Mr Gerald Giam Yean Song asked the Minister for Health (a) how many people in Singapore are currently diagnosed with attention deficit hyperactivity disorder (ADHD); (b) what is the median age of persons diagnosed with ADHD; and (c) what financial support is available for persons living with ADHD who are (i) under 21 years old, (ii) between 21 years and 65 years old and (iii) older than 65 years.
The Senior Minister of State for Health (Dr Janil Puthucheary) (for the Minister for Health): Mr Speaker, Sir, academic research has estimated the prevalence of attention deficit hyperactivity disorder (ADHD) among children and adolescents to range between 5% and 8%, and among adults to range between 2% and 7%.
Children aged six years and below are eligible to receive subsidised consultations and therapy of up to 70% for ADHD under the Child Development Programme (CDP) at the KK Women’s and Children’s Hospital and National University Hospital (NUH), if referred to the programme from polyclinics or from Community Health Assist Scheme (CHAS) general practitioner (GP) clinics. For school-going students aged seven years and above, school counsellors and special educational needs officers provide school-based interventions at no charge, in consultation with the Response, Early Intervention and Assessment in Community Mental Health (REACH) teams when necessary. Cases requiring further medical attention will be referred by REACH to the Child Guidance Clinic (CGC), which offers subsidised consultations and therapy of up to 70%.
Eligible patients referred from polyclinics and CHAS GP clinics to public Specialist Outpatient Clinics (SOCs) for the management of ADHD can also receive means-tested subsidies of up to 70%. Singaporeans who face difficulties with their remaining bills can approach medical social workers for financial assistance, such as MediFund.
Mr Speaker: Mr Gerald Giam.
Mr Gerald Giam Yean Song (Aljunied): I thank the Senior Minister of State for the reply. Given that an estimated 5% to 8% of children have ADHD of varying degrees in Singapore, this would be equivalent to about 38,000 to 60,800 children aged 14 and under. So, what proportion of these children have been treated for ADHD or currently undergoing treatment?
Second, ADHD symptoms typically appear between the ages of three and six years. Does the Ministry of Health (MOH) provide or fund training to parents or preschool teachers on how to identify symptoms of ADHD in children and provide guidance to their parents on how to seek professional help and financial support to get it diagnosed and treated early?
Lastly, what forms of psychoeducation are available in Singapore to help people with ADHD and their families learn about their condition, the treatment options and coping strategies, and are there any subsidies available to lower-income households for these interventions?
Dr Janil Puthucheary: Sir, I thank Mr Giam for the questions. I will note that his five questions are related to the treatment of ADHD, and his original question was to do with some data statistics. So, I will try to answer the questions he has asked, partly on the basis of my prior professional experience rather than the data that I have been able to gather in advance of his Parliamentary Question.
We do not require the reporting of a diagnosis, such as ADHD. So, his first question on what proportion has been treated, we do not have the data because practitioners and parents are not required to report the suspicion of a diagnosis or the confirmation of a diagnosis. And so, we are unable to confirm a global national number on what proportions are treated. Individual clinics perhaps and, especially those clinics which are operating as part of an academic medical institution, will have institution-based or demographic-based data, but that does not represent the national database.
ADHD is one of a number of neurodevelopmental conditions that may manifest as an educational challenge or a neurodevelopmental challenge. So, parents certainly are supported in this as part of the consultations and the contact that they will have with healthcare workers and teachers around the neurodevelopmental progress and educational progress of their child. So, ADHD is not the only thing that is looked out for when a GP or community health professional looks at, for example, whether the child is reaching appropriate developmental milestones. But it is certainly one of the possible differential diagnoses in addressing whether a child is reaching the developmental milestones within an acceptably normal range. It is something that GPs, paediatricians and community health workers are trained for.
So, for parents, they are not explicitly taught the symptoms and signs of ADHD, just as they are not expected to know about pathologies and diseases. But when they engage in looking at their child, reading about developmental milestones, understanding whether their child is within that range of normality, this is actually one of the things that they are doing: is my child progressing through the normal neurodevelopmental stages? And so, if they have concerns and they approach the professionals that deal with these issues, ADHD is one of the differential diagnoses that they will be considering at the time. The financial support, as I have explained in my original reply, is available as part of the subsidy process that we have within our healthcare framework.
Mr Speaker: Assoc Prof Jamus Lim.
Assoc Prof Jamus Jerome Lim (Sengkang): Can I just quickly clarify with the Senior Minister of State if the statistics that he offered for the prevalence apply to Singapore, because he referred to academic studies. So, it is not clear to me whether those were academic studies for just Singapore in particular or countries in general. And I ask this in part because my understanding is that diagnosis of not so much ADHD, but autism spectrum disorder (ASD) appear to be relatively higher in prevalence for advanced economies in general, including perhaps Singapore. So, I am just wondering whether there is this sense of comparing to other benchmark countries.
Dr Janil Puthucheary: Sir, the studies that I quoted and looked at were international studies, not confined to the Singaporean population. But we have no reason to believe that they do not apply to our population base.
Ministry of Health
16 February 2024
https://sprs.parl.gov.sg/search/#/sprs3topic?reportid=oral-answer-3473
Office of the Leader of the Opposition 