Young and in trouble!

Many factors can trigger depression in children and teenagers.

BY the time she was six years old, Amy (not her real name) had already been sexually abused by her father for four years.

Amy never told anyone about it because her father had said it was their “little secret”. The secret was blown when Amy's uncle somehow found out about it, and informed her mother about the abuse.

Sadly, instead of believing her, Amy's mother turned her anger on the child, insisting that Amy must have been lying.

Dr Lai: Every time they get a compliment, it’s like a deposit for their self-esteem.

With her mother furious with her, Amy believed that she must have done something wrong, and that she was responsible for the mess her family was in. She took it upon herself to somehow make things right. She killed herself.

While this case did not happen in Malaysia, experts say there is definitely a disturbing trend where children as young as six years old are expressing suicidal tendencies.

Penang Hospital consultant (child and adolescent) psychiatrist Dr Lai Fong Hwa says he started noticing suicide cases among Malaysian children in the last five to 10 years.

“Kindergarten-going children can suffer from depression. Actually, even children who are four or five years old can suffer from depression, but usually these cases are due to biological causes rather than external causes,” he says.

Many factors can trigger depression in children and teenagers that, if left undetected and undealt with, could lead to suicide.

One factor, he explains, is the overemphasis on academic performance and achievement, even among pre-schoolers, which makes schools an extremely stressful environment.

“Some parents have the tendency to say things like If you want mummy to love you, you must get straight As in your exam.' What happens is the child then equates academic performance with whether his parents will love him. So if the child doesn't do well, in his mind, his parents don't love him anymore.

“Even though parents may have good intentions, they should never say things like that because it can have serious negative repercussions. What they should say is We will love you no matter what',” says Dr Lai.

Children, he says, need what is called an “emotional bank account”.

“Every time they get a compliment, it's like a deposit for their self-esteem. But every time they are criticised, the account gets depleted. What's important is that they should always have a good emotional bank account, because otherwise, when difficulty comes, they have nothing to draw from.”

He adds that children these days are constantly drummed with the message that they're “not good enough” because society expects them to achieve certain academic standards.

In the younger children, this stress can cause them to fear school.

“If a child has been quite happy attending school, and then suddenly fears school a few months down the road, it shows that something is not right. School should be fun, not torture. This is why I encourage parents to send their pre-school children to playgroups, rather than to classroom-environment kindergartens,” says Dr Lai.

Apart from academic achievements, shoving a child into multiple co-curriculur activities can also be extremely stressful.

According to Childline project director Michelle Wong, the helpline has received calls from children who are stressed out from having “too many exams”.

“One girl contacted us, saying she was having piano, violin, ballet and school exams all in the same month, and she could not cope with the pressure. She didn't know what to do,” Wong says.

Dr Lai adds that when a child has so much on his plate, the actual time spent with his parents is usually minimal, which is unhealthy for the child.

One question he frequently uses in his clinic when testing children on who they turn to for support is: “If you are alone on an island, and you can wish for one person to be with you, who would it be?”

“A normal child below the age of 12 would usually name their mother, or father, or a sibling whom they're close to. If they've been brought up by their grandparents, then it's also quite normal for them to name a grandparent.

“But when a child starts wishing for a friend instead, it shows that he doesn't look to his family for support. This can be dangerous as his friends are not likely to be able to fully help him should he get into any problem,” Dr Lai explains.

His concern is very real. In the last few weeks, there have already been several sudden deaths involving students under the age of 18.

Last month, a 14-year-old boy hung himself after having a fight with a friend. Another 17-year-old boy hung himself over “academic issues”.

In another case, an 11-year-old boy who fell to his death from the 14th floor of a flat in Penang left behind a handwritten note. His family has, however, denied it is a suicide note, saying that he had always written letters to express himself.

Early this week, a 12-year-old boy in Sabah hung himself with his shoelaces he was apparently upset over not being able to return to his hometown to see his grandfather.

Dr Ng: Children often use acting out as a way to express their inner distress.

“The trend is worrying. Children shouldn't be killing themselves,” Dr Lai says.

Depression among children and teenagers, more often than not, may appear as irritation or agitation, as opposed to the typical expression of sadness, says clinical psychologist Dr Ng Wai Sheng who has served in various settings including children social services, substance abuse rehabilitation and inpatient and outpatient psychiatric settings.

“This may partly explain why adults often overlook depression in young people. Depressed children and adolescents may be mislabelled as “angry” or “moody” kids. For young children, their behaviour may be confused with Attention-deficit hyperactivity disorder (ADHD).

“Children often use acting out as a way to express their inner distress, resulting in some being labelled as the bad kid'. Another common sign is the deterioration in academic performance and motivation, which may lead to the mislabelling of being lazy' or not smart enough',” she explains.

Divorce between parents has also frequently been linked to depression among children, but Dr Ng says it is not so much the divorce per se but rather how the divorce is handled that could be the determining factor.

“There is evidence to show that when a divorcing couple handles the matter prudently and maturely, and remain supportive of their children, the children continue to fare well in their lives,” says Dr Ng, a Fulbright alumni.

This includes communication between the parents and the child, whereby the child is assured of continuous love and support, and there is emphasis that the child is not responsible for the parents' decision.

However, she notes that the stigma of belonging to a single-parent or blended household could pose a challenge for children in Asian societies.

Senior community consultant paediatrician Datuk Dr Amar Singh says that based on his 30 years of experience working with children, child abuse (physical, emotional, or sexual) is also a trigger factor for suicide among children. For teenagers, peer relationship (including boyfriend or girlfriend problems) is also a common cause.

So, what can be done about children and teenagers who are suicidal?

The key is communication, say the experts.

“A majority of those who commit suicide would tell at least one person before they carry out the plan, so look out for the warning signs (refer to graphic above). If one suspects that a child/adolescent may have suicidal tendency, it is important to stay with the person, and raise the issue sensitively but directly with the person. Talking about death or suicidal thoughts does not mean you're putting ideas in the person's head'. That is a myth!

“Instead, talking about it openly, albeit with care and respect, gives the child the opportunity to share with you what's already in his head, and allows you to show that you care about him. Discussing the issue also provides for at least a 50% chance for him to consider alternative options to suicide. Avoiding the subject means you lose even that 50% chance of influencing him,” says Dr Ng.

Dr Amar, who is also Head of Paediatric Department Ipoh Raja Permaisuri Bainun Hospital, agrees.
“Many Malaysians are afraid to talk about this issue, but they need to realise that drugs aren't always the solution (for depression).

“You need to probe and ask the right questions, and you most definitely need to talk about it,” he says.

Stories by LISA GOH lisagoh@thestar.com.my

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Reaching out for help

US naval fleet to shift towards Pacific by 2020

New strategy: The US plans to shift the bulk of its naval fleet to the Pacific, as Defence Minister Stephen Smith dismissed fears the move would stoke tensions with China. Picture: AP AP

SHIFTING FOCUS:While the US plans a ‘new strategic focus’ in Asia, China warned that now is not the time to ‘make waves’ in the South China Sea, which it claims

AFP, BEIJING and SINGAPORE

US fighter jets take off from the flight deck of the Nimitz-class USS George Washington for joint military exercises between the US and South Korea in the Sea of Japan (also known as the East Sea) on June 26, 2010.

China’s Xinhua news agency warned yesterday it was no time to “make waves” in the disputed South China Sea, after the US said it would shift the bulk of its naval fleet to the Pacific Ocean by 2020.

“It is advisable for some to refrain from muddying the waters and fishing therein,” said Xinhua, referring to the sea, which is part of the Pacific and the subject of overlapping territorial claims.

China claims the sea in full, and it is also claimed in whole or part by Taiwan, Brunei, Vietnam, Malaysia and the Philippines.

“As regards the South China Sea tensions, it is some other claimants, whether emboldened by the United States’ new posture or not, that sparked the fire and have been stoking the flames,” the agency said.

It was Beijing’s “genuine wish” to turn the South China Sea “into a sea of peace, friendship and cooperation,” Xinhua added.

The commentary was a reaction to US Secretary of Defense Leon Panetta telling a summit in Singapore yesterday that the US would shift the bulk of its naval fleet to the Pacific as part of a new strategic focus on Asia,

The decision to deploy more ships to the Pacific Ocean, along with expanding a network of military partnerships, was part of a “steady, deliberate” effort to bolster the US role in an area deemed vital to the US’ future, he said.

He insisted the switch in strategy was not a challenge to China, saying both countries had a common interest in promoting security and trade in the region.

“By 2020, the navy will re-posture its forces from today’s roughly 50/50 percent split between the Pacific and the Atlantic to about a 60/40 split between those oceans,” Panetta said.

“That will include six aircraft carriers in this region, a majority of our cruisers, destroyers, littoral combat ships and submarines,” he added.

The US Navy currently has a fleet of 285 ships, with about half of those vessels deployed or assigned to the Pacific.

Although the total size of the overall fleet might decline in coming years depending on budget pressures, Pentagon officials said the number of US naval ships in the Pacific would rise in absolute terms.

The US also planned to expand military exercises in the Pacific and to conduct more port visits over a wider area extending to the Indian Ocean.

Panetta was speaking to mainly Asian defense officials and officers from 27 countries at the Shangri-la Dialogue, an annual summit organized by the London-based International Institute for Strategic Studies.

VIDEO: US EXPLAINS PACIFIC-FOCUSED MILITARY STRATEGY CCTV News - CNTV English



Unlike previous summits, China chose not to send a high-level delegation to the event, prompting speculation as to what lay behind the move.

Since US President Barack Obama unveiled plans in January to shift toward Asia, the Pentagon has offered up few details about how it intends to achieve that goal.

Yesterday’s announcement on the future of the US fleet provided the clearest evidence yet of a shift to Asia, and the speech appeared designed to reassure allies that Washington would back its much-publicized “pivot” to Asia with tangible action.

In his speech, Panetta said budget woes in Washington would not affect the plan to tilt towards Asia, which he said would take years to fully realize.

The US planned new investments in capabilities needed “to project power and operate in the Asia-Pacific,” including radar-evading fighter jets, a new long-distance bomber, electronic warfare and missile defenses, he said.

“But make no mistake — in a steady, deliberate and sustainable way — the United States military is rebalancing and is bringing an enhanced capability and development to this vital region,” he added.

Military commanders are revising doctrine to take into account new weapons that “could deny our forces access to key sea routes and lines of communication,” Panetta said.

Amid a growing US-China rivalry, US officials privately acknowledge the push for a larger military footprint is meant to reinforce US diplomacy when confronting Beijing’s assertive stance in the South China Sea.

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American drone wars and state secrecy!

How Barack Obama became a hardliner?

He was once a liberal law professor who campaigned against the Iraq war. Now, according to revelations last week, the US president personally oversees a 'kill list' for drone strikes in Yemen and Pakistan. Then there's the CIA renditions, increased surveillance and a crackdown on whistleblowers. No wonder Washington insiders are likening him to 'George W Bush on steroids'

The revelation that Barack Obama keeps a 'kill list' of people to be targeted by drones has led to criticism from former supporters. Photograph: Carolyn Kaster/AP



Amos Guiora knows all about the pitfalls of targeted assassinations, both in terms of legal process and the risk of killing the wrong people or causing civilian casualties. The University of Utah law professor spent many years in the Israel Defence Forces, including time as a legal adviser in the Gaza Strip where such killing strikes are common. He knows what it feels like when people weigh life-and-death decisions.

Yet Guiora – no dove on such matters – confessed he was "deeply concerned" about President Barack Obama's own "kill list" of terrorists and the way they are eliminated by missiles fired from robot drones around the world. He believes US policy has not tightly defined how people get on the list, leaving it open to legal and moral problems when the order to kill leaves Obama's desk. "He is making a decision largely devoid of external review," Guiroa told the Observer, saying the US's apparent methodology for deciding who is a terrorist is "loosey goosey".

Indeed, newspaper revelations last week about the "kill list" showed the Obama administration defines a militant as any military-age male in the strike zone when its drone attacks. That has raised the hackles of many who saw Obama as somehow more sophisticated on terrorism issues than his predecessor, George W Bush. But Guiora does not view it that way. He sees Obama as the same as Bush, just much more enthusiastic when it comes to waging drone war. "If Bush did what Obama has been doing, then journalists would have been all over it," he said.

But the "kill list" and rapidly expanded drone programme are just two of many aspects of Obama's national security policy that seem at odds with the expectations of many supporters in 2008. Having come to office on a powerful message of breaking with Bush, Obama has in fact built on his predecessor's national security tactics.

Obama has presided over a massive expansion of secret surveillance of American citizens by the National Security Agency. He has launched a ferocious and unprecedented crackdown on whistleblowers. He has made more government documents classified than any previous president. He has broken his promise to close down the controversial Guantánamo Bay prison and pressed on with prosecutions via secretive military tribunals, rather than civilian courts. He has preserved CIA renditions. He has tried to grab broad new powers on what defines a terrorist or a terrorist supporter and what can be done with them, often without recourse to legal process.

The sheer scope and breadth of Obama's national security policy has stunned even fervent Bush supporters and members of the Washington DC establishment. In last week's New York Times article that detailed the "kill list", Bush's last CIA director, Michael Hayden, said Obama should open the process to more public scrutiny. "Democracies do not make war on the basis of legal memos locked in a [Department of Justice] safe," he told the newspaper.

Even more pertinently, Aaron David Miller, a long-term Middle East policy adviser to both Republican and Democratic administrations, delivered a damning verdict in a recent issue of Foreign Policy magazine. He wrote bluntly: "Barack Obama has become George W Bush on steroids."

Many disillusioned supporters would agree. Jesselyn Radack was a justice department ethics adviser under Bush who became a whistleblower over violations of the legal rights of "American Taliban" John Walker Lindh. Now Radack works for the Government Accountability Project, defending fellow whistleblowers. She campaigned for Obama, donated money and voted for him. Now she has watched his administration – which promised transparency and whistleblower protection – crack down on national security whistleblowers.

It has used the Espionage Act – an obscure first world war anti-spy law – six times. That is more such uses in three years than all previous presidents combined. Cases include John Kiriakou, a CIA agent who leaked details of waterboarding, and Thomas Drake, who revealed the inflated costs of an NSA data collection project that had been contracted out. "We did not see this coming. Obama has led the most brutal crackdown on whistleblowers ever," Radack said.

Yet the development fits in with a growing level of secrecy in government under Obama. Last week a report by the Information Security Oversight Office revealed 2011 had seen US officials create more than 92m classified documents: the most ever and 16m more than the year before. Officials insist much of the growth is due to simple administrative procedure, but anti-secrecy activists are not convinced. Some estimates put the number of documents wrongly classified as secret at 90%.

"We are seeing the reversal of the proper flow of information between the government and the governed. It is probably the fundamental civil liberties issue of our time," said Elizabeth Goitein, a national security expert at the Brennan Centre for Justice. "The national security establishment is getting bigger and bigger."

One astonishing example of this lies high in the mountain deserts of Utah. This is the innocuously named Utah Data Centre being built for the NSA near a tiny town called Bluffdale. When completed next year, the heavily fortified $2bn building, which is self-sufficient with its own power plant, will be five times the size of the US Capitol in Washington DC. It will house gigantic servers that will store vast amounts of data from ordinary Americans that will be sifted and mined for intelligence clues. It will cover everything from phone calls to emails to credit card receipts.

Yet the UDC is just the most obvious sign of how the operations and scope of the NSA has grown since the 9/11 terrorist attacks. Under Bush, a key part was a secret "warrantless wiretapping" programme that was scrapped when it was exposed. However, in 2008 Congress passed a bill that effectively allowed the programme to continue by simply legalising key components. Under Obama, that work has intensified and earlier this year a Senate intelligence committee extended the law until 2017, which would make it last until the end of any Obama second term.

"Obama did not reverse what Bush did, he went beyond it. Obama is just able to wrap it up in a better looking package. He is more liberal, more eloquent. He does not look like a cowboy," said James Bamford, journalist and author of numerous books about the NSA including 2008's The Shadow Factory.

That might explain the lack of media coverage of Obama's planned changes to a military funding law called the National Defence Authorisation Act. A clause was added to the NDAA that had such a vague definition of support of terrorism that journalists and political activists went to court claiming it threatened them with indefinite detention for things like interviewing members of Hamas or WikiLeaks. Few expected the group to win, but when lawyers for Obama refused to definitively rebut their claims, a New York judge ruled in their favour. Yet, far from seeking to adjust the NDAA's wording, the White House is now appealing against the decision.

That hard line should perhaps surprise only the naive. "He's expanded the secrecy regime in general," said Radack. Yet it is the drone programme and "kill list" that have emerged as most central to Obama's hardline national security policy. In January 2009, when Obama came to power, the drone programme existed only for Pakistan and had seen 44 strikes in five years. With Obama in office it expanded to Afghanistan, Yemen and Somalia with more than 250 strikes. Since April there have been 14 strikes in Yemen alone.

Civilian casualties are common. Obama's first strike in Yemen killed two families who were neighbours of the target. One in Pakistan missed and blew up a respected tribal leader and a peace delegation. He has deliberately killed American citizens, including the radical cleric Anwar al-Awlaki in September last year, and accidentally killed others, such as Awlaki's 16-year-old son, Abdul-Rahman.

The drone operation now operates out of two main bases in the US, dozens of smaller installations and at least six foreign countries. There are "terror Tuesday" meetings to discuss targets which Obama's campaign manager, David Axelrod, sometimes attends, lending credence to those who see naked political calculation involved.

Yet for some, politics seems moot. Obama has shown himself to be a ruthless projector of national security powers at home and abroad, but the alternative in the coming election is Republican Mitt Romney.

"Whoever gets elected, whether it's Obama or Romney, they are going to continue this very dangerous path," said Radack. "It creates a constitutional crisis for our country. A crisis of who we are as Americans. You can't be a free society when all this happens in secret."

Death from the sky

• Popularly called drones, the flying robots used by Obama are referred to as unmanned aerial vehicles by the defence industry that makes them. The air force, however, calls them RPAs, or remotely piloted aircraft, as they are flown by human pilots, just at a great distance from where they are operating.

• The US air force alone has up to 70,000 people processing the surveillance information collected from drones. This includes examining footage of people and vehicles on the ground in target countries and trying to observe patterns in their movements.

• Drones are not just used by the military and intelligence community. US Customs and Border Protection has drones patrolling land and sea borders. They are used in drug busts and to prevent illegal cross-border traffic.

• It is assumed the Pentagon alone has 7,000 or so drones at work. Ten years ago there were fewer than 50. Their origins go back to the Vietnam war and beyond that to the use of reconnaissance balloons on the battlefield.

• Last year a diplomatic crisis with Iran broke out after a sophisticated US drone, the RQ-170 Sentinel, crash-landed on Iranian soil. Iranian forces claimed it had been downed by sophisticated jamming technology.

 By Paul Harris guardian.co.uk,  Newscribe : get free news in real time