SINGAPORE – A new nationwide research initiative will screen children and adolescents aged eight to 18 for not just mental health conditions but also neurodevelopmental ones like autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD), and track them over a period of up to 10 years.

       The Building Resilience and Intervention (Brave) study by the Institute of Mental Health (IMH) will focus on four conditions commonly seen in the institute’s child guidance clinics – ASD, ADHD, anxiety and depression.

       The ambitious project targets 40,000 households in Singapore with at least one young Singapore citizen or permanent resident born between 2007 and 2016.

       Unlike nationwide studies that rely on self-reports of signs and symptoms, the Brave study will offer not only screening, but also a diagnostic test for those who screen positive for at least one of the four conditions. This will be done in the first two years, or the first phase, of the study.

       The initial online screening questionnaire may take up to 30 minutes to complete. The researchers will collect demographic information so that they can identify both protective and risk factors, such as potential challenges faced by the family, including conflicts, divorce and financial issues.

       If required, study participants will be invited to undergo a comprehensive assessment to establish a diagnosis, said Dr Lim Choon Guan, chief of IMH’s department of developmental psychiatry and the study’s principal investigator.

       The participants will get a report at no charge. Assessments for ASD and ADHD can cost several hundred dollars to a few thousand dollars, depending on the required tests.

       There will be no intervention, but the IMH team will direct participants who need help to avenues of support, including counselling services at a family service centre or school, or clinical consultations, said Dr Lim.

       Study participants will be followed up with at the one-year mark to see how they are faring and if new conditions have cropped up, he said.

       Associate Professor Daniel Fung, IMH’s chief executive and co-investigator of the Brave study, said at a press conference on Nov 22: “We’re trying to build up a cohort of young persons who have common... mental health conditions, and (looking) at the potential causes and associations of these mental illnesses in the young is quite important because of the long-term outcomes.”

       The study will establish the prevalence of common conditions, particularly ASD and ADHD, as the nationwide prevalence of these neurodevelopmental conditions is currently unclear, he said.

       At IMH’s child guidance clinics, which tend to see more teenagers than young children, about 24 per cent of the 1,500 new cases in 2023 were ADHD cases. About 10 per cent of the patients had ASD, another 10 per cent had depression and 6 per cent had anxiety, Prof Fung said.

       “I think we hear a lot about anxiety and depression, but less so about ADHD, ASD,” he said.

       Ms Sharon Chan, whose eight-year-old daughter, Lauren Lim, was diagnosed with ADHD at IMH in May 2024, said the signs cropped up a few years ago.

       But she took Lauren to the doctor to get an official diagnosis only this year to help teachers and other people who interact with her understand that she has this challenge.

       Lauren’s kindergarten teacher had reported that the girl would walk around the classroom when it was time to sit and do work.

       “In Primary 1, the teachers commented that her desk was untidy, her bags not packed and her homework not done... When there were certain instructions, she would forget to write them down, or she might not have heard them,” said Ms Chan.

       One of the things Ms Chan did for Lauren was to ask the teachers at school to announce when the period is over, so she can prepare for the next class.

       Otherwise, Lauren may not know if the class has ended or if the teacher has just stepped out for a while, said Ms Chan.

       Early intervention, such as in Lauren’s case, is one of the aims of the Brave study.

       Dr Lim told the media at the press conference that the researchers aim to answer three questions with the study over 10 years.

       He said: “First, how many children actually need help? Second, looking at preventive intervention, can we prevent problems before they happen? Third... how many of them will go on to develop mental health problems?”

       He added: “Currently, most support services respond to problems rather than proactively prevent them. This, alongside the stress placed on parents and caregivers, highlights the urgent need for improved, preventive approaches to help our young.”

       The Brave study is supported by a $1.5 million grant from Temasek Foundation.

       Mr Kee Kirk Chuen, the foundation’s head of health and well-being, told reporters: “What attracted us to the study were the insights into the social, cultural and even economic factors that could protect them or put them at risk.

       “These are valuable insights that we need to know before we can say what is the best support we can get to the children and youth, because mental health is a very complex problem.”

       The Brave study is led by IMH, in collaboration with partners such as National University Hospital, Tan Tock Seng Hospital and the National Council of Social Service.

       IMH will send out invitation letters over the next few months to the 40,000 eligible households identified.

       Those who do not receive a letter for their child but are interested in participating in the study can register at www.brave.sg