• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Education and Services for Children and Youths With Emotional and Behavioral Disorders in Singapore

Posted on: Tuesday, 21 March 2006, 06:00 CST

By Chen, Kaili; Soon, Tan Chee

ABSTRACT:

To describe the current status of special education and services for children and youths with emotional and behavioral disorders (E/ BD) in Singapore, the authors highlight the country's overall structure of special education and mental health, identification of and intervention with children and youths with E/BD, perspectives about E/BD, and unique features of the service delivery system. The authors also discuss challenges to enhance the quality of educational services and future possibilities in Singapore.

KEY WORDS: emotional and behavioral disorders (E/BD), mental health, special education

Singapore, being in the confluence of the East and the West, faces special challenges in the area of nurturing and educating its children and youths, who are often described as the future of the nation. Although seeking to imbibe values distinctive of the Chinese. Indian, and Malay cultures, the government realizes that it faces an uphill task as youths are exposed to different cultures through various media, such as the Internet. At the same time, the demands of a fast-changing society put a great deal of pressure both on individuals and families. Indicators of mental health among children and youths and the rate of juvenile delinquency suggest that the issue of providing education and services for children and youths with emotional and behavioral disorders (E/BD) should be examined more closely. It is gratifying to recognize that the government is addressing these concerns through the provision of rigorous special education services and the training of personnel in the area of special needs.

In Singapore, there is currently no consensual definition for E/ BD that is common among researchers and practitioners in the various fields of education, mental health, or social services. In general, the classification of children with E/BD is based on the two major clarifications used in psychiatry: the International Statistical Classification of Diseases and Related Health Problems. 10th revision (ICD-10; World Health Organization, 1992), and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994; Tam, 2004).

Children at Risk: Handbook for Teachers, a guide book jointly published by the Ministry of Community Development, Youth and Sports (MCYS, 2004), Ministry of Education (MOE), and the National Council of Social Services (NCSS), adopts the U.S. National Mental Health and Special Education Coalition definition for E/BD. It defines emotional disorder (not E/BD) as a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects the general well-being of the child: (a) the inability to learn that is unexplained by intellectual, sensory, or health factors; (b) the inability to build or maintain satisfactory relationships with peers and teachers; (c) the expression of inappropriate behavior or feelings under normal circumstances; (d) the presentation of a general pervasive mood of unhappiness or depression; and (e) the tendency to develop psychosomatic symptoms.

However, in schools, teachers may view children with emotional or behavioral difficulties as those who exhibit emotional outbursts or are rude or disrespectful. This could be because of the teachers' difficulty in understanding the child's behavior; as a result, it is not uncommon for teachers to resort to punishment to manage such behaviors.

Overall Structure of Special Education and Mental Health Services in Singapore

Special education in Singapore began in 1947 when the Trafalgar Home was built by groups of volunteers to provide special classes for children with leprosy (Quah, 1993). A few years later, individuals with hearing impairment had their own school run by the Association of the Blind. Since then, educational services for special needs students have improved tremendously. Currently, there are 20 special education schools run by various welfare organizations with government aid. The majority of these schools are intended for children and youths with disabilities aged 6-16 years; a few of them also provide programs for preschoolers and infants.

Children and youths with disabilities are educated in a range of different settings, including general and special schools. The Report of the Advisory Council for the Disabled: Opportunities for the Disabled (Ministry of Community Development, 1988) states, "Whenever appropriate and feasible, special education should be provided within the regular educational system. A child should only be placed in a special school if he cannot be well educated in a regular school" (pp. 37-38). In most cases, however, special education services are provided outside the general education system (i.e., the majority of students with disabilities are educated in special schools), and only some of those with milder learning disabilities (LD), E/BD, sensory disorders, or other physical disabilities are found in the general education system (Lim & Nam, 2000). In July 2004, fewer than 800 of the 4,703 registered students with disabilities were being educated in general education schools (L. Lee, 2004; "Where Different Needs Are Met," 2004). In addition, as education for children and youth with disabilities is not compulsory, the number of school-aged children and youths with disabilities who stay at home or in institutions is unknown.

Special Education

In Singapore, there is no special education legislation per se. Therefore, there is no law that requires an individualized education program for each special needs student. Furthermore, unlike many other countries, special education is not provided by the Ministry of Education (or MOE, as it is called in Singapore). Instead, special schools and agencies are managed by voluntary welfare organizations (VWOs), as it is believed that these organizations have a strong sense of mission and that their autonomy and flexibility allow them to respond quickly to new needs and demands (Lim & Nam, 2000). Therefore, the individual associations responsible for the school curriculum and management employ the teachers and paraprofessionals. Nevertheless, VWOs play an essential role in partnership with the government, which has taken on a central, coordinating, and monitoring role in the society.

In addition, there are services jointly designed by the MOE and other service providers. For example, the Pathlight School is registered with the MOE and funded jointly by the MOE and the NCSS. The Pathlight School is the first autism-focused school offering the Singapore mainstream curriculum with special accommodations and supports for students with autism spectrum disorders (ASD). This school caters to the needs of students with ASD (aged 6-16 years) who are cognitively able to access mainstream academic curriculum but require additional supports, such as smaller class sizes, teaching staff trained in autism, and special accommodations.

In August 2004, Prime Minister Lee Hsien Loong called for an inclusive society in Singapore and announced that S$200 million (about US$100 million) would be used to provide special needs training for both special and general education teachers (L. Lee, 2004). In addition, beginning in 2005, each of the 20 special education schools run by VWOs receives an extra S$12 million (about US$6 million) a year, in addition to the S$30 million (about US$15 million) they now receive ("Where Different Needs Are Met," 2004).

Students with disabilities often require special assistance and support. However, teachers in general education schools faced with students with various disabilities in their classes lack appropriate classroom management and intervention skills, personnel support, and resources. Fortunately, in August 2004, the MOE proposed measures to enhance support for students with special needs in general education schools by providing adequate training in special needs support to a critical core of general education teachers and the appointment of special needs officers (SNOs) to support children with ASD and dyslexia in particular (L. Lee, 2004). The stated aim is that, by 2010, 10% of staff in all schools in Singapore will be trained in special needs support at the certificate level or its equivalent and 236 SNOs will be recruited and trained at the diploma level. This will involve training approximately 400 teachers per year beginning in 2005 and 20 SNOs in 2005, followed by another 40 to 50 SNOs per year beginning in 2006 (L. Lee). No doubt this announcement of training for general education teachers and SNOs is welcomed by schools with much relief.

Mental Health Services

Mental health services in Singapore began in 1841 when a 30-bed "insane hospital" was built (Tsoi, 1985). Soon, the number of patients increased; in 1928. the Woodbridge Hospital was commissioned to accommodate 1,030 patients. Outpatient services were started in 1953, and the Child Psychiatric Service started in 1970 in the same hospital (Tsoi).

Today, there are various public and private hospitals that serve individuals with psychological or psychiatric problems. The Department of Child and Adolescent Psychiat\ry (DCAP), which is a member of the National Healthcare Group, provides psychological and psychiatric services for children and youths aged younger than 18 years. The major recipient of referrals of children with social, emotional, or behavioral difficulties in Singapore is the Child Guidance Clinic (CGC), run by the DCAP to provide assessment and treatment for students with E/BD.

The CGC administration established the Children's One-Stop Psycho- Educational Service (COPES) to provide a comprehensive, multidisciplinary assessment and intervention service for students requiring learning, social, emotional, or behavioral support. Students with adjustment difficulties (such as change of school, relationship break-ups), addictions, and other developmental disabilities (e.g., autism) also receive intervention from COPES. The psychiatrists, psychologists, and social workers work together to provide counseling intervention and medical intervention when necessary. In the meantime, however, priority is given to students who are not receiving adequate services or do not qualify for services from other agencies.

Other Related Services

The Singapore MCYS also provides various services and programs for people with disabilities to help them integrate into society with support from their families and caregivers. The MCYS operates various day activity centers and sheltered workshops and hostels and provides training in daily living skills, social skills development, vocational abilities development, art and hobby craft skills, as well as occupational therapy and functional mobility and physiotherapy for individuals with disabilities.

E/BD in Singapore

E/BD can be viewed us the extreme forms of everyday behavior. A behavior becomes a problem when there is some form of dysfunction. In determining the nature and extent of general and special education and related services. Turnbull. Turnbull, Shank, & Smith, and Leal (2004) recommended that the following factors of the behavior be observed: (a) frequency: how often it occurs: (b) duration: how long it lasts; (c) latency: how long it takes for the behavior to begin once there is an opportunity: (d) topography: a description of motor behavior or physical movements; and (e) magnitude: the intensity of the student's response. Other factors such as the age, intelligence, and temperament of the child and the effect of the behavior on the child's progress in life will need to ' be taken into consideration as well.

E/BD can be categorized into two dimensions of behavior: internalizing and externalizing. Internalizing behavior is 1 directed toward oneself (Reynolds, 1992) and involves mental or emotional conflicts, such as depression and anxiety. Externalizing behavior is directed toward others, such as striking or bullying other children.

Internalizing Behaviors

The issue of mental health is complex and multifaceted. The meritocratic system in Singapore, which forms the underlying bedrock of the political structure, requires that opportunities be made available purely on an objective basis. Hence, educators channel students to different streams based on their academic performance and test results at Grades 6, 10, and 12. It is, therefore, not surprising to find that almost 1 in 10 Singaporean parents also suffers "children education stress" (Phua, 2001). A local survey found that two out of three Singapore students suffer from "study stress" (Phua). A child psychiatrist estimated that 14,000 to 16,000 people under the age of 19 years suffer from depression (Li, 2003). However, the widely held concern that the Singapore educational and examination primary school processes are stressful for children was not supported by the result of a study by Parker et al. (2003). That study involved a comparison of the levels of stress between 969 sixth graders whose final examination scores would determine their academic stream in secondary school and 1,039 fifth graders who faced only an internal school examination at the end of the year. Analysis of the results from the study showed that, although the stress level of the sixth-grade students was generally higher than that in the fifth grade across the year, the levels did not indicate a differential rise during the examination period.

Results of another study on youth suicide conducted in 2001 indicated that social relationships, rather than academic stress, were the primary factor contributing to stress and suicidal ideation (H. C. Lee, 2003). The study revealed that three quarters of the suicides involved teens aged between 14 and 19 years. In only three suicides were school grades a precipitating factor. The Samaritan of Singapore, which runs a helpline for troubled people, reported that two thirds of the callers aged below 19 years were troubled by problems with family members. Problems with boyfriends or girlfriends or peers came second, and problems at school or work ranked third.

Because students who exhibit internalizing behaviors characteristic of some types of anxiety disorder may be less disruptive to classroom teachers, the students are in danger of not being identified as E/BD (Heward, 2003). Such students may be afraid to express what they think or feel for fear that their thoughts or feelings might make them vulnerable to criticisms from others or that they might be seen as signs of weakness. Some children may feel guilty that they should even entertain negative thoughts or feelings. These beliefs could have arisen from low self-esteem resulting from bad grades or poor social relationships with peers and adults.

It is not unusual for teachers to experience a sense of inadequacy when presented with such students in their classrooms. Teachers feel that they lack the requisite knowledge, skills, and temperament to handle those students. However, efforts have been made by various agencies, such as the MOE and Ministry of Health, to raise the level of awareness of parents and teachers.

Externalizing Behaviors

Unlike internalizing behaviors, children and youths, with E/BD who externalize behaviors often attract the attention of teachers and the law. Students with antisocial behaviors often exhibit aggressive behaviors directed either toward persons or property. When students exhibit antisocial behavior in school, they are often admonished by the teacher or the school disciplinary master. All schools in Singapore are required to track disciplinary offenses. According to the MOE, disciplinary offenses have shown a downward trend in primary schools and have remained stable in secondary schools (Ng, 2004). In primary schools, the most common problems cited that accounted for more than half of all offenses were tardies or failure to do assignments. In secondary schools, tardiness, truancy, and improper attire or grooming accounted for more than two thirds of the offenses.

An indicator of the incidence of children and youths with behavioral problems is the number of juveniles who are arrested and charged in the Juvenile Court (Quek, 2004a). In 2002, the number of 9- to 16-year-olds charged in Juvenile Court was 388. In 2003, 578 were charged-a rise of 49% from the previous year. The most common offenses were related to petty crime, such as stealing, shoplifting, or hawking pirated Versatile Compact Disks/Discs (VCDs). The number of juveniles charged with theft rose from 164 in 2002 to 340 in 2003. Those arrested for selling pirated VCDs and similar offenses climbed from 130 to 222, and the number of rioting and unlawful assembly cases rose from 90 in 2002 to 140 in 2003. A study by the Juvenile Court suggested that the rise in youth crime could in part be attributed to the economic downturn in Singapore, resulting in tightened budgets at home and less spending money for teens (Quek, 2004b).

Identification of E/BD

Most identification of E/BD occurs through the school community and medical community. In 2003, the Psychological Assessment and Research Branch of the MOE and Kenneth W. Merrell, professor and director of the School of Psychology Program of the University of Oregon, designed the School Social Behavior Scales^sup Singapore^ (SSBSS^sup Singapore^) to assess the social competencies and behaviors in primary school students (Tam, 2004). The SSBS^sup Singapore^ comprises two major components: social competence and social problem behavior. By using the SSBS^sup Singapore^, psychologists and counselors can gather data on students with social, emotional, and behavioral difficulties in schools before they are referred to the CGC for further assessment.

In COPES, the Social Skills Rating System (SSRS) (Gresham & Elliot, 1990) is used to gather objective data from parents, teachers, and pupils, which leads to the design of interventions for home and school, including the direct instruction of social skills, reinforcing already existing social skills, and techniques to eliminate undesirable behavior. However, in many cases, social- skills training is not sufficient.

As teachers interact closely with their students in the classroom each day, they are in a strategic position to monitor the mental well-being of their students. Teachers may notice a gradual or drastic change in the behavior or performance of their students and try to find out more through talking with them. In Singapore, students whose behavioral problems persist despite sustained teacher intervention may be referred to the head of the Pupil Welfare Department or the teacher counselor. Further referrals could be made to educational psychologists, educational counselors, and guidance officers in the MOE or relevant mental health practitioners. Parents seek help from their doctors or are encouraged to seek help through the school system.

According to the U.S. Department of Education (2002), in the 1999- 2000 school year, approximately 1% of the school-aged population in the United States was served for E/BD, whereas some experts believe that a more a\ccurate identification rate was 9%-10% of the school population (Walker, Zeller, Close, Webber, & Gresham, 1999). In Singapore, however, it is difficult, if not impossible, to estimate the prevalence of children or youths with E/BD because there is no consensual definition of E/BD or a standard and reliable screening instrument for children and youths at different ages. Therefore, percentages and types of E/BD exhibited by children and youths are also unknown.

Perspectives About Children and Youths With E/BD in Singapore

First, on the positive side, in general, the youth of Singapore do not appear, in general terms, to display the same degree of angst, anger, and nonconformity seen in the United States. The structures and societal expectations regarding behavior seem to be clearer. The harsh penalties concerning drugs and the emphasis on academic achievement seem to be "push" factors that keep students away from behavioral problems. Second, in the Singaporean context, the underlying assumption of E/BD, often immediately made, is that there is something wrong with the child. The idea that services should "move to the child" has not yet taken hold. However, since late 1986, there has been a theoretical shift from the individual approach to the ecological approach in practice. For instance, the Student Care Service, a voluntary social work organization aiming to remove obstacles that make learning difficult for students as well as providing professional support for teachers in managing students with special needs or problems, has adopted the ecological perspective that takes into account the effects of interactions of the child with parents, teachers, community, and culture.

Unique Features of the Service Delivery System

In Singapore, parents who have difficulty managing their children with behavioral problems may seek help from the Family Service Centers or the Singapore Children's Society in MYCS. Family Service Centers are neighborhood-based community resource centers that provide assistance in family-related matters. Parents of children with severe behavioral problems who are aged below 16 years may file complaints against their children at the Juvenile Court, claiming them to be "beyond parental control." These complaints are screened by social workers from the Singapore Children's Society, who decide whether the court should hear a case or whether it should go to a counseling agency. Cases that go beyond the Juvenile Court are indeed for those who are "beyond parental control." These numbers increased by a third between 2002 and 2003. Many of these cases involve children or youths who run away from home, take drugs, are promiscuous, are violent toward their parents, or have attempted suicide (Quek, 2004a).

Intervention: A Look to the Future

Special education in Singapore has achieved significant development in the past 40 years since the country's independence in 1965. However. Singapore still has some way to go in its provisions of special education and services for students with E/BD compared with many other developed countries. There are many challenges, as well as opportunities, in terms of how educational and mental health services can be improved to better serve children and youths with E/ BD.

Challenges

Singapore has no special education legislation per se, and education for children and youths with disabilities is not compulsory. Generally speaking, the current provision of special education includes services such as screening, assessment, counseling, and a wide range of therapies. However, education and services for students with E/BD in Singapore lack overall direction. There could be a greater level of central coordination of services. The underlying "pillars" or principles of meeting the needs of individual students with E/BD could be used to design services to enhance accessibility, equitability, and inclusion. At present, without a formal mandate in the official educational authority and structure, individual VWOs can exercise their professional influence on the school only through the process of work and both direct and indirect contact with the regular education system. Furthermore, many services, such as occupational therapy and physical therapy offered at the community or school level in many countries, are still attached to hospitals and medical services in Singapore, which makes the services less accessible for students and families.

As indicated earlier, the majority of students with disabilities are educated separately from their typical peers. The segregated services model means that when there are academic difficulties, outside sources are sought for support. This thinking transfers to behavioral, social, and emotional difficulties. If a child has major behavioral issues, many schools are not sufficiently equipped to address them. Other than the inpatient unit at Institute of Mental Health (IMH) that can help the extreme cases, in regular schools, there is no specific resource classroom, program, or trained school staff for students with severe E/BD. Without adequate support, these students often end up leaving school (D. Peat, personal communication, November 2, 2004).

Future Possibilities

A multitier structure that provides various interventions corresponding to the needs of students of different degrees of E/BD must be considered. First, in general education schools, special education and services are needed for children and youths with E/ BD. In the general education settings, students with E/BD can benefit from special education support, such as the provision of learning and behavioral support assistants in the inclusive classrooms and resource classrooms that are designed to suit individual needs. In 2005, training for general education teachers and SNOs was in place to support students with ASD and dyslexia. Perhaps parallel provisions may be considered to meet the needs of students with E/BD.

E/BD programs outside regular schools are needed. These programs could be places where (a) students with E/BD learn the skills necessary to function, (b) parents and others receive guidance concerning how they should approach the children when they are reintegrated to the family, and (c) a classroom component directly teaches the social and school-survival skills to function at school. Such programs could be linked to several receiving schools where teachers are trained in classroom management that would allow these students to be successful upon their reintegration to the schools. Perhaps the funding could be cross-ministry (MCYS, IMH, MOE), with consultation with proressional expertise on the design or the facility, the program, and the initial training. Another option would be setting up programs similar to the Pathlight School. Such facilities can greatly enhance the quality of education and service for students with E/BD.

A community-based residential setting where children could go for observation and intervention (behavioral, social and emotional, and medical) would also provide significant support to children and youths with severe E/BD. This setting could be designed for students with severe E/BD and their families or caregivers to receive comprehensive treatments, educational services, and interventions.

In summary, special education for children and youths with E/BD in Singapore has made great strides in the past 4 decades. As the government of Singapore and its people continue to improve and update the quality of the special education system and other related services for students with E/BD. the move toward greater inclusion and individualization of educational programs will become a reality in Singapore.

ACKNOWLEDGMENT

The authors thank Dr. David Peat at the CGC, Singapore, for his assistance.

REFERENCES

American Psychiatric Association. (1994). Diagnostic und statistical manual of mental disorders (4th ed.). Washington. DC: Author.

Gresham, F. M., & Elliot, S. N. (1990). The social skills rating system (SSRS). Circle Pines, MN: American Guidance Service.

Heward, W. L. (2003). Exceptional children: An introduction to special education (7th ed.). CITY, NJ: Merrill Prentice-Hall.

Lee, H. C. (2003, February 27). Teen suicides: Relationship problems the main cause. The Straits Times, p. 4.

Lee, L. (2004. September 24). Teachers get special needs training. The Straits Times, p. 1.

Li, X. Y. (2003. October 12). Singaporeans have little sympathy for the depressed. The Straits Times, p. 4.

Lim, L., & Nam, S. S. (2000). Special education in Singapore. The Journal of Special Education, 34, 104-109.

Ministry of Community Development. (1988). Report of the advisory council for the disabled: Opportunities for the disabled. Singapore: Author.

Ministry of Community Development, Youth and Sports. (2004). Children at risk: Handbook for teachers. Singapore: Ui-Li Print and Services.

Ng, J. (2004. May 20). Wield the cane? Our students are not that bad. The Straits Times, p. 4.

Parker, G., Cai, Y., Dear, K., Henderson, A. S., Poh, G. T., & Kwee, G. C. (2003). Examination stress in Singapore primary schoolchildren: How compliance by subjects can impact on study results. Acta Psychiatrica Scan, 200(108), 239-243.

Phua, S. (2001, July 19). Stress in the city. Streats, p. 3.

Quah, M. L. M. (1993). Special education in Singapore. In M. L. Quah, S. Gopinathan and Gopinathanand, & S. C. Chang (Eds.), A review of practice and research in education for all in Singapore: Country report submitted to the Southeast Asian Research, Review and Advisory Group (pp. 89-102). Singapore: National Institute of Education.

Quek, T. (2004a, August 29). Why teens went on crime spree. The Straits Times, p. 4.

Quek, T. (2004b, September 6). More parents try to get court to discipline kids. The Straits Times, p. 1.

Reynolds, W. M. (1992). Internalizing disorders in children and adolescents. New York: Wiley.

Tam, B. K. Y. (2004). Learners with emotional and behavioral disorders. In L\. Lim & M. M. Quah (Eds.), Educating learners with diverse abilities (pp. 201-231). Singapore: McGraw-Hill.

Tsoi, W. F. (1985). Mental health in Singapore and its relation to Chinese culture. In W. Tseng & D. Y. H. Wu (Eds.), Chinese culture and mental health (pp. 239-250). New York: Academic Press.

Turnbull, R., Turnbull, A., Shank, M., Smith, S., & Leal, D. (2004). Exceptional lives: Special education in today's school (4th ed.). Columbus, OH: Merrill Prentice-Hall.

U.S. Department of Education. (2002). Executive summary: Twenty- third annual report to Congress on the implementation of the Individuals with Disabilities Education Act. Washington, DC: Author.

Walker, H. M., Zeller, R. W., Close, D. W., Webber, J., & Gresham, F. (1999). The present unwrapped: Change and challenge in the field of emotional disorders. Behavioral Disorders, 24, 293- 304.

Where different needs are met. (2004, September 24). The Straits Times, p. 2.

World Health Organization. (1992). International statistical classification of diseases and related health problems (10th rev.). Geneva, Switzerland: Author.

Kaili Chen currently teaches in the Early Childhood and Special Needs Education Academic Group, National Institute of Education in Singapore. Jan Chee Soon is working on her Ph.D. in School Psychology in the University of Minnesota, Minneapolis. Copyright 2006 Heldref Publications

Copyright Heldref Publications Winter 2006

Source: Preventing School Failure

More News in this Category