18 THE STRAITS TIMES FEBRUARY 2 2012

QMy son, who is 12 years old,behaves like any other childof his age, except that he isextremely hyperactive.

He was diagnosed with attentiondeficit hyperactivity disorder whenhe was younger.

He was prescribed Ritalin and hashad follow-up visits to the doctor forthe past four years.

However, to date, hishyperactiveness has not subsided.

He still behaves like athree-year-old child and is extremelyhyperactive, when he is out of hishome.

We were really embarrassedwhen we brought him to the home ofa close relative, because he threwtantrums and wanted to wrestlewith other boys of his age.

He gets very upset when he doesnot get what he wants and startspunching walls and threatening hismother.

We are really going through ahard time dealing with his moodswings and are at a loss.

We would like to know who wecan consult to seek help for him.

AIt does sound like your sonhas features of attentiondeficit hyperactivity disorder.

It also sounds like there areother issues which need to beaddressed as well if he is behavinglike a three-year-old and throwingtantrums at the age of 12.

Attention deficit hyperactivitydisorder can co-exist with otherconditions such as a specific learningdisability, a mood disorder such asanxiety or a conduct disorder such asoppositional behaviour.

These co-morbid conditions doneed to be evaluated and managedfor a better outcome in the treatmentof attention deficit hyperactivitydisorder.

In Singapore, methylphenidate inits various formulations (includingRitalin, Ritalin SR, Ritalin LA andConcerta) would be generally used inthe management of attention deficit

hyperactivity disorder.

However, medication cannot beexpected to yield the best outcomewhen used in isolation.

Behavioural management andstrategies for the child, parents andteachers; educational support inschool; along with identification andmanagement of co-morbidities; areall integral to the holisticmanagement of a child.

In his book The Explosive Child,Dr Ross Greene, an American childpsychologist, describes acollaborative problem-solvingapproach to successfully managingchildren with severe non-compliance,

temper outbursts and physicalaggression.

He describes a model whereparents and children can bothdiscuss their concerns andcollaborate on a solution to aproblem.

For example, from yourperspective, the problem may be thatyour child’s physical aggression iscausing distress to himself and tothe members of the family.

From your child’s perspective, theproblem may be that he is not gettingsomething he wants.

A collaborative problem-solvingapproach helps both parent and childbetter understand and respect eachother’s concerns and results in themcollaboratively coming up with asolution which meets both theirneeds.

A collaborative problem-solvingapproach together with timely andappropriate treatment of attentiondeficit hyperactivity disorder may helpyou get a better handle on workingwith your son and help him throughhis teenage years.

DR JENNIFERKIING,clinical director ofthe childdevelopment unitat the NationalUniversity HospitalQ

I am a 63-year-old woman. Is it safe touse Naphcon-A for my dry eyes once aday?

I find using it to be more effective thanusing lubricating eye drops in easing the irritationin my eyes.

I do not smoke cigarettes or wear contactlenses and I have no other health problems.

ADry eye syndrome is one of the mostcommon reasons a patient turns up at anophthalmologist’s clinic.

The syndrome usually affectspost-menopausal women, adults over the age of60 and younger individuals who wear contactlenses for extended periods of time.

Diseases such as blepharitis, which is theinflammation of the eyelash follicles, andmeibomian gland dysfunction, which occurs whenthe oil-producing glands in the eyelids becomeblocked or inflamed, can also cause dry eyes.

So can other diseases in which the immunesystem attacks the body, such as systemic lupus,rheumatoid arthritis, which affects the joints, andSjogren’s syndrome, which curtails the productionof tears and saliva.

The symptoms of dry eyes are irritation,dryness, soreness, itchiness, a burning sensation,chronic redness, intermittent blurred vision andexcessive tearing as a reflex to the dryness.

There is no complete cure for the disease.

Rather, the management of the disease is moreabout achieving an acceptable level of eyecomfort, which differs from patient to patient.

Each eye doctor also seems to have his ownpreferred method of managing this ailment.

When deciding which therapy to prescribe, anophthalmologist would normally customise amanagement plan according to the cause of thedisease, the severity of the symptoms and thelifestyle of the patient.

The treatment of dry eye syndrome may includeone or a few of the following strategies:

● Use artificial tears to maintain comfortThere are many formulations and brands ofartificial tears available which can reduce dry eyesymptoms to a manageable minimum.

Preservative-free tears can be used as often asdesired.

● Lubricate the eye overnightFor more severe dry eyes, it is very helpful to uselubricant ointment or gel preparations just beforegoing to sleep.

● Use punctal plugsNormally, tears from the eye drain through a tinytear duct (puncta), which is situated at the nasalcorner of each eyelid, into the nasal passages.

Placing either a temporary plug made ofcollagen or a permanent plug made of silicone in

the lower lid punctum can reduce the rate ofdrainage of tears from the eye, making any naturalor artificial tear last longer on the ocular surface.

● Practise good eyelid hygieneThis is important for the maintenance of a healthylipid tear layer.

The symptoms of dry eyes commonly co-existwith meibomian gland dysfunction. Commerciallyavailable products can help cleanse the skinaround the eyelashes and reduce the amount ofbacteria growing there.

They include eyelid cleansing pads which maybe helpful in combination with warm eyelidcompresses and eyelid massage.

● Take omega-3 fatty acid supplementsBeneficial effects have been achieved when suchsupplements have been used as an adjunctivetherapy.

● Get prescription medicationIf you have severe dry eyes, you may requireprescription medication such as topical steroids,topical non-steroidal anti-inflammatory drugs andimmune-modulating compounds.

Their use requires careful monitoring by anophthalmologist.

Naphcon-A is a topical eye medication which isa combination of an antihistamine and adecongestant. It is used for the relief of eyeirritation and/or nasal congestion (the blockage ofnasal passages due to swollen membranes), or forthe treatment of allergic or inflammatory ocularconditions.

It is not normally used as a long-term solutionfor dry eye syndrome. If you find that it is the mosteffective medication among all else mentionedabove, it may be that you are suffering from anallergic eye disease.

Hence, you may want to consult anophthalmologist for an opinion.

DR NATASHA LIM,medical director of SingaporeMedical Group’s Centre for EyeSurgery and The Lasik SurgeryClinic at Wheelock

ST FILE PHOTOIf you have severe dry eyes, you may require prescription medication such as topical steroids, topicalnon-steroidal anti-inflammatory drugs and immune-modulating compounds.

Dry eyes needdaily medication

ST FILE PHOTOA collaborative problem-solving approach helps both parent and child betterunderstand and respect each other’s concerns.

Got a problem?E-mail your question to sthealth@sph.com.sg.Specify Ask The Experts as the subject and include yourname, age, gender, identity card number and contactdetails.

12-year-old behaves like a toddler

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