by Singapore’s standards seems impossible to obtain. This can lead to harmful impacts on neurodivergent individuals, including low self-esteem and decreased opportunities, says Benjamin Low, psychologist at Psych Connect. This is often compounded with the co-morbidities of ADHD, including anxiety, depression and learning disabilities according to the ADHD Institute. The support offered is increasing in homes, schools, and work, however the stigma surrounding mental health in Singapore still inhibits many from getting the proper help they need, says Low. The Singaporean ADHD community say they want better education surrounding the disorder. More than anything, they want people to accept them for who they are.

Sng says primary school was tough and involved frequently being sent out of the classroom. His school report was littered with the same phrases, heard to death by many neurodivergents: ‘you’re capable of much better work’, ‘needs to work harder’, ‘needs to stop talking and pay attention.’

“I was heavily multitasking in class. So I’m tracking the lesson, I’m reading a book at the same time. If it’s a slow day I was writing code, programming all over the pages of my textbook. And once in a while we’d have a chess game going under the desk. And still there was just enough time to look out the window and daydream.”

Despite this, Sng’s grades remained above average, and his ADHD flew under the radar for decades. “I think somewhere along the way, I realized if I was to survive school, I had to mask my ADHD… I did not know it was ADHD at the time, but I just realized there were certain things I had to mask.”

His experience is not unique.

Shalom Lim was diagnosed with inattentive ADHD this October. He says university was stressful for him as his ADHD made it hard to pay attention and adhere to deadlines. “I really struggled big time. Instead of doing my degree over three years, I did it over six years,” At one point, Lim thought he was going to fail due to a careless mistake. “My undergrad thesis did not go well. I actually got flagged for plagiarism because I made a careless mistake, and because of that I scored a flat zero.”

In Singapore, Lim says people are not as forgiving of disorders such as ADHD compared to his experience with western society. “They’ll say things like ‘if you don’t work hard enough it’s a reflection of your poor character’.” He says there is not enough recognition or acceptance for people with disabilities. “In mainstream media or even day-to-day interactions, it’s always the disabled people who are able to conform to the love of meritocracy who get recognised.”

Lim says in a society where conformity can be put on a pedestal, there can seem like there is no room for diversity. “I feel stigmatised, guilty, and ashamed for something that isn’t even my fault. Sometimes I just wish people would be more open to diversity.”

Lim and his late brother both have muscular dystrophy, a neurological disease that is suggested to be linked with ADHD, according to a study conducted in 2012 . Lim’s brother was also neurodivergent, and passed away just three years ago from heart failure. Lim says the link between muscular dystrophy and ADHD/autism spectrum disorder is not recognised by all healthcare professionals, and although the diagnoses of autism are rising, it is not yet inclusive to all disabilities.

“Why can’t they also include autistic persons with muscular dystrophy? Like my brother, my brother was never included because nobody knew his autism was linked with muscular dystrophy.”

Lim hopes to see more support for not just ADHD, but other neurodevelopmental disorders as well. “We’ve come some way, but from my perspective as a neurodivergent person I really don’t think it’s enough.”

“We need to know that in Singapore, ADHD support is still in a sense young. So there’s a lot more misconceptions about it, a lack of information about it,” says Tina Tan, a social worker and mother of an ADHD son. She delivers workshops and training to parents and educators to inform them about ADHD, including how to spot it in children and how to support them. “I encourage educators to use the universal learning design, which is an approach that helps every student learn better. When you incorporate them, you’re actually helping everyone in the class.”

Tan says she debated whether to tell her son’s teachers about his diagnosis due to fears of his differences being highlighted in the classroom. Fears, she says, every parent feels. “For sure things are improving, although there is still way more to go in terms of being more inclusive, being more gentle and appropriate in the education scene.” She says whilst her experience with informing the teachers was pleasantly reassuring, others have described it as harrowing.

“When we talk about ADHD awareness, we’re also helping parents to realise that they need to, first be aware so that they can support their children, but then they need to help the children be aware, because otherwise the children don’t know how to understand and advocate for themselves.”

With this in mind, she says it’s important to remember an ADHD child cannot be properly supported if the parent is not supported. It is for this reason that the SPARK (The Society for the Promotion of Attention-Deficit Hyperactivity Disorder Research & Knowledge) group was started in 2000. SPARK started as a support group for parents with ADHD children to meet and share their experiences and advice with others. Tan says 20 years ago, the support for and understanding of ADHD was lacking and the group has helped to promote research and empathy towards the disorder. The group runs sessions, webinars and in-person meet ups to help the community of parents with ADHD children feel less alone.

Tina Tan says she adapted her parenting style to accommodate to her son’s needs. Photo: Madison Fiorenza.

Unlocking ADHD is another support group founded by Moonlake Lee, where members can share their experiences, information and advice with other Singaporeans. The group’s mission is to empower people and help them view ADHD as a strength.

Despite the growing support, many people are still too afraid to speak up about their diagnosis. Sng says many individuals who seek his counsel have done so under strictly anonymous conditions, due to fears of others in their lives finding out. “People are afraid to lose their jobs,” he says. “They question ‘will I lose my insurance?’, ‘What’s going to happen to me?’ And there are certain professions where, no matter how understanding officially everyone wants to be, just being open with the fact that you have ADHD could end it.”

“In public communication we do not talk about it being a disability because there is a lot of stigma to it.” says Tan.

Advocates say the word disability still causes discomfort and shame for many people in Singapore, and in a culture that demands an explanation for any necessary accommodations, invisible disabilities like ADHD are not often taken seriously. “The definition of disability on psychiatric grounds in Singapore is narrow,” says Low. Currently, the Singaporean government does not recognise ADHD as a disability, and there are no subsidies offered apart from reduced cost of appointments and medication through the public healthcare system, Low says. Like Australia, the public system is a road of long waiting lists and lengthy administrative hoops to jump through. Those privileged enough to take the private road are more advantaged in receiving a diagnosis and treatment.

Stigmas surrounding mental health represent another barrier to accessing help. Low says Chinese cultural influences mean many Singaporeans are not used to discussing their emotions and struggles, and this perpetrates heightened shame in people with ADHD when experiencing emotional difficulties, or if they cannot meet the academic and occupational levels of success that neurotypicals can. “It inhibits communication, and self-recognition that there is a problem.” Low says this can cause people to internalise this shame and in his experience of treating ADHD there are many cases of self-contempt and anxiety as a result.

Deepa Vijayan was diagnosed with ADHD at 38. She says her late diagnosis can be attributed partly to her gender and stereotypes surrounding ADHD. Typically seen as a disorder that only affects young hyperactive boys, Vijayan’s ADHD flew under the radar throughout childhood. With a lack of information about the disorder, she spent many years believing she was irresponsible and not cut out for even the simple and enjoyable tasks in life. As an Indian woman in Singapore, she says there is a higher pressure to do well, because she needed to go against a few extra barriers to prove herself as worthy as everyone else.

Vijayan is an entrepreneur and runs a business with her husband. Photo: Madison Fiorenza.

“When I wasn’t able to do that, it made things more difficult because not only did I have to prove myself as a minority, but I also had to fight against this thing, which I didn’t know was ADHD.” She says it was a relief to finally be diagnosed however, she laments a life where she could have achieved more with adequate recognition and support. “I think I still have a lot of grief about the fact I wasn’t diagnosed earlier, because once I realized what I could do, I felt kind of cheated that I couldn’t do it earlier. I could have just spent the last 20 years feeling very different and I feel like it was a waste of life that was wasted to illness in a sense.”

In terms of change, the ADHD community isn’t asking for much. “I think if you are a parent or a teacher or in any position to help a child who has any of the symptoms to take it seriously,” says Vijayan. “I think there are a lot of strengths and I think they can be highlighted, but the conversation also needs to be about how difficult it is as well so they realize that it is a medical problem and not like some cute quirk.”

“I think Singapore is moving ahead.” says Tan. She sits on the parent and community partnerships council which is moving an initiative called success beyond grades, aimed at providing accessible pathways for people, like those with ADHD, who struggle with achieving high grades.

“I wish I had people in my life, adults, parents, who knew about this or knew about the possible treatments when I was much younger, because my life would have been very, very different. I would have been able to- it’s not bragging or anything- just, I know I would have been able to do a lot of very incredible things.” says Sng.

Sng took part in a study by Roger Ho, a professor in psychological medicine at the National University of Singapore. He’s leading research in using functional near infrared spectroscopy (fNIRS) to diagnose psychiatric disorders including ADHD. The research is looking to improve the accuracy of psychiatric diagnosis by machine learning. Sng has also guided many people towards an ADHD diagnosis and encourages anyone who suspects they have ADHD to take those steps.

“I’m 57 right now, I’ve had an incredible life… I have no regrets. But having my medication with me right now, I am convinced the best years of my life are in front of me. And I’m excited about what is possible as a result of that.”

The shards of shredded napkin go purposefully into the bin. Cups and plates are carefully removed from the table and stacked neatly. The heat pours through the shopping centre doors as we approach the exit. The cool air and sharp sounds and glaring colours finally fade as the doors close behind us. Before the traffic and the construction and the sheer number of people crash into us, there is a moment of peace.

The 2022 Curtin Journalism Singapore Study Tour was funded under the federal government’s New Colombo Plan scheme.

Categories: Mental Health, Singapore

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